Imitating traditional development paths is impossible for emerging economies. The World Economic Forum, in collaboration with BCG, suggests that health systems in emerging economies need to make the right investments now to avoid problems that developed economies have encountered.

1. Health Systems Leapfrogging in
Emerging Economies
Abuja, May 7-9

2. Health Systems Leapfrogging in Emerging Economies.pptx 1
Copyright©2014byTheBostonConsultingGroup,Inc.Allrightsreserved.
Report: "Health Systems Leapfrogging in Emerging Economies"
Published as of January 2014; Next report due in January 2015
Content
Preface
Section I: Why health systems need leapfrogging
A. Context and problem
B. Opportunity
C. Destination
Section II: How health systems leapfrogging works
A. Definition of leapfrogging
B. Leapfrogging matrix
Section III: What health systems leapfrogging can achieve
Case study 1: Organizational innovation in medical service
delivery in India
Case study 2: Overcoming human resource constraints through
innovative workforce models in sub-Saharan Africa
Case study 3: Providing access to antenatal ultrasound care to
rural communities in Uganda
Case study 4: Reducing maternal and newborn mortality through
simple and inexpensive disruptive product innovation
Case study 5: Closing gaps in immunization coverage through
better data management in sub-Saharan Africa
Section IV: Conclusion
Click on image to download report
Note: Online version at http://www3.weforum.org/docs/WEF_HealthSystem_LeapfroggingEmergingEconomies_ProjectPaper_2014.pdf

3. Health Systems Leapfrogging in Emerging Economies.pptx 2
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Cost
$51B, equaling 20% of GDP
(2012) or 10 times public health
expenditure (2012)
Duration
300 years with existing training
infrastructure
Source: World Bank, WHO, Africa Health Workforce Observatory, BMI, IFC, BCG
Exhibit 1: Imitating traditional development paths is
impossible for emerging economies
800
600
400
200
0
No. of doctors in Nigeria (K)
794
203020302012
X 12
94
67
No. of doctors with current training resources
No. of doctors to match OECD levels
Nigeria would need over 700,000 additional doctors to
reach OECD levels by 2030

4. Health Systems Leapfrogging in Emerging Economies.pptx 3
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1,000
750
500
250
0
2022
Health expenditure (Index: 1995 = 100)
3.7% p.a.
10.7% p.a.
7.4% p.a.
3.5% p.a.
0
4
8
12
16
Global health expenditure (trillion USD)
2022
67%
33%
2012
79%
21%
1995
90%
10%
2012
Developed economies
Emerging economies
1995
Exhibit 2: Emerging economies are increasing their health
expenditure
Source: World Bank, Business Monitor International, BCG
Developed economies
Emerging economies
For every additional $100 spent on health in 2022 (compared
to 2012), $50 will have come from emerging economies

5. Health Systems Leapfrogging in Emerging Economies.pptx 4
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Ideal path
Path to avoid
70
60
50
40
8’0004’000 5’000 6’000 7’0003’0002’0001’0000
Health-adjusted life expectancy (years, 2010)
Health expenditure per capita (PPP USD, 2010)
Developed economies
Emerging economies
Health expenditure as % of GDP
Exhibit 3: Health systems in emerging economies need to
avoid the path of health systems in developed economies
Health-adjusted life expectancy: Estimates the number of years in full health an individual is expected to live at birth by subtracting the years of ill health (weighted according to severity) from overall
life expectancy
Source: World Bank, WHO, The Lancet, BCG

6. Health Systems Leapfrogging in Emerging Economies.pptx 5
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Source: Expert interviews, Working Group discussions, literature survey, BCG
Exhibit 4: Proposed health systems vision
Achieve better physical
and mental health
outcomes across all
demographic and socio-
economic groups
Improve individual's
satisfaction with the
health system by
respecting their
dignity
Keep the provision of
health financially
sustainable for both
individuals and the
economy as a whole

7. Health Systems Leapfrogging in Emerging Economies.pptx 6
Copyright©2014byTheBostonConsultingGroup,Inc.Allrightsreserved.
Ideal state
Requirements
Actual state
• Increased nutritional intake
• Skilled attendance at birth
• Breastfeeding
• Vaccination
• Nutritious food
• Trained midwifes
• Nutritious food
• Availability of vaccines
• Malnutrition
• Absence of trained midwifes
• Malnutrition
• Absence of vaccines
Maternal
& prenatal
Infancy
Maternal and
newborn health
Child and
adolescent
health
Adult and
reproductive
health
Healthy
aging
1 2 3 4
Life stages
Leapfrogging as a method to
close the gap (quickly, cost-
effectively and with scale)
between actual and ideal state
Source: WHO Europe, Health at key stages of life: The life-course approach, 2011, BCG
Exhibit 5: The life course approach helps identify areas of
major impact

8. Health Systems Leapfrogging in Emerging Economies.pptx 7
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Source: Expert interviews, BCG
Exhibit 6: Two meanings of leapfrogging: Transformation of
an entire system and significant changes within a system
Actual Ideal
ActualIdeal
Supply side
Demandside
Today
Vision
Significant changes
within a system
Transformation of
an entire system

9. Health Systems Leapfrogging in Emerging Economies.pptx 8
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Exhibit 7: Leapfrogging innovations satisfy three conditions
(how?) as they move a system toward an ideal state (what?)
Source: Expert interviews, Working Group discussions, BCG
How?
What?
Acceleration
Cost-effectivenessScalability

10. Health Systems Leapfrogging in Emerging Economies.pptx 9
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Innovation
types
Prevention &
Health promotion
Workforce
Information
Service delivery
Financing
Leadership/
Governance
Medical products
0
1
2
3
4
5
6
Operating model change Behavior changeB C
Health
System categories
Micro-insurance products can increase access to
care for low income populations while limiting
exposure to financial risk. (Example: Hygeia
Community Health Care in Nigeria)
Using social marketing employing proven
commercial marketing techniques to promote can
improve individuals' health choices. (Example:
Greenstar social marketing for family planning
in Pakistan)
Incentivizing the workforce to prolong equipment
longevity through careful handling, regular
maintenance, and safe re-use of devices sold as
single-use products. (Example: CARE hospitals
in India)
Rewarding health insurance buyers for healthy
lifestyles by adjusting premiums to measurable
exercise activities and consumption habits can
improve health and cut costs. (Example: Discovery
Insurance in South Africa)
Telemedicine can improve the quality of care for
remote communities by leveraging centrally-located
expertise. (Example: Fortis and GE Healthcare tele-
ICU in India)
Defined global standards for measuring health
outcomes can allow meaningful international
benchmarking and sharing of best practices.
(Example: International Consortium for Health
Outcomes Measurement ICHOM)
Strengthening supply chains for medical products,
for example through supply chain integration, can
make products more accessible and affordable to
low-income populations. (Example: "Deliver" Project
by USAID)
Empowered community health workers can
promote health and provide primary care, supported
by and acting as a gateway to more qualified health
workers. (Example: Pesinet child health programs in
Africa)
A holistic approach to prevention and health
promotion can bring health considerations into every
aspect of people’s' daily lives. (Example: Health
Promotion Board in Singapore)
Imposing excise taxes on unhealthy products
(foods, tobacco, alcohol) can discourage unhealthy
consumption habits (Example: Sugar tax in Norway)
Providing food labeling to help consumers better
make more health-conscious choices (Example:
"Traffic light" nutrition labeling in the United Kingdom)
Increasing workforce awareness of financial
considerations can reduce costs by promoting
transparency and rewarding suggestions for process
improvements. (Example: Narayana Health cost
awareness policy in India)
Insights from behavioral sciences can be used to
effect behavior change in both the demand and
provision of medical services. (Example: Abdul Latif
Jameel Poverty Action Lab study on immunization
incentives in India)
Intersectoral governance can bring health
considerations into all aspects of public policy making
in a holistic manner (Example: National Committee on
Public Health in France)
Exhibit 8: Leapfrogging matrix with major themes
Source: Expert interviews, project partner organizations, desk research, BCG
Technology
Mobile technology can be harnessed to
communicate to broad population
segments, especially in rural and low-income areas
(Example: Kenya Integrated Mobile MNCH
Information Platform)
Smart cards for health insurance buyers can
streamline administration, facilitate data collection
and mobility, and improve the quality of service
delivery while preserving patient privacy (Example:
RSBY biometric smart card in India)
Refocusing medical product innovation on value to
create products balancing quality with cost can
increase access to care for low-income populations.
(Example: Philips' infant warmer; QIAGEN
CareHPV Test)
Clinical decision support (CDS) software can
empower health workers to improve the quality of the
services they provide. (Example: Diagnostic software
used by "Minute Clinic" walk-in clinics in the United
States)
Care can be moved from hospitals to homes by
smart phone technology enabling remote support
and tracking of therapy adherence. (Example:
Helius software tool by Proteus Digital Health in the
United Kingdom)
A nationwide, integrated electronic health record
system can improve quality and efficiency of care by
avoiding data silos (Example: Electronic Health
Record System in Estonia)
Mobile technology can be used to prevent disease
and create demand for health care via mobile-phone
based health education programs and counseling
hotlines. (Example: Project Masiluleke in
South Africa)
A C
Proven theme Nascent theme

11. Health Systems Leapfrogging in Emerging Economies.pptx 10
Copyright©2014byTheBostonConsultingGroup,Inc.Allrightsreserved.
Innovation
types
Prevention &
Health promotion
Workforce
Information
Service delivery
Financing
Leadership/
Governance
Medical products
0
1
2
3
4
5
6
Operating model change Behavior changeB CHealth
System categories
Hygeia Community Health Care (HCHC):
Provides low-income populations in Nigeria
with affordable health insurance covering
essential treatment
Greenstar: Conducts social marketing to
raise public awareness of reproductive
health, leveraging private healthcare
providers to act as franchisees
CARE hospitals: Improve equipment
longevity and reduce waste be safely
reusing devices sold as single-use
products
Discovery Insurance: Rewards health
insurance buyers for healthy lifestyles
through a variety of benefits
Fortis & GE Healthcare tele-ICU:
Reorganizes delivery of critical care by
connecting remote ICUs with centrally
located intensivists through telemedicine
International Consortium for Health
Outcomes Measurement: Defines global
standards for measuring health outcomes
and foster better decision-making
USAID "Deliver" Project: Provides
technical assistance to streamline medical
supply chains in emerging economies,
increasing availability and affordability of
medical products
Pesinet: Deploys community health
workers with limited expertise to detect and
monitor childhood diseases with remote
assistance from physicians
Singapore Health Promotion Board:
Invests in the maintenance of public health
using a holistic approach, bringing health
considerations into every aspect of
people's daily lives
Sugar Tax in Norway: Charges excise tax
on unhealthy food (also: tobacco, alcohol)
to discourage unhealthy
consumption habits
"Traffic light" nutrition labeling in the
United Kingdom: Simplifies food labels to
avoid obesity by helping consumers better
understand products
Narayana Health cost awareness policy:
Incentivizes physicians to take financially
prudent decisions and make suggestions
for cost savings and process improvements
Abdul Latif Jameel Poverty Action Lab
study on immunization in India: Provides
non-monetary incentives for parents to
immunize their children, thereby
overcoming cognitive biases
National Committee on Public Health in
France: Creates an inter-ministerial
committee to act as a steering body in
coordinating health policies across all
ministries concerned.
Exhibit 9: Leapfrogging matrix with concrete examples
Source: Expert interviews, project partner organizations, desk research, BCG
Technology
Kenya Integrated Mobile MNCH
Information Platform: Provides
pregnant women with mobile phone-
based health information to promote
safe pregnancy
RSBY Smart Card: Uses biometric
smart cards to register low-income (and
often illiterate) insurance
takers, streamline administration and
service delivery and facilitate data
collection
Philips infant warmer: Provides
reliable, easy-to-use and cost-effective
infant thermo-regulation to reduce
neonatal mortality in
low-income countries
Clinical decision software used at
MinuteClinic: Enables nurse practi-
tioners to treat routine ailments with
computerized medical guidelines on
diagnosis, treatment and drugs
Proteus Helium system: Administers
hypertension therapy remotely via smart
phone technology, moving care from
service points to homes
Electronic Health Record System in
Estonia: Creates a nationwide,
integrated electronic health record
system to improve the quality and
efficiency of diagnosis and treatment
Project Masiluleke: Leverages mobile
technology for HIV/AIDS and TB
prevention through phone-based
counseling and text message-supported
self-testing
A
Project
Masiluleke
Proven example Nascent example

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