IYEWO

As of 2016, about 6,000 of 30,000 PHCs in Nigeria were assessed to be functional but suboptimal. Health systems with strong primary care can address up to 90% of a population’s health needs, lowers over all cost of care, reduces the frequency of emergent and critical health needs, and are more equitable and resilient to disease outbreaks such as COVID-19. 

Studies have shown that adults who have primary care providers have lower odds of morbidities and early death than those who see specialists alone. 

In Nigeria and many African countries, the cost of health care is mostly out-of-pocket, particularly in the informal sector which makes up more than 60% of the population. This makes seeking proper primary care delayed till illness is critical, predisposing to severe complications, financial bankruptcy, and needless loss of life.

We developed Iyewo to address access to primary healthcare.

Iyewo is a service for the informal sector in Nigeria that seeks to improve primary health care delivery and community health promotion in Nigeria starting with the city of Lagos through a people-centered solution that provides medical and referrals. preventative, early diagnostic health services.

Iyewo has 3 components:

• Clinic: conveniently accessible locations in local communities will facilitate the engagement and encourage the practice of seeking care early. The clinic will provide in-person and telemedicine consultations, annual screening, and wellness checks, social determinants of health, and referrals as needed.
• Community health service:  This team serves to extend care beyond the clinic and highly skilled clinicians through health promotion to address pertinent social determinants of health that drive disease and ill-health. This team also draws from local youths who are trained to fill various positions.
• Health savings wallet: Facilitate individual health care financing through small & micro-savings. The wallet will also grant access to installment pre and post-payments as well as group discounts for partnered services like diagnostics, inpatient or specialist care.

When a person registers with IYEWO, their medical history is collected and a savings wallet is opened for them. The next appointment is made for an annual screening/ wellness check. The medical history helps the clinic team to prepare for the visit, during which the patient is seen by the doctor to review field history, collect additional history and conduct a full physical examination. Age and risk-appropriate diagnostic tests are carried out.

The patient has a 2nd visit to discuss results with the clinician, characterization of health status done and the clinician prescribes appropriate treatment and recommendations for diagnoses given. With consent the care coordinator is brought on board to help patients create a care plan, connect them with community resources and guide them through the next steps.

Patients get education, monitoring, and support with check-ins through SMS, phone/ video calls, or in-person visits as specified by community health workers.

Patients who cannot immediately afford the cost of a pertinent treatment can be cleared to complete treatment and make installment payments through their wallets. Patients can also make installment prepayments towards treatment such as mammograms, elective surgery.

Our target population are informally employed Nigerians, many of who are daily earners relying on daily earnings or profits for livelihood. This group makes up 60% of global population.

In our first target Location Lagos has a population of 23 million in the state with just 2500 doctors. Patients a discouraged due to long waits at hospitals which impacts their poor infrastructure. A country with 34% adult mortality rate and 8th globally in infant mortality. Our current community is a mixed use area with dense commercial activity having only a handful of hospitals and health centers serving it.

Iyewo will provide accessible health care by situating clinics close to places of informal business to reduce time spent traveling to providers, and digital platform to streamline connectivity to patients, and easy access to readily available community health workers who provide closer to home care, are members of the community which improves trust and acceptability of service. A culture of saving and financial planning for health will manage the burden of health costs and being able to negotiate lower costs for the group with other service partners. Iyewo is also designed to be accommodating to the lifestyle of informal market by having extended work hours, weekend clinics and telemedicine service.

Consumer-Centric: We apply deep community linkages, and relationships, as well as locally recruited and trained community health workers in the delivery of our services. Our community workers were recruited from youths residing in the local government areas of our services, this removes the possible social and cultural learning gaps and ensures an understanding of the nuances and challenges specific to the community members. In addition to these, we have a service design specialist co-founder with over 12 years of experience in human-centered design, with a focus on healthcare service delivery in Nigeria.

We conduct intermittent reviews of the quality of service and changing needs of the community. Through these, we identified indigent patients who could no longer afford their medications and created a scheme to provide medications to help maintain disease control. from our surveys both qualitative and quantitative we have identified a demand for a clinic within the market and a willingness to pay. 

We conduct focus groups with community members and patients to understand their challenges and get input on the next steps and needs.

Even though the vision has been to create a health system with a strong primary health care foundation, the push for our first clinic is driven by the clamor of the community who have expressed satisfaction with the care received and want us to expand our services to clinic care.

Diverse Knowledge Base and Experience: Our team of founders, advisors, and staff have diverse social backgrounds, knowledge, and experiences across global health, clinical medicine, design, marketing, and digital products development tailored to the Nigerian market. This provides deep insight and empathy as we embark on this solution design and implementation.

Team Culture: We are driven by resilience, empathy, agility, and excellence. These push us to pursue a very complex challenge, open our minds to the realities of community members, and allow us to adapt to the realities of our target markets, which we currently meet and are serving on the field.

A big attraction to Solve is access to experts as well as young entrepreneurs who are in a similar stage as us. The opportunity for peer coaching in addition to global expert mentorship provides rich insights for our business growth. MIT's network also gives an exciting avenue to partner with institutions and organizations with aligned goals to collaborate with. Strategic support with technical resources and financing avenues are also key to our interest in the MIT Solve program.

In addition to the traditional in-person clinics, our solution leverages technology to deliver access to more people per time while using less human capital by providing telemedicine consultation, digital access to the care team, scheduling, and community support. 

Primary care is essentially absent in Nigeria, disease burden is high due to preventable illnesses. Our design of merging community care delivered by low-skilled workers with in-clinic primary care provides a continuum of care through a spectrum of connected services and multidisciplinary teams. This improves acceptability and availability of care through personal connections and collaborations in the community.  This approach is different from traditional health care delivery that is detached, impersonal, and not dynamic to accommodate the changing needs of informal markets and daily earners. Available health care is not proactive about preventing illness or complications, unlike our solution that will guarantee health screening and initial doctors visit within 90 days of enrollment. The major shift we hope to achieve is to associate orthodox health care with caring, accessibility to our target population.

Over the next 12 months we plan to:

1. Set up an Iyewo Clinic in Lagos Island, Lagos, Nigeria. 
2. Enroll 2,000 subscribers. 
3. Build Minimum viable digital services. 
4. Complete annual health assessment for subscribers within 90 days of enrollment. 
5. Train 10 community health workers in frontline delivery of IYEWO services.
6. Create a partnership program for supplemental service providers (e.g dieticians, fitness services providers, etc)

In the next 5 years, our goals include:

1. Create a health system by establishing a network of primary health clinics.
2. Build the iyewo integrated digital app
3. Increase our subscriber base (patients) to 100,000
4. Improve health and financial literacy in our service communities through community outreach to other states in the country. increasing grassroots and market, radio campaign.
5. Expanding to 50 communities

• Lower the rate of uncontrolled non-communicable diseases such as hypertension and diabetes in our service community/ patients by 5% in 12 months.
• Facilitate optimal/recommended health savings for 20% of our subscribed members.
• Increase the number of trained community health personal health by at least 10 per community in 12 months.
• Hold at least 4 community-led health promotion activities per community in 12 months.

Our goal is to onboard 2,000 clients in the first year of operation under our continuous primary care access program Iyewo. We hope to achieve this by:

1. Ensuring access to a digital wallet and bank card for at least 2,000 clients on Lagos Island, 
2. Providing a local modular and properly digitized clinic staffed with clinicians trained in patient-centered care, and
3. Conducting bi-weekly engagement with 2,000 subscribers at their chosen, safe location within Lagos Island

To achieve these, we will be engaging our current clients and prospects within the target geography through quarterly outreaches, and culturally smart consumer marketing through our community health workers. We hope to reach 20,000 people during the outreaches and reach 500,000 community members, market women and men, and local artisans with our marketing campaigns. This target is based on our pilot experience of retention after outreaches.

In addition to these, we will deploy well-trained clinicians and community health workers with digital health platforms that enable continuous connectivity with our clients, clinic visit scheduling, and storage of health records. The digital platforms will be tailored to each group of health workers, the clinicians work with a full electronic health record with AI-guided decision support to guide quality care interaction during every visit. The field version of this platform will support our community health workers with continuous data capture during every client visit, as well behavioral health prescriptions based on the current health status of our client.

We train our team with our standard curriculum which we hope to deploy at scale in the future through our training hubs (online and onsite), during this pilot phase our trainers will conduct the training and closely observe its impact on our clients' interaction and perception of quality.

We are basing our market penetration strategy on an ethnographic insight as well as a database of our target audience. It is with insights from here that we are tailoring our overall service design.

To successfully deploy our digital health platforms, we rely on our woman-led highly skilled digital workforce. We will also collaborate with an existing commercial bank in order to guarantee the quality of our health savings service.

Finally, to deploy this service successfully we rely on funds to manage our operations, as well as clinician volunteers that can donate their time, especially during our outreaches.

We are implementing all of these based on the assumption that there shall be internet service access in our target community, in addition to a safe and secure environment that guarantees the safety of our staff and the infrastructure we are deploying. We are working with an assumption that our target audience's literacy level is basic education, and their technology literacy is low. We are therefore deploying technologies that guarantee their online safety.

The core technology behind our solution is a web-based electronic health application and a user mobile application.

Our web-based electronic health application has a clinic and field module, with AI capabilities on both of them. The AI capabilities provide decision insights based on the current health clinical data of our patients.

Our user application is a digital wallet in its pilot phase. We will also be deploying a bank card at this point. In the next iteration, we shall be upgrading it with additional AI capabilities and a marketplace of relevant wellness products and services. The AI component is to support the consumption and educational needs of our clients with the right fit of additional quality of life-enhancing services, as well as health information properly tailored to their current health status.

Our team is led by a woman physician and women hold more than 50% leadership and managerial roles at our organization. We have gone to great extents to make accommodations for both birthing and non- birthing staff with newborns. We have an open platform that has fostered discussions, suggestion on improvements by all staff. Also there is a direct channel of communication across the organization to ensure everyone feels heard and valued. The organization acknowledges and celebrates notable festivities and holidays across the faiths of all our staff. 

Client subscription forms part of our business to consumer model where patients enroll in our clinic and subscribe to our health wallet service.  Membership/subscription fee is charged, then fee for single or bundled services and administrative charges on health savings accounts.

Business to business model, by partnering with businesses that provide diagnostic and higher level of care services beyond primary health. A commission is earned on charges paid by referred customers.

Our business enterprise is embedded with our social impact mission. Our operating strategy includes charging fees for medical and home care services rendered by the organization. 

Sourcing grants to support key programs and subsidize care for low income clients such as cervical cancer screening, targeted health education or reproductive health. We have a small group of donors which we plan to increase to adopt indigent patients, donate specific care packages or generally use donations.

At this time the organization has not received any outside funding. activities so far have been self funded by the founder. 

We are applying for grants to test the next phase of our pilot and we have raised $4500 within a month of announcing our enterprise plan to close family and friends.