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Worldwide, an estimated 10.0 million people contracted tuberculosis (TB) disease in 2017, of whom only 64% were detected and reported.

According to the World Health Organization, Nigeria is among the eight countries that account for 64% of the global gap in TB case findings. In 2017, only 104,904 TB cases were notified out of an estimated 407,000 expected TB cases. This indicates a treatment coverage of just 25.8% with nearly three-quarters of expected TB cases in Nigeria missing and unaccounted for.

Among diagnosed TB patients, self-reported delays in diagnosis have been estimated to range from 1 to 6 months after symptom onset, suggesting that by the time an infectious patient is put on treatment, many close contacts of that patient will have been exposed to mycobacterium tuberculosis and at risk of developing active TB.

The missing, delayed, and cases unaccounted for is as a result of:

• Unavailability of proper digital tools to directly observe treatments.
• Unavailability of presumptive TB diagnostic pathway in healthcare centers.
• Inefficient ongoing TB awareness and pop-up access to treatment.
• TB misdiagnosis The diagnosis of a TB patient thus provides a window of opportunity for us to screen for and treat active TB among patient contacts and to offer preventive therapy to those at risk of progressing to active disease. 

What is it?

9thDigit is an online/offline health-tech ecosystem developed for the medical management of tuberculosis; The ecosystem delivers multidisciplinary and collaborative health services by synchronizing online and offline TB care services so as to ensure the provision of equal and undisruptive access to quality healthcare experience to the immunocompromised, people living with HIV, maternal & pediatric health, and displaced persons.

What does it do?

Our tool predicts TB risks for household contacts of adults with pulmonary TB using clinical and demographic predictors that are easily collected in clinical settings, without the need for obtaining measurements that would delay contact screening and preventive therapy. And the spread trajectory is predicted using index case social connection as a predictor.

A presumptive TB pre-assessment test is administered to susceptible contacts via a WhatsApp chat linked with Athenahealth electronic medical record API (WhatsApp has excellent active user coverage, aggressive video/audio compression algorithms, and affordable cost of access); afterward, a confirmatory test is employed, at designated TB clinics to initiate a comprehensive TB treatment regimen which is been closely monitored by a local pharmacy and remotely via 9thDigit’s App.

What processes and technology does it use?

Machine Learning, Artificial Intelligence

The customers we serve are health insurance providers, healthcare providers, the government, and International intermediaries. We adopted a B2B2C & B2G Business model – Our ecosystem offers values that is been defined by the needs of the different patient populations and their associated effective care journey including beyond care itself; Our consumer-oriented nature works such that, it increases the number of healthcare touchpoints and outcomes. Where we:

·         Support payment and financing;

·         Leverage community care support services;

·         Integrate home, near-home, and virtual care services;

·         Track daily life activities; and

·         Connect users with traditional modalities of care.

This makes us form part of a broader package of products and services offered by our customers and help them provide on-demand service.

Our users are Patients with limited or no health coverage, People living with or at risk of HIV/AIDS, people experiencing a form of discrimination, Maternal & Paediatric Health, People experiencing homelessness, Non-English speakers, and displaced persons. our solution helps our users alleviate barriers such as the lack of knowledge about TB transmission, perceived low risk of infection and disease, and long wait times at clinics.

Our thirteen-man management team has at least 7 years of startup experience, they work 40 hours weekly to ensure the actualization of our shared mission. They came from diverse cultural and professional backgrounds with long years of honing their respective skills garnered through project involvements and specialization courses. Their residency in Nigeria is uncompromised and are actively involved in grassroots volunteerism where real-time community problem is at their highest and solution to the same is conceived.

We create value co-creation from user engagement. i.e. drive community engagement by the implementation of a unique model where we integrate diverse functional traits which are community oriented in peer-2-peer, social media networks, and virtual currencies; We assort users relying on their health-seeking behavior.

Awarun Tunde the founder/CEO has 15 years of experience in developing and implementing health-related community development projects, having previously successfully co-founded open-source software businesses; with Healthcare Revenue Cycle Management and Vaccine Inventory Management gaining ascendance. His vast engagement with International NGOs as a Monitoring, Evaluation, Accountability, and Learning specialist drew him closer to his community where he consistently interacted with stakeholders on a different level of accountability. Consequently, Tunde understands the implementation gaps experienced in implementing initiatives for the interest of the benefactors and the beneficiary. He bagged a master’s degree in patient safety and healthcare quality from the Johns Hopkins Bloomberg School of Public Health.

Damilola Teidi is a prolific business development expert with 10 years experience of working with a couple of African startups that she helped grew into large businesses through her position in coordinating key acceleration programs. She has an M.Sc. in mechanical engineering from M.I.T.

Atolagbe Oluwatosin is the author of the best-selling finance book "Mystery of the five talents" highlighted by Forbes, Entrepreneur, and LinkedIn. Tosin cofounded Cash & Co. where she grew into one of the largest expert HQ content to more than 1000 of the world's top publications. Tosin’s doggedness in writing helps get her voice heard – She is a tech advocate, a policy influencer, and a digital marketing specialist. Tosin is a master’s holder of Computer Science, Economics, and Statistics from the International University of Andalucia.

Prior to co-founding 9thDigit, Koseunti was the CTO of Orwell Linkso Inc. with more than 100 retail locations. He oversaw all IT initiatives including software development, sales technology, mobile apps for customers and employees, security systems, customer databases/CRM platforms, etc. He has an M.Sc. in computer science and an MBA in operations management from UCLA.

So far, we have 25000 indirectly managed users shared among 79 customers spread across the country.

8000 TB infected persons undergoing varied lengths of a treatment regimen based on respective case severity.

The Nigerian healthcare system is not only under-resourced but largely overwhelmed and incapable of meeting the needs of millions of people in all parts of the country.

Competing in the MIT Solve Challenge is an expression of one of our business’ marketing strategies for 2022 which is to apply for hackathons, entrepreneurship boot camps, and competitions so that we can build a viable network to occupy new grounds, for technical support, initiate partnerships, and raise funds.  This we hope will help us achieve our ultimate milestone of detecting 1,000,000 TB cases so as to EndTB by 2030.

Product Development Technology – We are using data science, machine learning, and artificial intelligence technology. Our operation is centered on data that we leverage for disease surveillance – spread rate, trajectory, and tracking likelihood of infection. With this data, our resources are channeled appropriately having a pre-informed knowledge of the targeted location.

User Engagement – We drive customer engagement by the implementation of a unique model where we integrate diverse functional traits which are community oriented in peer-2-peer, social media networks, and virtual currencies; We assort users relying on their health-seeking behavior.

Fair Payment – We frown at the “One size fits all” billing model so, based on users’ consistency of their health consciousness, they earn points that are redeemed in lieu of payments. And users can also compare health insurance providers’ policies to aid their selection.

Open Source – We have an open-source community where developers optimize our software development kits to further our design.

There are three key social impact goals our enterprise plans to achieve and they are to: 

• Increase access to essential medicines, medical supplies, and vaccines.

• Reduce financial barriers to health services 

• Increase Access to medical diagnostics and devices.

In other, for us to achieve goal 1, we are partnering with drug manufacturers for a direct supply of their drugs to our chain of pharmaceuticals strategically positioned within a cluster of users. 

To achieve goal 2, we will promote health-seeking behavior by repeatedly prompting users on information about their nutrition, mental health, vitals, etc. Pecks are attached to this action which invariably reduces the cost of their subsequent doctor visit. Moreover, user data gathering can pre-inform their case severity to present the appropriate payment schedule. 

Goal 3,  We will be promoting the availability of diagnostic tools by proposing an installments payment on behalf of healthcare providers to equipment manufacturers.

Our impact metrics are being measured using this approach:

Access to Healthcare -

(Number of beneficiaries) methodology - For a given reporting period, add the total number of medical files for new patients plus transferred patients plus patients who stopped using the service as of the end of the reporting period to get the total number of beneficiaries. This metric is often used as an input for other output metrics, for example, the ratio of patients to medical professionals or caregivers.

(Number of patient visits and/or consultations) methodology - Count the total number of patient visits and/or consultations conducted at the end of the reporting period to get the total number of patient visits and/or consultations.

Improved Quality of Healthcare –

(Results of medical intervention) methodology - For effective management of chronic conditions, we measure the proportion of patients whose condition is 'under control,' using data from the Health Management Information System (HMIS). The period must be specified, i.e., it is important to establish the number of patients that are under effective management for a certain number of consecutive months

(Patient satisfaction) methodology - The Net Promoter Score is an index ranging from -100 to 100 that measures the willingness of customers to recommend a company’s products or services to others. It is used as a proxy for gauging the customer’s overall satisfaction with a company’s product or service and the customer’s loyalty to the brand.

• Repeat patients: Use the client retention rate at the end of the reporting period to gauge the number of repeat patients, as follows: Client retention rate = Total number of clients at the end of the reporting period / (Number of new clients during the reporting period + the total number of clients at the beginning of the reporting period).
• Satisfied patients: Send clients an SMS survey after their consultation or service to follow up with their level of satisfaction.

Healthcare Awareness raising/Preventive Care –

(Number of preventive visits and/or screenings) methodology – Add the total number of preventive visits (check-ups, screenings, immunizations) during the given reporting period

(Healthcare awareness campaigns, and/or educational activities) methodology – reporting by describing educational impact objectives and activities (e.g., advertisements, events, etc.) and tracking reach, duration, and overall success.

Affordability of Healthcare –

(Beneficiaries are broken down by socioeconomic status) methodology - Surveying a sample of customers via mobile phone or household survey, using poverty measurement tools like the Progress out of Poverty Index (PPI).

(Number and/or percentage of subsidized procedures) methodology - Add the total number of individuals who received service and their bill was covered by a national insurance provider, and then divide by the total number of medical treatments provided by the facility.

(Price benchmarking against competition) methodology - Identify the scope of healthcare services and procedures, and their associated costs, provided locally or at regional or international destinations. Then conduct cost comparisons.

Purpose | The problem

The purpose of this brief is to coordinate the design, planning, and execution of engaging a vaccine-preventable infectious disease management ecosystem in order to develop and sustain the health behaviors that will stop the spread of Mycobacterium tuberculosis. The focus is on personal and social protective behaviors such as practicing personal hygiene, consciously monitoring body vitals, attention to nutrition, self-isolation in case of symptoms, and peer-2-peer interventions.

Outcome objectives

Minimizing morbidity and mortality from Mycobacterium Tuberculosis in Nigeria

Ecosystem’s objectives

To help reduce the health burden posed by vaccine-preventable infectious diseases and most importantly to stop the spread of Mycobacterium Tuberculosis by instilling positive health-seeking behaviors.

Target audience 

Primary

• Young people, aged 15–35 years. They are both the most exposed to the economic impact but also have a perception of invulnerability. They are the slowest to adopt the behaviors necessary to flatten the curve. And while not as vulnerable as higher-risk groups, they are not immune either.

Secondary

• Seniors and those with chronic health conditions are mostly immunocompromised.
• Potential partners who are willing to support the cause.

Measures of impact

1. Scale of reach and engagement.

Input – Intervention – Ecosystem design

Implementation – Environment – target audience getting exposed to the ecosystem and physical/social support.

Output – Brain – I want to protect myself and others from Mycobacterium Tuberculosis.

Outcomes – Behaviour – Unconscious practice of positive health-seeking behavior.

Impact – Reduced transmission and impact of Mycobacterium tuberculosis in the country.

We use data as a central part of the solution. TB risks for household contacts of adults with pulmonary TB are predicted using clinical and demographic predictors that are easily collected in clinical settings, without the need for obtaining measurements that would delay contact screening and preventive therapy. And the spread trajectory is predicted using index case social connection, and colocation as a predictor.

Our API performs a number of methods (or functions) that accesses our services. This includes the following methods: age_groups; regions; countries; pregnancies; ranked_differential_diagnoses; knowledge_window; triage_score; and predictive_text.

We use machine learning and A.I. We leverage the logit model to predict the probability of an event's occurrence. Our model/methods are evaluated through Likelihood Ratio Test – If an improvement over a model with fewer predictors is demonstrated, then the logit is said to provide a better fit to the data; we tend to compare the likelihood of the data under the full model against the data under a model with fewer predictors.

We are also using blockchain for our revenue cycle management on a hyperledger platform, deployed on the mainnet, and the use of dedicated proof of stake consensus algorithm.

Ten ways we incorporate DEI into our business practices are:

1. Getting employee Feedback
2. We built in communication and recognition.
3. Diversified Hiring Practice
4. Encourage a culture that valued differences
5. Provide DEI Training
6. We start with Leadership
7. We encourage collaboration.
8. Promote Pay Equity
9. Consistently Review Organization’s Framework.
10. Closely consider Gender Pronouns

The customers we serve are health Insurance Providers, the government, and International intermediaries. We adopted a B2B2C Business model – Our ecosystem offers values that is been defined by the needs of the different patient populations and their associated effective care journey including beyond care itself; Our consumer-oriented nature works such that, it increases the number of healthcare touchpoints and outcomes. Where we:

• Support payment and financing;
• Leverage community care support services;
• Integrate home, near-home, and virtual care services;
• Track daily life activities; and
• Connect users with traditional modalities of care.

This makes us form part of a broader package of products and services offered by our customers and help them provide on-demand services.

And our users are Patients with limited or no health coverage, People living with or at risk of HIV/AIDS, people experiencing a form of discrimination, Maternal & Paediatric Health, People experiencing homelessness, Non-English speakers, and displaced persons. our solution helps our users alleviate barriers such as the lack of knowledge about TB transmission, perceived low risk of infection and disease, and long wait times at clinics.

Reinjection of sales commission into operation – These are the sales from medical and analytic equipment, including consultation fees from equipment planning, and medical tourism.

• Fee-for-service for online consultation and other medical services
• Fee from value-added packages and membership plans
• Sale of customized consumer healthcare service packages to individuals as well as corporate clients
• Sales of products under the direct sales model
• Commissions from the marketplace model
• Advertising revenue

We received grants from these funding organizations:

Meta Inc. - $15,000

Tony Elumelu Foundation - $5000

Lagos State Employability Trust Fund - $5000

Jim Leech Mastercard Fellowship Foundation - $5000

Seedstar - $45,000