Basic healthcare for the last-mile

Healthy Entrepreneurs provides sustainable basic health care where no one else will go. 

Over 2 billion people worldwide living in remote and hard to reach areas, have no access to basic healthcare. They lack quality medicines, healthproducts, and education. Due to the absence of diagnosis and treatment of infectious diseases in these remote areas, the disease is not treated and continues spreading. The distance to products and services makes them particularly vulnerable. Due to a lack of knowledge, people are unable to make well-informed decisions about their own health and that of their children.

Healthy Entrepreneurs (HE) deploys a last-mile distribution model to deliver affordable and reliable health products and services to the poorest women and children living in rural areas of Sub-Sahara Africa via a network of trained community health entrepreneurs.

Our trained entrepreneurs receive a starters kit with $70, - value of products to build the business and are equipped with a smartphone with two apps. The ‘Health-app’ contains over 125 videos and provides support for health education and screening, the ‘Product-app’ promotes health products in the assortment and provides a solution for online ordering. HE’s basket of goods targets the health of children under-5 years with products like anti-malaria medications, as well as sexual and reproductive health and rights products for women with items such as sanitary pads, and contraception. The advantages of the integrated supply chain of HE are procurement close to the source, bypassing the regular (expensive) wholesale and retail and organization of monthly deliveries of the full range of items to locations close to the entrepreneurs.   

Via the network of trained entrepreneurs and an effective distribution chain, a broad package of affordable basic health products and services becomes available in these remote areas. In fact, the HE-model empowers Community Health Workers to execute their role they were selected for in their community, provides them with additional sources of income and motivates them to perform their task as CHW.  

With the help of simple diagnostics and access to a remote expert, we expand the range of products and services offered. We aim to make screening of common diseases easier, more accurate and better accessible by carrying out easy to use and affordable rapid-tests, simple point-of-care diagnosis or apps. Based on the test result the patient will either receive treatment or be referred to an expert. In case no physical triage is required to prescribe a treatment, the expert will be available at a distance through phone or chat. In other cases, the patient will be referred to the nearest health facility.

The successful extension of services and products directly contributes to the value proposition of the entrepreneur and more health impact and improved health outcomes in the remote­­­­ communities. By using simple and easy-to-use diagnostics. basic health care is even more accessible to people living in remote areas.

The last-mile distribution model enables HE to unlock remote communities with access to basis healthcare. HE proves that medical care in remote areas is possible and we have made it cheaper, more effective and more sustainable. 

The innovative element is the creation of a platform allowing for various services for screening and diagnostic to be offered in remote and hard to reach areas. The project is based on a combination of existing diagnostics, apps, training, supporting technology (apps) and expertise (doctor) at distance. The creation of such a model and platform requires the involvement of various stakeholders including the national government, health experts, suppliers of various diagnostics, entrepreneurs and researchers. 

Technology is at the core of the business model of HE. Automizing and standardizing operations is the key to serious scale. For this innovation new applications are used. The applications will use triage for immediate patient assessment. We will use several applications to detect the disease and provide advice for treatment. Also a platform is created whereby the entrepreneur has direct access to advice and support from a doctor on distance. 

In the next 12 months we identify 3-5 propositions with the potential to diagnose and screen for diseases and corresponding supportive application. The outcomes are several targeted propositions for remote areas that include the use of diagnostics and access to communication with a remote expert. The business case is viable once at scale.

The key objectives are to (1) identify the right diagnostics/screening tools and self-test (2) the use of experts at a distance (3) the design of a supporting e-health solution and (4) to build evidence for market value an customer demand by testing different models, considering both the entrepreneur and end-user perspective. 

HE wants to be a role model, working in partnership with governments and other stakeholders, using a sustainable business model based on entrepreneurship to ultimately gain access to all isolated communities to diagnose and treat common diseases. In 2022 we aim to have 35,000 franchisees in eight countries reaching more than 70 million people with health-related products. Our goal is for all programmes to be financially self-supporting. We continue to work on the growth of the network and usage of diagnostics, but also on the range of impactful products and services. Research is used in optimising the effectiveness and impact. 

Our entrepreneurs and their costumers live in rural areas. A family (five people) spends an average of $ 45 out of pocket expenses per year on basic health care. The health entrepreneurs are preferably women. Experience shows that women are more reliable and motivated to improve the health of their village. HE works with official Community Health Workers (CHWs), who have been trained by the government and chosen by their community as the 'to-go' person for health issues. By offering reliable, affordable products of high quality combined with education, the entrepreneur will build trust and track record in their community.

To date, HE has on-boarded and trained 3500 micro-entrepreneurs (78% women) in 5 countries. This network has reached over 1.000.000 rural households. The retention rate of entrepreneurs is >95% after three years. Going forward, HE plans to grow the network to 33.000 entrepreneurs in total in 2022, reaching 40 million people. Independent research concludes significant improvement in health and wellbeing (M. Kok 2017). Our entrepreneurs tend to be more motivated and spend more time (+20%) on their health work, referred twice as many patients, and followed more refresher training, than regular Community Health Workers. 

In the next 12 months we expect to train an additional 3000 entrepreneurs, reaching a total of 6500 entrepreneurs. Each entrepreneur brings quality health products and service into their community. With the combination of screening and diagnostic, we can target 75% of untreated people effectively in remote areas. The ambition is building a financial breakeven operation by growing the network of entrepreneurs, improve the portfolio of products and services offered and preparing the operation for private investors. 

Management responsibilities lie at country level. In all countries HE employees are competent and motivated. During the start-up countries are managed by an international manager. The team consist of: country coordinator, supply chain manager, operations manager and finance manager. The expansion of the network means the organization itself expands. However in each country a compact core management team remains.  

The support office in the Netherlands provides support on the management of the ERP system, applications, finance, international procurement and business development. The management team in the Netherlands also provides the operations with training and opportunities to share knowledge and proffesionalize.  

HE implements a volume-based model based on rapid growth of the number of micro-entrepreneurs and products sold. HE generates revenue (18%) from the sale of goods to the micro-entrepreneur network. The entrepreneur generates on average a revenue of 30% on the sales of goods. In order to contribute to the overall profitability and the demand, HE includes a range of products beyond health commodities that generate higher margins, such as washable sanitary pads, lubricants, feminewash, diapers and solar lamps. The revenue split enables microentrepreneurs to earn sufficient income to support their families.

Families in such isolated areas spend an average of $43 a year on basic healthcare, making the potential annual turnover for an entrepreneur $13,500 in the existing market.

The added value for the patients is in the accessibility, affordability and reliability. Patients spend normally between 3-8 hours to reach the health facilities that provide basic health services only and are facing stock-out issues for 60% of the pharmaceuticals. The cost of transport to reach a health facility is between $1,5 and $2 and the average price of a treatment is around $1. Entrepreneurs at community level offers access to all basic health solutions at an affordable price.

As a global community on social challenges, Solve equals entrepreneurial connectivity. Meeting ‘valuable mentors’ who are willing to share their expertise is a great opportunity. We are fully aware that our business model could constantly be improved by other people. As our model is scalable, we are keen to learn, discuss and create ways to expand our business or the start-up of an operation in a new country.

Solve is the right way to be to connect with investors and experts interested to make a difference. We believe that Solve can help us reach our next level of 30.000 entrepreneurs.

Our ambition is to remain an effective organisation and remain in control of our sales and expenses even with the big growth we envision. Central to our objectives are introducing new diagnostics and professionalization and standardisation. At the same time, the entrepreneurial spirit that is so chararcteristic for the organization, is key to being able to focus on customer needs and putting them at the core of everything. Our ambition is to realize the funding for our growth and innovation, and focus on operational excellence. We belief Solve brings the perfect platform and support to achieve these goals