INSTADOC

In Nigeria and many low-resource countries, an employee stands a higher risk of developing mental health illness pre-, intra- or post-employment (in case of job loss) as a result of factors that may predispose to or precipitate the illness such as a toxic workplace, stress, constant feeling of discouragement among others. It is established that up to 90% of individuals living with mental disorders in low-resource countries receive no mental health care (Naslund et al, 2017). 

The shortage of health care workers in Nigeria, including mental health specialists, further brings to bare the need to address the rising prevalence of mental health illness particularly as a result of workplace circumstances. Referral for mental health care from the primary care facilities in Nigeria is typically cumbersome as the mental health facilities and mental health professionals are insufficient to cater for the growing population of those who need it.

Furthermore, the insecurity challenges across the nation pose a risk to commuters who have to travel far to access mental health care in facilities where they usually experience long waiting time.

Instadoc is a mobile and web based application that enables swift access to "scarce" mental health care providers for employers and employees. This access is provided directly to individuals and through collaboration with health insurance companies that cater for the the employers' organizations. Instadoc helps to improve the underwriting decisions and commitment of the insurance companies, reduce the health care costs per employee through health promotion strategies, ensure healthy employees and therefore improve productivity at workplaces. 

Instadoc enables us to:

1. Provide access to mental health specialists and therapy sessions without geographical limitation by leveraging technology. Instadoc brings together health care workers from various parts of the world hence addresses the challenge of shortage of health workers in Nigeria. Instadoc users are able to consult doctors and schedule their therapy sessions at a convenient time during the day and at an agreed time with the health care professional virtually or via telephone call. Without internet access, the health care workers are just a phone call away. In addition, the healthcare workers ensure they follow up with the clients and they provide a report of the activities after each consultation while the clients provide feedback through our online forms. This has improved the positive outcome of therapy sessions by 60%.

2. Organize wellness sessions and screening checks for employers and their employees, identified by insurance companies and on-demand. This is aimed at bringing to the fore the need for ensuring the mental health of employees, training employees to identify mental health risk factors and issues that are present, and providing access to mental health specialists. All these are done from the comfort of their location at any time of the day. Every session is tailored to meet the need of the employees.

3. We share training materials with participants in a simple, comprehensible and jargon-free manner, and with the general public through blogs. We maintain the confidentiality of the employees who use the app. This has increased the access to reliable information and encouraged better health choices by employees in Nigeria.

We believe that we can positively influence employers and employees to adequately care for their mental health needs from the comfort of their location.

Instadoc is primarily targeted at persons in low-resource countries like Nigeria from age 18-50. According to the World Health Organization (WHO, 2020), for every US$ 1 put into scaled up treatment for common mental disorders, there is a return of US$ 4 in improved health and productivity.

Our priority is to ensure that we can effectively contribute towards improving healthcare and overall wellbeing of our target population and potentially scale to those outside of that band where necessary. 

With Instadoc, mental health wellness sessions are scheduled and delivered, structured to accommodate the needs of each individual organization. It also provides an opportunity for improved access to a mental health specialist from any part of Nigeria by taking out prolonged waiting time and bureaucracies experienced when trying to access the few mental health providers across the country.

Instadoc networks mental health providers across the country through our application and provides the opportunity for them to provide the needed knowledge and care to people across Nigeria. 

The Instadoc idea was birthed by Dr. Funke Ogwa from her experience as a clinician in Hospitals in Lagos Nigeria. The trend of mental health issues in the workplace worsened by the "hustle and bustle" in the cosmopolitan city was real and required strategic innovation. Having an information technology (IT) resource person with expertise in strategy and project delivery has been key to the success of the team. The increasing demand for our services and the increasing level of stress across the country continually puts us on our toes to ensure that needs are met in a manner that is tailored to the challenges of every organization and individual.

The team has grown in recent times to comprise doctors (including medical consultants), nurses, pharmacists, software developers, a project manager and a business development officer who reside in various parts of and outside Nigeria. We also have volunteers who join the team when the need arises. 

Financial: Instadoc has been built 100% through bootstrapped funds. In order to scale this solution up and get it to serve more people, there is a need for a substantial investment in technology and logistics to further deliver this very important solution to people and organizations who need it the most. 

Market: There is a need to be able to network with more organizations to provide wellness sessions to the employers and improve productivity.

There is also a need to increase the awareness through various platforms for people to become aware, download and use the mobile application and to disseminate the phone numbers for calling the volunteer staff.

Technical: In addition, we would be required to pay more for our cloud-based data storage platform to accommodate the increasing population of users. We would also need to get more CUG phones for the rising number of our workforce.

Instadoc is innovative as it is built on the rails of technology. It focuses on workplace health promotion and service delivery.

Instadoc operates as a mobile and web based application that connects people with health professionals, thereby scaling the hurdles of long-wait times and other constraints associated with existing healthcare access methods. The Instadoc model also utilizes regular mobile telephony to strengthen coverage and care. Clients have their consultations on a mobile phone even when there is no Internet access.

Nigeria has a mobile telephony coverage of over 95%, which is an advantage, while Broadband penetration is still growing and expected to reach ~70% by 2025.

The mobile application has automation built in and although it currently runs on the Android OS, it is expected to go-live within the iOS environment in the next 3 months.

The Impact goals of Instadoc in the next one year are:

1. Consistently increase accessibility to mental healthcare by at least 25% to individuals and organizations through Instadoc and wellness sessions.

The strategies for achieving this are: 

• Mapping out the organizations for reach monthly, quarterly and within 1 year.
• Scaling up publicity on social media platforms and having pitch decks for target organizations.
• Providing information in simple formats that are jargon-free
• Continuous quality improvement of strategies
• Weekly Review of our processes.

2. Deepen usage of telemedicine among at least 5% of the youth and employed population in Nigeria as a viable alternative to regular methods of hospital visits. 

The strategies for achievement are:

• Incentivizing referrals through a rebate system
• Ensuring that feedbacks on services are provided after each service
• Review of the feedbacks weekly
• Training and re-training of members of our team on strategies for reaching the youth population following our reviews
• Implementation of support groups

Over the next five years, the impact goals of Instadoc are to:

1. Increase access to quality mental health care by 80% to corporate organizations and individuals through instadoc and wellness sessions.

Strategies for achievement: 

• Continued Mapping of more organizations for reach monthly, quarterly and yearly.
• Scaling up publicity on social media platforms and having pitch decks for target organizations.
• Engagement of more insurance firms to be able to reach more employers and employees of organizations that they provide services to.
• Providing information in simple formats that are jargon-free through blogs, social media platforms and fliers.
• Continuous quality improvement of strategies
• Weekly Review of our processes.

2. To become the go-to web and mobile application for employee health promotion by 50% of organizations in Nigeria.

Strategies for implementation: 

• Incentivizing referrals through a rebate system
• Ensuring that feedbacks on services are provided after each service
• Review of the feedbacks weekly
• Regular updates on the mobile and web application
• Continuous quality improvements
• Training and re-training of members of our team on strategies for reaching the youth population following our reviews
• Implementation of support groups
• Scaling up procurement as the company grows to meet the needs of our clients

3. Deepen usage of telemedicine among at least 20% of the youth and employed population in Nigeria as a viable alternative to regular methods of hospital visits.

Strategies for implementation:

• Incentivizing referrals through a rebate system
• Ensuring that feedbacks on services are provided after each service
• Review of the feedbacks weekly
• Regular updates on the mobile and web application
• Continuous quality improvement
• Training and re-training of members of our team on strategies for reaching the youth population following our reviews
• Implementation of support groups

Outcome Indicators: At least 75% of employees demonstrating adequate knowledge of mental health care and taking charge of their mental health within the workplace environment after each wellness session and consultation depending on which aspect they accessed, 50% increase in the productivity of employees within the organization accessing our services.

Process Indicators: 

• 100% of clients who use Instadoc for mental health care have quality access to mental health care workers;
• 85% of employees who attend wellness sessions and receive training materials can apply the strategies taught to improve their mental health;
• 30% of employers and employees in Nigeria become aware of the services they can access through Instadoc.

Balancing Indicators: Increased workload on our team.

Instadoc provides improved opportunity to address the mental health needs within the workspace of employers and their employees. This is done by organizing wellness sessions virtually and on-site for organizations who make individual specific requests, and are identified by their insurance providers, to provide the needed access to mental health care specialists for employees without the need to travel far to access care through virtual and phone consultations. Our immediate goals are to improve the mental health of employers and their employees who are faced with the rigors of maintaining a healthy work-life balance, and to make access to mental health professionals seamless within the work space. These will ultimately lead to increased productivity of employees and growth of the organizations, a healthier work-life balance for employers and employees, reduced cost of health care for individuals and organizations, and improved underwriting decisions of their insurance companies. Data from the World Health Organization (WHO) show that workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains.

Instadoc is an application that runs on the web and on mobile devices through the two most popular app stores - iOS app store and Android Play store.

On the web, users are able to access Instadoc by visiting the portal while mobile users have the option of using the mobile web or download the application. 

The experience is largely similar on all of these tools.

The consultants also use the same interface for most of their consultations that require Internet, like video or e-chat sessions. Asides these methods, consultants also hold sessions via regular mobile telephony to deepen reach across all locations.

Our monitoring and evaluation team collects the data using google forms and from the admin end of the mobile and web application. A pre- and post-session assessment is done for baseline and post-session knowledge and action point evaluation. They make a pictorial representation which is shared with the respective organizations and individuals. A graphical representation of the impact from the wellness sessions and mental health care consultations is usually shared with Doctorkk Health in order to evaluate the processes. 

Each member of the team gets paid for every job done and for overtime.

Diversity: Our leadership team comprises equal proportion of males and females from multiple ethnic groups in Nigeria. We believe that “everyone should have a seat at the problem-solving table,”.

Equity: We design our policies, practices, and resources with the goal of reaching out to people of all backgrounds across the country without prejudice. 

Inclusion: We strive to create an environment in which everyone feels valued and respected. Solve specifically seeks to support social entrepreneurs who use human-centered, inclusive technologies to solve world challenges. We know that when solutions are designed with the most underserved populations in mind, they benefit everyone. 

1. Target Reach: Instadoc caters to employers and employees in different parts of Nigeria. We consistently serve some organizations through their insurance providers to ultimately enhance productivity and mental health within the work environment. We want to scale this from two multi-national insurance firms to more firms that operate within the country so as to reach more people in the work space in Nigeria. We are also working at ensuring that individuals can access other aspects of health through Instadoc as we provide a holistic care to the Nigerian populace.
2. Revenue Model: The insurance companies have been funding the wellness sessions while individuals who need to access mental health services choose to pay through their health maintenance organizations (HMO) or out-of-pocket. Subscription packages vary depending on the mode of delivery of the service; whether on-site, chat only, phone call with chat, or phone call with chat and video consultation. We will also pursue donations and grants to enable us scale up effectively. We are already in talks with HMOs to enable us reach out to more people and to efficiently deliver these services to their clients while taking out prolonged hospital waiting time.
3. Input Efficiency: We will continue to leverage on technology to provide services to our clients. We are working on the user interface and user experience of the application to make it more attractive. We have a pool of ad-hoc staff whom we train ahead of every increased task to enable us deliver quality services to more people. 
4. A WHO-led study estimated that for every US$ 1 put into scaled up treatment for common mental disorders, there is a return of US$ 4 in improved health and productivity. There has been 60% improvement in the underwriting decisions of the insurance firms that Instadoc has partnered with, as well as improved productivity by 50% in the respective organizations

We started by 100% bootstrapping for the funds needed for the organization. Our reach was initially limited to individuals. However, with consistency, we were able to reach out to organizations who found our services professional and valuable to their firms. They continued to engage us and we got paid for the services. We re-invested the revenue and were able to scale up our services to more organizations for a fee. Also, individual clients continue to make subscription for services when the need arises. 

We also look out for grant opportunities to support our work on a larger scale to individuals and to organizations. Our services are currently subsidized to individuals to improve their access to the quality services we provide in Nigeria,  a low-to-middle-income country.

Instadoc started by leveraging on telephone conversations for individuals who were mentally stressed at work to access quality mental health care. We initially provided our services free of charge to clients while we bootstrapped for funds. However, in order to ensure sustainability, we included user fees through subscription packages available on our website. 10 individuals made subscription initially while the service providers on our team provided pro bono services. 

However, with more referrals we grew to 1386 individuals with six companies across Nigeria and our reach is wider. 

We are working tirelessly at engaging more companies and more individuals to offer our services to them.

We also work with diagnostic facilities who aid our reach to our clients and provide ambulance services to convey them for physical investigations when the need arises.