Tokyo, Japan, 4-5 February 2013 Abu Dhabi Weqaya Programme Tackling NCDs: Application to Low and Middle Income Health Markets Reehan Sheikh Technology Strategist Platform Health ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

Tokyo, Japan, 4-5 February Abu Dhabi has been ideal market for innovation in health data 2.1m lives: Big enough to matter, small enough to manage… Highly strategic government with broad-based popular trust Extreme pace and depth of socio- economic development – very high burden of NCDs Plural and diverse payers and providers Relatively well-resourced health system enabling innovation

Abu Dhabis greatest health challenge Tokyo, Japan, 4-5 February Implementing the Dubai declaration GCC Council of Ministers Addresses at least six of the eight objectives UAE: Worlds 2 nd highest prevalence of diabetes

Modeling suggests rapid cost increase Predicted costs of UAE National diabetes treatment, AED Tokyo, Japan, 4-5 February Direct healthcare cost Societal cost

Delivering model at scale: Overview of Weqaya Tokyo, Japan, 4-5 February Interventions Population Standard clinical care Nutrition (trans-fats, food labeling) Physical activity (gyms, AD UPC) Tobacco control Group Workplaces and schools Local communities, families Segments: Disease groups e.g. diabetics Individual Clinical care Encourage: Weqaya reports Enable: Website/call centre Interventions Population Standard clinical care Nutrition (trans-fats, food labeling) Physical activity (gyms, AD UPC) Tobacco control Group Workplaces and schools Local communities, families Segments: Disease groups e.g. diabetics Individual Clinical care Encourage: Weqaya reports Enable: Website/call centre Population Group Individual Approach Screen Screen individuals iteratively 97% adult Emiratis screened (>190,000) PlanClinical Standards, website/call centre ActClinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco) Approach Screen Screen individuals iteratively 97% adult Emiratis screened (>190,000) PlanClinical Standards, website/call centre ActClinical care, targeted lifestyle behaviour change (diet, physical exercise, tobacco) 1 2 PLAN SCREEN ACT

An individual score and customized call to action Tokyo, Japan, 4-5 February Principles of data feedback Patients should have access to their own health data: -Personal Health Record (secure paper mail-out) -Electronic Health Record ( -Smart Portable Health Record (Weqaya Data Architecture)

7 Pay for Quality and Pay for Health Based on compliance with evidence-based care pathways and clinical quality indicators Mechanism set-out in Standard Contract (between Healthcare Facilities and Health Insurers) Expectation it will affect base payment by <10% Compliance with high quality care receives a bonus Pay for Quality Pay for Health Based on individual health status Health initially defined as 10-year risk of cardiovascular event (heart attack or stroke) Contract between individual and Disease Management Programme AED1,000 per 1% reduction in risk to maximum of AED5,000 (5%) No health improvement – no money

Tokyo, Japan, 4-5 February In AD eHealth systems are a platform for health Everyone can know their numbers… … and the numbers can change health outcomes ControlWeqaya % engaged with care* % with HbA1c <7.5% % with LDL:HDL ratio <3.5 Control Weqaya ControlWeqaya

Two domains of Weqaya action Healthcare Sector Clinical care standards Patient empowerment Customer-centred services Research and Innovation Health Guardians Nutrition Physical activity Tobacco control Alcohol control Employers and schools Urban Planning 9

We set clear targets based on global evidence Tokyo, Japan, 4-5 February Target risk reduction Annual Weqaya targets

Screening: Adaptations for medium and low income countries Tokyo, Japan, 4-5 February $1 $2 $15 Non-clinical staff Train the trainer SMS-based reporting Clinical/para-clinical staff Train the trainer SMS-based reporting Personal Health Record Per person costAdaptation

Data Exchange in low and medium income countries 12 Data capture (mobile device) Unique identifier (patient, clinician, etc.) (Simplified) diagnosis, treatment provided, outcome, etc. Standardised data Kilobyte range (works with 2G mobile phone) Data store Donors Clinicians Programme managers Academia WHO UN – Development Goals (MDGs) A A B B C C Option to create central health philanthropy bank to administrate

Range of data systems enable secure ubiquity Measuring health Opt-out screening Opt-in data sharing Taking health promoting action Ubiquitous Weqaya Programme Point of decision prompts (e.g. Weqaya label on healthy food) At home monitoring Secure data sharing

Standardized and Centralized Health Data 14 Health & Wellness data can be capture in the field using basic mobile technologies 1 All Health & Wellness information is saved centrally for population and individual level analysis 2 Healthcare workers can immediately access data captured in the field and begin a two-way dialog 3 In healthcare facilities, providers can get a full view of the patient 5 Personal health/wellness tracking and intervention can be tied to clinical information allowing a view into effectiveness of intervention and patient behaviour change 4

Thank You Questions? Reehan Sheikh Platform Health