Afya Pap by Baobab Circle

Baobab Circle’s mission is to harness the power of digital connectivity and artificial intelligence to improve health outcomes in resource limited settings. Our product, Afya Pap, is a patient centred platform using AI and behavioural science to provide personalized management of chronic health conditions via smartphone or feature phone. We now include COVID-19 advice to reinforce public health policy in the 7 African nations we operate. In addition, we have developed an autonomous triage tool to help identify and track patients/symptoms. Finally, we upgraded our live SMS consultations with Doctors to allow video/voice calling to our 50,000 diabetic subscribers at high risk of COVID19 complications. Baobab Circle is a limited company headquartered in the UK with operations across several African countries.

Chronic health conditions are a huge societal/economic burden for Africa. 25% of Africans over 25 suffer from hypertension. In Kenya services for primary healthcare are overburdened by long queues and not enough time is spent explaining to patients how to manage their condition. As a consequence preventable strokes, heart disease and early mortality are placing undue strain on health systems. In the wake of COVID19 – patients have found access to Dr’s curtailed further. For the users of Afya Pap, an already vulnerable population are high risk for COVID19 complications, a sense of urgency is leading to a shift in perceptions of telemedicine. Shifts in supply/demand have already resulted in an increase in requests from both sides for us to provide voice/video links between patients and Drs. Through our pharmacy partners, we can integrate online and offline health to facilitate prescriptions and bring a wholistic healthcare experience, while helping patients avoid possible vectors of disease transmission. Telemedicine also means we can care for patients across the spectrum of primary care. The longer this pandemic enforces these dynamics, the more entrenched telemedicine will become as a healthcare delivery platform, equally distributing demand continentwide adding further resilience to healthcare systems across Africa.  

Our product, Afya Pap, consists of an AI driven chatbot designed to provide personal consultations daily and behaviour change for Diabetics. Recently we expanded content to include Covid19 prevention messaging. Most people who contract Covid19 will have mild symptoms that can be managed at home whilst observing self-isolation procedures. This adaptation for COVID19 also includes a triage service. Once a user answers various questions, we give advice on actions to take based on the symptoms provided, known exposure to infected persons and recent travel. This data is sent to our existing measurements tracker ‘caregiver portal’ – allowing Dr’s to track patients remotely and to observe symptom trends within a population geographically. In turn we assist authorities to allocate resources appropriately. Finally we upgraded our ‘Ask-a-Dr’ feature from live SMS consultations to include live/instant voice/video consultations. This feature has successfully tested with our 50,000 users and we are scaling up. Each day ~0.42% of our subscriber base place calls seeking consultation. In anticipation of a doubling of subscribers and quadrupling of daily usage due to an influx of highly motivated clients with easier access to Drs we will be expanding our team of physicians accordingly over the next few weeks.

Maurice a self-employed phone repairer struggled with managing his diabetes until Afya Pap. His high blood glucose levels were affecting his eyesight, threatening his livelihood. His medication costs were increasing too. During a clinic visit he would be told to adopt a healthier lifestyle but not how and he felt helpless. Using daily coaching Afya Pap taught him how to eat with his family by reducing carbohydrates. He receives medication reminders and is also able to access further information on specific symptoms or medicine side-effects via our Ask a Doctor feature. Our localised and personalised information has improved his health

Our 50,000 diabetics are increasingly vulnerable in the wake of COVID19. By providing consultations via mobile phones we provide care, med prescriptions etc, without individuals leaving home and exposing themselves. We are also partnering with governments in Zimbabwe and Kenya. Our technology complements existing public communications by providing personalised/interactive health messaging.

In both nations, Covid19 cases are managed at designated centres. Concerned citizens call a MOH toll-free line. Community health workers support by visiting homes. Our innovation strengthens capacity by enabling remote follow up/tracking. We also provide information enabling authorities to respond quickly, reducing infection rates today in future. 

Prior to COVID19 telehealth was not viable in Africa. Changing market dynamics has pushed several companies to attempt telehealth solutions; we hold significant advantages.

active audience of 50,000+ diabetics (the most at-risk group for COVID19).

active team of Dr’s clinics and pharmacies currently managing them.

Established registration/remote tracking systems (easy access). Dr’s can record/recall observations/recordings during voice/video consultations.

Ability to offer free service during COVID19.

Instant and scheduled calls (most competitors offer call scheduling only).

Geographic reach across 7 nations (alternate offerings are national or subnational).

Additionally, we have established revenue streams from our diabetes management tool and glucometer/strip sales.

Afya Pap has been designed based on client-server architecture. this requires all clients to be decoupled from the server logically and physically. The platform will have support for these clients: Mobile Application, USSD Menu, SMS Alerts and the Web Portal. For the server side, the platform will be based on a microservices architecture i.e. a decoupled distributed system. The server-side application architecture will be based on the n-tier architecture.

USSD Client: For each country we operate in we integrate with local Telcos/Network Aggregators to connect to the platform’s USSD and SMS adapter in order to render a USSD Menu for users with any USSD enabled devices. USSD gateways for each Telco differ in implementation. As a result, our platform comes with inbuilt adapters for translation to a JavaScript Object Notation (JSON) data format that the rest of the microservice components are able to interact.

Web Client: Web modules are implemented using data light technologies, such as AngularJS Framework, for rich and light rendering on the web browsers. An Admin Web is used for administration purposes (Management of System Users, System Configurations, e.t.c.) and a Reporting Web (Reporting Dashboard) is used for reporting and analytics. All web applications aremobile responsive allowing access from smartphones and tablets.

Mobile Client: Currently Afya Pap is available in Android format but we are building for iOS. The purpose of these apps is to connect to the back end securely via the edge gateway. Apps are developed using a Hybrid Mobile App Framework (Flutter UI Framework). 

last year we sent daily localized health information to >50,000 phones. We have tracked user progress through our caregiver portal. We have sent >500,000 medication reminders. Our AI chatbot has had >5.5 million conversations. Our doctors provide ~332 consultations/day. We are continuously demonstrating that hospitalizations/health complications can be prevented by providing on-demand mobile tools that speak in the language and the cultural context of the region. The caregiver portal and triage tool allows us to identify geographic clusters of symptoms, ensuring appropriate allocation of resources.

Telehealth in Africa has traditionally failed to overcome obstacles unique to its demographic. Public preference for most services demands physical interaction because of mistrust/misunderstanding of technology. High demand for in person consultations compounds supply constraints. Urban hospitals are overwhelmed while underused in rural environments (rural dwellers lack information on health services near them). These are some reasons we adopted AI to provide consultations instead of live Dr’s.

COVID19 has shifted the paradigm. Harsh curfews/punitive measures imposed on positive diagnosis has led to a >40% decrease in hospital admissions. At the same time, clinics are closing citing PPE shortages. Shifting supply/demand has already resulted in an increase in requests from both sides for Baobab Circle to provide voice/video links between our 50,000 patients at high risk of COVID19 complications and Drs. The longer this pandemic enforces these dynamics, the more entrenched telemedicine will become as a healthcare delivery platform which will help equally distribute demand across healthcare systems continentwide, increasing consultations and increasing quality of healthcare to the marginalised and the very last mile. We request support for our telehealth services during COVID19 thereby increasing mobile internet adoption/usage for healthcare and adjacent services, improving public health and saving lives across LMICs.

50,000 Currently, we aim to serve 1,000,000 in the next 12 months and at least 5 million in 5 years.

The AI triage, daily consultation and remote monitoring service is currently being deployed. To date we have grown the company through partnerships with mobile network operators, insurance companies. Our mobile network operator partners (MTN, Econet and Telkom) allow for free and direct SMS marketing to their subscriber base as part of a revenue share agreement. Our corporate partners pay for our services on behalf of their clients and employees as part of their wellness or insurance strategies

Goal within the year is to move from revenue generation to profitability, in the next 5 years we want to be running a profitable business with tangible evidence of mass employment of community health workers and evidence of thousands of lives saved. 

Challenges we have envisioned include the COVID19 perceived as not a threat by the public, lack of government support/regulatory issues and competition. On the first point, we believe COVID19 risk awareness is increasing within the population, partly due to companies like ours helping to disseminate actionable information but also spurred by a noticeable increase in infections. It took 100 days to infect 100,000 and less than 20 days to double – Africa is at the beginning of its COVID19 epidemic. African economies cannot handle sustained periods of shutdown, so human interactions will have to adapt. Hospital admissions are already down >40% and it is becoming clear that habits are changing with telemedicine gaining traction.

Governments are interested in our service– we are currently negotiating agreements with both the Kenyan and Zimbabwean ministries of health in order to facilitate nationwide rollout.

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CEO, Dr Precious Lunga, an epidemiologist, has a track record building innovative mobile health services. After established Econet’s Health Unit in Zimbabwe in 2014 Precious launched ‘EcoHealth Tips’ an SMS messaging platform attracting >700,000 paying subscribers within 8 months. Prior to that Precious advised UNAIDS, implementing/managing programs across Africa. Dr Lunga sits on the board of the London School of Hygiene and Tropical Medicine (Currently informing global COVID-19 responses) and in 2008 was honored as a Yale world fellow for her commitment to global health. Precious received her PHD in Neuroscience from the University of Cambridge in 2003. COO, George Franklin and Precious met while he at Iwol Capital investing in African healthcare opportunities. Previously, George worked at Merrill Lynch and received his MBA from Columbia Business School. Baobab Circle was created with a shared vision to solve for growing disease burdens, opaque data sets, Dr/patient imbalances and poor infrastructure.

NGO initiatives include private sector consortiums such as Safe Hands (Funded by Dalberg) where we have been brought on as the content delivery and telehealth partner to support 5 million individuals in Nairobi. PharmAccess is another example where our remote health tracking and personalized disease management tools are used to support diabetics in underserved communities. Our telco partners (MTN Uganda, Telkom and Zamtel) have entered into agreements allowing us to leverage their marketing platforms and SMS blasting, granting us access to their subscriber base. MNOs also provide access to new markets. Our concept has been successful with local players (Telkom and Zamtel) which helped secure the MTN Uganda partnership, providing access to support 15 million across the country. Our expansion plan involves leveraging partnerships within multination MNOs like MTN. For our telemedicine response to COVID19, MNOs are also able to provide us with toll free fixed lines, allowing anyone on any network within that nation to access our Doctors using any phone. We are currently integrating with Telkom and are in the application phase with MTN and Safaricom. Insurance providers and pharmacy partners such as Fidelity and Madison Life along with Pharmacy groups such as Goodlife and Guardian allow us to bring the online into the physical environment. The pharmacies act as a store front for our glucometer business and also allow our telehealth Doctor’s to prescribe medicines – in turn, our insurance partners provide access to new users and facilitate payment for these products. 

Our initial product has 50,000 people using it 3-4 times a week with a proven revenue model. For each condition that we provide coverage for we charge a $1/month subscription fee. With our telco partners this is paid for by the user via airtime. With our insurance and corporate partners, typically they pay for their clients to access our service. Their main motivation for this is to try and introduce healthy habits into their client base thereby reducing claims against them.

In 2019, we also became the exclusive distributer of a smartphone enabled glucometer. These are typically paid for by an insurance partner and given for free to the insured Afya Pap user. This reduces complications on last mile delivery logistics and provides cash flow visibility. Users of Afya Pap are the most engaged, deliver the most data and have the best health outcomes when pairing our software with our smartphone enabled glucometer. We sell the starter pack (Glucometer, 50 lancets, 50 strips) for $30 in most markets and associated strip refills for $15 – essentially making a $10 margin on each item. Strip refill orders are a recurring revenue stream and orders are made roughly once every other month, thereby increasing revenue per user from $1 per month to $6 per month. Future revenue streams include charging for telemedicine consultation, advertising and a revenue share agreement with partner pharmacies for drugs prescribed by our doctors via our telehealth solution. 

Revenue model described above, we are on track to break even. 

Funding and support for partnerships. Partnerships are key to our growth strategy across Africa 

Access to Ministries of Health and Telcos are the major routes to scale for us. Our partners (MTN Uganda, Telkom and Zamtel) have entered into agreements whereby they allow us to leverage their marketing platforms and SMS blasting, granting us access to their subscriber base. Typically, one SMS blast yields a subscriber conversion rate 1-2%. These partnerships have also allowed us to replicate our app offering into an interactive USSD/SMS format which provides access to users on all mobile phones. Importantly, this service is prorated by the MNO, meaning SMS conversations with our chatbot and Dr’s are free to the user. 

MNO partnerships also helps reduce payment friction for the user. Users pay via mobile money or airtime deductions. We invoice the MNO directly at the end of each month.

MNOs also provide access to new markets. Our concept has been successful with local players (Telkom and Zamtel) which helped secure the MTN Uganda partnership. Our expansion plan involves leveraging partnerships within multination MNOs like MTN.

For our telemedicine response to COVID19, MNOs are also able to provide us with toll free fixed lines, allowing anyone on any network within that nation to access our Drs using any phone. We are currently integrating with Telkom and are in the application phase with MTN and Safaricom.

The African CDC has stated that for countries to scale up testing and contact tracing at the level needed, 1 million community health workers must be deployed across the continent by October'20. This creates job opportunities for younger people to work in the health sector, boosting system resilience. Typically training for community health workers takes over 6months. For accelerated testing and tracing to work a much shorter COVID-19 focused training must be adopted. Our proposal is to specifically re-purpose Afya Pap to support remote community health worker training on COVID-19. We propose to start in Kenya, Uganda and Zimbabwe where we have strong engagement with health ministries. Our interactive service has been tried and tested extensively as a health coaching tool by over 50 thousand users. COVID-19 content is developed and we would work with the ministries for further localization. Afya Pap is available local languages. An additional advantage is that we  include additional training tailored to support people with underlying conditions. This is important due to the high risk of severe COVID-19 in people living diabetes etc. This training module is also important in promoting sustainability of jobs beyond COVID-19 by linking the training to existing gaps in the health system. Baobab Circle initially applied our health education methodology within the sphere of non-communicable diseases focusing on managing diabetes and hypertension. These patients are 3 times more likely to die from Covid 19 complications. Africa currently has over 19 million diabetes patients and over 100 million suffer from hypertension.