TED Conversations

Steve Garguilo

Emerging Markets, Johnson & Johnson


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What can a sustainable telemedicine business model look like, and how do we get buy-in from those with the resources to make it happen?

In developing regions such as sub-Saharan Africa, the ratio of people-to-doctors is as high as 50,000:1. In the US, this ratio is 390:1. This means patients have to travel long distances at a considerable expense just to reach a doctor.

I worked with a team from Penn State University (http://www.mashavu.com/) on a unique, sustainable telemedicine solution comprised of highly low-cost, ruggedized biomedical devices designed specifically for the developing world. Devices will collect medical information including weight, body temperature, lung capacity, pulse rate, blood pressure, stethoscope rhythms, photographs and basic hygiene and nutrition information. These readings would be paired with a healthcare questionnaire, medical history, and pictures which describe their symptoms, and then sent to a doctor for remote triage. The doctor then provides feedback through the same device. The solution would enable doing the initial triage and would provide the patient with remote health advice.

Though there have been MANY telemedicine projects in the past, most of them were experiments - they were VERY expensive and lacked an entrepreneurial outlook to ensure economic sustainability. A major constraint is that 95% of the biomedical diagnostic equipment used in Africa is imported, extremely expensive, not ruggedized and not repairable when it fails. This will be a low-cost, ruggedized option for decentralized diagnosis and triage of patients.

Three years of work in Kenya and Tanzania shows that people are willing to pay for a service like this because it cuts down on travel time/costs, and a pay-per-use business model will make this a sustainable venture rather than philanthropic. What should the model look like to really make it work? What are the flaws with this concept? How can we manage/mitigate/be willing to embrace the complexity? I want to influence decision makers at J&J, but don't have all the answers. I look forward to responses from the TED community!


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  • Mar 5 2011: Telemedicine in a developing world context is a wonderful opportunity for mental health parity inclusion at the inception of a new system. I would be willing to develop templates, informed by cultural and universal values, for health care professionals to screen for abuse and social-emotional well-being.

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