I stepped off the plane into over 30°C temperatures and humidity comparable to what you would experience in a good shower in London (if you’re lucky) – It felt like Sri Lanka was greeting me with a nice warm hug. This warmth is embodied by its people whom I experienced as incredibly welcoming and kind.
Healthcare challenges and mobile landscape
As of 2018, Sri Lanka had a total population of over 20.95 million, approximately 19.6 per cent of which live in urban areas . This high urban population density has placed strain on healthcare centres in and around major cities. At the same time, inequitable distribution of healthcare resources across the country has limited access to specialist care for the majority of the rural population. Other epidemiological and demographic transitions are placing further strain on Sri Lanka’s health system. These include rapid growth of the elderly population, increased prevalence of noncommunicable diseases (NCDs) and higher levels of healthcare-seeking behaviour due to increased prosperity.
Mobile is well positioned to be leveraged for health systems strengthening
As of Q3 2018, Sri Lanka’s five mobile operators were serving 29.8 million mobile connections, with subscription penetration at 135 per cent . Sixty-two per cent of mobile connections are broadband enabled and of the 15.2 million unique subscribers in Sri Lanka, 58.4 per cent are mobile internet users. Smartphones account for 45 per cent of mobile connections, with a YoY growth of 16 per cent .
This high broadband adoption and smartphone penetration among Sri Lankans enhances the opportunity to use mobile apps to provide more sophisticated digital healthcare services than those typically enabled by 2G channels. In April 2016, Digital Health (DHPL) responded to this opportunity by launching a mobile-based digital health platform called Doc990.
DHPL’s vision to provide integrated e-commerce services for Sri Lanka’s healthcare sector
DHPL is a joint venture partnership between four entities: Digital Holdings Lanka, a subsidiary of mobile operator Dialog Axiata, Asiri Hospital Holdings, Nawaloka Hospitals and Durdans Hospitals in Sri Lanka. This joint venture is the first cross-sector partnership of its kind in Sri Lanka’s healthcare industry. Doc990 supports digitally enabled appointment booking, management and payment for both patients – known as doctor channelling in Sri Lanka. Patients can access Doc990 through interactive voice response (IVR), web and app platforms or Doc990 agents. As of December 2018, patients can book appointments with 2,500 doctors, across 270 medical specialisations, from over 90 hospitals.
Although the appointment booking service, Channel Your Doctor, proved to be a suitable market entry point, DHPL had a broader ambition to provide integrated e-commerce services for Sri Lanka’s healthcare sector. It has since expanded the Doc990 offering to include several complementary services, such as Tele Doctor Service, Medicine to Your Doorstep, Healthcare to Your Doorstep, My Health Records and Lab Reports.
DHPL has disrupted the digital health space in Sri Lanka through its strategic partnerships on Doc990
My experience in working with the Doc990 team was of a group of people who were truly passionate and enthusiastic about the work they are doing. This, paired with DHPLs strategic vision, is probably at the core of its success in disrupting the digital health space. There are several strategies that have allowed Doc990 to rapidly gain over 40 per cent of the doctor channelling market share and over 158,000 customers, positioning it as a market leader in digital healthcare in Sri Lanka:
- Targeting one of the largest private hospital groups, Asiri, for the first deployment of Doc990 was an ambitious yet crucial strategic move. With buy-in from Asiri, Doc990 was able to gain access to 30 per cent of the private sector market share. With demonstrated success at Asiri, Doc990 has since secured contracts with several other private healthcare providers, including the other top three private hospitals in Sri Lanka
- Using trusted hospital brands and community members to promote Doc990 was an effective way to drive use of the service. When Doc990 first entered the market, it leveraged the Asiri brand to promote the service, and within six months had established itself as a prominent provider of doctor channelling services. In addition, Doc990 agents, such as pharmacists and shopkeepers, are trusted members of the community and effective promoters of the service.
- Agreements to secure the Doc990 IVR short code across all mobile operators has expanded the reach of the service beyond Dialog Axiata subscribers to the entire Sri Lankan population. Similarly, integration between Doc990 and eChannelling, the competitor doctor channelling service, has enabled patient access to hospitals where Doc990 is not used as the primary booking system.
- DHPL partners with expert organisations to optimise management and delivery of Doc990. DHPL has partnered with HealthNetBuy to provide Medicine to Your Doorstep, and with Emergency Calls and Certis Lanka for the Healthcare to Your Doorstep service. These partnerships allow Doc990 patients to access a well-managed prescription delivery service and home-based care services without the need for DHPL to invest in infrastructure and cover the implementation and operating costs of these services. These strategic partnerships have allowed DHPL to focus its energy and resources on the core Doc990 value proposition.
DHPL prioritises value creation for Doc990 beneficiaries, shareholders and partners
Doc990’s success is also attributed to the value it delivers to its customers (patients), its shareholders and its partners:
- Doc990 benefits patients by reducing the cost and time it takes to access healthcare. Doc990 saves patients between Rs300 and Rs675 (roughly $1.68–$3.78) in transport costs each time they book a digital appointment, consult with a doctor virtually, have lab results delivered to their phone or use the virtual pharmacy for home delivery of prescription medication. Patients also save between one and three hours of travel and waiting time when they use Doc990’s remote healthcare services.
- Private hospital group shareholders benefit from increased patient appointment bookings and higher revenues, as well as improved financial reconciliation and automated reporting processes. This partnership with DHPL has positioned Dialog Axiata as a leader in the digital health sector, opening up new revenue streams for the mobile operator. In addition Doc990 is driving increased usage of other Dialog services such as its eZ Cash mobile money service. eZ Cash is one of many payment mechanisms available to Doc990 customers. Steady month-over-month growth in the percentage of appointment booking payments made through eZ Cash indicates the growing potential of digital health services to drive the use of mobile money.
- DHPL partners, such as HealthNetBuy, Emergency Calls and Certis Lanka benefit from lead generation coming through the Doc990 platforms as well as credibility and exposure that comes from partnering with an established digital service like Doc990 and its shareholders, Dialog Axiata and the leading private hospital groups.
What’s next for Doc990?
The digital health space in Sri Lanka is incredibly competitive and DHPL are continuously evolving the Doc990 service offering to remain competitive. In an effort to increase affordability of Doc990 for lower income segments and drive increased usage of the web and app based platforms, in January 2019, DHPL waived the service fee for doctor channelling on these platforms . DHPL also has several new patient-facing Doc990 features that will be launched in 2019, including a wellness feature and on-demand content feature. DHPL will also be integrating a health insurance feature as an alternative to out-of-pocket healthcare payments for doctor channelling, prescription purchasing and lab test fees on Doc990.
 Lanka Business Online (2019), “Doc990 waives service fee for Doctor Channelling with #FreeTheFee”.