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Ep03: Part 1 – Asia Pacific Challenges and Opportunities with Farhana Nakhooda


00:03 Tony: Welcome to Digital Health Today, Asia Pacific Edition, your go-to podcast to learn about the transformation of healthcare in a region with over 4.5 billion people across more than 40 countries. I’m your host, Tony Estrella.

Today’s topic is an overview of the Asia Pacific region, both for its similarities, as well as its differences for how people interact with health care across the various countries and cultures. For those of you who may be new to Asia Pacific, this would be a great overview; for those of you who want to learn how to segment this expansive area, to consider its diversity of its population, economic development, and, of course, to understand the opportunities to transform healthcare through technology. And regardless of whether you’re already operating here, we’re learning more about the region for the first time, I think you’ll enjoy hearing from my guest today Farhana Nakhooda.

Farhana is an experienced executive in digital health. And I first met her when she became the APAC head for Health Catalyst, an exciting company, we’ll learn more about in our conversation. Like me, Farhana worked all across Asia Pacific. And I’m excited to hear from her and for her to share her insights with us on a range of topics, including what she’s learned from living and working across the region. Welcome, Farhana. To start with, can you tell us more about why you chose to live in Asia Pacific?

01:16 Farhana: Yeah. So actually, my mom is Singaporean and my dad is Canadian. So I grew up in Canada my first 10 years of my life and then I moved here when I was about 10, and went to an international school here and went back to Canada. So because I kind of spent half my life here as a kid, I always had a passion for Asia, and always loved being out in this part of the world.

And so when I graduated in Canada with my degree in biochemistry and molecular biology, I started off in medical research, first in Canada, but I decided that I really loved being in Singapore, and my parents are actually still here, and so personally, I came back here just to have a different experience. And I started my career actually in medical research in the National University Hospital in Singapore, doing pain management research.

And so that’s what brought me here. But I stayed here, because I really loved what I was doing in the medical research world. However, I needed a change and wanted to actually bring my healthcare background and knowledge into more of a business domain, because I realized I wasn’t kind of a research person, though, being in a lab and working with rats and microscopes, that wasn’t my thing. However, the domain of it was what excited me and that’s what made me decide, okay, why don’t I try and bridge my medical background with some business background? And then that’s when I ended up staying in Asia Pacific, focusing on digital health.

02:54 Tony: So you’ve settled into Singapore, you’ve made a career decision now to leave the research world and go and pursue other opportunities. And I know from our other conversations that led you to IBM. Tell us more about that decision?

03:07 Farhana: Yeah. So when I first joined IBM, honestly, it was kind of funny, because I heard about IBM and I always thought they were just a computer company and that they had big mainframes. But then when I went to interview with them for a position in their life sciences division, I kind of got exposed to their website and everything they’re doing, and I was just absolutely amazed by the technology they had, about the research they had.

And what really honestly blew me away about being in a big company like that was that they were projecting out 10 years in advance. I mean, they were always ahead of the game technically. And in fact, sometimes they were so far ahead of the game that when we would go to customers, and we’d be talking about, I mean, I’ll give you a perfect example. That when I first joined them, we were talking about personalized medicine, and this was in around 2002. And that was a long time ago. And people hadn’t really, this is a talking about bringing genomic data, healthcare data together, and really personalizing treatment. And when we’d go talk to customers about this, they’re like, what are you talking about? I mean.

And it was always fascinating to me to always be that far ahead of the curve and always seeing where the researchers’ minds were. Because the research part of IBM, they’re not salespeople, they’re researchers, right? So they’re always projecting out as to what’s going to be the next big thing. And so it was amazing that way. And of course, what was also fantastic was just having this huge multinational company where I was getting to learn about health care systems all over the world and understanding how many similarities there are, but yet, there are some differences, right, and trying to leverage knowledge around digital health across all these different countries, and see what’s relevant and what’s common and what are the common messages to me. To me, that was super fascinating and super fun.

05:08 Tony: Thanks, Farhana. That’s wonderful that you found a business that you could work with that gave you the opportunity to collaborate with others and really focus on working in healthcare across the region. I think many of us would aspire to be able to find that fit with our businesses that we work with to give us that level of personal satisfaction.

Now that we know your background, let’s transition to the conversation about Asia Pacific and how to segment it. And when I get that question, I usually start by describing six clusters, sub-regions, within this broader area. The first two, based on population size are China and the Indian subcontinent. Both are a billion plus people in each one of those areas, collection of, not just one primary country, but others that surround it, or the regions that surround it. And then we move to Japan and South Korea. And then Southeast Asia, which is a collection of numerous countries, and it is where I call home in Singapore, and is obviously as you do as well. And then last would be Australia and New Zealand.

Now what brings these clusters together and why they’re somewhat separated from each other, I mean, there’s multiple reasons why I consider that that’s the case. The first may be intertwined history, such as, and that includes language, cultural, religious beliefs, and lifestyle. There may also be common climates or geographic position that creates a natural grouping. And that’s certainly the case for Southeast Asia, where there’s a lot of countries clustered around the equator.

And in doing this, separating out these clusters, you’re now able to start thinking about smaller groups of segments where both for commercial reasons, for healthcare system design, the way that people may think, and their general economic means may be similar enough for you to start creating some generalizations. But like you would see in Europe, if you can talk about Western Europe or Eastern Europe, it all still eventually it comes down to the country. So if you’re thinking about the Baltic states versus the Nordics, that gives you a smaller cluster to think about, but ultimately, you have to think about the individual state. With that context Farhana, why don’t you tell us a little bit more about how you view the opportunities and segmentation for this region?

07:18 Farhana: Now, if you take countries like India, and China, right, where they’re huge, huge populations, but you’re really almost dealing with two countries in one, right, because within those markets, you have the very developed part of the market and you have the developing part of the market. And to some extent, that kind of accounts for the urban and rural areas. Right? And so what I always used to find fascinating was that sometimes when we go in positions, for example, in India digital health solution, where, for example, I remember, we were looking at asset tracking within the hospitals and being able to tag things and I remember meeting a CEO of a hospital in India, and they were saying, well, we have 20 people that we can employ to do all of that asset tracking, why do you need a digital solution for that? We’re employing people and why do you even need to be talking to us? I mean, it’s so much cheaper, and we’re giving them jobs.

And it’s hard to argue with those kinds of discussions. But yeah, in the same breath, you would be talking to other hospitals that were very, very focused on automation and saying, yeah, absolutely. Let’s talk about these kinds of technologies, right? And so what I found is interesting learnings was that one of the things that came up in my years in IBM was this whole concept of bringing health care and social services together, because social determinants of health is such a big thing. They say that, you know, I mean, our health care, and our medical care only accounts for less than 10% of your longevity, of how long you live.

The majority of your life depends on your lifestyle and social factors, how you live your environment. And what I found fascinating was that Korea and Japan, their ministry of health was combined with their Ministry of Social Services, right? It was Ministry of Health, Labor and Welfare. I mean, they had thought about this before everybody else in the world, and they thought that health care was actually part of social services. So when we would go talk to them about looking at even early things like population health management and bringing health and social together, they were already down that path, because the ministry itself was combined as well. Right?

Some other interesting trends that we’ve noticed that was very interesting is that Singapore, Australia and New Zealand tend to follow very similar pathways for a lot of their digital health solutions. So as an example, when you look at the national electronic health record that Singapore builds, which was a longitudinal health record from birth to death, Australia quickly followed suit, difference being that it was patient-controlled in Australia versus Singapore. But again, because these are two markets facing very similar challenges: aging population, chronically ill population, and when you think about health care costs, and we all know that 80% of healthcare costs are basically caused by 20% of the population, and those 20% are typically the chronically ill that tend to keep going back, and a lot of the elderly.

And so when you look at the health care systems of places like Singapore, Australia, New Zealand, they’re all facing those same things. So a lot of the acute care is public, because of course, in Australia, it’s a national health care system. But Singapore government subsidizes health care as well, so the public hospitals play a big role. And so their issues are all about how do we keep patients out of the hospital? How do we keep them at home? How do we provide services for patients at home? How do we prevent people from getting sick in the first place?

And so it was always interesting for me to look at the market from the lens of developed markets and developing markets. But also, as you said, each of these markets is so vastly different in so many ways, as well. So it was always for me fun in some respects to really kind of go into these markets knowing okay, there’s some similar challenges. But what are those nuances? Like I said, I mean, in the case of India, in many instances, they like to do things themselves, so they have a lot of people to do things, right. And so from a digital health perspective, their typical idea would be to custom build or to leverage their own resources.

And then when you go to a place like China, of course, it’s different again. Even though India and China are like, huge populations, without like I said, the Chinese clients that we would talk to were very, very interested in learning what we were doing and where the cutting edge technologies were. But again, they were also very different in the sense that their priorities were also different. So if I could take China, for example, a lot of the hospitals are revenue-focused. And so a lot of their conversation was how do we keep patients and how do we retain them, and how do we increase our revenue in the hospitals as well? Because that was a business for them.

So again, just interesting differences between them, all very, very focused, of course, on becoming digitized, and moving forward in the digital domain, but all in different maturity curves, all going at different speeds.

12:44 Tony: That’s really helpful, Farhana. So to summarize, what we’re seeing is that APAC is made up of a variety of countries, and there’s multiple ways for people to segment how to pick an individual country and make a decision as to how to evaluate the opportunity for healthcare and healthcare transformation. I like to think of it that one of those factors is what is their current economic status? A second factor is, what’s their health care system maturity? How has that been in the past? And what does that mean going into the future? And then the third is, what is the cultural norms for that particular country? And how that guides, how individuals make healthcare decisions or providers make their decisions? What are some of your thoughts when you think about those three factors and thinking about the segmentation of countries and your experience in the region?

13:32 Farhana: Yeah, I think those are excellent ways to look at the different segments. You know, as I mentioned before, you can take a developing versus develop market approach, and some of the markets are kind of a combination of both. But what we’re starting to see, which is making it very interesting in this part of the world as well, is that you’re seeing places like Vietnam that are actually, historically if we go with your three categories, they have pretty immature health systems, but yet, they’re now trying to leapfrog right. And so we’re now seeing them actually push ahead very quickly, with digital health and even looking at things like personal health records, for example.

You know, the other way that we like to look at some of these different markets is, are they funded primarily by the government? Or is it really a combination of government and private, and that for us, at least in health catalyst is a very big factor. And if I could give you an example of that, when we’re working with governments right now around the area of health analytics, those that are government funded are looking at things like universal health coverage and things like value based care, because the government is funding it, and so therefore, they want health care institutions and hospitals to do more with less. Right? They want very good outcomes at very low cost.

So when it’s government-driven, you actually see a huge amount of focus on let’s cut costs and improve quality. But then when you go to a place like India, which has a very, very low government spend on it, the major healthcare systems that we focus on would be the private hospital groups. And that’s really because they have larger budgets to focus on new technologies and they, of course, look at both revenue costs and quality because they’re private. But you can also see a very big difference in some of their priorities as well.

So I think the three that you talked about, the economic side of it, the health systems, and the cultural norms, they all play a huge role. I completely agree. And I also think whether like I said, it’s really primarily government-driven or not, also plays a big role in kind of the way that we approach these markets.

15:46 Tony: And that’s a good point, because who pays for health care obviously, will influence the adoption and also how widespread innovation might reach the average individual or even basic care.

15:57 Farhana: Absolutely, yeah. And the cultural norms is a very good one as well, because also, a lot of that comes from the way the government looks at health care as well and that also drives trust. I mean, a good example is how Asia Pacific generally has done fairly well in the COVID situation. And that’s because we’re a fairly obedient part of the world where we just follow what our governments suggest, and we trust the government somewhat. Whereas in other countries, it’s not necessarily the case, and so therefore, that also plays a very big role. Because as healthcare gets more mature, accountability back to the individual becomes even more important, right, and getting them to play a part in their own health is also critical. And so that cultural norm part of things in many instances, you can actually implement a lot more programs in this part of the world, just because if the government endorses it, you may get a lot more adoption.

16:54 Tony: Yeah. And the way I think about that is intergeneration households, and the role that that plays for the average person, especially say, in Singapore, or Malaysia, or in China, where you have households living together across many types of families, decision made by one is actually with, with a fourth side of thinking about what happens to the rest of my family. I know you actually had that as part of your life when COVID first hit, and you had to think about balancing your parents with your children and whether they go to school or not. So I think that’s a challenge.

17:25 Farhana: No, that’s a great example. I mean, I completely agree. And I think that’s something that’s intergenerational thing is a great thing in terms of caregiving and support. But it’s also been a bit of a concern during COVID, right? Because do you bring friends over when you have 18 year old parents at home? And it’s a big concern. So yeah, that’s a great example, Tony.

17:45 Tony: Yeah. And you know, one thing that I’m very excited about in the future, as we think about these various regions is, where are the top hubs of creativity and innovation coming together? Clearly, Singapore is one of those markets. And one of the things that’s astounded me in the past has been, if you look at the size of Singapore, it’s really small, five and a half million people. But if you looked at the number of startups, by country in Asia Pacific, Singapore ranks behind China, and India. And it’s a great cluster for leading minds from technology, from academia, from government, from the private sector, to come together to create change. And I’m sure you’re seeing that as well, in the work you do.

18:25 Farhana: Oh, yeah. There’s huge opportunity around innovation in Asia Pacific. And if I go back to my days in IBM, for example, I mean, Japan was always doing very innovative things in the healthcare space. I mean, they were looking at natural language processing and text analytics probably 15-20 years ago, right, when it wasn’t even thought of. And when you look at other markets, like India, they have their own niche areas of innovation, especially around telemedicine, because again, they’ve had no choice, they had to reach out to the rural areas, and they’ve come up with some very innovative ways of really, you know, reaching out and gaining access as well.

So Singapore, like you said, absolutely is a big one. Taiwan is actually another great hub for innovation. Japan. I mean, it’s almost as if every region has their own niche areas, depending on what their biggest pain points are in their market. But as you rightly said, there’s a great opportunity across Asia for these countries to leverage each other’s best practice and innovation. And I think that’s, a huge opportunity, actually.

19:35 Tony: Yeah. And when we’re trying to identify great opportunities, we also have to look at some of the root causes of what’s causing people to think about what how to manage their health better. And one, pollution is a really big factor in this part of the world. Right? In China, we clearly have a lot of pollution from manufacturing, and Southeast Asia, we have the haze that comes from burning trees through deforestation and those cause really widespread health challenges for people.

And I think when we’re looking at how to evaluate this region, we have to look at environmental factors, cultural factors, and then even regulatory decisions to identify where’s the opportunity for digital health and healthcare companies to make a difference. So when you look at the future, next two to four years for this region, what excites you most?

20:26 Farhana: What excites me most is that I think in a way, the COVID situation has highlighted, I think, to the world that there is a huge opportunity in Asia Pacific for healthcare transformation. If you think about how quickly the governments acted in this part of the world and manage the disease, they collaborated with one another. New Zealand was a great example. Australia, interestingly, as a Western society, that has a health care system very similar to Canada. But you look at the numbers and Australia how they’ve managed to contain it versus unfortunately, Canada, you know, it’s a huge difference.

So I actually believe that this has been happening for a while, but I think it’s just going to get stronger and stronger, is that places right now like Singapore, Australia, New Zealand, who have been collaborating, their governments have been collaborating in health care for years are going to really leverage one another’s best practice even more. And I believe that this is going to be really an exciting opportunity from a digital health perspective, but an overall healthcare transformation perspective. Right?

The amount of healthcare waste that we have is unbelievable. I mean, this is really the overuse of the healthcare system, things across even on the clinical domain of clinicians, even with the same patient doing very different things. I mean, these are things where now we have good examples around the world, and even in Asia Pacific, where you can reduce clinical variation, increase quality, and cut costs massively. And these are the kinds of best practice that I believe we’re going to see more and more sharing.
Even on the pandemic side, I think all the countries like New Zealand, Singapore, Taiwan, that have been best practice, they’re going to share each other’s best practice as well. And so I’m very excited, and I’m very bullish about the future for healthcare in Asia Pacific. Because I really do think because of the factors you mentioned earlier, because of the cultural norms, because of the various maturing healthcare systems and maturity levels, that there’s a huge amount of opportunity for those that are less advanced to quickly leapfrog others and learn from each other, and those that are already advanced to actually leverage each other’s innovation and best practice.

22:39 Tony: That’s very helpful, Farhana. And you know, decreasing costs, improving quality, all done in a collaborative manner, that’s like the Holy Grail, right, we get everybody to work together? We’ve come to the end of this episode. But for our audience, be sure to tune in next week when we continue our conversation with Farhana with an emphasis less on what happened in her earlier in her career with IBM and working across the region, and more of an emphasis on population health. So we’ll speak to you again shortly here Farhana, thank you very much for your time.

23:09 Farhana: Thank you, Tony. Thanks for the opportunity.

23:12 Tony: And that’s a wrap for this episode. Before I go, here’s how you can support us. Please share this podcast with others. And if you subscribe, you’ll get updates on new episodes and other content. You can also get in touch with me on twitter at EstrellaVino using the spelling of my last name, or email at [email protected] if you have any questions, suggestions, or ideas for future episodes.

And finally, please visit our website at we’re on our second home at see our other episodes from our podcasting team including Dan Kendall, and Eugene Borukhovich. This show was researched and written by Taliossa and produced along with Mission Based Media. The sound of music was by Ivan Yurich. And until next time, I’m Tony Estrella and thank you for listening.

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