Convert organic waste to fertilizer to bring personal smartphone healthcare solutions to shared community-based SMART clinics
Around 250 million slum dwellers are estimated to be suffering from chronic diseases. They lead difficult lives with poor sanitation, intermittent employment, low awareness and no access to affordable and effective healthcare.  When afflicted, they are caught in this vicious cycle of chronic diseases:
Unhealthy lifestyle -->Increased risk of non-communicable diseases -->Contract non-communicable diseases ---> No access to early diagnosis/treatment --> Debilitating symptoms --->Loss of productivity -->Lower income
They don’t have access to technology and solutions that are proving effective in chronic care. We bridge this gap by bringing to them remote healthcare services through SMART clinics. A SMART clinic present in/near a slum will have Internet of things (IoT) environment. It will provide screening through IoT-enabled medical device, electronic health records, health analytics based prescriptions and video consultation with doctors present around the world to solve disease. SMART clinics will provide healthcare services for cardio-vascular, diabetes and hypertension. Furthermore, a SMART will give food and medicine coupons to make the dietary prescription affordable.This idea will make healthcare efficient, effective and affordable for slum dwellers at large. The idea is to take advantage of individualized smartphone application to shared community-based SMART clinics
These services will be subsidized by the revenues generated from a waste management system. This system will convert organic wastes into quality fertilizer using human-powered waste to fertilizer convertor. The power required to run the converter will be generated by patients exercising on bicycles as prescribed by SMART clinics. The revenue generated by selling the fertilizers will subsidize the service cost the SMART clinic. Our innovative business model leverages patient’s exercise as a financial resource making it affordable and sustainable.
What are the key outcomes and impact of your solution?
The key outcomes and impact of the solution can be categorized into the following:
Better accessibility: The metrics we will measure -
1. Proportion of population in neighboring areas covered through this system to estimate the penetration of the program
2. Reduction in incidence rate of chronic diseases in the area due to screening of patients earlier
3. Reduction in the distance between patient and service/product
4. Does it reduce the time a patient spends to find/use treatment
Improved awareness: The metrics we will measure-
1. Increase in number of people who are able to detect diseases in early stages
2. Reduction in mortality due to prevention of diseases due to better monitoring by patients
Better Diagnosis: The metrics we will measure
1. Increase in the percentage of diagnosed people monthly/annually
2. Decrease in proportion of people from target group progressing to the next stage in chronic disease
Increased cases of Prevention: The metrics we will measure
1. Reduction in incidence rate of chronic diseases in the are
2. Number of patients diagnosed with high risk and prevented from onset
3. Cost savings by preventing the high-risk people from disease onset
4. Time to progress to next stage in chronic disease is increased due to preventive measures
Better treatment Outcomes: The metrics we will measure
1. Proportion of patients who do not reach the fatal stage
2. Decrease in mortality rate due to chronic disease
3. Decrease in proportion of people progressing to the next stage in chronic disease
4. Measure of increase in time taken to progress to next stage
Better Quality and Reliability: The metrics we will measure
1. Reduction in Patient Turnaround time
2. Time saved due to availability of medical services in vicinity
3. Cost savings due to multiple trips to medical facilities
4. Number of times queues faced by a patient
5. Patient satisfaction using survey form
Better compliance: The metrics we will measure
1. Percentage of test /doctor appointments complied,
2. Percentage exercise regimen compliance
Reduced Cost and Increased Affordability: The metrics we will measure:
1. Difference in cost of our solution compare with costs others
2. New source income generate/Amount of income generated
Triple Bottom line
1. Social: Increase in the productivity of urban slum dwellers as they will have access to better medical treatment
2. Environmental: The project will result in a cleaner environment as waste management project will lead to recycling of organic waste into useful end products
3. Financial: Urban slum dwellers will be able to afford appropriate medical services due to generation of funds from their exercise on bicycle-powered waste converter machines
What actions do you propose to realize your stated goals?
Actions that will be undertaken to achieve the following outcomes
1. Standard 1-room SMART clinics will be set up near urban slums to increase accessibility.
2. Video conferencing application, a key feature of the SMART clinics will be setup so that doctor present anywhere can provide video consultation to the patient.
1. A native dweller will be trained and hired to run the basic operations of a clinic.
2. Apart from his clinic duty, he will also be responsible for spreading awareness about SMART clinic in the slum. Slum dwellers will be more willing to trust the initiative if a native will be responsible for word-of-mouth promotions.
Quality and Reliable treatment
A SMART clinic will be an automated IoT environment that will provide IoT medical device screening, electronic health records, real-time analytics based prescriptions and video consultation with doctors present around the world. Following are the components and functions of the SMART clinic-
1. Stationary medical devices to screen diabetes, hypertension and cardiovascular disease. These will provide inputs to the IoT by collecting clinical data like blood glucose or heart rate as raw data and transferring them to the cloud.
2. A cloud/storage device that stores the raw data, EHRs, analytics, visualizations, prescriptions for each patient from all clinics.
3. Wi-Fi network with standards and protocols connecting all the above components pervasively
4. Elixir, a central platform that has following multiple applications-
· A risk rating application that determines the vulnerability of the patient to chronic diseases based on the initial screening data and machine learning
· An electronic health recording (EHR) system that converts screening data into an electronic health record for the patient
· An analytics application that generate statistics and visualizations for the doctor using the EHR. It recommends general prescription for diet, exercise and medication(using machine learning) for doctor’s reference
· A video conferencing app connects the patient present in the clinic to his doctor present anywhere in the world with his laptop and access to the central platform
· A scheduling app which schedules the patients next visit according to his statistics/risk, convenience and the doctors availability
As package of accurate and efficient applications it will ensure better treatment outcomes, quality and reliability. Regular, short and affordable visits to SMART clinics will help patients engage & make better health decisions in real time & reduce the rate of progression of the disease.It will eliminate the need for costly, long hospital visits, tests, and hospitalizations
1. The services provided to patient which include tests, doctor consultation, food coupons and medicine coupons will be provided at subsidized costs.
2. These costs will be subsidized using a waste management service will be run by the patients
3. This waste management system will require patients to convert untreated waste high quality fertilizer using bicycle powered waste-fertiliser convertor.
4. Patients will be prescribed exercises by the doctor in the form of cycling times on a waste fertilizer convertor.
5. The revenue generated from the patient’s exercise will be used to subsidize the costs of their medical visits and food coupons which will incentivize them to comply. A part of revenues will be used to for the operating costs of SMART clinics.
6. This waste management program solves two purposes , regular exercise for patients to manage/prevent disease and also make the services of the SMART clinic economical viable and sustainable
1. Food and medicine coupons will be provided to each patient in accordance with his dietary and medicinal prescription
2. The food items will be determined based on the customized suggestions provided by the health analytics based on the results of screening test and doctors suggestion
3. Each food coupon could be used only against specific food items / a customized food basket, an assortment of the nutrient requirements of the patient
4. A collaboration with United Nations World Food Program (WFP) and World Health Organisation will be established to provide the food baskets and medicines against these coupons. WFP already provide food baskets in refugee and emergency situations.
5. These food and medical coupons will be provided for by the funds generated from the waste management service
6. The medical treatment compliance will be ensured by SMS service which will remind the patients regarding their appointments and their medication, dietary choices and exercise schedule
Distribution and Adoption by target group
1. A free initial screening scheme would attract people to visit the clinic for the first time
2. The adoption of program would be increased by the introduction of a referral scheme. The referral scheme would incentive people who will promote the program and ensure people sign up for the screening test in the SMART clinic. The incentive for referee would be one free medical consultation with the doctor in SMART clinic
3. The one local support staff will also be responsible for spreading the word about the program and getting more people to sign up for the screening test. The support staff would be a native of that slum who would be trained to screen people using IoT enabled medical kit. As the person would be local, people would be more willing to trust him.
Adoption by consumer (farmers) of the fertilizers
1. Collaborate with the government to include our fertilizer in the fertilizer subsidy scheme government provides to farmers. This will generate pull towards the product
A typical visit to the SMART clinic is described below:
· Patient arrives at the SMART clinic (2-10 minutes) away from his home) for his scheduled appointment. This scheduled appointment will ensure that the patient need not spend time waiting in a queue for visiting a doctor
· He enters the clinic and shows his ID proof /SMS to the staff who verifies him in a minute
· The staff helps him/her through his tests through the automated and stationary medical devices in 5-10 minutes
· Immediately his screen data is updated to his/her EHR, automated real time analytics and visualization happens, automated prescriptions are generated for diet, exercise and medication, and his results and data is stored in the cloud
· In next 10-15 mins, he goes through a check-up with a doctor on video-conferencing who has access to the results and records.
· He/she will be enrolled on prevention or management programme according to his/her results
· Doctor’s prescription regarding medication, diet, exercise prints on a prescription paper and an SMS. His next appointment is also in the SMS
· Food coupons, medicine coupons, exercise appointments are given to him by staff
Who will take these actions?
Solvers and MIT
IOT enabled medical devices: Solvers will collaborate with MIT to develop IOT-enabled medical kit to screen patients for chronic diseases
Risk-rating system: Solvers will develop a machine learning algorithm to assign a rating based on the likeliness of developing a chronic diseases
Health analytics and EHR: Development of application for automatic creation and updation of electronic health record creation from clinical data recorded in IoT enabled devices. Development of health analytics app that uses statistics and machine learning to provide to support doctors in advising the patients
Scheduling system: Solvers need to develop a scheduling software for medical appointments of patients with doctors using video conferencing. Scheduling system also needs to be developed to schedule timings for patients to exercise on bicycle powered waste convertor
IoT Infrastructure: Development of the IoT infrastructure to connect above applications containing medical devices, cloud, a central platform and network devices
SMART clinic: Designing of the standard model of a 1 room SMART clinic.
Human powered waste- fertilizer convertor: Development bicycle run waste fertilizer convertor
Video Consultation and Prescription: Specialized doctor will be needed to treat and monitor patients with different chronic disease. They will provide medical consultation over video conferencing at a subsidized price
World Food Programme and World Health Organisation (United Nations)
Food and Medicine Coupons: Patients will be provided food coupons as per their medical condition. These food coupons will be subsidized by the funds generated from waste management program. WFP will be leverage to source appropriate food baskets in exchange for these coupons. WFP will be reimbursed for these food baskets by revenue generated from waste transformation into fertilizer
Infrastructure: Setting-up of one room clinics near urban slum would require government intervention to acquire necessary land and other clearances. Government support would be required for construction of necessary infrastructure near the urban slums
The target group is urban slum dwellers of developing regions of Africa, Asia and Latin America. People who live in urban slums lead difficult lives including poor sanitation, intermittent employment, and low awareness. Quality healthcare is not possible in such localities. Diseases have high incidence rate and has more serious consequences for the people residing in such communities. Due to resource constraints, they are more expensive to treat leading to low compliance. Slum dwellers are trapped in this vicious cycle and hence, they have high vulnerability to chronic diseases.
Chronic diseases have the following cost associated with them which are exacerbated for the slum dwellers due to the resource constraints and lifestyle
1. Economic cost: Slum dwellers have to bear the cost of chronic diseases as they generally don’t have insurance. In addition to these direct cost, there are indirect costs associated as they have low productivity and daily-wage earners are impacted the most
2. Social cost: Patients also have to go through tremendous emotional and psychological pain. They are treated poorly and the entire family has to face the burden when one member suffers from chronic disease. Chronic diseases require constant monitoring and hence, these costs are generally very high and span a long duration
It is estimated that around 250 million people in slums are affected by chronic diseases worldwide. As per WHO estimates, 44 million households fall into poverty every year due to medical costs. 90% of these households are situated in low-income countries. 
Slum dwellers healthcare needs can be summarized using the following 4As:
1. Awareness: They have low awareness regarding risk factors that can make them ill. They do not have enough information about how their lifestyle may be making them more ill. Chronic diseases generally have subtle indications in the initial phases. Slum dwellers who struggle for livelihood, medical check-up for minor symptoms seems uneconomical. Hence, early detection of diseases is very low. Limited information regarding medical resources available to them contributes to the problem
2. Accessibility: As the slum don’t have appropriate amenities for a healthcare system, most of the medical facilities are located at a distance from such settlements. They have to travel long distance and stand in queues to visit a doctor. Due to the economic constraints, these long distance trips can be very costly for the target group. The target group does not have accessibility to appropriate medicines and doctors due to social exclusion and lack of economic resources
3. Availability: Medical treatment in developing countries is generally expensive and they don’t have access to insurance. Urban slum dwellers don’t have resources available to them to ensure that they can be treated appropriately. With limited income, they choose to spend money on immediate consumption needs. The available medical options are expensive for them and they see little benefits in spending on preventive care until it is a medical emergency. Self-medication is more common place in slums and potentially more dangerous
4. Assurance: Slum dwellers are not sure if they are receiving the right care as the number of medical professionals are scarce. Personal health records are not present which means doctors have to diagnose and treat the patients with imperfect and incomplete information. They are not sure if people can be held accountable for wrong treatment as the costs for the target group are very high. They have low trust in the healthcare system
What do you expect are the costs associated with piloting and implementing the solution, and what is your business model?
The costs of project can be categorized as fixed costs and variable costs. The variable costs will have a cost component which will depend on the number of users and other will be recurring costs. The fixed costs will also depend on the expansion of the project. Some of the fixed costs are incurred for one location and others can be used across all locations
These costs will be incurred for a single location and will need replication across other locations. Hence, these costs will multiply with the expansion of project across different locations
1. Costs will be incurred in the acquisition of land for SMART clinics. The construction of smart clinics will require one-time investment. The investment will increase as pilot project expands to other locations. It will cost ~1000000 INR
2. Video-conferencing equipment will be one time upfront cost to provide remote medical services. It will cost ~300000 INR
3. Stationary medical equipment to screen individual and to create health records will be needed in clinics. It will cost ~10000 INR
4. Waste convertor for patients to exercise and generate revenue by converting waste to fertilizer. It will cost ~900000 INR
5. Cloud storage will be needed to store the electronic health records. It will cost ~ 3600 INR annually
These costs will only be incurred in the initial phase of the project and can be used across different locations of the project
1. Fixed cost for developing the Elixir platform to provide healthcare analytics, risk rating for individual patients. This will cost ~500000 INR
The total fixed cost for pilot project will be ~ 2713600 INR
These are variable costs and they will depend on the number of participants in the program
1. Food coupons and doctor appointment subsidies need to be provided by the project. This cost will be sourced through the revenue generated in waste management system
These costs will have recurring nature and do not depend on the number of participants and will be incurred for one location. They will multiply with increase in number of locations of project
1. A local native needs to be hired for screening the patient and creating awareness regarding the project. This will cost around ~120000 INR annually
2. Wi-Fi network will be needed for connectivity of remote medical services. This will cost around 12000 INR
The total variable cost in pilot project will be 132000 INR as the cost incurred on food coupons and medical consultation will be reimbursed by the revenue generated from production of fertilizer from organic waste
The project will be implemented in a phased manner with the development of requisite infrastructure in the initial 6 months. After the development phase, a pilot project will be launched in India’s largest slum, Dharavi situated in Mumbai
1. In this phase, the scheduling algorithm for doctors and waste converter equipment would be developed
2. Health-care analytics algorithm to identify the high-risk patients would be developed
3. IOT enabled medical kit for screening the target group would be developed in the initial phase
4. All the stakeholders including the government, doctors need to engaged in the program and their cooperation needs to confirmed
1. Pilot project would be launched India’s largest slum, Dharavi situated in Mumbai by setting-up of standard one-room clinic near the slum
2.Gauge the demand of waste management services to understand the sustainability of the project
1. Based on the feasibility analysis of pilot project, the implementation phase will build upon the pilot phase.
2.The implementation phase will involve expanding the project to other urban slums in India. This will provide economies of scale leading to reduced cost
3.The referral system will be implemented which will involve one free medical consultation to patient if he brings a new patient for screening
4.Customized food coupon system will be implemented in collaboration with public distribution system
5.The SMS system to ensure patient compliance will be launched to ensure effective treatment of patients
6.Data collected by screening the target group would be used to understand the lifestyle behaviour that can be attributed to increase in incidence rate of chronic diseases in certain regions. This will help in launching prevention program for target group in general to decrease the overall incidence level of diseases
- http://solvecolab.mit.edu/challenges/2016/cure-chronic-diseases/c/solution/1329036 ( clinical healthcare from a distance)
- http://solvecolab.mit.edu/challenges/2016/cure-chronic-diseases/c/solution/1329161 ( wearable wrist watch is wearable IoT enabled med-device)
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- Bale, Harvey E. “Proposal - Improving Access to Health Care for the Poor, Especially in Developing Countries” GlobalEconomic Symposium. http://www.global-economic-symposium.org/knowledgebase/the-global-society/financinghealth-care-for-the-poor/proposals/improving-access-to-health-care-for-the-poor-especially-in-developing-countries(accessed August 23, 2013 ).
- WHO 2010:World Health Report: Health System Financing - The Path to UniversalCoverage, Geneva, World HealthOrganization, http://www.who.int/health_financing/Health_Systems_Financing_Plan_Action.pdf.
- Xu, K., Evans, D. B., Carrin, G., Agullar-Rivera, A. M., Musgorve, P. & Evans, T. 2007:Protecting household fromcatastrophic health spending. Health affairs, 26, 972-983. http://www.who.int/health_financing/documents/covprotecting_cata/en/.
- Mathias Cousin, Tadashi Castillo-Hi, Glenn H. Snyder Devices and diseases: How the IoT is transforming medtechThe Internet of Things in the medical devices industry https://dupress.deloitte.com/dup-us-en/focus/internet-of-things/iot-in-medical-devices-industry.html
How can we help people prevent, detect and manage chronic diseases, especially in resources-limited settings?