Sustainable Orthopaedic Care in Africa

Neil Sheth is Chief of Orthopaedic Surgery at Pennsylvania Hospital and Associate Professor of Orthopaedic Surgery at the University of Pennsylvania (Penn).  He graduated from Penn with a biomedical engineering degree and a minor in finance.  He then spent two years on Wall Street in Solomon Smith Barney's Healthcare Investment Banking Division prior to attending Albany Medical College.   After medical school, he completed an Orthopaedic Surgery and Trauma Residency at the Hospital of the University of Pennsylvania and then pursued an Adult Hip and Knee Reconstruction Fellowship at Rush University and at the Endo Klinik in Hamburg, Germany.  As Penn faculty, his research focuses on sustainable solutions for delivering musculoskeletal care in Sub-Saharan Africa.  He has led a team of over 70 people since 2015 to build an Orthopaedic Center of Excellence in Tanzania through several partnerships, both across Penn’s campus and beyond.

Road traffic crashes are responsible for a catastrophic burden of musculoskeletal injuries in the developing world, including nations such as Tanzania. Resulting musculoskeletal injuries often require surgery, but access to timely, safe, and affordable surgical care is often lacking. (Premkumar 2017) The discrepancy between supply and demand for orthopaedic services leaves thousands left behind without adequate care. Appropriate musculoskeletal care allows patients to walk and return to productive lives.

We propose building an Orthopaedic Center of Excellence in Tanzania with Kilimanjaro Christian Medical Center (KCMC). This center will be initially staffed by foreign thought leaders year-round, and eventually transitioned over to a new local surgical workforce trained at the center. This Penn partnership includes 25 confirmed academic institutions donating 2 weeks/year in conjunction with remote surgical guidance. Alliances within and external to Penn (GE and Nebula surgical) will provide a steady supply of staff, equipment and implants.

Our collaboration with KCMC has identified the major barriers to orthopaedic care delivery in northern Tanzania: (1) inadequate capacity – space (only one orthopaedic operating theater) and workforce (only 4 Orthopaedic Surgeons); (2) lack of a consistent orthopaedic implant supply (most implants are donations – no surgery without donations); and (3) excessive cost of orthopaedic care. 

KCMC serves a catchment area of 12.5 million people of which > 90% can’t access orthopaedic care (Premkumar 2017).  Five billion patients globally do not have access to surgery, and these same factors contribute to that deficit. 

Our proposal addresses all three barriers.  Capacity: an Orthopaedic Center of Excellence on the KCMC campus includes a phased plan for eight operating theaters and 200 beds.  KCMC’s collaboration with Penn includes an international partnership with 25 academic partner institutions, all donating surgical volunteer teams for two weeks/year.  Implants: an alliance with Nebula Surgical, an Indian implant manufacturer with a Tanzanian distributorship, offers access to low-cost, quality orthopaedic implants. Affordability: patients will be treated regardless of their ability to pay through a cross subsidized model and an orthopaedic endowment annuity. This model creates a unique system for training and care delivery, within the larger Tanzanian health system.    

We propose building an Orthopaedic Center of Excellence on KCMC’s campus in conjunction with their Department of Orthopaedic Surgery. Phase 1 includes two operating theaters and 50 beds.  Our 25 global partner institutions will donate two weeks/year to perform surgery and train a local workforce.  Each volunteer team will include four board certified Orthopaedic Surgeons, four senior residents/fellows, a team of nurses, therapists, and related staff.  Directed by our research on what is currently needed clinically in this region, our clinical focus will be pediatric orthopaedics, trauma, joint replacement, and plastic/soft-tissue reconstruction. 

Nebula Surgical will provide quality, low-cost implants; having a steady implant supply will allow for more patients to be treated. 

All patients will be sub-classified: Package A – amenities package; Package B – basic package; and Package C – concessions package.  Each package is differentiated by adjunct services (e.g. private room/nurse, food provision, twice daily physical therapy) but surgical care quality is the same regardless of the Package designation.  Package A patients would pay extra for a private room, which would offset the cost for Package C patients who currently cannot afford any care. Package B is covered by health insurance for which a fee schedule already exists. 

We started the KCMC collaboration in 2014.  KCMC is one of three tertiary referral centers in Tanzania, and covers five states (population of 12.5 million people).  KCMC encounters a massive burden of orthopaedic trauma which is inadequately addressed due to current capacity and system level constraints. 

Patients in Tanzania that can afford care will receive emergent care (e.g. femur [thigh bone] fracture) when needed, but commonly travel abroad for elective surgery (e.g. total hip replacement). Patients that do not have the financial means are unable to access care (Premkumar 2017).  Patients who currently present to KCMC with a femur fracture and are unable to pay, are placed in skeletal traction for six weeks.  The fracture is unlikely to heal, and if it does, it may heal in a crooked position which prevents the patient from ever being pain free or ambulatory. 

Our established relationship with KCMC has helped our team understand the cultural and economic nuances of Tanzania.   Our model focuses on Package B patients resulting in sustainability and being able to treat more Package C patients – prompt surgical care will result in less morbidity and deformity, and result in more patients returning to the workforce. 

In the developing world, road traffic crashes result in substantial morbidity, mortality and long-term deformity.  Without access, adequate surgical care is not possible, and a majority of patients do not have the means to pay for care if it were available.  Our proposal looks at creating a system within a system for a specific region of Tanzania with a catchment population of 12.5 million people.  The democratized nature of the project – equalizing the quality of care regardless of the patient’s ability to pay – prevents the less fortunate from being left behind.

In June 2012, I participated in Operation Walk Tanzania – a non-profit that performs total hip (THR) and knee replacements (TKR) in developing nations using surgical staff volunteers.  We performed 50 operations over three days, but there was concern for post-operative complications and follow-up.

In February 2013, I re-visited the local Orthopaedic Surgeon from our trip - 4 TKRs had gotten infected and 1 THR was chronically dislocating.  He stated, “We are not happy when you come here! Your team is very skilled, but you have left me with problems that I can’t solve!  Also, after your departure, patients were unwilling to pay for care from an African Surgeon when they were able to get free care from an American Surgeon!” “Blitz surgery” was clearly not improving the system and a novel solution was needed.

During the same trip, I also operated on a young girl that traveled 12 hours to have a THR for a chronic deformity.  The procedure was performed at no cost using remaining implants from our previous trip.  She did well for 16-months but then contracted Tuberculosis and subsequently infected her hip.  It is evident, a system needs to exist to address complications. 

“Neil, this experience was not about you!  You weren’t there to pat yourself on the back. We need to help healthcare providers to take care of their own patients.  Everything should focus on changing systems.”

This is what Dr. Enyi Okereke said to me upon our return from Lagos, Nigeria in 2007.  Dr. Okereke, a Nigerian, Penn foot and ankle surgeon, was my assigned residency mentor.  Through quarterly meetings, he peaked my interest in global surgery.  As predicted, Nigeria was intense – 300 clinic patients every other day, surgery from 7 AM to midnight on intervening days, and daily morning lectures to the house- staff before starting our clinical work.

On our return trip, I was overwhelmed by this experience and Dr. Okereke taught me this most important lesson, which I didn’t understand at that stage of my career.  Unfortunately, on November 25, 2008, Dr. Okereke passed away in Enugu, Nigeria at age 54 from a heart attack due to a lack of resuscitative medications.  I was asked to give part of the eulogy at his memorial service, and that day I realized that I needed to continue his life’s work – changing health systems in the developing world.

This endeavor represents a culmination of everything I have learned in my life.  Our project capitalizes on my background, education and training in biomedical engineering, finance and orthopaedic surgery.  As Penn faulty, I have access to some of the brightest minds on the planet in their specific field.  The collegial Penn environment has allowed me to engage several different schools/specialties: Department of Orthopaedic Surgery, Global Health Institute, Wharton School of Business, Perelman School of Medicine, Leonard Davis Institute of Economics, Center for Women’s Studies, School of Public Policy/Public Health, and School of Engineering and Applied Science. 

This intra-institutional collaboration has allowed me to involve students across campus to round out a team of over 70 individuals that are dedicated to making this vision a reality. In addition, we have forged strong alliances outside of the institution which include KCMC, the Tanzanian Health Ministry, General Electric Africa/Healthcare, Nebula Surgical, and NSK healthcare. The relationship between Penn and KCMC was solidified in April 2019 when two Orthopaedic Surgeons at KCMC became adjunct faculty in the Department of Orthopaedic Surgery at Penn Medicine.

Our novel solution is a business venture, which is run cost efficiently, will yield more profit to treat Package C patients and create a bonus structure for local healthcare providers.  The KCMC collaboration is meant to elevate the standard of care, offer a nee system and leave KCMC with an orthopaedic center, resources and a different/sustainable mindset to treat patients.  

One of the major challenges our team has encountered is the recent coronavirus crisis.  Our initial plan for this project included 25 volunteer surgical teams, each donating 2 weeks per year to travel to Tanzania to work with our colleagues at KCMC to collaborate, operate and educate.  Due to the current travel restrictions, our team formulated an innovative interim plan that could be conducted virtually.

Instead of having teams on the ground for two weeks at a time, some degree of the education can be performed virtually.  With use of GoPro technology will allow for live video streaming of surgery from anywhere in the world – our colleagues in Tanzania can watch real-time surgery performed by global experts.  In addition, surgical guidance can be provided through Xpert eye – surgery being performed live in Tanzania can be visualized and moderated/guided by a field expert from any corner of the globe.  This is a powerful interval step until the world returns to a position where travel is once again able to take place. Also, this technology will assist with future team extraction.  As we hand over the center to our KCMC colleagues, remote surgical guidance will allow for safe transition.

The ability to inspire is true leadership.  As Chief of Orthopaedic Surgery at Pennsylvania Hospital, I am fortunate to operate in the first US hospital; the original operating amphitheater still exists.  At the end of a long day, I sit for 30 minutes in this room and reflect on history, the awesome responsibility I have to take care of patients and the amazing privilege it is to do so. 

The healthcare system demands a great deal of its providers, and it is evident that most people are burning out; they have lost sight of the word PRIVILEGE.  Last year, I led a 45-minute discussion, held in the amphitheater, with the entire operating room staff to remind them of the PRIVILEGE we have to treat patients and how each and every person has been critical in advancing medicine.  That day I received over 100 texts/emails, from some people who had been at Penn for 40 years, stating that this was the most inspirational day they have encountered in their career.  I now am accompanied by several people when I take that time to reflect.

Our project allows me to inspire the next generation and be Dr. Okereke for someone else.  

Our project is a hybrid of a for profit and non-profit.  However, I am the Director of Global Orthopaedics (GOPENN), classified as a Penn Medicine project in Tanzania.   The GOPENN project is being coordinated as a venture between the Department of Orthopaedic Surgery at the University of Pennsylvania and the Executive Board and Department of Orthopaedic Surgery and Trauma at KCMC in Moshi, Tanzania.  

GOPENN is under the umbrella of The Trustees of the University of Pennsylvania, the owner and operator of Penn Medicine and the Department of Orthopaedic Surgery.

The key component that makes our project innovative is Penn’s partnership with 25 global academic institutions.  Across the world, the new generation of medical students are asking to be involved with global health during residency training.  A program that doesn't offer an opportunity is instantaneously less desirable.  The collaboration that Penn offers through our proposal aligns with the incentives of each university partner.  We are able to offer the most valuable element, access to thought leaders in their specific sub-specialty, at no cost.  

The collaboration with KCMC is founded on education at every level – surgical volunteer teams, in conjunction with remote surgical guidance and use of augmented reality technology, can assist our colleagues in Tanzania to adopt a new standard for the delivery of musculoskeletal care.  Our model doesn’t require local teams to travel outside of their country, thus minimizing the risk of “brain drain” – “Stay at home and we will come to you!” In addition, our incorporation of remote technology will allow for safe transition of the center to our KCMC colleagues once a new system has been created, evaluated and fine-tuned.

This global partnership adds to the unique nature of our work.  We are focused on building local capacity and sustainability - the current global surgery models offer short-term solutions, resulting in potential post-operative complications that add to the local healthcare burden. The massive burden of surgical disease in the developing world and associated discrepancy between supply and demand requires a solutions as innovative as ours. 

Our project goals have been defined through five years of clinical and epidemiology research as well as close collaboration with the local orthopaedic team at KCMC.   The cornerstone of our project is to deliver timely orthopaedic care to injured patients, which would not otherwise be available.  The following chart summarizes several activities and outcomes (short-term and long-term) that are inherent to our project.

Our team has conducted several research studies over the past five years to define the burden of orthopaedic disease at KCMC.  In 2015, KCMC treated 11,172 outpatients that presented with a musculoskeletal issue.  In addition, 1,430 patients were admitted to the orthopaedic ward, either from the outpatient clinic or the emergency department for surgical intervention.  Of the total number of admitted patients, less than 60% received any type of surgical intervention, which doesn’t necessarily equate to definitive fixation of their fracture.  (Premkumar A 2016)

This study was re-conducted in 2018 to determine the growth in the burden of disease, without the implementation of any system level changes. The total number of orthopaedic outpatients increased to 15,117 (35%) while the number of orthopaedic ward admissions increased to 1,672 (17%).  Of all of the patients that were indicated for surgical intervention, only 44.5% (744 patients) were able to receive definitive fixation – the remainder were treated in skeletal traction and were left with long-term deformities.  (Hardaker WM 2020)

We expect that our project would allow us to address the total burden of orthopaedic disease at KCMC.  In year 1, we expect the inpatient burden to be 1,850 patients (assuming 5% annual growth since 2018).  With increased capacity and treating all patients regardless of their ability to pay, our team estimates that between 2,000 and 3,000 surgeries would be performed annually during phase 1, with the ability to scale up with additional ORs and hospital beds (phase 2 and phase 3).

Our goals are based on three fundamentals: 1) improving surgical education, 2) creating a system to treat patients and minimize post-operative complications, and 3) enhancing economic productivity of orthopaedic patients. 

Currently, orthopaedic residents at KCMC complete a four–year training program, during which they spend a majority of time observing in the operating room and not performing procedures.  This model results in residents and surgeons having to go abroad to get additional training, also through observation only.  Our proposal offers education locally, either in person or remotely using live streaming technology, thus minimizing the risk of “brain drain.”  (Chaet A 2020)

The current landscape for global surgery only allows for “blitz surgery” over short visits by surgical volunteers.   This model leaves patients at high risk for a post-operative complication that may not be addressed due to local system constraints.  We propose creating a system within KCMC to increase surgical capacity and have the local orthopaedic team collaborate/interface with international thought leaders, so patients that have complications can be treated without falling through the cracks. 

The long-term goal is to have more patients return to the workforce and become economically productive members of society.  Our research demonstrates that nearly 50% of patients at KCMC with an orthopaedic injury lost their job.  Without prompt surgical treatment, fractures don’t heal, heal with malalignment and result in long-term disability.  Without surgical care for lower extremity fractures, patients will be unable to walk.  If you can’t walk, you can’t work. 

Our project proposal faces the following barriers: 1) financial, 2) legal, and 3) cultural.

Initial financing of the project is a major barrier.  Land for the Orthopaedic Center of Excellence has been donated by KCMC, and 25 academic centers have signed a non-committal letter of intent to be a part of the project, but the current facilities are not adequate to perform orthopaedic surgery.  The current infection rate at KCMC is greater than 50%, and only a small percentage of patients receive surgery when indicated.  A new, sterile facility needs to be built for the local team to collaborate with our team and treat patients safely. 

As we are partnering with KCMC, legal issues are minimized.  We are not looking to build a center to compete with local orthopaedic surgeons; the new facility is designed for the local team at KCMC to treat patients.  However, importation of medical equipment and orthopaedic implants may incur customs duties.  Also, KCMC is a non-profit organization, and since our project is a hybrid non-profit, we will need legal assistance to maintain that designation.

The cultural needs in Tanzania are different than those of the developed world.  Our team has defined the cultural needs in Tanzania in conjunction with the KCMC Department of Orthopaedics and Trauma.  However, as the project continues to advance, the understanding of the local environment is critical to help our team fine-tune our approach to ensure appropriateness for Tanzania. 

The initial financing for our proposal is something that The Elevate Prize can assist with.  Building the first phase of the center would allow for patients to be treated immediately in a sterile environment with the needed medical equipment.  Additional financing is being sought:  grants through the Global Health Institute at the University of Pennsylvania, endowment annuities from the University of Pennsylvania Department of Orthopaedic Surgery, the Lutheran Church of Tanzania, and the Samaritan’s Purse (ongoing collaboration with KCMC).  In addition, our partnership with NSK healthcare in Tanzania is helping to identify alternative local options for financing.

A strong partnership with the Executive Board of KCMC is extremely helpful in navigating the legal environment of Tanzania.  Our team has already received approval from the Tanzanian Health Ministry to partner with KCMC on this project.  Continued work with the Healthy Ministry will be needed to prevent excessive taxation on imported equipment and implants being used at the Center of Excellence.

The continued collaboration with KCMC’s Department of Orthopaedic Surgery and Trauma will be needed as we continue to re-calibrate our approach to treating Tanzanian patients. In addition, programs to foster patient education and increase local outreach will require understanding of local cultural elements which will rely upon our forged relationship with KCMC. 

We are currently partnering with these organizations in the following capacity:

At the
University of Pennsylvania:

1.      Department of Orthopaedic Surgery: logistical and legal support for the project (Global Orthopaedics) and controller of the Penn Ortho Tanzanian Fund

2.      Global Heath Institute: annual medical student research support

3.      The Wharton School: pitch book, business plan and financial modeling

4.      Leonard Davis Institute of Economics: Impact Money Multiplier (IMM) calculation

5.      Center for Women Studies: research support for local impact of orthopaedic injuries on women

6.      School of Public Policy: annual research support for an MPH student

7.      School of Engineering and Applied Science: systems optimization and building design

Outside of the University
of Pennsylvania:

1.      Kilimanjaro Christian Medical Center: local partner in Tanzania and campus location for proposed center

2.      Tanzanian Health Ministry: legal support

3.      Dalberg Consulting: legal and healthcare consulting

4.      General Electric Africa/Healthcare: consulting support, introduction to potential investors, and provision of radiology equipment

5.      GE Capital: financial consulting/modeling in conjunction with the Wharton School

6.      GE Building Design: designing and costing of the new center 

7.      Clinic in a Can: modular operating room and orthopaedic ward design

8.      Nebula Surgical: preferred orthopaedic implant manufacturer for distribution in Tanzania

9.      NSK Healthcare: local radiology outfit collaboration with KCMC and access to additional initial funding sources

10.   Twenty-five academic orthopaedic surgery departments throughout North America, South America, Europe, and Asia 

There is a discrepancy between supply and demand for orthopaedic services in the developing world.  After building a sterile facility and forming a critical partnership with Nebula Surgical for implants, our model offers the most expensive resource at no cost – access to global thought leaders in multiple orthopaedic sub-specialties.   In order to address the growing burden of musculoskeletal trauma, the developing world is in need of a new facility, steady access to implants, on-going education, and a new mindset.

Key Resources: Financing for the new Orthopaedic Center of Excellence at KCMC, 26 institutional volunteer surgical teams (including Penn) and video streaming technology (Xpert eye) for remote surgical guidance and augmented reality

Partners and Key Stakeholders: KCMC, Penn Department of Orthopaedic Surgery, 25 academic partner institutions, GE Healthcare, and Nebula Surgical

Key Activities: Surgical education for local teams, governance of the new center, loan management for Package C patients

Type of Intervention: Service based surgical guidance and education

Channels: In-person (through surgical volunteer teams) and virtual (through remote surgical guidance and augmented reality)

Segments: All patients with a musculoskeletal injury/disease, especially poor patients that currently do not have access to surgical care

Value Proposition: Increase the number of patients treated surgically when indicated, minimize post-operative complications, and improve patient’s ability to return to work

Cost Structure: Building and facility maintenance; management staff

Surplus: Cross-subsidized coverage of Package C patients and a bonus structure for the local team

Revenue: Package A and B patients, endowment annuity from Penn and optional donations 

Planned funding for this project is a combination of sustained donations (e.g. endowment annuity from Penn and patient donations), grants (e.g. the Penn Global Health Institute), and raising investment capital for building the facility.  This proposal represents a service subsidization and organizational support model. With volunteer surgical teams being present with the local team to collaborate and operate on patients together, the service component and education will be offered at no cost. 

Based on the patient Package designation, Package A patients paying a premium for amenities such as a private room, and Package B patients having insurance coverage will yield surplus revenue for cross-subsidizing Package C patients.  The focus on Package A and B patients is the key to making this venture financially sustainable and allowing for more Package C patients to be treated.  

The current employees that staff KCMC’s Department of Orthopaedic Surgery  (i.e. surgeons, residents, nurses, physical and occupational therapists) are given a government based monthly salary.  This salary is expected to continue as the team collaborates to treat patients at KCMC, just in a new facility.  Therefore, all revenue will be used for cross-subsidization, paying a bonus structure to hard-working local team members, and as operational equity to be placed back into the Orthopaedic Center of Excellence.  Our volunteer teams are exactly that – they are volunteers and thus do not receive any percentage of the revenues.

The team has received several grants over the past five years dedicated to this work.  In 2018, we received a $40,000 grant from the Global Health Engagement Fund for creating a surgical video library, containing several different orthopaedic surgeries, for our colleagues at KCMC.  With the addition of two KCMC surgeons as adjunct faculty at Penn Medicine’s Department of Orthopaedic Surgery, KCMC now has had access to the Penn Orthopaedic Portal and complete surgical video library since April 2019.  In 2019, we also received a $5,500 grant from the Penn Undergraduate Research Mentorship Program used to fund a Wharton student to focus on calculating the impact money multiplier (IMM) according to the Rise Fund (HBR January 2019).  The Global Health Institute at Penn has also supported our project with an annual grant of $4,000 to fund two medical students and conduct research on the ground in Tanzania.

In addition, nominal funds have been raised through the Penn in Tanzania Fund.  A total of $20,000 were raised in the last 12 months through patient donations. 

Our proposal estimates a total of $6 million for the project, with an initial capital expenditure as follows: building Phase 1 of the facility (2 operating theaters, pre-op and post-op holding area, 50 ward beds, patient physical therapy gym) ($1 million), required medical and non-medical equipment ($2 million), and cash for operations and management fees until the center becomes financially sustainable ($1.5 million).  Focus will be placed on raising additional funds for Phase 2 (2 additional operating theaters and 50 beds) ($500,000) and Phase 3 (4 additional operating theaters and 100 beds) ($1 million).

Land Cost: $0 (Already donated by KCMC)

Rent: $0

Utilities: $0 (Covered by KCMC for the proposed new center)

Electronic Medical Record Installation / IT: $0 (the proposed new center to be outfitted by KCMC)

Constructing a portion of Phase 1 of the facility: $350,000

Identifying and Employing a project leader in Tanzania: $75,000

X-pert eye Technology: $50,000

Travel to Tanzania: $25,000

Total: $500,000

We are applying for the Elevate Prize because we believe our proposal is transformational, innovative, purpose-driven, and solves a major problem in the developing world.  The novelty of our project is predicated on our ability to capitalize on global thought leaders to help educate the next generation of orthopaedic care givers in Tanzania.  Based on the research our team has conducted and published since 2015, this model is scalable.  With acquisition of the proper target market specifics, this model can be recreated in Nicaragua, Cambodia or any region in the developing world. 

We believe we are at a tipping point.  Five years of research and collaboration with KCMC has helped us quantify the burden and define the barriers to delivering timely and effective orthopaedic care.  The next step for us is to build a proper Orthopaedic Center of Excellence – giving the local team a sterile facility to work in along with in-person and/or remote surgical guidance can start addressing the burden of musculoskeletal disease.  The Elevate Prize would assist our team with financing the construction of the new center as well as identify and employ a team leader in Tanzania.  We have secured the most difficult components of this venture – 25 teams outside of Penn and a preferred vendor (Nebula Surgical) to provide quality implants at a discounted price. We now have to create a place to treat patients, as the current KCMC facility offers inadequate surgical capacity and exhibits a high rate of infection.

Partnership is needed at this stage of the project for funding the construction of the new Center as well as identifying and employing a local team leader.  The marketing and media exposure provided by The Elevate Prize would help our team determine the correct local team leader.  Our partnerships with the Executive Leadership Team and Department of Orthopaedic Surgery at KCMC are critical to the success of this project, but locating local talent to lead and focus on project management on the ground is paramount; this allows our colleagues at KCMC do what they do best, which is deliver effective healthcare.  In addition, the media exposure through The Elevate Prize would lead to potential further funding of subsequent project phases as well as increased awareness of the global impact of road traffic crashes.  

Through The Elevate Prize, we would look to make connections/partnerships with large organizations that have had a major impact in East Africa including: The World Bank, International Monetary Fund, Africa Development Bank, and Vodacom (especially as telehealth plays a bigger role in delivery of healthcare across Africa). We believe that coaching and mentoring provided by The Elevate Prize team would help us strategize and identify other pertinent alliances in the region.  We have listed a few specific companies in Tanzania/East Africa below.

1.   Dalberg Consulting – forging a stronger relationship will help with local consulting and guidance for navigating the Tanzanian healthcare environment 

2.  Tigo Pesa – partnership to increase access to health insurance for KCMC Package C patients

3.  Pharm Access – alliance with Tigo Pesa to offer a top-up program for Package C patients that have insurance (either Tigo Pesa
insurance or Community Health Fund (CHF) insurance from the Tanzanian Government) 

4. Amref / Air Ambulance – begin a conversation for KCMC to become the preferred provider for orthopaedic care in northern Tanzania

5.Kilimanjaro SAR – partnership to increase the number of airlifted patients with an orthopaedic injury to be brought to KCMC 

6.Jubilee Private Health Insurance – partnership to create an orthopaedic package for their insured patients which requires care to be given at KCMC