S-PAQ

94% of all maternal deaths occur in low income countries and most maternal deaths are preventable with proper healthcare service. The capacity of healthcare service providers must be improved. Considering lack of basic resources at small health centers, the solution has to be designed to work autonomously even without external source of electricity.

S-PAQ is a turnkey solution which enables healthcare workers in low resource environment to provide quality healthcare service. The package is composed of IOT medical device, smartphone, solar panel and battery and digital platform. Following navigation of smartphone application, users can easily implement primary antenatal checkup.

After wide diffusion of S-PAQ, access to antenatal healthcare service for women will improve and additionally, the capacity of entire national healthcare system will be improved. If pregnant women take high quality healthcare service at neighbor health center, they shouldn’t need to go to the hospital in most situations

About 295 000 women died during and following pregnancy and childbirth in 2017 and 94% of all maternal deaths occur in low and lower middle-income countries. Most maternal deaths are preventable with timely management by a skilled health professional working in a supportive environment. The main factors that prevent women from receiving or seeking care during pregnancy and childbirth are poverty, distance to facilities, lack of information, inadequate and poor-quality services and cultural beliefs and practices. As Universal Health Coverage initiative proceeds, some countries in Africa applied free charge for primary healthcare services. As a consequence, vast needs in healthcare service occurred with limited capacity of healthcare system. Now one of the most critical issue is enhancing capacity of entire healthcare system to correspond increasing needs especially at primary healthcare facilities in low income countries.

However, medical practitioners in these facilities face multiple constraints such as lack of electricity, medical equipment, consumable, human resource, training opportunities and information of the latest practices as well as heavy workload in time of specific campaigns. These problems are interrelated and a single solution to one problem may not be effective in the field as other problems prevent the solution from delivering impact.

S-PAQ helps local healthcare workers in low resource setting to deliver primary healthcare service for pregnant women with application and medical devices to navigate proper clinical procedure. The package has three components as follows.

1) Navigation software platform with easy to use protocol, Electric Medical Record and reporting system to the department in charge of medical statistics.

2) Hardware including IOT medical device such as portable ultrasound device, mobile CTG device, rapid test kits and solar panel & battery system.

3) Analysis and improvement service using Machine learning technology. Although at the initial stage the protocols are programmed by rule-based but as the data accumulates, the system will be optimized with Machin learning solutions such as for protocol and criteria of evaluation of patients, referral system and training.

The hardware components can be flexible to add or reduce equipment. The solution is a turn key package as even the most basic facilities such as electricity is not available in many healthcare facilities in Africa. Although this package is developed mainly for primary healthcare for pregnant women at small clinics, this can be also used for mobile clinics or home-visit services.

The user of S-PAQ is healthcare workers in low resource setting. For example, a nurse who works at primary healthcare facility in an outskirt of Kinshasa DRC has to give cares for pregnant women without any support from medical doctors, no specific equipment not electricity. With S-PAQ, she will conduct a quality antenatal checkup alone at any time.

The primary beneficiaries are pregnant women who cannot access to high quality healthcare service because of lack of capacity at facilities. After S-PAQ installation, high quality primary healthcare service at neighbor healthcare facilities will be available for them.

The customers who pays for our solution are governments and donors. As S-PAQ is a turn key solution, the customers do not need to confirm compatibility of new device with other equipment nor availability of electricity. Accessing to the data base of S-PAQ platform, they can follow the actual situation in medical statistics.

The Challenge of MATERNAL & NEWBORN HEALTH seeks a solution which promotes access to essential health service for every woman who doesn’t have it in order to save lives from preventable or treatable causes. 

Our target population as primary beneficiaries are pregnant women in medium and low-income group in Africa. Our solution is aiming at expanding access to high-quality, affordable maternal and newborn care for women by using today’s technologies and devices in feasible way for every health care centers. As we see, our selected problem, solution and target are strongly related to those of The Challenge.

S-PAQ is an enabler for technology based medical devices to create impacts in low resource environments.

There are many IOT medical devices in the market such as CTG monitors, Stethoscope and portable ultrasounds. These might contribute to solve above mentioned problems; however, they cannot be used alone by healthcare workers in low resource setting. What they need to improve quality of healthcare service is not a part of solution but an entire package which can work without any additional input and which can create clinical impact alone. For these IOT devices, S-PAQ will be a platform which facilitates to enter into the market.

There are some packages of medical equipment for Mobile clinic or healthcare workers. These have similar function to S-PAQ but still, our solution has uniqueness in terms of alignment to country health system and integration of IOT device into national protocol of clinical practice.

Based on our experience as IOT medical device manufacturer, we learned that governments and local healthcare workers need a turn-key solution rather than individual innovative device. On the other hand, there are a lot of innovative startups in this field but each of them cannot implement pilot project in specific field to make its solution scalable in low resource setting. Our platform will solve this problem for both provider side and user side.

S-PAQ includes a device of portable ultrasound of Lequio Power Technology, a Japanese medical device manufacturer, which use sensor technology connected to the internet via smartphone. The Deep learning image recognition technology is also used by AI powered eye image diagnosis support system developed by a Japanese startup, Deepeyevision. 

A unique innovation of our solution is creation of platform which connects healthcare workers in low resource setting with latest technologies. The platform helps each device makers to prove effectiveness of their products in rural area and then the market will become bigger.

Another innovation is digitalization of data at primary healthcare level in low income countries. At this moment, in the most countries, healthcare workers record in papers and the record would be digitalized at higher level of health system. Using cloud technology, S-PAQ will dramatically improve this reporting system and quality of medical statistics.

The accumulated data in medical practice would optimize protocol, resource allocation and even training system. Although the existing rules or system would be set based on some authority, these criteria or system must be reviewed and optimized at each facility based because there are locality and seasonality. Just same as the management system of convenience store, data driven optimization will decrease cost and improve entire performance.

From 2015 to 2018, The portable ultrasound device of Lequio Power Technology was used in a project in Sudan. About 50 midwives were trained to examine antenatal ultrasound examination successfully. The link to the project report is following. English report starts at page 111

https://libopac.jica.go.jp/images/report/12306049.pdf

From 2018 to 2020, The ultrasound device were also used in Sierra Leone. The result is elaborated in academic paper under examination process. A following link is a local tv program reporting our activity. Our part starts at 14:43

https://www.facebook.com/AYVSierraLeone/videos/2503835679897011

Although other devices have also been tested in some developing countries, the package itself has not been used as it is at POC stage.

 1) Activities

Based on a collaborative experiment with a local government, the feasibility of the S-PAQ is validated. Through the experiments and examination, the first protocol and referral system will be embedded in the S-PAQ system. Then, the first official distribution project launched with installation of package at the primary healthcare facilities and trainings for healthcare workers. In this process, strong partnerships will be built with governments, hospitals and other stakeholders in healthcare sector. At the same time, the activities will be widely noticed by local people via mass media.

2) Outputs

As a consequence of the activities, the first batch facilities are equipped with S-PAQ and healthcare workers get ready to provide quality healthcare service in at least antenatal care. At institution level, the referral and reporting system will be established.

The local people are aware of installation of new system in neighbor clinics and expect better quality of service.

3) Short Term Outcomes

Healthcare workers at the facilities of primary healthcare demonstrate ability to give high quality healthcare service following navigation of S-PAQ system. The practitioners get higher skills and quality of service continue to improve.

Patients receive better quality healthcare and trust between clinics and people is built.

The governments and donors get small wins with evidence and decide to expand their funding.

4) Long Term Outcomes

High quality healthcare service is available for everyone even in lower income countries and the mortality rate decreases.

Although we have experimented home-visiting healthcare service which is origin of the idea for 7 families in Kinshasa, the product of S-PAQ itself has not been developed.

We are planning to conduct the first experiment with prototype for 50 people in November 2020 and the second for 200 people in March 2021. Before the end of 2021, The first commercial installation in DRC would be implemented for 100 primary healthcare facilities which would serve 50,000 people at the year.

Our goal in 5 years is 20,000 sets of S-PAQ to be installed in primary healthcare facilities in developing countries. The number of patients who will take the improved service is 25 million per year.

Our goal in the next 5 years is to make high quality healthcare service available for 25 million people in Africa. In order to achieve it, 20,000 sets of S-PAQ are needed to be installed in 10 African countries. As we will use an open source platform to develop applications, other players would replicate and co-develop improved system to accelerate impact creation.

As the step to the goal, we are aiming at launching a commercial project in DRC in 2021. To realize it, we will implement a pilot project in March to April 2021 collaborating with public healthcare facilities around Kinshasa. In order to develop a prototype with strong partners, we are planning to conduct a POC project with a partner clinic in Kinshasa in November 2020. In this POC we will widely invite medical device manufacturers who have an interest to join our package as well as our present partners.

1. Software application development

Although we will start our POC activities with existing applications such as Google Form, we need expertise on software architect and developer before starting our pilot project in March 2021.

2. Finance for a pilot project

Our existing financial capacity allows to implement POC activities. However, we need to develop prototype for a pilot project based on the result of POC and also dispatch some experts to the field in DRC. The expense is estimated about $200,000.

3. Working capitals for scaling up

After achieving PMF, we will rapidly expand markets to install our products. As some parts of customers will be local governments, accounts receivable would incrementally increase

1. Software development

Now we have a team of engineers who support us voluntary. Connecting with them, we are approaching to Code for Japan and Code for Africa who are famous civic tech communities. Through collaborating with them, we are planning to find some engineers to work with us from these communities.

2. We have financial barrier for a pilot project in March or April 2021.

We seek opportunities of financing by donors or enterprises after POC as well as grant programs like Solve.mit. In case we cannot find new source of finance, another debt would be considered.

3. Working capitals for scaling up

After achieving PMF, equity finance will be considered although some parts would be covered by debt against accounts receivable.

1) 2 full-time workers

Kuniyuki FURUTA, CEO at SOIK Corporation

Olivier KATABARUKA KABI, Managing director, SOIK Corporation sarl

2) 1 contract based part-time staff

Christine LUNJWIRE NZIGIRE, MD, Medical officer, SOIK Corporation sarl

She is working in the department of hygiene in the ministry of health in DRC

Note: we have two incorporated organization. SOIK Corporation in Japan and SOIK Corporation sarl in DRC.

There are three key expertise needed to our team; 1) Market understanding, 2) Solution understanding. and 3) Business experience in Africa

1) As we saw, we have three key players who will be affected by our solution, governments and donors as customers, healthcare workers as users and pregnant women as beneficiaries. Kuniyuki FURUTA has 8+ years’ experience as donor, Japan International Cooperation Agency, JICA. During his mandate in DRC for three years, he worked closely with the ministry of health, public hospitals and local people collaborating with other donors in healthcare sector.

Dr. Christine LUNJWIRE NZIGIRE has worked inside of the ministry of health in DRC to implement its policy since 2016. She has also engaged as clinical doctor at several hospitals since 2012.

2) As our solution is a combination of medical device, hardware and applications, management team needs to have broad understanding on these products. Kuniyuki FURUTA has worked in a Japanese medical device startup as Chief Operating Officer for two years. He led a digital transformation process of this portable ultrasound device developer as well as strategic partnership with other medical device manufacturers and software developers.

3) Considering complexity of business environment and regulation in Africa, profound business experience and strong relationship with local players are necessary to implement wide range of activities. Olivier KATABARUKA KABI has 10+ business experience in DRC in various fields. He has acquired certifications including an authorization of medical devices for Japanese companies.

SOIK has partnerships with following organizations.

-       Initiative for Global Perinatal Care, IGPC, a Japan based NGO, on technical knowledge on gynecology, obstetrics and pediatrics

-       Yushokai medical corporation, a Japanese healthcare service provider, on clinical practice outside hospitals

-       Lequio Power Technology Corp and other medical device manufacturers

-       Centre Hospitalier Alliance, a clinic in DRC on implementation of clinical trial

-       National Center for Global Health and Medicine, NCGM, a Japanese public organization on funding for training project for healthcare workers in DRC

The value proposition for the beneficiaries, who are pregnant women in underserved area, is high quality primary healthcare service at neighbor health centers and that for users, who are healthcare workers in developing countries, is a turn key solution to provide high quality healthcare service. The value for customers, who are governments or donors,  is strengthening the entire health system with data management. The metrics to be measured is the number of patients who receive a proper healthcare service.

To deliver the impact, we will provide a turn key package composed by hardware and applications with training to healthcare workers in primary healthcare facilities. We develop software applications and continuously try new medical equipment to be added to the package. At the field, we build close relationship with the local governments and formulate projects to get funding by government budget or donor finance.

After the installation of S-PAQ, we continue to support healthcare workers with consulting and maintenance services. This is another revenue stream from installation fees.

1) At the initial stage before the mid 2021

The major expenses are for travel expenses and implementation cost for POC and pilot projects. The expenses will be covered by a combination of debt and grants. After achieving PMF, we will seek equity opportunities.

2) In Long term

The major expenses are hardware product cost, maintenance & development of applications and marketing activities.

The revenue stream is installation fees of S-PAQ, maintenance and consulting, and marketing and research fee with data .

1) Grant financing for building prototype and implement pilot project with local government.

2) Seek partnership opportunities for collaboration which will improve our impacts. As other medical devices or solutions can be embedded in our platform, we are seeking partners who are interested in developing products together.

3) Mentors on business strategies and team management

Our Primary healthcare package will help to mobilize latest technologies for improvement of healthcare service delivery at IDP or refugee camps. In addition to the quality of healthcare service, our solution will integrate healthcare service protocols for displaced people into standardized system of national health system. This will promote their social integration.

With the fund of Andan Prize for innovation in Refugee, SOIK will install S-PAQ in IDP camp in DRC such as in Goma, Nord Kivu.

 Our primary healthcare package is technology-focused innovation especially for pregnant women’s health.

With the fund of the Innovation for Women Prize, we will develop a function in our platform for pregnant women to access ultrasound image data of their enfants. This function will help healthcare workers to build better relationships with patients.

 Our solution will empower the health workforce for newborns, pregnant women, and new mothers at primary healthcare facilities in low-income countries through mobilizing the latest technology based medical devices. Our platform will provide training programs for health workers as well as easy navigation system in order to make the care process easier for practitioners. As a consequence, healthcare workers will improve their capacity of assessment and the entire health system including referral capabilities will be improved.

The fund of the Health Workforce Innovation Prize will be used for developing training materials and navigation system to help healthcare workers improve their capacity to care patients.

Our digital platform is not using artificial intelligence technology at the initial stage but the system will be designed to accumulate data to be easy to be annotated. For example, a navigation function of our medical device platform for healthcare workers will be launched with rule-based system, following national protocols or internationally accepted algorithm. However, some of criteria such as triage and referral system would be adaptive to capacity or resource allocation in each region. Or, the inventory prediction with past data analysis would contribute to decrease costs of entire health system. 

The AI for Humanity Prize will be used to develop data collection system which will accelerate data analysis and AI use in healthcare in lower developing countries.

 As the primary goal of our solution is to improve quality of antenatal healthcare at primary healthcare facilities in low-income countries, we are qualified for this award.

We came up with this solution during discussion with people from the government in DRC. Our system follows national system and regulation in order to align with them. Our Primary healthcare package will be installed in public primary healthcare facilities.

The Bill & Melinda Gates Foundation Funded Award will be used to implement a pilot project which will be held in April 2021 partnering with the government of DRC. With the result of the pilot project, a bigger project will be formulated which will be the first commercial contract for SOIK.

Our solution is aiming at improving healthcare service for millions of people in low-income countries. We are a for-profit company and our customers, governments and donors, will pay for our product and service.