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Healthcare

Mohammad Anas Wahaj | 12 feb 2020

Recently published book 'Make Health in India: Reaching a Billion Plus' by Prof. K. Srinath Reddy, president of Public Health Foundation of India (PHFI) and adjunct professor at Harvard T. H. Chan School of Public Health, analyzes India's health sector since the 1990s, explores the challenges in delivering healthcare to the large Indian population and provides recommendations on various policy and management matters. The book starts with health data and indicators. This provides how some overall figures have improved but digging deeper shows marked inter-state variations. Due to this it is recommended that there is a need to customize policy-making specific to each state. India has poor immunization rate (62-64%), which is even lower than some under-developed economies of sub-Saharan Africa. Moreover, public health expenditure in India is among the lowest in the world (0.9-1.2% of the GDP). Another chapter explains how 55-63 million people in India have been pushed to poverty over the past decade because of out-of-pocket expenditure on health as families spend 10-40 per cent of their income on health. WHO recommends out-of-pocket expenditure not to exceed 15-20% of the total health expenditure. The book says, 'To achieve that even in stages, India must aim to bring it to 50% or lower as first step,' suggesting his would require 5-6% of GDP. The book discusses tussle between center and states over increasing in health budgets with Niti Ayog asking states to double their contributions. Currently center contributes 1/3 of total public health spending. Niti Ayog's proposal to hand over district hospitals to private medical colleges in public-private partnership (PPP) mode makes the author to term it as the 'partnership-for-private profit' model, showing discontent with the concept. Another chapter tackles the issue of inaccessibility of medicines - out of 55 million who became poor due to healthcare expenditure in 2011-12, about 38 million were impoverished because of spending on medicines alone. Although India is known as the producer of inexpensive drugs and is recognized as 'global pharmacy'. The book explains, 'While the low purchasing capacity of a large segment of the Indian population may be a contributing factor, the main reason is that many drugs in India are priced higher than they should be. While a reasonable level of profit is acceptable, high mark-ups over the manufacturing cost makes the drugs costlier than they need to be.' The book also addresses Ayushman Bharat scheme and Pradhan Mantri Jan Arogya Yojana (PMJAY) - 'While the activation of HWCs (health and wellness centers) is welcome, but the budgetary allocation to the National Health Mission (which covers rural and urban health missions) in 2018 and 2019 does not reflect the commitment to boost rural primary healthcare to the level needed. It is also disappointing to see that the Urban Health Mission component has been virtually ignored in these budgets.' 'In absence of effective primary health services, the uncontrolled demand for services under PMJAY will drain the health budget, and in turn, reduce the funds available for primary care and public sector hospital strengthening.' To address shortage of healthcare providers can debilitate the health system, the book recommends creation of a National Commission for Human Resources in Health. To tackle 'maldistribution of doctors', the book recommends establishment of a National Medical Service which should recruit fresh graduates in rural areas, post-graduates in district hospitals, and create a permanent cadre of specialist doctors. Read on...

DownToEarth: Unhealthy affair: Book review - Make Health in India
Author: Banjot Kaur


Mohammad Anas Wahaj | 28 dec 2019

According to nseinfobase.com, CSR spends of Indian corporates have increased 17.2% to Rs. 11867.2 crore in FY19 from Rs. 10128.3 in FY18. This is the highest spend since FY15 (Rs. 6552.5 crore), when the CSR spend was made mandatory through Companies Act 2013. It is observed that corporates are increasingly using their CSR spends on charitable contributions. The highest amount of Rs. 4406 crore were for schedule VII (II) that focuses on education. The next big spend was Rs. 3206.5 crore under VII (I) for eradicating hunger, poverty, malnutrition and promoting health and hygiene. Rural development got Rs. 1319 crore and remaining went for projects that include environment protection, benefits to the armed forces, disaster management etc. From geographical point of view Maharashtra and Gujarat were at the top to get contributions while Bihar and North-East states got the least CSR funds. Experts say that large spends have also seemed to have prompted closer attention to how the money is spent. Amit Tandon, founder and MD of Institutional Investor Advisory Services India (IiAS), says, 'There are more and more companies who are doing impact assessment...people recognise the need to do it.' Pranav Haldea, MD at Prime Database, says, 'Low CSR budget could act as a constraint for some companies to adopt monitoring mechanisms. It may only make sense for firms with very large budgets. Smaller companies may find it too expensive to employ an agency for external audits on a regular basis.' Read on...

Business Standard: Companies spent Rs 11,867 cr on CSR activities in FY19; highest so far
Author: Sachin P. Mampatta


Mohammad Anas Wahaj | 07 nov 2019

Human health is closely linked to the condition of the surrounding environment. According to the National Health Report (NHP) released on 31 October 2019, a degraded environment filled with air and water pollution continues to affect health of people in India. Air pollution-linked acute respiratory infections contributed 68.47% to the morbidity burden in the country and also to highest mortality rate after pneumonia. While contaminated drinking water caused acute diarrhoeal diseases that led to second highest morbidity at 21.83%. Moreover, cholera cases went up to 651 in 2018 from 508 in 2017. While releasing the 14th National Health Profile 2019, Dr. Harsh Vardhan (Union Minister of Health and Family Welfare, Govt. of India), said, 'Data helps us to navigate health needs and issues, and helps devise area specific programme strategies.' But despite the increasing burden of diseases in the country, the budgetary allowance for controlling diseases has been steadily dipping in the last few years, says the report. According to 2017-18 budget estimates, India spends only 1.28% of its GDP as public expenditure on health. The NHP report pointed out that per capita public expenditure on health has gone up to Rs 1657 in 2017-18 from Rs 621 in 2009-10. While states are bearing 63% of this expenditure, out of pocket expenditure by the patients are not included in this estimate, which is known to be the biggest reason behind increasing debt in the population. Read on...

DownToEarth: Diseases linked to a degraded environment continue to ravage India
Author: Vibha Varshney


Mohammad Anas Wahaj | 07 sep 2019

Trust between patients and care givers is one of the critical factors in determining success of healthcare system. And trust develops over a period of time through positive experiences that are achieved by providing quality care at the right time, effectively and efficiently at the right price. But, it seems, India's healthcare is lacking behind in satisfactory healthcare delivery. According to the recent report by Ernst & Young (EY) and Federation of Indian Chambers of Commerce and Industry (FICCI), 'Re-engineering Indian Healthcare 2.0', based on an online survey of 1000 patients across six geographical zones in India, 'There is a growing mistrust among patients against healthcare providers and the Indian healthcare system needs to tailor its current model for inclusion and mass healthcare to deliver true care with a focus on primary care, wellness and health outcomes.' The report finds that - 61% patients believe that hospitals did not act in their best interests; 63% of patients indicated that they were not happy with hospital responsiveness and waiting times; 59% patients felt the hospitals were not concerned about feedback and do not actively seek it. Kaivaan Movdawalla, Partner at EY India (Healthcare), says, 'For realising the aspired levels of efficiency, it is imperative for healthcare providers to shift from an incremental performance plus approach to a radical design to cost or direct-to-consumer approach for redesigning their operating models and cost structures.' Dr. Arvind Lal, Chair at FICCI Healthservices Committee and CMD of Dr Lal PathLabs, says, 'There is an urgent need to bridge the 'trust deficit' between the patient and the doctor; patient and the hospital; as well as government and the private healthcare provider for the Health of the Indian Healthcare.' EY recommends a '5E Framework' for building trust across all principal stakeholders, that is, policymakers, healthcare providers, payors and the public. This framework comprises integrating empathy, efficiency, empowerment, ease and environment to achieve the agenda of universal health access and the right to health. Read on...

Business Today: Most patients are dissatisfied with India's healthcare system, says EY-FICCI report
Author: P. B. Jayakumar


Mohammad Anas Wahaj | 05 sep 2019

Healthcare technologies enhance efficiencies, improve access and create informed patient-doctor relationships. Around the globe there is fast-paced adoption of these technologies. India too is undergoing health-tech transformation. According to a 15-country Future Health Index (FHI) 2019 report by Royal Philips, about 76% of healthcare professionals in India are already using digital health records (DHRs) in their practice. Moreover, 80% of healthcare professionals have shared patient information with other professionals inside their health facility, which is equal to 15-country average. India also meets the 15-country average when it comes to the usage of artificial intelligence (AI) within healthcare at 46%. Report also finds that a majority of Indian healthcare professionals who use DHRs in their practice report that DHRs have a positive impact on quality of care (90%), healthcare professional satisfaction (89%), and patient outcomes (70%) when compared to the 15-country average of 69%, 64% and 59% respectively. Rohit Sathe, President of Philips Healthcare (Indian Subcontinent), says, 'The report confirms that digital health technology is a pivotal pillar in delivering value-based care across the healthcare continuum in India. Tools including telehealth and adaptive intelligence solutions can help lower the barriers between hospitals and patients, thereby improving access to care and enhancing overall patient satisfaction, particularity in tier II & III cities in India.' Read on...

Livemint: Digital Health Technology can revolutionise healthcare in India: Report
Author: Nandita Mathur


Mohammad Anas Wahaj | 16 may 2019

The research, 'Development of a pathological healthcare system for early detection of neurological gait abnormalities', by Prof. Anup Nandy of National Institute of Technology (Rourkela, India) in collaboration with Prof. Gentiane Venture of Tokyo University of Agriculture and Technology (TUAT, Japan), aims to address human aging utilizing low-cost software solutions to early diagnose neurological gait abnormalities. Anomalies and abnormalities found in a person's walking style are termed as gait abnormalities. As human beings have different anatomical structure depending on age, gender and body-weight, they are prone to various gait abnormalities. Due to lack of awareness of such diseases and problems, the abnormalities get unnoticed at the initial stages. Moreover, the assessment becomes a little less credible without proper software and automation that uses data analysis. Scientists applied high level Machine Learning Algorithms for detection and periodic assessment of abnormalities. The software with the techniques of deep learning detects the various gait (walking) patterns, assess the collected data on specific parameters and the identified data is used in the detection or observing patient's improvements in various abnormalities like Cerebral Palsy, Parkinson's Disease and Equinus gait. Prof. Nandy says, 'As computer science enthusiasts and researchers, it's our responsibility to serve society and contribute to the betterment. This noble approach bridges the gap between Computer Science and Medical Science and is instrumental in the detection and assessment of various diseases. The low-cost software becomes affordable to everyone and can be beneficial to many in general.' Read on...

Monday Morning - NIT Rourkela: IMPACTING LIVES AND BEYOND: PROF. ANUP NANDY'S RESEARCH ON GAIT ABNORMALITIES
Author: Animesh Pradhan


Mohammad Anas Wahaj | 07 apr 2019

Biotechnology is expected to be the next big thing for the Indian economy, just like the IT industry has been, explains Amit Kapoor, President & CEO of India Council on Competitiveness and Honorary Chairman at Institute for Competitiveness. According to him, '...biotechnology industry seemed poised to take over the mantle. In the span of a decade beginning in 2007, the industry has grown exponentially in size from about US$ 2 billion to over US$ 11 billion in terms of revenue. By 2025, it is targeted to touch US$ 100 billion.' In the past, both Green Revolution (agricultural transformation) and White Revolution (dairy sector transformation) became successful because of the contributions from biotechnology. At present India's rising competitiveness in pharmaceuticals is also the result of biotechnological advancements and research. Moreover, energy needs of rural areas are also met by biomass fuel, produced through application of biotechnology. Mr. Kapoor explains evolution of biotechnology in India, 'As early as 1986, Rajiv Gandhi, recognising the potential of biotechnology in the country's development, set up the Department of Biotechnology...Department of Biotechnology has set up 17 Centres of Excellence at higher education institutions across the country and has supported the establishment of eight biotechnology parks across different cities...Biotechnology Industry Research Assistance Council (BIRAC) in 2012, which has successfully supported 316 start-ups in its six years of existence...As of 2016, India had over a thousand biotechnology start-ups.' According to Mr. Kapoor, the sector faces many challenges and they need to be addressed effectively and promptly - (1) India's research and development expenditure is quite low at 0.67% of GDP, not only compared to mature biotechnology economies such as Japan and the US (around 3%) but also in comparison to emerging economies like China (around 2%). (2) Specific to the biotech pharmaceutical sector, there are a few India-specific challenges with the country's IP regime. There are two main areas of contention for the industry in India's approach to intellectual property. The first issue lies in Section 3(d) of the Patents (Amendment) Act, 2005, which sets a higher standard for patentability than mandated by TRIPS. The industry argues that India's stricter standards for patents discourages innovation and dampens foreign investment. The second issue is that of compulsory licensing, which gives the government power to suspend a patent in times of health emergencies. Although India has used this option only once, the industry feels that such regulations keep investors clear of Indian markets. (3) Another challenge lies in the risk involved in the Valley of Death, that is, the risk of failure in the transition of innovative products and services from discovery to marketisation. Most of the early research funding, often provided by universities or the government, runs out before the marketisation phase, the funding for which is mostly provided by venture capitalists. It becomes difficult to attract further capital between these two stages because a developing technology may seem promising, but it is often too early to validate its commercial potential. This gap has a huge impact in commercialisation of innovative ideas. Read on...

The Economic Times: Why biotechnology can be Indian economy's next success story
Author: Amit Kapoor


Mohammad Anas Wahaj | 08 jan 2019

According to the 'Global Highly-Cited Researchers 2018 List' by Clarivate Analytics, India has only 10 researchers among the world's 4000 most influential researchers. Even though India has many globally renowned institutions, but it lacks breakthrough research output. Top three countries in the list are - US (2639), UK (546), China (482). Prof. CNR Rao, world renowned chemist from Jawaharlal Nehru Centre for Advanced Sciences and named in the list, says, 'About 15 years ago, China and India were at the same level, but China today contributes to 15-16% of the science output in the world, while we currently contribute only 4%.' Prof. Dinesh Mohan, environmental science academic at JNU and included in the list, says, 'Areas such as climate change, water and energy are areas where research is more relevant nowadays. Where you publish your work is also important for impact.' Dr. Avnish Agarwal, also named in the list, says, 'We need to improve our research ecosystem...There is a lack of focus on quality research in Indian academia. If teachers do not do high-quality research, they will not be updated with new developments.' Others in the list are - Dr. Rajeev Varshney (Agriculture researcher at International Crops Research Institute for the Semi-Arid Tropics-ICRISAT); Dr. Ashok Pandey (Researcher at the Indian Institute of Toxicology Research); Dr. Alok Mittal and Dr. Jyoti Mittal (Researchers in environmental science, water treatment, green chemistry and chemical kinetics at the Maulana Azad National Institute of Technology); Dr. Rajnish Kumar (Researcher and professor at IIT Madras's Department of Chemical Engineering); Dr. Sanjeeb Sahoo (Researcher in nanotechnology at the Institute of Life Sciences); Dr. Sakthivel Rathinaswamy (Professor and researcher in Applied and Computational Mathematics at Bharathiar University). Read on...

Firstpost: ONLY 10 AMONG THE WORLD'S TOP 4000 INFLUENTIAL RESEARCHERS ARE INDIAN: REPORT
Author: NA


Mohammad Anas Wahaj | 31 dec 2018

In India there are central government run healthcare institutions, public state run institutions and private medical colleges that provide modern healthcare education mainly the four year degree MBBS and after that post-graduate degrees of MS and MD. India also have a number of institutions that provide degrees in other healthcare systems like Ayurveda (BAMS), Unani-Greek (BUMS), Homoeopathy (BHMS), Naturopathy etc. Moreover, there are vocational training institutes that provide skills and courses to develop other medical staff like nurses, health assistants etc. There are also corporate run and other private medical colleges and universities and training institutes. India's healthcare facilities are generally concentrated in urban areas while rural areas are generally served by public hospitals and centers. Private clinics are also present in both rural and urban areas. They are generally run by a single doctor or doctor couple and provide basic healthcare. Diagnostic centers are spread all over due to technological advancements and compact and affordable equipments. Healthcare has major disparities between urban and rural areas when it comes to healthcare access. Healthcare has become one of India's largest sectors - both in terms of revenue and employment. The industry comprises public and private hospitals, pharmaceutical companies, pathology and diagnostics, medical devices industry, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The public sector constitutes primary health centers, central research centers and hospitals, state-run research institutes and hospitals etc. The private sector provides majority of secondary, tertiary and quaternary care institutions with a major concentration in metros, tier-I and tier-II cities. According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Rise of technology is creating new business models in the healthcare industry. Healthcare through smart phones and fitness trackers is new trend. Information technology is automating and streamlining various healthcare processes. Big data is creating new ways of improving healthcare delivery. Startups in India are promising to provide best healthcare at affordable cost more effectively. Latest healthcare equipment is not only imported but also manufactured in India. Digital technologies are enhancing every aspect of healthcare. Technology solutions are able to modernise current medical practices, reduce costs, eliminate any duplication of tests as well as streamline processes and update medical records in real time. Modern technology has great potential to increase access of healthcare services in rural communities, especially the ones where there is serious shortage of doctors. India has demonstrated since long a commitment to offer comprehensive healthcare to all citizens. This has been reaffirmed in the 12th Five-year Plan, National Health Assurance Mission, and more recently through Ayushman Bharat Program. However, the challenges remain and this goal has not been achieved as of yet. There are two critical components of successful healthcare systems. One is the financial aspects whereby citizens are protected against any eventuality and don't get into penury due to health spending. Second is the provision and delivery of healthcare services. It is imperative to ensure that healthcare infrastructure is sufficiently equipped to provide effective healthcare when needed by its citizens. Technology, public-private partnerships, access and affordability are the critical component in the future of India's healthcare. Better healthcare with policy, financial and physical framework will bring long-term benefits to the nation. Develop effective mechanisms to improve general health, and disease prevention strategies through campaigns, advocacy etc. To make India's citizens more aware about their health, inculcate better sanitization and cleanliness habits will help to improve overall health of India. Prevention before cure becomes the key for the country with the size and demographic profile like India. Health aware citizens, trained, sensitive and caring medical staff, cutting edge technologies and modern infrastructure, are the golden elements for a healthy future of India. Read on...

ilmeps/read: Healthcare in India: An Overview (Part 2)
Author: Mohammad Anas Wahaj


Mohammad Anas Wahaj | 13 oct 2018

Indian corporates that fulfil the conditions of Section 135 of the Companies Act 2013 relating to mandatory spending of 2% of last 3 years average profit on CSR are making a difference in vulnerable communities in India. According to the latest India CSR Outlook Report published by NGOBOX, Reliance Industries, HDFC Bank, Wipro, Tata Steel, NTPC, Indian Oil Corporation & ONGC spent more than their prescribed CSR budgets in FY 2017-18. The report analyzed CSR spends of 359 companies. The prescribed CSR budget of these 359 companies was Rs 9543.51 crore whereas the actual CSR spend was Rs 8875.93 crore (3/4th of total CSR spend in India). There is an increase in the prescribed CSR from 6% to 8% in the actual CSR spend from FY 16-17 and the number of projects have also increased by 25% from the previous year. REPORT HIGHLIGHTS: Maharashtra, Karnataka and Gujarat together received over 1/4th of India's total CSR fund. North-eastern states of Nagaland, Meghalaya, Mizoram and Tripura have received least funds; Public sector contribution is over 1/4th of the total; Oil, refinery and petrochemicals account for alsmost 1/4th of the total while healthcare and pharma contributes the least with just Rs 294 crore; CSR funding on education and skill increased by 50% from last year and is 1/3rd of the total CSR spend; Over 1/4th is spend on WASH (Water, Sanitation and Hygiene) and healthcare projects. Read on...

Business Today: Corporates spend 50% CSR funds in education, skill development: Report
Author: Sonal Khetarpal


Mohammad Anas Wahaj | 15 sep 2018

India's large size with huge population (1.25 billion), substantial part of which resides in rural and underdeveloped regions, brings both challenges and opportunities for implementing healthcare policies and initiatives, both public and private. Over the years ineffective implementation of such initiatives at various levels, has created lopsided infrastructure and uneven development in healthcare. Indian health system also lacks effective payment mechanism and has a high out-of-pocket expenditure (roughly 70%). Adverse health events (health shocks) have considerable impact on India's overall poverty figures, adding about seven percentage points. Health is associated with the overall wellness of the citizens. Good health reflects on the productivity and growth of the nation. More so in the case of India as substantial population is young. India has more than 50% (about 662 million) of its population below the age of 25 and more than 65% below the age of 35. By 2020, the average age of India's population is expected to be 29 years. Aging of this large population will happen at the same time. Having adequate infrastructure is key to avoid a massive health catastrophe for this elderly population in future. Health is also a key issue in the public policy sphere. In the public policy context healthcare issues are often related to accessibility, affordability, socio-economic disparities, healthcare delivery mechanisms, illness and diseases and their impact on society etc. India have a conceptual universal health care system run by the constituent states and union territories. The biggest challenge is to make it accessible and affordable for the overall population. Read on...

ilmeps/read: Healthcare in India: An Overview (Part 1)
Author: Mohammad Anas Wahaj


Mohammad Anas Wahaj | 22 jul 2018

In a developing country like India low-income groups often lack access to proper healthcare. But, mobile technology can provide ways to enable these groups have knowledge and resources to drive preventative healthcare. Lead researchers, Aakash Ganju (co-founder of Avegen), Sumiti Saharan (Neuroscientist, Team Lead of Design & Research at Avegen), Alice Lin (Global Director of social innovation at Johnson & Johnson), Lily W. Lee (President of Almata, a division of Avegen), explain the research conducted by their team on the digital usage patterns of underserved groups in two urban areas of India, and iteratively tested user interface and content design. Researchers generated primary research insights from more than 250 new mothers and fathers living in low-income communities, and achieve understanding of the core barriers and digital needs of this population. Researchers suggest, 'Embedding health care into digital tools requires that providers overcome contextual barriers and undertake deliberate design processes. To succeed, providers must develop a nuanced understanding of the obstacles to consuming information digitally, as well as glean insights from technology, interface design, and behavioral science.' Following are some insights from the research - (1) Cost is no longer the biggest barrier: In the last year, a strong government regulatory authority has promoted competition and consumer benefits that have rapidly driven down both smartphone and data costs. (2) Infrastructure can overcome any remaining cost barriers: Only 5% of people living in less-connected and less-developed localities owned smartphones, compared to a significant 56% of individuals with similar incomes living in neighborhoods with good mobile network and infrastructure. (3) Digital experiences are not often built for low-income, urban populations: The most pervasive barrier to digital adoption in India today is a lack of knowledge about how to use digital interfaces. Language is also a barrier. India has an overall literacy rate of 74%. However, only about 10% of Indians can communicate in English - the language of the Internet. Local language content is scarce. There are gaping holes in the understanding of early-stage user requirements and pain points, from both the digital interface and content experience perspectives. (4) There is a lack of trust in health-related digital information: Low-income, underserved communities who have not been exposed to authentic digital content often have extreme distrust in digital information pertaining to health. Only 12% of families thought information from digital sources was reliable, compared to more than 90% finding information from doctors and mothers to be most, very, or somewhat reliable. According to researchers, to truly meet the needs of underserved consumers, providers must focus on the following areas - (1) High-quality content: To engage users on digital platforms, providers must use differentiated content that connects with a user's specific journey. The form, tone, and continuity of content matters. Video formats optimized for small, low-quality displays are most effective in driving engagement. When visual formats are not feasible, audio formats are the next best alternative. Understand the environments in which users consume health. Include local elements in the content, like referring to local clinics etc. (2) Behavior change: Engaging users is vital to directing changes in consumer health behavior. It's important to be deliberate about the design of the user journey. Offering incentives for content consumption, sharing, and specific health-related behaviors can help nudge users toward desired health-related behaviors. (3) Technology: Mobile apps need to be light and fast, have low memory and data requirements, and be able to run on slow and patchy networks. Display data consumption frequently, enhanced ability to view offline content and share content within community is important for engagement. (4) Design team structure: Multidisciplinary teams that bring together expertise in technology, design, business and sustainability, end-user thinking, and behavioral sciences tend to create the most effective designs. To design for the end user, providers must design with the end user, particularly for populations who are not digitally fluent. Teams should develop a thinking environment and processes that allow for hypothesis development, application design, testing, analytics, and retesting in rapid, parallel, iterative cycles. Read on...

Stanford Social Innovation Review: Expanding Access to Health Care in India Through Strong Mobile Design
Authors: Aakash Ganju, Sumiti Saharan, Alice Lin Fabiano, Lily W. Lee

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