The future of healthcare is here - and can be found in Papua, Indonesia

Android Nov 3, 2021

New technology was adopted this year, just not where we expected

COVID-19 sparked an urgency for government, providers, and patients to find new solutions for patient outreach and care, both in wealthy nations like the United States and United Kingdom as well as less wealthy nations like India and Indonesia. At Halodoc for Midwives, we had the unique dual experience of building a frontline healthcare product whilst experiencing different nations’ approaches to tech adoption as our team collaborated across the world in London, Bangalore, Jakarta, West Sumatra, Medan, San Francisco, and Seattle.

What became clear is that the future of health tech should seek to reduce barriers, so what is the future of health tech if it doesn’t include new technology that requires investment and training like drones, AR/VR, or remote devices? The answer can be found by learning how 220 million Indonesians receive their basic healthcare services today - from their local midwife.

Understanding the market opportunity

80% of childbirths in the world’s third largest democracy are assisted by midwives. Over 220 million Indonesians receive their healthcare services from either a midwife’s private practice and/or their puskesmas, a free community clinic. Midwives are responsible for not just female health but family health - providing general care, immunisation, and family planning along with antenatal care and childbirth services. As a result, a midwife’s private practice takes care of 350 to 800 patients per month.

Instead of looking for a silver bullet, we set out to strengthen the bond between a patient and her provider

With the intention of reducing friction, we built Bidanku to provide a delightful patient journey. We created a user experience that is shared between a midwife and her patient, intended to strengthen their bond, professionalize a midwife’s services, and improve a family’s patient adherence. Unlike other health tech solutions, Bidanku requires no extra training; instead we leveraged midwives’ and their patients' ease of use with social apps to build a simple UI for the user to leverage patient messaging at scale.

Since our soft launch at the beginning of July, Bidanku went viral growing 10x in 12 weeks driven largely by word of mouth (aka the only positive example of viral we experienced this year). By the end of Q3, 10s of thousands of patients were now managed by Bidanku with private practice midwife clinics located in 75 cities, representing 28 out of the country’s 34 provinces.

In the first six weeks of launch, Bidanku was downloaded in 28 out of Indonesia's 34 provinces encouraged largely by word of mouth.

How we reduced barriers and improved a provider’s quality of care

Instead of requiring midwives to adopt new equipment or attend additional education programs, Bidanku is a job aide that leverages what a midwife already has - her smartphone - and gives her back time to spend with her patients. From the very beginning, we held the belief that a midwife knows how to provide quality care. She is instead bogged down by her repetitive administrative tasks and analog tools that hinder her from providing high quality care at scale. From this starting point, we drove product adoption through two vantage points.

Step one: speak to providers as business owners

Leverage smartphone adoption and hyperlocal social media

What is unique about midwives and the patients they provide care for is the prevalence of smartphones. Even though midwife clinics are predominantly located in resource constrained environments and serve the underserved, social media and Whatsapp are dominant methods of communication between a midwife and her community. Entrepreneurial midwives tout their services on WhatsApp, Instagram, and TikTok - educating their followers via Stories on general health, immunisation events, and this week’s activities.

Enable business analytics to enable data-first decision-making

Midwives are providers first, business owners second. They balance their books at the end of the day, managing copious amounts of transaction, reimbursement, and patient data. By providing a simple UI of analytics on top of their individual puskesmas reporting, we saw midwives increase their app usage by 2x per day. Borrowing from data visualisation for non-experts, we implemented a simple UI to enable a midwife to see her upcoming childbirths, patient visits by service type, and a performance view with a weekly and monthly comparison - requiring no extra work on behalf of the user. As a result, midwives are now able to better allocate their limited resources to optimise their practice.

Midwives view their clinic performance analytics to better allocate their limited resources.

Step two: view patients as tech-savvy consumers

Don’t expect patients to be health experts

We all know what it feels like to be in the examination room and have to be both the patient as well as your own advocate. It can be incredibly stressful in the moment, and oftentimes you forget the recommendations you receive from your provider. By not expecting the patient to be a health expert, Bidanku augments the midwife by providing tailored patient education sent after the midwife-facilitated consultation. We set out to help patients build healthy, preventive habits and reduce complications by providing illustrative recommendations that answer “What do I do next?” based on the patient’s individual health conditions and the medical protocol found in the Ministry of Health’s Pink Book.

Reduce barriers of entry by leveraging WhatsApp

Instead of expecting patients in underserved communities to download a new app or go to a new portal to access their patient health records, Bidanku meets patients where they are - largely on WhatsApp talking to their friends, family, and local businesses. Our goal with patient messaging is to reduce knowledge barriers and provide context for the patient to make informed decisions about her health. Here’s an example of what happens with a pregnant patient managed by Bidanku:

After visiting her midwife practice, a patient will receive her consultation summary with all her health parameters along with her tailored patient education. For example, if a patient is underweight and not meeting fetal milestones, she’ll receive a WhatsApp message after her consultation recommending a balanced diet with accessible, inexpensive meals like mung beans, sayur lodeh, and fruit. If a patient is overweight and meeting fetal milestones, she’ll receive a WhatsApp message reminding her to replace processed food and sugar with small, frequent meals that include tofu, fruit, and vegetables. Before her next scheduled visit, she’ll receive a next visit reminder along with context on why her next visit is important in monitoring her and her baby’s health.

Patients receive tailored recommendations based on their health conditions sent directly to their personal WhatsApp accounts.

Solving for healthcare’s last mile delivery

At Halodoc, we are building the future of integrative healthcare. Leveraging the best of human-centered AI, design thinking, and behavioral economics, we are focused on up skilling the midwife to enable her to do more — treat more patients, diversify her services, and improve her patient outcomes. Midwives are the frontline workers for every community. They embody the best of healthcare - empathy and access - and together, Halodoc and midwives aim to  improve access and simplify healthcare for all.

Special thanks to Andrew Trister, Julie Frye, and David Rossow at the Gates Foundation for all your continued support and collaboration.

About Halodoc

Halodoc is the leading healthcare platform in South East Asia. Our mission is to simplify and bring quality healthcare across Indonesia, from Sabang to Merauke. We connect over 20,000 doctors with patients in need through our tele-consultation services. We partner with over 3,500 pharmacies in 100+ cities to bring medicine to your doorstep. We've also partnered with Indonesia's largest lab provider to provide lab home services as well as recently launched a premium appointment service that partners with over 500 hospitals that allow patients to book a doctor appointment in-app.

We are extremely fortunate to be trusted by our investors such as the Bill & Melinda Gates Foundation, Singtel, UOB Ventures, Allianz, GoJek, Astra, Temasek and many more. We recently closed our Series C round and in total have raised around USD$180 million for our mission. Our team works tirelessly to make sure that we create the best healthcare solution personalised for all of our patient's needs, and are continuously on a path to simplify healthcare for Indonesia.

We’ve only just begun at Halodoc for Midwives and are always hiring. If you’re interested in joining us, please look to our jobs board for more information.

Margaret Jennings

VP of Artificial Intelligence at Halodoc