HealthCare Mobile

There is currently no low fidelity tech solution that provides an inclusive experience to seeking home based primary healthcare in semi rural/rural regions in Nigeria. HealthCare Mobile is a platform that connects patients to community health workers to provide fast and affordable home-based primary care services. We apply a systems thinking approach to address the current pain points in Nigeria's fractured primary care system such as, low unemployment rate of CHWs, access to fast and affordable primary care in semi rural/rural regions, and the ability to track emerging diseases in remote areas. HealthCare Mobile is the first service of its kind to offer semi-urban, urban poor, and rural Nigerian patients an alternative to the high prices and long wait times of the existing health care system. HealthCare Mobile has the potential to transform patient access to care and positively impact health outcomes, health care worker incomes and economic development.

A major problem persists that there are many individuals who lack access to health services especially in semi-urban, poor urban, and rural parts of Africa, reflecting a structural social inequality that cuts across geography and income. This is due to a myriad of reasons: inadequate health facilities, high medical cost, poor infrastructure, and lack of job opportunities for community health workers. Specifically in Nigeria, with a population of 200 million people, it has a huge health infrastructure problem. There are approximately 700,000 registered Community Health Workers (CHWs) and 75% of them are underutilized due to lack of employment opportunities. In addition to this problem, 20% of Nigeria’s 30,000 Primary Care Centers (PHCs) are functional. As a result, many patients are forced to travel further to secondary and tertiary medical facilities where they experience long wait times and pay almost triple the cost for primary care services. In a customer discovery with over 3000 respondents, 72% expressed cost and understaffed health facilities as the number one barrier of accessing primary health care in Nigeria, followed by long commute times, and lastly long wait times at health facilities. To summarize, most not Nigerians, spend time seeking verses receiving primary health care services.

HealthCare Mobile is a platform that connects patients to Community Health Workers to provide fast and affordable home-based primary care services in peri-urban, rural, and remote regions in Nigeria. For Patients: With a short Unstructured Supplementary Service Data (USSD) code (which is available on any cell phone and doesn’t require internet connectivity to function), patients can register, pay, and request the nearest registered Community Health Worker to administer home-based Primary Care Services. Health Workers: Are directly connected to people who need their services. They generate an income for themselves for each patient they visit – promoting social entrepreneurship by providing health care to the community and financial benefits for health workers. Health Care Mobile is the first service of its kind to offer semi-urban, urban poor, and rural Nigerian patients an alternative to the high prices and long wait times of the existing health care system  Additionally, HealthCare Mobile leverages Artificial Intelligence (AI) to apply predictive analytics to geo-tagged USSD messages for disease surveillance of emerging disease outbreaks in rural and remote regions. This enables governmental agencies and policy makers to make data-driven decisions on resource allocation in rural and remote impacted regions.

Nigeria’s health sector is a $15.3B dollar market with $1.3B spent annually on medical tourism in India, Europe and the United States. Serviceable Available Market is 13.3B

Mobile penetration in Nigeria at 87% = 172 Million people (including feature and smartphones). 

Target Market - $5.32B includes people with cellphones that live in semi-urban and rural areas who require regular medication, expectant and new mothers, young children and parents.

During my customer discovery (3486 respondents), 72% expressed cost and understaffed health facilities as the number one barrier of accessing primary health care in Nigeria, followed by long commute times, and lastly long wait times at health facilities.

HealthCare Mobile address patient needs by 

1. Significantly reduce infant mortality during and after birth 2. Change health orientations in communities 3. Provide sustainable and low-cost access to health services 4. Provide employment opportunities for CHWs while promoting socio-economic growth. 

Currently, there are no companies in Nigeria that leverage either Mobile apps or USSD to provide access to primary care services in Nigeria via CHWs. However, there are competitors in this space that operate outside of Nigeria

Last Mile Health is a nonprofit based in Liberia that leverage CHWs to provide home based primary care services however, their tech platform is a mobile app for their CHWs and not patients. They provide smartphones to CHWs for data collection not considering Liberia’s low mobile internet penetration at 10% 

Living goods is a nonprofit similar to Last Mile health but based in East Africa (Kenya and Uganda) and Myanmar. 

HealthCare Mobile takes a system thinking approach by 1.) increasing employment of CHWs in Nigeria 2.) Leveraging USSD to provide access to on demand primary care services to populations in semi urban, and rural parts of Nigeria. Thus, promoting sustainable socio-economic development in Nigeria.

HealthCare Mobile is a USSD Application that allows users to register and search for available CHWs based on their State and LGA (Local Government Area) to provide home based primary care services. A USSD is a short code that enables one to reach customers in hard to reach areas, available on any cellular device and does not require internet connectivity to function. Nigeria accounts for the largest mobile subscribers in Africa at 87% of which 20% have a smartphone. With a short USSD code, Nigerians are using their cell phones for banking, telecoms, agriculture and sports. With HCM they can now use it for Healthcare. 

Furthermore, HealthCare Mobile allows patients to view their previous appointment history. This feature was incorporated because millions of Nigerians currently lack the ability to track their medical history and therefore unable to practice preventive medicine. With this feature, Nigerians are able to prevent the prevalence of preventable diseases in their families and communities. 

Moreover HealthCare Mobile, will incorporate mobile payments through business payment APIs such as Paystack and Flutterwave. It is by leveraging these technologies, which exist successfully in the health, finance, and social impact spaces, that HealthCare Mobile will reach patients in need of primary care.

Finally, utilizing geotagged USSD messages for disease surveillance powered by AI. To my knowledge there is no platform in Nigeria that utilizes geotagged USSD messages for disease surveillance. This is particularly important for hard to reach areas that are not connected to the grid or lack internet connectivity.

HealthCare Mobile’s MVP is a USSD Application that allows users to register and search for available CHWs based on their State and LGA (Local Government Area), and allows the CHWs to connect with users to provide primary care services. A USSD is a short code that enables one to reach customers who are in hard to reach areas, available on any cellular device and does not require internet connectivity to function. USSD projects have been successful in helping regional health centers distribute health information and tips from providers to patients in Zimbabwe. In another example, USSD technology was trialed in South Africa, where it facilitated the interactions of informal caregivers, patients, and health centers. In other mobile technology examples, such as M-Pesa in Kenya, mobile money applications have successfully penetrated the market while facilitating transactions, leading to the lifting out of poverty of 10s of thousands of households by redefining income potential and access to finance.  

As of September 2018, mobile penetration was at 87% and expected to increase with Nigeria’s fast-growing population, so these types of mobile technologies are viable solutions for accessing large numbers of beneficiaries. HealthCare Mobile’s technology bridges this gap by facilitating an inclusive experience whilst seeking primary health care services. The team plans to leverage these existing technologies by actually connecting the patient to providers who can deliver primary health services in the patient's households, stepping up the level of access made available in other examples. 

HCM employs a systems thinking approach that leverages low fidelity technology - USSD (input) coupled with employment of CHWs (input) to increase access to affordable home based primary health care (output). Thus reducing the amount of time and money spent on transportation, and primary care at secondary and tertiary medical facilities (outcome) ultimately transforming patient access to care, positively impacting health outcomes, health care worker incomes and economic development (impact)

We have mobilized our health workers in Enugu to engage the community by hosting a series of free COVID-19 educational seminars at various health centers. The purpose of these seminars is to disseminate information on how to prepare and protect yourself during the ongoing pandemic.  In April 2020, we hosted two seminars and registered 256 new users on the platform.  Through this initiative, we are developing features on the platform that allow registered users to:

1) Receive daily updates on COVID-19 via SMS messaging

2) Anonymously report suspected symptoms of COVID-19 to health official for assistance

3) Receive information on test and isolation centers in the area

*Intervention = Visit. Average number per household in Nigeria - 4 people

We launched HealthCare Mobile in partnership with the Ministry of Health in these states (Anambra, Enugu and Edo) in April 2020. HealthCare Mobile is currently implementing a demonstration pilot with a target of on-boarding 900 patients and 90 Community Health Workers to facilitate 900 healthcare visits across three states. The objective of the pilot is to confirm feasibility, demand, and price point. All activities in this 1st phase will be done using low cost IT solutions. The CHWs will administer the following test/examinations: physical examination, blood sugar and hypertension levels, maternal and early child care, and Rapid Diagnostic Test for Malaria, Dengue. Upon completion of this pilot and year one, we are projecting to complete 4,500 visits (interventions). By year five, we project 500,000. visits across two countries in West Africa. 

Success for us is when HealthCare Mobile is the platform not only used among all patients seeking primary care, but ubiquitously used to create networks aimed at building primary health resiliency at the population level. Our core ethos remains that primary care programs have to adapt to individual health needs, integrate into current care practices and make optimal use of health system resources so as to improve health outcomes & reduce cost.

Methods

1.)   Leveraging our current CHW network, signing people up at schools, churches, health fairs, banks, and community events

2.)   Digital marketing: 60% of internet users in Nigeria say that they discover new brands on social media with Facebook (87%) being the most visited social media platform followed YouTube (76%) and Instagram (67%). In addition, leveraging retail sites, radio and television.

3.)   Partnerships with health-related MNOs such as the World Health Organization

We plan to measure the social impact we are having through the following key metrics:

-Active users: The key metrics include the number and type of users that are engaging with the platform. This assesses the beneficiaries of our intervention.

-Healthcare services: Key metrics include the type and number of services.  This assesses the impact we are having on increasing access to affordable primary healthcare services, building strong and healthy communities, and disease reduction.

-CHW employment statistics: Key metrics include the number of CHWs employed, income generated. This assesses job creation for CHWs and the impact we are having on increasing employment opportunities for CHWs.

Regarding cultural sensitivity, this pilot started in Anambra, where the project’s SME, Jennie, has great familiarity due to experience living and working there as a native Nigerian. She maintains a strong network in the region and has leveraged this network for expanding out the idea and conducting hundreds of potential customer interviews. This is true even for within the team, as team members Lucky and Blessing were connected to Jennie through Nigerian networks. They also bring specific community knowledge in health and technology in the impacted communities and are assets in local community knowledge. 

Pricing of our services will be a risk that impacts HealthCare Mobile in it’s pilot phase. One question is how to best balance the social and health impact of connecting patients and CHWs in the local community health network with the need for a sustainable revenue model for the service. The primary goal HealthCare Mobile is improving health access and outcomes, so the balance is taken seriously. Another challenge for pricing is that there is an unclear precedent. In the research that the team conducted, it was found that prices for services varied greatly between health centers in the community. 

One final risk to consider would be any future technology expansion as the service grows after it’s pilot phase. The issue would not be the number of users, as USSD and mobile money technology has successfully reached hundreds of thousands of people, but rather any adaptations that the users would find beneficial.

Cultural Sensitivity - This risk is therefore largely mitigated at the level of this project, the pilot in Awka, though future expansions would need to consider this risk as HealthCare Mobile expands beyond Anambra and eventually Nigeria, though that is beyond the scope of opportunities that would potentially be funded by this challenge.

Pricing - By centering the health service on the patient, HCM will be adjusting the community health cost structure. During the pilot, HCM is going to consider 30% of each patient visit as a starting point, and adjust based on learning from the pilot in an iterative process.

Technology Expansion - As technology develops, the team's technology SMEs and experience in the field will be able to inform any necessary changes, and potential partnerships with other ventures and technology resources should be able to support future changes.

N/A

Jennie Nwokoye Part-Time 

Robert Treval Part- Time 

Lucky Bardeson Part- Time 

Blessing Onyirimba Part- Time 

Jennie Nwokoye

Jennie is the Founder of HealthCare Mobile. She brings 5 years of consulting experience in the health and technology sector. In addition to this experience, she has first-hand experience seeking primary health care services from time spent living in Nigeria. This experience is the key driver for her passion to address access to primary healthcare in Nigeria as a Subject Matter Expert for the HealthCare Mobile.

Robert Treval

Robert currently works as a Federal Consulting Analyst and brings to the project a research and academic experience in global health and social impact, with burgeoning practical experience in the practice of social entrepreneurship. A recent graduate of Georgetown’s School of Foreign Service, he is excited to serve as the Strategy Lead for HealthCare Mobile. In this role, he guides not only the preparation before the pilot, but also the evaluation after the pilot while determining the impact of the results.

Lucky Bardeson

Lucky serves as the Chief Technology Officer for HealthCare Mobile. Lucky is a software developer based in Nigeria with 7 years of experience designing and building tech solutions for clients in Nigeria. His exposure to Nigeria’s tech sector gives him leverage to create tech solutions that will successfully operate in Nigeria and around the African Continent.

Blessing Onyirimba

Blessing  is a Community Health Officer and Chief of Staff with 6 years of experience working in both private and public health institutions across Nigeria. Princess brings her wealth of knowledge, and network to the HealthCare Mobile Team. 

The team formed a partnership with the Ministry of Health in Anambra, Enugu and Edo state(s) to provide logistical and security support while conducting the pilot in the state. Furthermore, the team will work with a local partner - Blue Diamond Health. Blue Diamond Health is a professionally operated and Hospital-link service provider that allows patients to utilize home-based care as a tool to promote recovery. Services include: nursing care, nutrition management, physiotherapy, and basic health screenings. Blue Diamond Health will provide human capital needed to facilitate home based health visits.

In order to create a sustainable business, HealthCare Mobile will have 3 revenue streams:

(1) Services provided by CHWs. HealthCare Mobile takes 30% of each patient visit promoting a sustainable business model;

(2) Sale of USSD data to MNOs, government institutions for resource allocation. This is related to the AI disease tracking tool for emerging diseases. Our goal is to provide this as a service to public health officials to make informed decisions on resource allocation and investments to respond to potential epidemics, and pandemics;

(3) Our Sponsor a CHW initiative for MNOs with Last Mile Distribution Initiatives. They can sponsor a CHW to get their products (pharmaceuticals) into hard to reach areas. We’d take a percentage of pharmaceutical sales.

Believe it or not, access to basic primary care has been a major challenge for 90% of Nigeria's population. In an interview in 1978 with the father of Nigeria's Primary Care System - Late Professor Olikoye Ransom-Kuti, he mentioned that most health services sought out by Nigerians was treatment of preventable diseases. These diseases such as malaria and typhoid are linked to the ability to access fast and affordable primary care. However, the problem still persists that many individuals lack access to health services especially in semi-urban, poor urban, and rural parts of Nigeria reflecting a structural social inequality that cuts across geography and income. This is due to a myriad of reasons: inadequate health facilities, high medical cost, poor infrastructure, and lack of job opportunities for community health workers. We understand that in order to realize our impact, we have to make something that Nigerians want. That is leveraging existing systems and technologies to improve access to primary care services. We understand that this problem is two sided and addressing one side without addressing the other will not generate the desired impact needed in Nigeria. We need to increase both employment opportunities for CHWs and patient access to fast, affordable, and efficient primary care services. 

By applying to Solve, we expose our idea to allies who identify with this challenge and are willing to see idea come to fruition by donating time, and resources. 

In Nigeria, most women and young girls face numerous vulnerabilities such as low unemployment, low education completion rates, sexual assault, and early teen pregnancy. Community Health Worker roles are predominantly filled by women, yet out 700,000 registered community health workers in Nigeria, 75% are underutilized due to lack of employment opportunities. HealthCare Mobile seeks to address this problem by providing training and job opportunities for women and older teen girls to be the pillar of community health in their communities. As such, they will gain the financial freedom to support themselves and their families thus promoting long lasting socio-economic empowerment.  

Specifically in Nigeria, with a population of 200 million people, it has a huge health infrastructure problem. There are approximately 700,000 registered Community Health Workers  and 75% of them are underutilized due to lack of employment opportunities. In addition to this problem, 20% of Nigeria’s 30,000 Primary Care Centers (PHCs) are functional. As a result, many patients are forced to travel further to secondary and tertiary medical facilities where they experience long wait times and pay almost triple the cost for primary care services. Our Health Workers: Are directly connected to people who need their services. They generate an income for themselves for each patient they visit – promoting social entrepreneurship by providing health care to the community and financial benefits for health workers. Our team will use the prize to R&D and expansion to other countries in West Africa.

HealthCare Mobile leverages Artificial Intelligence (AI) to apply predictive analytics to geo-tagged USSD messages for disease surveillance of emerging disease outbreaks in rural and remote regions. This enables governmental agencies and policy makers to make data-driven decisions on resource allocation in impacted regions. Our team will use the prize to R&D and expansion to other countries in West Africa.

Community Health Workers (CHWs) are people who provide limited health services to a community of less than two thousand people. They provide services such as immunizations, pre-natal/post-natal care, health screenings, health education, diagnosis, and treatment – particularly to community members who may not have access to hospitals or clinics. They also serve as the critical link between communities and healthcare institutions/systems. CHW programs have been around for many decades. One of the most notable CHW programs was the Chinese barefoot doctor in the mid – 1900s who brought healthcare services to areas where there was a scarcity of trained health professionals. 

Currently, there is a heightened interest in CHW programs to increase access to healthcare across sub-Saharan Africa to reduce child mortality rates, spread of diseases, and to promote healthy communities. Africa is the second largest populous continent with an estimated population of 1.2 billion people. This number is expected to double by 2050. With this in mind, it is imperative for CHW programs to keep up Africa’s growing population and demand for access to healthcare services. However, the problem still persists that there are many individuals who lack access to health services especially in peri-urban, poor urban, and rural parts of Africa, reflecting a structural social inequality that cuts across geography and income. This is due to a myriad of reasons: inadequate health facilities, high medical cost, poor infrastructure, and lack of job opportunities for community health workers. 

Specifically in Nigeria, there are approximately 700,000 registered CHWs and 75% of them are underutilized due to lack of employment opportunities.  There is a need to develop a capability that will empower community members to be local health providers within their communities. Research shows that community-based interventions and human-centered designs are effective platforms for delivering healthcare services and promoting healthy communities. Evidence indicates that well-implemented community-based health programs can: 1) Significantly reduce infant mortality during and after birth 2) Change health orientations in communities 3) Provide sustainable and low-cost access to health services 4) Provide employment opportunities for CHWs while promoting socio-economic growth. 

HCM is the first service of its kind to offer semi-urban, urban, and rural Nigerian patients an alternative to the high prices and long wait times of the existing health care system. HCM has the potential to transform patient access to care and positively impact health outcomes, health care worker incomes and economic development.

Our team will use the prize to R&D and expansion to other countries in West Africa.