SPAQ

The maternal mortality rate in the Democratic Republic of the Congo is 493. This means that pregnant women here are a hundred times more likely to die than in developed countries such as Japan. One of the causes is poor health service levels. Even if they come to a medical facility, they cannot expect sufficient quality of service. Although many digital solutions such as electronic medical record and IoT medical devices have emerged in the market, they haven’t been used in most of small health centers in Africa. The major causes are three missing integrations.

①     New solutions are not integrated into routine process of examination. Digital solutions have each own app. Data collection software and IoT devices are separated from routine process of Antenatal Consultation(ANC) of local health workers.

②     Operator of Data collection is not integrated into user group of collected data. Typical data collection software has an objective of data collection itself only. Health workers who are expected to input data has no benefit from those data.

③     Customer success is not integrated into key objectives of projects. Although the financial sustainability has to be assured by every introduction of new solutions, clinical aspect is only focused in various projects. As medical facilities or health workers are main customers or users , the solution has to realize both clinical impact and financial success in order to assure the sustainability. of use of the solution.

We solve above-mentioned problems by combination of technology and business model innovations.

①     Integrated digital package of different devices to facilitate daily use:

SPAQ is an all-in-package of digital obstetrics health care services for small African health centers. It is composed of smartphone, software, medical devices, solar battery, identification cards and other consumables. By following the navigation of the smartphone app, health workers can cover all standard indicators without any omissions including examinations with IoT devices. Innovative devices such as portable ultrasound and fetal monitors are linked with the smartphone App platform. As ultrasound is included in standard ANCs process in SPAQ, average 88% of ANCs conducted with ultrasound examinations at 7 health centers in Kenge, DRC.

②     Integrated process of digitalized ANCs to enable data collectors to benefit from data: 

The health workers input results of examinations following a navigation of SPAQ app. For some indicators such as blood pressures, abnormality is automatically displayed with alerts to avoid missing signs of high-risk pregnancy. Some functions can skip time consuming tasks such as calculation of the Estimated Date of Delivery, double check of calculation and simple interpretation of results. As transition of results are displayed automatically, users don’t need to search health record documents for previous results. All the data are registered in a cloud server to be shared with experts in urban area to help local health workers remotely.

③     Integrated objectives that create both clinical and financial impacts

To assure financial sustainability, SPAQ is designed to increase income of health centers. First of all, health centers need to understand what patients want in order to increase the number of customers. SPAQ has a function of questionnaire for pregnant women. Based on continuous data collection on patients’ satisfaction, SPAQ and health centers have improved the quality of service focusing on patients’ needs which are sometimes different from clinical quality. During 4 months of trial in 7 health centers in Kenge DRC, the centers saw 74% increases in ANCs and 42% in income which can cover our subscription fees as well as creating clinical impacts such as 28 lives saved. A nurse at the St. Ésprit health center reported that the salary of workers increased after the installation of SPAQ.

1. Pregnant women

Pregnant women will be able to receive quality medical services in terms of clinical and satisfaction. First, from a clinical point of view, portable devices such as ultrasound, fetal monitors, and biochemical analyzers included in SPAQ will increase the number of examination indicators. In addition, prenatal checkups digitized by the app also reduce calculation errors and oversight of abnormal values. This improved quality of examination is a base of appropriate intervention. As a result, out of 1,000 digital ANCs with SPAQ, 79 abnormalities (including twins and ectopic pregnancies) were found, 17 were transferred, and 28 lives were saved.

We should not ignore the subjective satisfaction of pregnant women. 99% of pregnant women are more satisfied than regular antenatal care, but this is not necessarily due to clinical impact. Two-thirds of the pregnant women who were satisfied appreciated an ultrasound examination, and the reason for higher satisfaction was because of information on the gender and presentation of the fetus. The remaining 1/3 were satisfied with the fact that digitization of data reduces the risk of losing paper documents. In this way, pregnant women were able to increase their level of satisfaction by "no clinical aspect", which has been overlooked, and the number of monthly ANCs has increased 74% in average of 7 health centers.

2. Health workers 

Health workers working in health centers especially in rural areas benefit from SPAQ. They can obtain benefits such as an increase in the coverage of examinations, no need for manual calculations and double checks, a reduced risk of overlooking abnormalities due to support for interpretation of examination results, as well as remote consultation by specialists. Some health workers also testified that better health services are motivating themselves by patients who presented greater appreciation. Some health centers have even increased salaries for health workers due to increased revenues.

3. Management of facilities

It is very easy for the management of the health center to introduce the SPAQ package that includes the equipment and other necessary materials. The maintenance is not required and consumables can be supplied by SOIK. SOIK provides advice on how to improve profitability, such as how to set additional charges for patients. As a result of the demonstration so far, SPAQ has improved their income by 42%.

Since signing a public-private partnership agreement on developing digital maternal and child health solutions with the Ministry of Health of the Democratic Republic of the Congo, SOIK has conducted more than seven pilot projects in five provinces. In addition to the central government, we have built a training and trial system in collaboration with organizations such as the Obstetrics and Gynecology Association, the Midwifery Association, and the Provincial Department of Health. Through those experiences, we have closely communicated with and observed the communities to know real needs of patients and their families, health workers, and government officials. Our insights have been reflected in software improvements, specifications and selection of devices included in packages, payment methods (purchase, rental, subscription), etc. For example,  as we got to know the pregnant women were most interested in fetal presentation among ultrasound examination results, we added it into the standard examination indicator in SPAQ.

Five health facilities are already paying customers of SPAQ. The Ministry of Health and Kwango Provincial Health Department have obtained budget for SPAQ procurement and are currently in the procurement process.

We are trying to create a new digital platform under a new business model. By joining SOLVE as a member, we believe that we can share various experiences such as business model, medical, and solution aspects, and learn from other members. We would like to exchange experiences and thoughts with other innovators on key questions, such as what factors are important to make health facilities more attractive to pregnant women.

Through collaboration with innovative solutions from other SOLVE members, SPAQ and their solutions may also be enhanced. For example, a new portable IoT medical device can become part of our platform by linking data with SPAQ. We would like to find such partners through the SOLVE network.

Many trials of great digital solutions for health centers in Africa failed after the project period. Connecting to our digital platform makes it easy to integrate the device as part of routine and ensure that they are actually used. In addition, since a business model for supplying consumables and after-sales service has been established, financial sustainability is also ensured. This will greatly boost the overall market for digital solutions for small health centers in Africa.

Conversely, software-only solutions without devices are not currently widespread in health centers. This is because there is no benefit to users or health center management. Health centers can be digitally connected in a lasting way through the proliferation of SPAQ's digital solutions that attract pregnant women and increase the profitability of health centers. Not only statistical information such as DHIS2, but also each examination result of patients can be digitized, shared and analyzed. There are tremendous insights that these data will give us. We are working to analyze ANC results of deceased pregnant women to develop algorithms and indicators for identifying high-risk pregnancy. By optimizing the method of identifying high-risk pregnant women for each region, the accuracy to identify pregnant women to be followed up will improve. The method of follow-up will also be digitized, and the next checkup date will be automatically reminded by SMS. The health center will be urged to call each pregnant woman who has not come on the scheduled date. By analyzing various data cross-sectionally and realizing more appropriate interventions, new approaches to reduce maternal and neonatal mortality will be implemented.

SOIK will improve the following indicators in 10,000 medical facilities by 2026 through improvement and dissemination of SPAQ, a digital obstetrics solution that supports general doctors, midwives, and nurses working in small-scale medical facilities in Africa.

1. Improve the quality of healthcare services

2. Increase the number of antenatal consultations

3. Reduce maternal and neonatal mortality

At 10,000 medical facilities, 40,000 health care workers will perform 500,000 digital antenatal examinations per month. 

1. Mortality rate of pregnant women and newborns
2. Antenatal consultation coverage
3. Number of SPAQ installation facilities
4. Number of SPAQ operators (healthcare workers)
5. Number of digital Antenatal consultation
6. Profitability of introduced medical facilities (sales for digital antenatal consultations, comparison with before introduction)
7. Number of countries and provinces where pilot projects are implemented

We believe that in order to create a large social impact in a short period of time, it is important to rotate a loop that reinforces rather than a linear logic. The loop is shown in the following diagram.

As the number of medical facilities with SPAQ (1) increases, the number of medical facilities with the capacity to provide standard services (2) increases. 

Strengthened medical facilities improve the quality of medical services (3).

Improving the quality of service will improve patient satisfaction(4). 

The happier the patients are, the more patients will come and receive the service (5). 

The more services provided, the more income the health center will earn(6). 

More revenue means more investment and will buy other SPAQ devices(1).

By strengthening and rotating such a loop, the indicators of medical services (identification of abnormalities, appropriate number of patients transferred, etc.), which are higher goals, will improve(C).

As a result of all changes, the maternal and neonatal deaths will be reduced(A)

The indicators specifically measured by the trial in Kenge, Democratic Republic of the Congo are as follows. 

1. 7 facilities 

4. 99% of pregnant women improved their satisfaction 

5. The number of ANCs increased by 74%  

6. Increased revenue per medical facility by 42% 

SPAQ's software consists of a smartphone app and a web app on the cloud. The smartphone app authenticates pregnant women and health workers with cards using QR codes or NFC. Basic Information such as the ID number and the date of the next visit of the pregnant woman are sent to each person by SMS.

The smartphone app works with each software on other IoT devices to automatically share data. Data saved on the smartphone is shared with the web app via the Internet. The web app can analyze the data acquired from each smartphone and manage accounts. This data is shared with advisory specialists in remote locations, or used for statistical analysis by health administrators. The autorisation of access to the data is managed by the Government of the Democratic Republic of the Congo.

Health workers (general physicians, midwives, and nurses) working at small health centers enter data using a smartphone app. Data entry is performed for each examination along the navigation of the app, eliminating the need for tedious calculations and searching for documents. SPAQ is designed to allow care providers to become data collectors without burden.
Therefore, the existing reporting system is used for data submission, and the existing supervision system is used for supplying consumables and supervision. Data are generated at health facilities, but health administration personnel, such as provincial health departments and health zones, are users of statistical data and supervisors who regularly visit health facilities. Remuneration for their additional work is also built into SPAQ's business model.
The data collectors will be the biggest beneficiaries of this system. Inputted data is immediately fed back as calculation results, presence or absence of erroneous input, transitions using past data, etc. The web application also records data such as which operator performed how many tasks each month and whether the image quality of the ultrasound examination is acceptable.

Our product was originally developed to enable small health centers in remote areas to deliver high-quality medical services. As designed for the use in the low resource setting, the smartphone app can be used offline. Since all components of package are portable, it can be used even in out-reach, so isolated village people with no access to health center can also be beneficiaries. 

According to our customer health center, out reach with SPAQ boosts the profitability of the health center because pregnant women in villages are particularly satisfied and pay more additional fees.

In addition, as we are currently forming a project with UNFPA, SPAQ have a great potential impact even in conflict-affected areas with poor access to medical care, such as North Kivu Province in the Democratic Republic of the Congo.

SPAQ not only increases geographic equity because it does not require infrastructure. Digitization can also reduce cultural and educational inequality. For example, although a Christian faction banned caesarean section, SPAQ user saved the life of a pregnant woman who was a follower of that faction by convincing her of the need for surgery with an ultrasound.
Dr. Tuka from the Barierre Health Center discovered a 27-week ectopic pregnancy by the ultrasound. When he told the pregnant woman, she refused the operation, saying that the priest forbade caesarean section. Dr. Tuka persuaded the father of the pregnant woman that she needed an operation because her life was in danger, while showing him the ultrasound images on his smartphone. His father accepted to operate her daughter in the capital, Kinshasa, and her life was saved. His father expresses his deep gratitude to Dr. Tuka.

The main users of our products are health workers in health centers. SPAQ offers them a solution that can dramatically improve the quality of health services while collecting and using data.

SPAQ's customers are broadly divided into health centers (toB) and governments and aid agencies (toG). Through the introduction of SPAQ, health centers can easily improve the quality of health services and increase profitability. By introducing an all-in-package solution, governments and aid agencies can easily manage projects and obtain quantitative results in realtime.
The main channels are donor agencies, ministries of health and provincial health departments. In each provincial health department, SOIK organizes   8-day training and a trial for several months at about 3 medical facilities. As a result, the introduction of SPAQ will be added to the annual activity plan of the provincial health department. Donor agencies and the Ministry of Health will finance this action plan and SOIK will receive the revenue. 

However, the problem is securing financial sustainability after project implementation. For this reason, target medical facilities then subscribe to SOIK's subscription service and make monthly payments. SOIK will provide services such as Internet connectivity, provision of ID cards, and supervision by provincial health departments.

Our basic revenue model is (1) to sell products in the "to G model" to expand users and sales, and (2) to invite subscribers in the "to B model" to assure continuity of use of solution. 

To G model mainly covers the cost of product procurement and training implementation by formulating projects through ODA(Official Development Aide) and obtaining financial resources through the annual activity plans of the Ministry of Health and Provincial Health Departments. SOIK earns revenue from to B subscriptions, mainly to cover consumables costs required after hardware procurement. 

After realizing a certain scale of government procurement, we plan to raise funds through equity finance to obtain funds for expanding the market.

So far, about 1 million USD has been procured through subsidies and borrowings with supports from the Japanese government. This enabled product development and trials in five provinces. 

After establishing the current business model, 2 out of the 7 target facilities of the Kwango pilot project purchased the product, and 3 paid for it through the rental and subscription model. Kwango Province has already secured funding for the purchase of equipment and training for about 40 medical facilities in its annual activity plan for 2022 which is in the procurement process. The Ministry of Health has solicited tenders to purchase equipment for 130 medical facilities which is also in the procurement process.