In4Net

In4Net is a digital empowerment tool that leverages the availability of mobile phones to strengthen global monitoring systems and communication channels to detect and respond to current and emerging infectious diseases in real-time.

Joseph Mulabbi

Uganda ranks as 159 (out of 189) in terms of HDI and is considered a least developed country (UNICEF, 2018). Of the 45 million citizens, 75.64% live in the rural areas (World Bank, 2019) with limited access to basic services. As for health in particular, we have an inadequate health workforce, with doctor-patient ratio in Uganda estimated at 1:25,725 and the nurse-to-patient ratio at 1:11,000 relative to the minimum recommended ratio of 2.3 of all healthcare workers (WHO, 2019). This has lowered the quality of health care given to patients.

This above situation leads to an environment where the vast majority are ill-informed and un-prepared to adequately deal with their health issues, even policy makers find it hard to collect health data in such areas and community members are often become apathetic and seek medical advice when the situation is dire. While many attempts are made to improve the populations health, they generally focus on un-scalable and costly methods: TV campaigns, face-to-face community outreach awareness, emails, smartphone apps, etc.

Simply put, these methods do NOT reach the most vulnerable demographic.

In4Net has the potential to provide health care providers and policy makers with more accurate, real-time insights on the risk of COVID-19 and other infectious diseases. The innovation can deliver health information to influence individual behaviors to prevent and mitigate outbreaks. 

As demonstrated in South Korea, widespread testing is critical for early detection and to manage infection rates. However, widespread testing has yet to be achieved in many countries resulting in higher than reported rates of infection, impeding effective reopening plans.

While it is difficult to estimate the number of people affected especially in rural communities, countries struggling to lower the rate of infection, achieve widespread testing and encourage hygiene behavior, represent the scale of the problem the solution can solve. Other factors such as limited access to health care create barriers to testing, particularly in low and middle incomes countries further contribute to the challenge. 

By promoting the adoption of better behavior, encouraging those who can to get tested, and measuring the potential spread, the solution can surface key indicators that contribute to ensuring better prediction and detection.

Our solution serves all Ugandan citizens, particularly the under-privileged in the rural areas and with low-tech phones. 

We feed the platform with relevant information, and we have a voluntary self-registration section where the citizens provide their gender, age, and location, for us to understand how the usage and needs vary based on the user’s demographic. While we do have a free questions section (answered by the Ministry of Health’s call center), we plan on introducing satisfaction surveys in the near future to ensure we are constantly meeting the users’ expectations and providing the content they want.

As for the Ministry of Health (MOH), they will rely heavily on our platform as a front and center of their posters and campaigns, particularly during the Covid19 pandemic where traveling and community meetings are discouraged. At the request of the MOH we can send out SMS awareness campaigns on rabies/vaccinations, performed surveys, provided self-screening, etc. Most importantly, we can also provide usage data/reports to help guide their decisions and policies.

Additionally, as a cost effective, globally accessible solution, the innovation benefits any population at risk of being infected by COVID-19 and has the potential to detect emerging infectious diseases. The solution offers mechanisms for early detection that can help prepare health care systems and allocate necessary resources such as medical equipment and personal protective equipment, mitigating infectious disease emergencies.

Decision makers have limited insights into the true conditions making it difficult to detect and prevent outbreaks among the workers. Workers have limited channels to access information and report concerns. In4Net has the ability to close this gap thereby directly impacting and improving the livelihoods of the workers.

Our mHealth platform provides every Ugandan free and MOH-approved health information through USSD, SMS, and a responsive website, covering the last mile and the bottom of the pyramid. In4Net (Health Information Education Platform) is available on all Ugandan Mobile Network Operators by dialing *787# and through the website (www.in4net.com). Through either channel the citizen can: - see symptoms, precautions and general information for various diseases; - see information on maternal health, baby development, and vaccines; - get contact details for health facilities; - and more. Our main objective is to get information about health to the most vulnerable citizens and to facilitate the interaction between citizen and the entities that offer health basic services so as to well prepare ourselves to counter current and emerging disease outbreaks. As part of this project, we prepared with the Ministry of Health and make freely available health content.

The Innovation will benefit all vulnerable people without discriminating on age, gender, or ethnicity. However, all health entities will also benefit because information about their health-related services and products will be at the reach off all citizens. The vulnerable people have access to health information via USSD and can interact with the Ministry of Health (call center) to clarify their doubts.

In4Net is particularly relevant, given: - low physician density: 25,000 patients per physician (average); - Impractical outreach awareness campaigns: which are slow and resource-intensive due to the materials and personnel required to visit all the rural areas; - Inadequacy of conventional technologies: TV & Radio are expensive as a continuous means of communication and many citizens don’t own TV’s or radios; While Internet reaches only (the richer) 10% of the population.

In4Net is is affordable (i.e. free) solution that focuses on information for prevention and mitigation of health issues of the Covid19 pandemic and beyond. Besides Coronavirus, the platform is filled with other relevant information such as HIV/AIDS, Maternal Child Health & development, malaria, diabetes, strokes, etc. We are introducing disease surveillance now through self-screening. Our solution exists within the National Health System ecosystem as we are integrated with the Ministry of Health contractually and technically.

According to our telecommunications regulator, over 80% of Ugandan adults and adolescents possess cellphones, turning it into the ideal vehicle through which to deliver services and solutions to the citizens. Of these cellphone-holders, however, only 20% have smartphones, a third have feature phones, and the rest (the majority) have basic phones. These different devices, and inconsistent network coverage, makes conventional mobile apps less adequate for our reality. Through Unstructured Supplementary Service Data (USSD)--a technology available on all cellphones--we avail to citizens pertinent push & pull health information provided by the Ministry of Health (MOH), and even employ the MOH call center to respond citizen's questions. This is particularly relevant given the costs and distances required to reach the health centers, which often deters the underprivileged from going until their health issues is very severe.

The proposed innovation also provides decision critical data in key regions to enhance disease surveillance systems. Offering real-time analytics, decision makers can leverage the insights to accurately detect risk of outbreaks. Rather than reactively respond to global health crises, organizations will be able to rapidly respond to early warning signs and prevent or lessen the impact. 

The potential of In4net’s survey, grievance and broadcast modules goes beyond COVID-19 and can adapt to other demands such as measuring and monitoring the impact of climate change and risk of another pandemic with high-risk populations. 

Scaled globally, the technology can be adapted to collect and analyze data on additional key indicators such as the wellbeing of healthcare supply chain workers to support global health security. 

Our potential to scale to new markets will depend mostly on the kind of partnership we create especially with governments, NGOs and the availability of funding required to enter into a new market.

Because our solution is affordable, it is easy to scale.

We shall therefore work to create more collaborations, partnerships as well as engage in strategic and vigorous advertising and marketing campaigns to help us make the platform know to the unknown markets.

Given that kind of setting, we shall then work in our first year to establish our base in the East African markets (countries) i.e. Uganda, Kenya, Rwanda, and Dr. Congo. Upon our success in those markets, we shall then venture into Ethiopia, Nigeria, Tanzania, Ghana etc. as well as figure out how able we can scale to some Asian countries in year 3-5.

We also intend to leverage the available grant competitions by fully participating in them for grants and awards something we believe will give us a good platform to make know of our produce and its services to potential investors, mentors, collaborators, entrepreneurs etc. from which we can easily find people who can help us scale our product into new markets.

Success is measured based on the rate of engagements on the platform as well as the accuracy of the platform to offer real-time analytics and response actions decision makers can leverage to detect and respond to disease outbreaks even before they happen. Also the usability of the users to be able to navigate through the platform to access the data needed when needed.

By growing the number of users on the platform who access information and those who place in their reports and inquiries on different disease symptoms and the number of people engaging our 24/7 caller center will help us determine our impact rate.

We shall also measure impact based how many grants, revenue, awards the project receives both from the public and the private sector in Uganda, East Africa, Africa and Globally. This shall also be complemented by the number of both local and international NGOs and governments we shall be working with to implement the solution.

Finally our impact shall be measured based on the number of countries where we scale the project as well as the number of people altogether the solution is able to provide healthcare data and services to.

The main barrier we face are resources and guidance. The first is legal guidance to navigate the tricky waters of how to renew the Ministry of Health contract in a manner that facilitates revenue generation, as well as with the operators. We would also like to do better with regards to patents and trademarks.

Second we would like to explore the revenue generation with more energy. Third we would like to increase the functionalities and features of the platform in alignment with the needs of the users and the revenue generation.

We ideally would like to receive non-equity-based grants to address the barriers above. In the absence of such grants, we are willing to pursue equity-based support, and partnerships (we have already initiated one with a local business development company).

Other barriers include;

• Financial – Since we are largely a bootstrapped, self-funded venture, we are looking to raise capital to make our next phase plans reach fruition.
• Product Development – Our product is a relatively new concept in public health space in Haryana and India. We don’t have many precedents to emulate, so we will be setting our own product benchmarks.
• Indian Bureaucracy – Health sector in India is tightly controlled state matter with state bureaucracy calling the shots on virtually every aspect of it. Breaking this status-quo may be a challenging task. 
• Outreach – We hope that our product’s capabilities will be its selling pitch. However, we do recognize the need to tap into newer markets and hence, we need a well-rounded strategy on outreach and product positioning.

 Possible barriers that we can see for next five years: -

• Adaptability – To adapt to functioning of different state governments, where cultures and style of working can be in stark contrast to what we’ve seen.
• Competition – Although we don’t see much in terms of competition within India at this moment, but in a few years, we do see competition in this space heating up as governments (states and federal) see the benefits of investing more into Tech based initiatives in public health space. 

How we shall overcome the above barriers!

• Raise just enough capital at the start, to have sufficient funds for product development needs while also ensuring our focus firmly remains on maintaining our fiscal prudence and lean philosophy.
• Invest the maximum on developing a robust and fail-safe product that delivers. We feel that much of the barriers for a young company like ours, are removed once we have credibility and market goodwill.
• By developing a close working relationship and rapport with governments and personnel in key industries. As an example, Ministry of Health has shown keen interest in tech-enabled governance and we've already developed a great trust with our work during the CoVid-19 outbreak, which gives us a higher platform of acceptance. Such initiatives can start dialogues and spawn newer opportunities.
• By staffing our team with the right personnel. While we are a team of multi-taskers, we do feel the need to have designated people manning specific tasks for accountability and overall company health.
• By keeping ourselves aware of the peer research and development in this sector. While we shall have confidence in our own capabilities, we shall always keep ourselves aware of the market direction and advancements.

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We need partners or support on solutions technology, mentorship, networking with fellow entrepreneurs and global change makers, funding and revenue model and marketing, media, and exposure, because we have a solution that already shows public utility through our concluded proof-of-concept, but we need to improve services, improve the marketing strategy in order to reach more people, in a short time, and for that we need support, both financial and technical. We believe that The Trinity Challenge is one big and very important platform we can leverage to achieve some if not all of the above needs as we move the project forward. We also ideally would like to receive non-equity-based grants to address the financial barriers. In the absence of such grants we are willing to pursue equity-based support, and partnerships which we believe that The Trinity Challenge members are all potential partners we can easily reach out to for partnership, investment, and collaborations.

We need partners or support on solutions technology, mentorship, networking with fellow entrepreneurs and global change makers, funding and revenue model and marketing, media, and exposure, because we have a solution that already shows public utility through our concluded proof-of-concept, but we need to improve services, improve the marketing strategy in order to reach more people, in a short time, as well as be able infiltrate new markets across the globe and for that we need support, financial, mentorship, collaboration, partnership and technical support. We believe we can leverage The Trinity Challenge to achieve some if not all of the above needs as we move the project forward especially by making use of its network of founding members such as Google, Facebook, Microsoft, Bill & Melinda Gates Foundation, Institute for Health Metrics and Evaluation, etc. These members present a vital network of global tech giants and experts in software, investment and mentorship. We shall seek to engage them based their experience and capacity to help us move forward.

We also hope to partner with governments' Ministries of Health, WHO, and other both private and public entities for financial, mentorship, and technical support services.