1. 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 reehan.sheikh@opensecurehealth.com ITU Workshop on E-health services in low-resource settings: Requirements and ITU role (Tokyo, Japan, 4-5 February 2013)

2. Tokyo, Japan, 4-5 February 2013 2 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

3. Abu Dhabis greatest health challenge Tokyo, Japan, 4-5 February 2013 3 Implementing the Dubai declaration GCC Council of Ministers Addresses at least six of the eight objectives UAE: Worlds 2 nd highest prevalence of diabetes

4. Modeling suggests rapid cost increase Predicted costs of UAE National diabetes treatment, AED Tokyo, Japan, 4-5 February 2013 4 Direct healthcare cost Societal cost

5. Delivering model at scale: Overview of Weqaya Tokyo, Japan, 4-5 February 2013 5 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

6. An individual score and customized call to action Tokyo, Japan, 4-5 February 20136 Principles of data feedback Patients should have access to their own health data: -Personal Health Record (secure paper mail-out) -Electronic Health Record (www.weqaya.ae)www.weqaya.ae -Smart Portable Health Record (Weqaya Data Architecture)

7. 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

8. Tokyo, Japan, 4-5 February 2013 8 In AD eHealth systems are a platform for health Everyone can know their numbers… 200820092010 … and the numbers can change health outcomes ControlWeqaya % engaged with care* % with HbA1c <7.5% % with LDL:HDL ratio <3.5 Control Weqaya ControlWeqaya

9. 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

10. We set clear targets based on global evidence Tokyo, Japan, 4-5 February 2013 10 Target risk reduction Annual Weqaya targets

11. Screening: Adaptations for medium and low income countries Tokyo, Japan, 4-5 February 201311 $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

12. 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

13. 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

14. 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

15. Thank You Questions? Reehan Sheikh Platform Health reehan.sheikh@opensecurehealth.com www.opensecurehealth.com