PENSA *660#

Africa carries 25% of the worlds disease burden, yet only 1% global spending on health. This issue is worsened as of the 1.4 billion Africans, an estimated 1 billion dont even have Internet access. In Mozambique--Ranking 180 (out of 189 countries) in terms of Human Development Index (HDI)--the 2017 national census states that less than 10% of the population have Internet access. We also have an inadequate health workforce, with 0.055 physicians and 0.401 nurses and midwives per 1000 people, relative to the minimum recommended ratio of 2.3 of all healthcare workers (WHO, 2019). This leaves the population vulnerable to health issues, a matter made worse since we are below the poverty line on average (living on less than $1 per day), and over 2/3 of the population live in rural areas. Some of our health facilities respond to 140,000 patients and lie over 30 KM away from their patients.

How then, does one keep healthy an under-privileged demographic, with few possessions, no Internet, and living far from the nearest Health Facility? How do we inform them on the importance of hygiene/washing hands in the fight against cholera? Or that a health diet prevents strokes? Or how to stay safe in the light of pandemics and the spread of new disease? How can we communicate with, and influence the behavior of, such a hard to reach yet vast demographic?

Finally, how do we effectively and efficiently hear from the patients (directly and in-directly) to improve and cater the health system to them?

Despite our HDI ranking, over 60% of Mozambican family's possess mobile phones, albeit low-tech (dumb) ones (like in many Low & Middle Income Countries). As such, our solution is built around the delivery of information and services around this ubiquitous device.

By focusing primarily on USSD (Unstructured Supplementary Service Data), we are free to the citizen (without even the need for airtime or Internet), available on all national Mobile Network Operators, work on low-tech phones, and provide simple to understand information. Besides providing useful information such as on disease, Maternal, Child, and Newborn Health; we also provide real-time information on health facilities providing Covid19 testing and vaccination, surveys to inform the National Health System of Covid19 vaccination hesitancy, complaints systems for health facilities and services, and more.

Our primary healthcare data is provided at the source, by the patient. With just the desire to improve the quality of care they receive, the patients are willing to provide feedback on their experience, free of charge. The complaints system we are testing, for instance, receives over 1,000 complaints per day in various categories (corruption, slow attendance, lack of equipment/material, etc).

Although we focus primarily on USSD our platform is multi-channel and bi-directional, and we are testing expansion into other medium. On the back-end, the Ministry of Health and partners can access anonymized and geo-referenced data and usage reports to inform decisions and health policies.

While our solution works for everyone, the focus (as per question 4) is on the under-served living in remote areas. Not only do we provide them with pertinent and useful health information/services, our bi-directional communication ensures that their voices and concerns reach the decision-makers leading the National Health System.

We also serve the National Health System (particularly the Ministry of Health), in providing them with (i) a way to learn what the patients think/experience/believe, and (ii) a communications platform to influence positive behavior change.

The entire team is composed of Mozambicans that have grown up influenced and/or affected by the constraints felt by the majority of the population. We come from different locations in the country, different walks of life, different perspectives (even including those originally sceptical of vaccines), but are bound by the aspiration to deliver something that fundamentally helps others lead healthier lives.

As our main client, we do our best to envolve the community on our limited resources. First we have a satisfaction section on the platform, designed to learn not just what is working well for the community, but also what should be improved (in terms of content, features, and more). Second, we routinely interact with health partners (both civil society and National Health Systems leaders) to learn from their perspectives and experiences with the community. Their inputs are often fed directly into our satisfaction section to help validate the impact of the new/different approach suggested by the partner.

We are applying to this challenge for 2 main reasons. First, 50% of Mozambican women above 15 years old are illiterate. With financial support from this Challenge, we can introduce a voice-based menu option to cater to them.

Second, despite the National Health System more often looking to us as a source of information, it's still mainly geared towards behaviour change. We would like technical support in improving our standing as a source of data for quality assurance. We anticipate that this will require an improved dashboard/interface for visualization, improved sharing and data comparision interface, and possibly even workshops on data usage.

Our technical innovation comes from employing an under-utilized technology (i.e. USSD) in a novel way/use case.

However, I believe the technology we use is merely a manifestation of our true innovation: delivering and improving upon a solution, in alignment with the needs and feedback of the community/users. We dedicated significant resources to constantly improve and tweak what we delvier and how we deliver, based on what our users say (i.e. satisfaction surveys) or do (i.e. how the use the platform).

Within a year we would like to strengthen the communities voice by creating an environment where their inputs/feedback lead to change. We want the community to feel like through us they have improved the quality of the care they receive.

Within 5 years we would like to expand our impact to other areas of community's lives: sustenance and income. We would like to contribute to improving the national food system so that people (particularly children) dont suffer from malnutrition in a country with so much fertile land. We would also like to help the population generate income to meet their basic needs.

We keep track of our "big picture" goals through quarterly meetings and assigning responsibilities. With regards to the first year goal, we are behind schedule due to the alignment required within the National Health System, as well as with strategic partners.

As for the 5 year impact goal, we are ahead of schedule in terms of creating the partnerships necessary to build the pilot.

Needs: Population is poorly informed on health issues and has limited access to health services (primarily due to distance/inconvenience).

Intervention: Provide information in an accessible format (via platform on mobile phone).

Output: Users successfully access the platform and find relevant health information.

Intermediate outcome: Users follow latest health guidelines. Patients know when to and seek professional care when needed.

Final outcomes: Community is healthier. Less spending on health needed (overall), as guidelines are followed and outbreaks/issues are quickly contained (or at least not worsened) by the community.

Our core communication technology is USSD (Unstructured Supplementary Service Data). This is a  telecommunications technology that works like an menu-based SMS, and is extremely popular in LMIC countries due to its reach and ability to work on even low-tech (dumb) phones.

The communication technology is connected to modular and extensible components on the back-end, include (i) a decision-tree health chat-bot; (ii) surveys/data collection; (iii) ad-hoc components built on request, such as our vaccination scheduler.

As mentioned in question 6, our primary healthcare data is provided at the source, by the patient. With just the desire to improve the quality of care they receive, the patients are willing to provide feedback on their experience, free of charge. The complaints system we are testing, for instance, receives over 1,000 complaints per day in various categories (corruption, slow attendance, lack of equipment/material, etc).

As mentioned in question 24, our solution is flexible and extensible, so we can quickly add components to allow for data collection from Community Health Workers, other data sources, etc.

We have long valued diversity at Source Code, and actively seek to recruit a diverse team. When seeking new talent, we explicitly encourage participation of under-represented groups. During the recruitment process we also favor candidates that are under-represented in the company.

Our main beneficiary is the population we serve. They want/need to remain informed on health guidelines/outbreaks; so we provide them with free, easily accessible, easy to understand, credible and trusted, health information and services. They access this via USSD (dialing *660#), and following the instructions on their phone. Besides accessing the information and services, we also request their input/feedback on different health aspects (treatment at health facilities, beliefs/opinions on health topics, etc).

Our main partner is the National Health System (NHS). They want a means to quickly and effectively communicate with a large base of users, as well as hear from those same users. On the platform, we put this information or configure the survey for the NHS. On a back-end system, the NHS can access reports/data on our interventions. In return, the NHS advertises our platform, further solidifying our brand as credible.

Our customers are the companies and civil society organizations in the health industry. They want to reach the population with their product/event/initiative, or want to hear from the public. We can configure both of these on the platform for the company/organization. This group can also access reports on their "purchase" through a real-time web-interface.

Funding our work has been through many means, in the most dire we've resorted to 100% funding from the co-founders for an entire year. Thankfully, we have both government and civil society contracts about to materialize.

Regardless, due to the inconsistency of grants, we see a strong revenue stream as crucial to our long-term sustainability and growth.

Our business model is similar to Facebook: offering our service free to the end-user (community), and generating revenue from businesses/organizations that want to access those users. This B2B model has 3 main areas:
1. Advertising via SMS campaigns to our users - we can send general messages or targeted messages (to those of a specific age, gender, location, or interest) regarding a product / event such as condoms, hand sanitizers, and nappies.
2. Advertising via USSD menu – we can include in our menu, information on private health facilities/pharmacies or new products (eg. we recently included information on HIV home-testing kits).
3. Market research – through our surveys we can ask our users if and why they use particular products, helping our clients gain insights to help them better sell their products. This can also be used by NGO’s as part of their monitoring and evaluation to understand if their intervention had the desired impact.

All of our services come with real-time data and analytics as an added value for the client.

In the last 2 years we have received close to $130,000 through different grants including Elevate Prize Fund and CovidAction. In that same period, we also received over $50,000 through revenues. We are currently signing contracts slightly above those mentioned above.