Public health entrepreneurship

PUBLIC HEALTH ENTREPRENEURSHIP
Prepared By
Nabaraj Paudel
Masters of Public Health, Pokhara University
1

SCOPE AND STATUS OF
AT NATIONAL AND GLOBAL CONTEXT
Presented By
Nabaraj Paudel
Masters of Public Health Service Management
Pokhara University
2

COURSE CONTENT
Entrepreneurship in public health
 Definition of Public Health Entrepreneurship
 Public health entrepreneurial scope
3

IF YOU GIVE A FISH TO A BEGGAR, IT MEANS YOU FEED HIM JUST ONCE
BUT
IF YOU TEACH HIM HOW TO CATCH A FISH, THIS MEANS YOU FEED HIM FOREVER 4

AN EXAMPLE OF VALUE ADDING
Apple in Mustang has very low value
Wine made by the apple in Mustang has high value
Apple Cider in the current market has the highest value.
5
Note: It is a negative example

AS A PUBLIC HEALTH PROFESSIONAL,
WHAT DO YOU WANT TO BE?
6
1. Employer 2. Employee
The terminology difference between employee and
employer is small but the role of each is huge different.

BACKGROUND
 The ILO estimates that some 88 million young women
and men throughout the world are unemployed.
 The scenario is even worse in the least developed
countries like Nepal.
 According to the report of Nepal Rastra Bank, remittance
contributes about 25% to the country’s GDP.
 According to the report of Department of Immigration of
TIA about 1500 Nepali youths migrate abroad daily to
foreign job market.
(Source: Volunteer Initiative Nepal, available from
https://www.volunteersinitiativenepal.org)
7

ENTREPRENEUR
 Entrepreneur is the ability to take the factors of
production or service-land, labor and capital and
use them to produce new goods or services.
 The entrepreneur perceives opportunities that
other business executive do not see or do not
care about.
 Entrepreneur sees a need and then brings
together the manpower, materials, and capital
required to meet that need. [1]
8

ENTREPRENEURSHIP
 Entrepreneurship involves initiating changes in
production. [1,2]
 The entrepreneurs always search for change,
respond to it , and exploit it as an opportunity.
 Need to shift resources from approaches that
have produced low value into areas of higher
productivity and yield.
 Entrepreneurs create value. [1,2]
9

PUBLIC HEALTH ENTREPRENEURS ARE:
 Change agent of population health,
 Pioneer of innovations that benefits the wellbeing of
humanity,
 Offers sustained improvement in the health of
populations in the face of need
 Need to shift resources from approaches that have
produced low value into areas of higher productivity
and yield.
 Social entrepreneur [2]
10

The opportunistic creation and implementation
of catalytic innovations intended to offer
sustained improvement in the health of
populations in the face of need; without being
limited by the resources currently in hand;
involving collaboration with and accountability
to the constituency served and the outcomes
created. [2]
11

PUBLIC HEALTH INNOVATION
Scott Frank 2007, scott.frank@case.edu
12
Public health Value
Low High
Cost
Low Entrepreneurship
opportunity
Target ideal
High Entrepreneurship
opportunity
Non Sustainable
project

Success is measured by:
 Improved health outcome
 Change in social environment
 Sustainable programming
13

PUBLIC HEALTH IS INHERENTLY
ANTI-ENTREPRENEURIAL
1. No profit motive
2.Governmental stuck in the box (Clinical vs PH)
3.Slow moving relative to corporate world
4. “Products” are harder to sell (cigarette and alcohol
VS milk)
5. Lack of accountability (individual level)
6.Stifled by funding restraints -best practice paradox
14

PUBLIC HEALTH IS INHERENTLY
ANTI-ENTREPRENEURIAL
7.Brain drain-under trained work force, both in numbers
and specialties
8.Hard to target an audience when we have no specific
target audience (healthy population)
9.We don’t really know how we’re doing
10.Our focus is need and not just needs that will pay. [2]
15

PUBLIC HEALTH OFFERS INHERENT
OPPORTUNITIES FOR ENTREPRENEURSHIP
1. Play on people’s fears!!!
2. They may not know it, but everybody needs us,
and the market is wide open.
3. We are selling some fabulous things : decreased
expenses, increased happy times
4. Small bites = big change
5. Passion abounds 16

PUBLIC HEALTH OFFERS INHERENT
OPPORTUNITIES FOR ENTREPRENEURSHIP
6. The market is more receptive. The time to innovate
is now!!
7. Timing is good for public health and medicine to
play nice again
8. The nature of public health is responsive.
9. There is an inherent need for innovation because we
have failed with things in the past. So something has
to change!
10.Evaluation tools for outcome(improved health) [2]
17

THE SCOPE OF PUBLIC HEALTH
ENTREPRENEURSHIP
A. Life insurance companies
B. Large scale companies/factories
C. Public health insurance / benefits schemes
D. Health product production establishment
E. Public health consultancy agencies
F. Fitness centers [3]
18

A. LIFE INSURANCE COMPANIES
19

 Life Insurance companies are offering attractive
options for consumers who want to protect their
dependents.
 Life insurance can protect the ones you love and be
the foundation of your financial plan.
 Since thinking about your own mortality is not
pleasant, some people try to avoid contemplating
thoughts of their own demise.
 Force saving
20

Nepal
 Growing faster in Nepal
 Direct significance in Health
 Do not protect from financial risk of disease
India
 More popular in India especially the female child
USA
 More emphasis health services coverage
21

BENEFITS OF LIFE INSURANCE
 Financial risk protection
 Saving (force saving )
 Wealth creation
 Tax saving
22

DISADVANTAGES
23
 Suicide and
Homicide
 Life
insurance company
won't pay death
benefits if the
policyholder commits
suicide within a
specific period of
time (2 years) after
their policy takes
effect.

B. LARGE SCALE COMPANIES/FACTORIES
Industries and entrepreneurship projects related
to public health include
 Design and development of healthy homes
 Sustainable approaches to water, energy
 Food production, healthy food stores
 Health and recreational institutions
 Behavior change institutes
 Information and communication
 Smoking/tobacco cessation reality TV programs [4] 24

25

26
 Design and development of
healthy homes
 Sustainable approaches to
water, energy and food
production
 Healthy food stores
 Tobacco cessation projects
 Health and recreational
institutions
 Behavior change institutes
 Unplanned urbanization
 Improper food storage
and handling
 Weak food inspection and
regulation
 Problem in effective
implementation of
UNFCTC
Developed countries Developing countries

C. PUBLIC HEALTH INSURANCE /
SOCIAL HEALTH INSURANCE
 Social Health Insurance (SHI) is a prioritize
government program based on comprehensive social
contributory scheme with government subsidies for
the poor.
Objectives of Social health insurance
 Ensure access to quality health
 Protect from financial hardship and reduce out-of
pocket payments. [5]
27

C. PUBLIC HEALTH INSURANCE /
SOCIAL HEALTH INSURANCE
 This program is expected to play an important
role in achieving Sustainable Development
Goals by 2030 by propelling the country towards
Universal Health Coverage. [5]
28

TOTAL NO OF ENROLLMENT
(JAN 2017)
32

C. SOCIAL HEALTH INSURANCE IN
NEPAL
 Health insurance Vs disease insurance
 Gradual change in the number of acceptors of
SHI in Nepal.
 Implemented in 25 districts
33

C. SOCIAL HEALTH INSURANCE IN GLOBAL
CONTEXT
Private insurance model
 Predominately private insurance and funding
 Predominately private providers
 Medicare/Medicaid
Ex: USA
34

GLOBAL CONTEXT
Beveridge model (Public)
 Taxation is the source of funding
 Universal scope to all citizens
 Not related to income
 Public providers and governmental ownership
 Complete coverage with basic health benefits
and free access to all citizens.
Ex: UK, Norway, Denmark, Portugal
35

GLOBAL CONTEXT
Bismark model : Public Private Mixed
 Related to income
 Compulsory health insurance premiums paid by
employ and employers
 Selective scope
Ex: Japan, Holland, Austria, Switzerland
36

D. HEALTH PRODUCT PRODUCTION
ESTABLISHMENT
Medical products
 Nepal CRS Company is a key driver in the growth of
Nepal’s private health sector and pioneer social marketing
company in Nepal started its operation in 1978 with the
launch of its first condom brand. [1]
 It continues to distribute low-cost family planning (FP),
maternal child health (MCH) and other health products
through its innovative social marketing initiatives.
 CRS contributes approximately 25% to the overall
national FP achievements on reversible methods.
(NDHS 2011).
37

ESTABLISHMENT
Vaccines
 Bill and Melinda Gates foundation supported in
vaccination.
 Goal of Bill and Melinda Gates foundation is to
prevent more than 11 million deaths, 3.9 million
disabilities, and 264 million illnesses by 2020
through high, equitable, and sustainable vaccine
coverage and support for polio eradication.
38

ESTABLISHMENT
Technology
 Special attention should be given to GMP
 MHM-Sanitary pads,
 Diabetes: food manufacturing, BP checker, …
 IPD: Vaccines,
 Malnutrition: super floor, balanced diet
restaurant
39

ESTABLISHMENT
Technology
 You tube series on public health
 Online newspapers on Health (swastha Khabar
Patrika)
 Journals
 Blogs
40

ESTABLISHMENT
 Temp Traq offers a patch-like smart device, which
monitors body temperature 24/7.
 It continuously senses, records, and sends temperature
data to mobile devices so caregivers can keep track
without unnecessarily disturbing the child.
41

D. HEALTH PRODUCT
PRODUCTION ESTABLISHMENT
 QardioCore promises a discrete as
well as easily usable heart monitor
without patches and wires.
 The FDA-approved, medical-grade
wearable uses sensors to record
clinically accurate continuous
ECG, heart rate, heart rate
variability, respiratory rate, skin
temperature, and activity data. 42

E. PUBLIC HEALTH CONSULTANCY
AGENCIES
1. Consultancies for health research
 Tool development,
 Intervention design,
 Monitoring and Evaluation
 Baseline and End line survey
 Data analysis
 Proposal development and technical assistance
Eg. New ERA (NGO)
2. Establishment of health promotion centre.
43

E. PUBLIC HEALTH CONSULTANCY
AGENCIES
Health Consultancy for technical assistance
(TA) on different areas
 Nutrition, Meat inspection/food inspection
 Reproductive health, Family planning,
 Safe motherhood
 Occupational health and safety
 Environmental health management
 Monitoring water quality
 Monitoring drug quality
 Quality of care 44

E. PUBLIC HEALTH CONSULTANCY AGENCIES
Information centre
 Public Health Information Centre (PHIC)
Training institution
 Technical assistance,
 Formal training course/ informal training course
45

F. FITNESS CENTERS
 Fitness services is defined as “the overall intangible
activities based on physical activities that create value
for individuals by offering them physical,
psychological, social and economic benefits”.
47

F. FITNESS CENTERS
 Limited motion lifestyle that today’s consumers face
due to mechanization and automation, has led
significant consumer interest in fitness center (FC)
offerings as a way to compensate the lost physical
activities.
48

F. FITNESS CENTERS
 There have been continuous increases in the number
of participants of the FCs in the US and Nepal
where FCs has been rapidly proliferating around the
globe.
 Recent economic successes and increases in the
national income of Turkish consumers along with the
effective marketing efforts of sports and physical
activity services might also be contributing to this
trend. [6]
49

OTHERS
Waste management
 Diffetent Pvt. Ltd is managing health care waste and
municipal solid waste.
Water Supply
 Promotion of filters/ water purifiers
Eg. Environmental and public health organization of
Nepal (ENPHO)working in WASH sector and
emphasis in water filtration.
52

OTHERS
Health education materials production
 Training manuals development
 Message mapping
 Designing and development hoarding board,
poster, pamphlet, flip chart related to health
Electronic health
-Mobile apps (SMS, APPS)
-Electronic health records (BMI)
- Telemedicine
53

BENEFITS OF PUBLIC HEALTH
ENTREPRENEURSHIP
 Economic Growth
 Productivity
 New technologies, products and services
 Marketplace change
Improved health status and wellbeing
54

QUESTIONS FOR DISCUSSION
 Why the status of Public Health
Entrepreneurship is very low in Nepal?
 What are the barriers of Public Health
Entrepreneurship in Nepal?
55

SOCIAL MARKETING
 It is a marketing strategy modeled after corporate
marketing, used by health professionals to develop
successful health messages.
 Many different definitions of social marketing exist,
but most have these common components:
 The adoption of strategies used by commercial
marketers.
 A goal of promoting voluntary behavior change (not
just improved knowledge or awareness).
 An end goal of improving personal or societal welfare.
 The use of pro-health messages.
Eg. ORS, Iodized salt
56

SOCIAL ENTREPRENEURS: SOME EXAMPLES
Social entrepreneurs work for society.
Monetary benefits is not subject of priority.
For examples:
 Mahabir Pun, pioneer of wireless technologies to
develop remote areas of the himalayas.
 Anuradha Koirala, founder of Maiti Nepal, provides
shelter to the sexually violated, trafficked and
helpless women.
 Sanduk Ruit provides eye surgery facility in low cost
to thousands of poor cataract patients across the
globe.
57

CONCLUSION
 Entrepreneurship involves initiating changes in
production and finally entrepreneurs create value
 Success is measured by improved health outcome,
change in social environment, and sustainable
programming.
 Debate on Public Health Entrepreneurship inherently
anti entrepreneurial vs. offers opportunities for
entrepreneurship.
 Bring positive change to achieve improved health
status 58

RECOMMENDATION
 For beginners of public health entrepreneurship, it is
recommended to review the Public Health Innovation
matrix.
59

REFERENCES
1. Dahal A, A textbook of Health
Management.Bhotahity Kathmandu:vidyarthi Pustak
Bhandar;2012.
2. Scott Frank, Kristina Knight, Gayle Effron.
Reinventing Behavior Change through Public
Health Entrepreneurship. United states: Case
Western Reserve University;2007.
3. Hanlon. Public Health Administration
60

REFERENCES
4. Hernanden D, Carrion D, Perotte A, Fullilove R.
Public Health Entrepreneurship Training in the next
Generation of Public Health Innovators. New York:
Association of Schools and Program of Public Health;
2014 Dec. Vol (129).
5. Annual report FY 2073/74 (2016/17).Teku
Kathmandu :Social Health Insurance Program. Social
Health Security Development Committee: 2017
Oct.89p.
61

REFERENCES
6. Yildiz SM. An importance-performance analysis of
fitness centre service quality: Empirical results from
fitness centres in Turkey. African Journal of Business
Management. 2011 Aug 18;5(16):7031.
7. Australia F. Let's get physical: The economic
contribution of fitness centres in Australia. Economic
Pt Limited[Online] https://secure. ausport.
gov.data/assets/pdf_file/0007/459880/FitnessAust_Eco
nomicContribu tionFitnessCentresAustralia. pdf
[Accessed 28th October 2012]. 2009 Jul.
8. Nepal Demographic and Health Survey 2016
62

Financial stupid are everywhere,
Don’t be one of them.
-Nabaraj Paudel
64

Public health entrepreneurship

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