Ilara Health Operating System

Existing healthcare systems in Africa are already fragile and will be unable to keep the rapidly growing population healthy. 500m people across the continent struggle to access a simple blood test and over 55% of the time, clinical guidelines are not followed for common conditions. Investments in the health care system are missing, so that a yearly $66bn health financing gap exists across the continent.

Unfortunately, due to the above-mentioned factors, in the vast majority of cases, poor quality of care is delivered at the primary health care level. These facilities lack the tools to support accurate data collection which could support them to identify areas for improvement, new services and pilot activities towards better patient care. Most documentation, which includes patient records, is mostly kept in a physical format, leading to inefficient patient and clinic management. 

Diagnostic devices are needed, healthcare protocols need to be implemented and patients have to be accurately monitored and treated. Additionally, primary healthcare facilities can’t access the financing needed to make these improvements. Ilara Health sees digital infrastructure for strong data collection in combination with smart financing as key to enabling primary healthcare clinics to improve quality of care for patients in need. 

We strengthen the primary health care ecosystem from the bottom-up, by equipping primary healthcare facilities with the Ilara Health Operating System. We then harness the data generated to make quality lending decisions towards optimized clinical and operational performance. With access to our embedded smart financing, facilities are able to improve service offerings and operations across diagnostics, infrastructure, non-diagnostic equipment and pharma. 

Unlike competitors’ solutions, the operating system is designed for Sub-Saharan Africa. It was developed through a human-centered design process engaging over 1300 health care facilities, and solves the majority of pain-points identified by our clients by digitizing the core components of facility operations, yet doesn’t require constant power or internet connectivity to function. It offers: 

Health Records: We digitize what has previously been an analog environment, with an EMR, scheduling and appointment reminder and a patient portal. We integrate scripted workflows based on local clinical care pathways for common conditions of interest to encourage standardized care as well as predictable and desirable outcomes of care for patients. In this way, we ensure that our system is fit for use for our target users while complying with guidelines of clinical care and of system development. 

1. Patient Engagement:  Allowing healthcare facilities to communicate directly with patients, with messaging, marketing of new health services, patient health literacy information (tips) and remote patient monitoring. 

2. Practice Management: Operations staff can manage their patient registry, payment processing, inventory management and access analytics. Medical staff can access continued medical education, enabling them to stay up to date with offline modular learning and tests, and a discussion forum.

3. Health Data Exchange: Facilities benefit from patient segmentation, and can communicate with public health for more accurate disease surveillance and healthcare utilization tracking, research and regulatory reporting. 

4. Integrated Diagnostics: Our suite of diagnostics address the majority of health areas we see; metabolic diseases, cardiovascular diseases, infectious diseases, maternal/neonatal/child health and sexual/reproductive health and have AI or telemedicine functionality. They can be easily deployed by clinical officers or nurses and test results feed directly into the operating system. 

We serve primary healthcare facilities in areas that have been historically underserved, where quality of healthcare is low, and serve low to middle income patients who lack the funds to seek healthcare elsewhere. 

Since January 2019, we have engaged over 1300 clinicians at small and medium healthcare facilities in order to explore the pain-points they experience as well as those of their patients. This research demonstrated that facilities lack access to diagnostics tools to deliver quality care in their communities, and lack the cashflow to take advantage of leaps in medical diagnostic technology and digital health tools. This led us to develop our first offering, connecting facilities to tech-enabled diagnostic technology through smart financing options. 

We then began to develop the underlying operating system that connects these devices; the operating system was designed for and built by clinicians with experience working in the local context and in developing health information systems. We have collated input and feedback from the very users we intend to serve in order to build a product that allows primary healthcare facilities to work more efficiently and effectively. 

In recognizing the finance gap in accessing capital for improved infrastructure, quality pharma and non-diagnostic equipment, we have grown our embedded financial offering. We harness the data generated by the operating system to make quality lending decisions. In some cases for the first time, facilities are able to access financing to optimize performance and meaningfully improve the quality of care delivered to their patients. 

We have built a team composed of entrepreneurs, medics and engineers who are deeply embedded in the Kenyan health ecosystem. The team on the ground is 100% Kenyan. 

At each stage of our solution’s development we have followed a human-centered design approach, we have engaged with over 1300 primary healthcare facilities (management, clinical staff, administrative staff) across Kenya to build a holistic understanding of their pain-points regarding clinical and operational management. The solution is designed for and is built by clinicians with experience working in the local context and in developing health information systems.

Collating input and feedback from the very users we intend to serve has enabled us to design a “light-weight” system that makes it easier to bridge the IT literacy gap by providing simple yet functional interfaces for users to interact with. We have been developing and testing the health records offering of the operating system with Internal Medicine and Cardiology specialists locally to ensure fit for use. Following feedback on the first version of the operating system from our clients, version 2.0 was rolled out in August 2022. 

A few key staff profiles below: 

Emilian Popa, CEO

https://www.linkedin.com/in/emilianpopa/ 

Emilian is a hands-on company builder, investor and entrepreneur with deep knowledge of the African context, with 12 year’s experience launching, fundraising, growing and exiting successful businesses on the continent. He was an investment professional with DiGAME (Digital Growth Africa), an Africa focused subsidiary of Zouk Capital. He has 7 years of experience with leading consulting firms in Europe, US, Africa. He holds a joint MBA from Columbia Business School and London Business School.

Eric Mbuthia, CTO

https://www.linkedin.com/in/eric-mbuthia-kanyi-0000b217/

Eric has over a decade of experience in the health sector in Kenya, firstly as a primary care physician and later shifting to a focus on building knowledge systems that leverage digital healthcare technology. Eric spent five years as Technical Director at Access Afya where he oversaw the development of its EMR, telemedicine, mobile field data collection tools and their analytics/reporting framework. He has post-graduate training in Health Informatics from Swansea University and a Bachelor of Medicine and Bachelor of Surgery from the University of Nairobi. 

We see strong alignment to the MIT Solve Novel Measurement for Performance Improvement call. At this stage in the growth of our solution, with financial support from MIT Solve we will be able to enhance our analytics and reporting engine to drive more real-time and actionable insights into the operations of a clinics and patient care indicators.

Additionally, we will be able to build out deeper patient engagement through our digital platform as well as be in a better position to develop and deploy richer educational content through our platform in a bid to promote delivery of standardized, outcomes-assured care, allow facility owners/managers run their clinics more efficiently and with deeper integration into the public health system. 

Furthermore, as we grow the operating system and aligned financial offering, we would value support from MIT Solve in identifying aligned partners and stakeholders for rollout. Culturally, the success of the operating system relies on local communities to engage in health seeking behaviors. We engage in awareness and marketing campaigns to mitigate this, and would seek the support of the MIT Solve community to identify tactics and techniques tailored to each of the new markets we seek to enter. 

As we grow the operating system, we are seeking debt and revenue share financing. We would value support from MIT Solve in connecting with prospective funders and investors. 

Finally, the operating system requires accurate and transparent data input. Each staff member is trained in the necessary area to overcome any technological barriers. We would appreciate support from SOLVE MIT in how we can make the operating system as user-friendly as possible. 

The Ilara Health operating system allows for holistic data collection, and we harness this data to make informed lending decisions. Facilities are able to access smart, affordable financing to make needed improvements that optimize performance and contribute to improved quality of care. This combination of services is unheard of in this target market, where primary healthcare facilities are priced out of electronic medical record systems (EMRs) that are designed for users in Western markets and can't access commerical loans. 

Software as a Service: Existing distributors do not offer operating systems (including EMRs) as a service. Providers bypass initial costly investments and can quickly adopt the operating system for a fixed, monthly payment. 

Data Management: The system provides secure, digital data management that is harnessed to inform new services and pilots, enabling us to strengthen the primary healthcare ecosystem from the bottom up. We integrate low-level analytics in our operating system to enable clinic operators to have better visibility into their operations.

Integrated Access to Finance: Facilities are able to apply for financing to optimize performance management and improve quality of care through the operating system itself. Decisions can be made rapidly pulling on the data in the platform in addition to further due diligence checks. This is unheard of amongst traditional lenders, where facilities are blocked out out due to high interest rates and cumbersome application processes. 

Connected Diagnostics: Our diagnostics integrate directly into the operating system. We do this while ensuring that data transmission between the operating system and the cloud is efficient to manage the costs of data transmission. 

Tech-Enabled Diagnostics: Existing distributors (e.g. Philips, Siemens) offer expensive, bulky legacy devices, prohibitive in cost and size for the facilities we target and requiring constant power and significant clinical expertise. Our suite of diagnostics have AI or telemedicine functionality and address the majority of health areas we see; metabolic diseases, cardiovascular diseases, infectious diseases, maternal/neonatal/child health and sexual/reproductive health. They can be easily deployed by clinical officers or nurses. 

Our goal is to improve the performance of primary healthcare facilities serving low and middle income communities across sub-Saharan Africa. We are currently active in 800+ primary health care facilities. By the end of 2023, we target to reach 1000 primary care facilities representing nearly 10% of primary care facilities in Kenya and ~8000 lives reached. Of the 1000 primary care facilities, we aim to roll out the operating system in 450. 

In 5 years, we expect to be active in 10,000 clinics, reaching 12m lives with access to quality healthcare. In order to achieve this, we use diagnostic devices as our entry point. This enables to build our network, strengthen relationships and learn their pain-points and those of their patients. We then introduce the operating system, and begin to collect data to inform lending decisions that ultimately contribute to improved quality of care.

In order to understand how are services meaningfully impact the lives of patients, we measure the following indicators: 

1. Total facilities with Ilara-offered products, disaggregated by geographical area (communities served)

2. Medical diagnostic products in Ilara Health's portfolio, disaggregated by disease/health issue, as a proxy for health areas covered

3. Medical diagnostics sold, disaggregated by type of device

4. Device utilization rate: # of tests performed, disaggregated by type

5. Total # of patients screened disaggregated by age, gender, geographic area, socio-economic status:

6. Clinical care quality score (Patients receiving appropriate diagnostic testing and management for key conditions of interest).

7. Patient satisfaction rate

8. Clinician satisfaction rate

Our research with over 1300 healthcare providers identified several barriers to improving quality of care. At the core of this was lack of data to identify priority areas for improvement. Our work is underpinned by the understanding that quality record keeping and data management is an essential step to improving quality of care, demonstrated by Mutshatshi, Mothiba, Mamogobo, Mbombi (2018). 

Additionally, our research demonstrated that facilities lack the cashflow to make much needed investments and also lack the quality financial records needed to access financing. This aligns with research by Abdulazeez, Abimbola. Abolarinwa,Timothy, Onyenekwe and Linda (2015) who identified lack of funding as a key barrier to quality data collection and management in healthcare facilities in Africa, and recommended injection of financial resources to tackle the issue. Furthermore they recommend investment in infrastructure and modern equipment to support better patient health and sustainable healthcare in the long run. 

Activities/Inputs: We provide an operating system on a Software as a Service basis to primary health care providers serving low and middle income communities in sub-Saharan Africa. We offer this in conjunction with access to tech-enabled diagnostics that communicate directly with the operating system for quality data management. 

Outputs: Facilities are able to accurately record data across the key facets of facility operation: health records, patient engagement, practice management and health data reporting. Facilities onboard new patients, patients receive essential tests and facilities have increased revenue. Access to holistic data enables Ilara Health to make informed lending decisions towards facility investments to improve quality of care. 

Outcomes: Facilities are able to operate more efficiently and effectively. Facilities access financing from Ilara Health, and are able to improve quality of services, and introduce new services to serve community need. Patients can access a wider range of diagnostic testing services, and can receive appropriate treatment more quickly. Facilities see an increase in patient numbers. 

Impact: Faster access to quality health services leads to improvements in patient health. 

Ilara's health operating system is primarily web-based, designed to run on internet browsers and mobile phone devices. 

We provide online access to our solution affordably to facilities through use of application development practices that are used for lightweight applications. Additionally, an agreement with one of the local telecommunications companies ensures that platform traffic through their network is not billed to the facility.

We have integrated SMS messaging to improve patient engagement to support patient reminders for follow-up appointments, health education/literacy messaging and patient/customer feedback.

We bring analytics to the forefront for facility owners/managers. At the macro level we want to integrate predictive analytics to better identify trends that we can support early interventions at facilities. We have in our pipeline, use of machine learning techniques to support risk stratification of patients of key chronic conditions to identify patients potentially needing much closer follow-up. Our platform is built on Spring Boot (Kotlin), Javascript and supported by PostgreSQL data storage. 

This varies depending on the type of data being collected. Clinical officers, nurses, medical doctors and administrators will all play a role in data collection. As the patient-facing aspect of the operating system is refined, patients will also be able to input their demographic data directly.  The results from the diagnostics feed into the operating system autonomously, and don’t require any interaction from the clinician to do so. 

 Staff are motivated to use the system as it provides the initial data we require to make informed lending decisions. Acknowledging the lower level of digital literacy in these areas, we have a team dedicated to offering comprehensive training to staff in use of the operating system to support quality data entry. . 

We are committed to growing the diversity of our team. As a team based in Kenya, the majority of our team is Kenyan, and 10/16 management roles are filled by Kenyans and one Rwandan. 

 In the last year we recruited two key female members to the management team. These are Joane Kayibanda as our General Manager for Kenya and Dr. Wanjiru Mwaniki as our Clinical Transformation Manager. Joane and Dr. Wanjiru work alongside Dr. Angela de Poli, our Head of Labs, Beverlyn Omwenga, our Head of Finance, and Esther Wamweya, our Head of Sales. This accounts for 5 of the top management positions and we are working towards 50/50. We are in the process of hiring for a Head of HR and are prioritizing the hiring of a woman for this role.

We have three main revenue streams: 

Operating System revenue: Ilara Health develops and avails the operating system to primary health care providers who can quickly access the operating system on a software as a service basis, bypassing initial costly investments and can immediately take advantage of quality patient record management, billing, pharma management, and medical education. 

Leasing Diagnostics Revenue: Ilara Health procures and avails diagnostics from diagnostics manufacturers disrupting the traditional diagnostic landscape. We enter 12-36 months asset leasing agreements with primary health care facilities, who pay fixed monthly fees and can purchase consumables on an as-needed basis.

Financing Revenue: We have introduced a new service line in which we finance medication for our partner clinics so that they are able to stock their pharmacies and generate enough revenue from their patients to be able to repay Ilara. 

We generate revenue through the operating system, clinics pay a monthly fee to access the operating system. We also generate revenue through the medical devices we lease to clinics and through financing and currently though medication financing. As we expand our offering, we will also generate revenue through financing for other non-diagnostic needs. 

We are in the process of raising our Series A and we will continue to seek grant funding to ensure we can reach facilities serving low-income individuals, for instance we have a soft commitment from GIZ to roll out a program in Ghana offering ANC.

To date we have raised $4.5M in equity, $630k in debt and $1.5M in grants, and are revenue generating. 

Equity 

Seed USD 735K Aug 2019

Series A USD 3.75M Dec 2020

Debt 

Microlumbia USD 25,000 Dec 2020, Matured & Fully repaid 

Kiva USD 50,000 Sep 2021 Currently servicing 

Proparco 550,000 Euros July 2022

We have secured the following grants: 

Making More Health Accelerator from Boehringer Ingelheim & Ashoka $- 170,000 grant 

SOLVE MIT - $10,000 grant 

Bill and Melinda Gates Foundation - $1,100,000 and $20,000 grant 

Intel - $100,000 grant

Cariplo Foundation - $42,000 grant

Tamer Fund - $25,000 grant