Providing access to primary healthcare services in Tanzania

According to the World Bank and the World Health Organization (WHO), they state that at least half of the world population cannot obtain basic primary healthcare services and 6% of the people live in low-and-middle-income countries and this has pushed them further into extreme poverty because of high health spending habits. Currently, at least 800 million people in the world spend at least 10% of their household budget on health expenses on themselves, children and many family members.

There are an estimated 600 million people in Africa who live in rural areas representing 50% of the continent’s population (UNDP, 2019). Their daily average wage is USD $2 dollars which excludes them from most of the healthcare services including health insurance programs. 90% of Africa’s 1.4 billion people lack access to basic healthcare due to poor infrastructure, incorrect medical information, propagation of common myths, lack of household support, long distance travel, high treatment cost, shortage of medical experts, long waits in hospitals and counterfeit medication. 98% of them have no access to health insurance, whereby they pay for their healthcare services out of the pocket (Swiss Re Foundation, 2021). According to WHO Universal Health Coverage report of 2019, about 97 million Africans incur catastrophic healthcare costs which put 32 million people into extreme poverty every year. 

In Tanzania, every day nearly 830 women die as result of complications during pregnancy or childbirth or still birth (UNICEF, 2018). One-third of maternal deaths in Tanzania are caused by hypertension and stillbirths, whereas half are caused by antepartum hemorrhage, both of which are linked to poor prenatal care. 91% of women in Tanzania pay for their maternal care out-of pocket or sometimes get assistance from their friends and relatives (Family Care International, 2007). This is about 30% of households who borrow money or sell their assets to pay for healthcare services. For example, only 17 percent of mothers and children in Tanzania received at least six of seven basic maternal and child health interventions, compared to 74 percent for the European or American wealthiest fifth of households.

Afya Bora is a solution-centric, data-driven and mobile management solution that matches patients especially pregnant women, mothers with newborn babies, pediatric patients and people living with chronic diseases to certified and registered healthcare service providers for medical home or office calls/visits and telemedicine services via its on-demand platform, allowing them to schedule medical appointments, talk and chat to health practitioners via short messaging services (SMS) and Interactive Voice Responses (IVR) and providing access to low-cost micro-health insurance policies for MSMEs. 

Afya Bora uses a simple model that leverages community involvement, trusted hospitals, pharmacies, health laboratories, doctors, midwives and technology to revitalize access to reliable and affordable healthcare services to underserved communities living in fragile context in Tanzania. Afya Bora aims to increase health resilient through fostering knowledge, precise decision making and better access to healthcare services in a sustainable manner.

Afya Bora incorporates video and audio consultation and virtual medical bookings to connect patients living in remote and marginalized communities with healthcare service providers for better care services. Through this solution, patients can share disease symptoms and medical information with their healthcare service deliverers in an intuitive way. Furthermore, Afya Bora uses short messaging services (SMS) to request for the nearest registered community health workers (CHW's) to administer home-based primary healthcare services. In addition, we use SMS to address prenatal health issues through sending text messages to pregnant women and their families/relatives to generate attitude and behaviour changes of mothers and the people that surrounds them. 

Afya Bora serves patients especially pregnant women and mothers with newborn babies with age 21 to 39 years and pediatric patients with age 0 to 14 years living in marginalized communities of Tanzania. This two population group (women and children) are disproportionately, in the sense that they lack access to healthcare services because of poor internet connectivity and poor infrastructure. As a result, they are at higher risk of death, disease, and poor mental health, and are in dire need of quality and affordable healthcare services. 

In antenatal care, pregnant women and mothers with newborn babies are underserved and vulnerable because pregnancy is significantly associated with negative birth outcomes, such as; preterm birth, low birth weight, low APGAR scores and adverse outcomes in childhood i.e. disturbed mother–child relation with risk of child neglect, emotional problems and symptoms of attention deficit hyperactivity disorder (Mongan D et al, 2019). Furthermore, women and children living in remote areas of Tanzania are most vulnerable and underserved because of the attitude and behaviour of the General Practitioners (GP's) and midwives that they overlooked through pregnancy consultation with any support and some developed perinatal depression. 

Afya Bora is reducing barriers to access reliable and affordable healthcare services by encouraging attitude and behaviour changes in mothers during pregnancy, helping community health workers (CHW's) track children missing vaccines, track real-time performance for healthcare service providers through engaging and supporting the health workforce and provide online education on malnutrition, mental health and sexual reproductive health. 

Afya Bora facilitates access to remote healthcare for women and children who are underserved and in fragile communities, while providing a holistic and robust technological solution based on data gathered from hundreds of thousands of video and audio consultations. Our technology can be seamlessly integrated by healthcare providers including hospitals, dispensaries and health laboratories and is mostly based on convenience and trust. This improves the experience for patients, gets them access to the best care possible, all while making doctors more productive.

Afya Bora is made up of a committed and well-organized team members, who share the same values and aspiration to help solve health and wellness grassroot problems in Tanzania. We are building a remote healthcare and structured healthcare delivery culture among the growing population of underserved African middle and low-income households. 

Our team has the right skills wielded by the right people to provide access to quality healthcare services in Africa. Our diversity and youthfulness are the sources of our strengths and continuity that helps us shape our views and progress. 

Tisha Singh is the Co-Founder and CTO of the Afya Bora where she brings with her 3 years of working experience in software engineering and development of Artificial Intelligence (AI) tools and products for different companies in India. She holds a Bachelor of Technical Engineering specializing in software development and Artificial Intelligence from the Lovely Professional University, India. Tisha is responsible with managing, approving and implementing all new and outstanding technological tools and information to our platform in order to keep them up-to date. 

Goodluck Tesha is the Co-Founder & COO of Afya Bora where he brings with him intensive knowledge and experience in business management and accounting. He holds a Bachelor of Business Management from Saint Augustine University of Tanzania. Prior the establishment of Afya Bora, he has co-founded an environment conservation organization and an online travel agency based in Tanzania. 

Reginald Victor Runyoro is the Founder & CEO of Afya Bora - where is he responsible managing and implementing the companies values, objectives and goals in a sustainable manner. He works hand-in hand with the operations, technical and marketing departments to ensure the growth of users and consumers. Reginald is an award-winning social entrepreneur, who has co-founded different companies in the Fintech sector, travel and tourism and clean energy. 

Jacqueline Gerald is the Chief Medical Officer of Afya Bora, where she is responsible with the provision of sexual and reproductive health, nutrition and maternal care education to women and children in marginalized communities of Tanzania. Prior Afya Bora, Jacqueline worked at Muhumbili National Hospital as Medical Doctor (MD) specializing in Pediatric issues and maternal care. She holds a Masters degree in  Paediatrics and Child Health from Muhimbili University of Health and Allied Sciences, Tanzania. 

Alice Tom is a fresh-graduate from the University of Dar es Salaam with a Bachelor degree in Information Communication Technology (ICT) from the University of Dar Es Salaam. She brings with her 2 years of experience in website development, chatbot integration and website management. She is responsible with managing and implementing different actions on the website as well as ensuring that the website is running smoothly in a sustainable manner. 

George Milanzi is software developer and computer engineer with over 5 years of experience working with different startups in Tanzania. George brings with him skills and knowledge in UI/UX designs, mobile application development (both Android and IoS) and design thinking to the company. George holds a Bachelor degree in Information Communication Technology (ICT) from the University of Dar Es Salaam, Tanzania. 

Afya Bora currently serves at least 3,200 people who are underserved and live in marginalized communities of Arusha and Kilimanjaro regions of Tanzania. 

We are applying to Solve because we believe that Afya Bora has a sustainable potential to foster and improve accessibility of healthcare services to underserved groups living in marginalized communities by reducing the time spent to access care, diagnostic journey and severe travel and testing for patients. Afya Bora wants to put patients at the center of the healthcare delivery system by empowering them through data collection and sharing, which aligns with the dimensions of the challenge.

We believe that in order to achieve our mission and vision, we need to establish mutual networks and partnerships with Solve because they offer accomplished entrepreneurs, investors, executives and other individuals (including legal and compliance) to deliver the business and leadership curriculum and offer mentorship that will help my Afya Bora's  figure out operational elements critical to survival and growth. Coached by Solve’s network of world-class mentors, the training and mentorship will create sustainable growth in the company's marketing strategies and build solid foundations to help grow the company to e next stage of growth.

We are applying for Solve because we are facing financial constrains, therefore we require funding that will help to continue with our product enhancement, marketing and human resources in order to expand our operations and grow our consumer base in a sustainable manner. Financial constrains are hindering our technical grow and the sustainability of some important features and functionalities that handle the management of patients and healthcare service providers. We are applying to Solve because it provides non-equity funding prizes and investments that will help the business to grow its operations, enhance our product and talent acquisition in order to make the business financially sustainable. 

We are applying to Solve because, beyond the program, I will remain in the Solve Global network and receive ongoing access to founder perks, 1-on-1 mentorship, office hours and events. This will give me the opportunity to get access to a community where they get to work and connect with over 5000 founders, some with similar needs and problems, more than 200 mentors and other high-value contacts. In addition, Solve will give our business more visibility and credibility to our stakeholders and partners who are ready and committed to support our mission. 

Afya Bora utilizes cutting-edge technologies including Artificial Intelligence (AI) and Short Messaging Services (SMS) to learn complex healthcare delivery value chain and enable healthcare service providers with specialist-specific health and wellness information that continue to provide access reliable care services and increase availability of medical specialist knowledge in remote areas with fragile context in Tanzania. For example in the rural and underserved communities of Arusha region in Tanzania, there is no pediatrician, therefore with our integrated Elsa Health Artificial Intelligence algorithms we can detect high-mortality illness to impact the lives of millions of women and children living in marginalized and undeserved communities. 

Our integrated Elsa Health Artificial Intelligence is among the few AI-powered health solutions supporting precise medical decision making. Afya Bora will grow to empower even more patients and healthcare service providers to better identify diseases and improve treatment outcomes respectively. Afya Bora allows healthcare service providers including hospitals and doctors to create and run a private medical practice in a subscription model. This virtual clinic is not centered only around medical booking appointments, rather the cornerstone of the unique care model is its daily "rounds", allowing doctors and physicians to respond directly to messages from their well-known patients or check on the progress of treatment. This process is supported by Elsa Health Artificial Intelligence (AI) that provides hospital, doctors and physician network with constructive feedback received from their patients on their online medical consultation and virtual clinic while providing training modules for performance improvement for the next medical consultation

Furthermore, Afya Bora uses SMS to encourage and generate attitude and behavior changes of expectant mothers and people who are around them during pregnancy and first six month's of the babies life. As a micro-health education product, it allows consumers especially pregnant women and mothers with newborn babies to increase their rate in health and wellness care continuity, to improve stimulation during the first six month of the babies life and to foster the early identification of warning signs to contribute to the reduction of maternal and infant mortality. 

The impact goal for our business for the next year to finalize our Minimum Valuable Product (MVP) that needs easy online payment integration systems and an Artificial Intelligence (AI) conversational chatbot that will enable the business to recruit at least 350 healthcare service providers and 150,000 subscribers. We expect our solution to improve the lives of women and children, and expand the use of AI-powered technologies for healthcare and wellness to new markets.

We plan to achieve the one-year impact goal by following the below plan;

1. The enhancement of seamless payment gateway scalability will help to redirect users and consumers to payment providers designated while deciding on the number of payment transactions for a certain period of time. 

2. Redefine and conduct market research; thereafter implement go-to market strategies that will increase the interaction and engagement of between healthcare service providers, patients, health insurance companies and marketplace operators. 

3. Developing a marketing site and an AI conversational chatbot that will help to reduce the increasing number of abandoned medical appointment bookings and medical consultations because of time-wasting checkout and or the amount of information needed to finish the booking

4. Developing and implementing intensive marketing strategies that are easier to reach our target user and consumer base. 

Our impact goals for the next five (5) years will involve adding more features to our platform (product enhancement) which includes building an in-app wallets based on Decentralized Finance (De-Fi) wallets to help people to save by installment for health insurance. We are planning to grow our userbase to 5 million and our consumer base to 2 million active subscribers in the next five (5) years. 

We expect/plan to achieve the five-years impact goal by the following ways;

1. Intensive marketing that will provide a vast coverage of the existing market by using all available outlets including billboards, brochures, radio and television, and e-commerce. Intensive marketing is most commonly used when the product is a very common product in the market and there are many different alternatives available. 

2. Recruiting at least 700 hospitals, 300 health laboratories, 500 pharmacy stores and more than 1,500 community health workers (CHW's) that will be available to provide reliable and affordable healthcare services instantly. 

3. The distribution of bulk SMS to at least 3 million mothers that will be supported during their pregnancy and first months of the baby's life. In total we are looking at about 5 million messages to be sent to these different healthcare key actors. 

4. Developing in-application wallet will act as an electronic decentralized wallet - whereby users and consumers could pay using the De-Fi wallet for their health insurance rather than spending it from their pocket or borrowing from relatives. 

5. We are seeking to raise a pre-seed capital of about USD $500,000 from Angel Investors and Venture Capitalists in order to grow the business's operation while scaling the business in other countries in a sustainable manner

We measure our progress toward our impact goals through the following ways; 

1. The increasing number of recurring consumers and referred users and consumers who use Afya Bora to access affordable and reliable virtual healthcare services

2. We look at the increase and decrease weekly and monthly recurring revenue generated from the provision of our virtual healthcare services

3. We track all short text messages (SMS) delivered to our subscribers in order to know how many people our SMS technology is reached over time. 

4. We record the number of pregnant women and mothers with newborn babies that have any disease concern and complications in order to know how many women and children that are underserved are served in a sustainable manner.  

5. The establishment of business partners and stakeholders play a crucial role in measuring the progress of the company because key partners and stakeholders have the ability to connect our business with other partners and investors. As a result this makes the business more eligible and credible to the market. 

Afya Bora aims to address the problem of accessing to reliable and affordable healthcare services to pregnant women and mothers with newborn babies, pediatric patients and people living with chronic diseases living in marginalized communities of Tanzania. Afya Bora is offering online healthcare delivery services including video and audio consultation, doctor-home visits, distribution bulk SMS about maternal and childbirth care, nutrition and preventable diseases.  Without internet connectivity, underserved pregnant women and mothers with newborn babies living in marginalized communities of Tanzania are able to receive reliable and affordable healthcare services instantly. This helps our business gather data to identify the areas in which we can generated potential sustainable impact. For example, the distribution of text messages linked with maternal nutrition and personal hygiene play a crucial role solving the grassroot problems of maternal mortality and childbirth death rate. 

Afya Bora is a mobile and web-based application that uses short messaging services (SMS) to connect patients especially pregnant women and mothers with newborn babies, and people living with chronic diseases to certified and nearest community health workers (CHW's) to provide faster and affordable online and home-based primary healthcare services in remote areas and peri-urban areas of Tanzania. 

Afya Bora's web-based and mobile application gives patients the opportunity to book for a medical consultation, receive virtual and audio consultation and request for doctor-home visit to receive healthcare services. The video and audio conferencing platform uses real-time communication technologies that helps to reduce the widening gap that exist between patients and community health workers in the healthcare delivery system. Afya Bora is data-driven - therefore it gathers all important data concerning sexual and reproductive health, maternal health and childbirth care, mental health and nutrition in order to reduce the existence of maternal mortality and childbirth death rate in marginalized communities of Tanzania

Our SMS technology works in two ways; firstly, patients can register, pay and order or request for certified and nearest community health workers (CHW's) to administer home-based primary healthcare services including antenatal and postnatal care to women and children who are underserved and living in marginalized communities of Africa and secondly, the SMS features aims to foster the early identification of warning signs to contribute to the reduction of maternal and infant mortality. The second SMS feature strategy is based on fostering knowledge through sending text messages to pregnant mothers and their families/relatives to generate positive attitude and behavior changes of the mother during her pregnancy period. 

Afya Bora has integrated Elsa Health Artificial Intelligence algorithms that has clinical support tools that empower healthcare service providers including hospitals, pharmacy stores and health laboratories with clinical data-driven for consistent and optimal clinical decision-making. The AI tool offers automatic symptom assessment, decision-making support, and next step recommendations. Health providers input patient demographics, vitals, symptoms, and test results (when available), and receive insights and next steps recommendations about their patients’ health. Therefore, with the assistance of Elsa Health AI, Afya Bora supports common pediatric illnesses (rash, gastroenteritis, etc.), nutrition-related illnesses, high-mortality illnesses such as malaria, sexual and reproductive conditions (including HIV/AIDS),and supports healthcare providers in identifying early childhood development milestones.

Afya Bora is made up by diverse team members who bring a wealth of different perspectives, experience, knowledge and skills to the grow of the business. It is very helpful in company to have team members who different background's and expertise's to help build inclusivity and innovation to the company. We incorporate diversity in the team in order to attract and retain top talents that will help the business to grow in a sustainable manner. Diversity in our team helps build a strong band, exclusive connections and welcome people who work in long-term goals. 

Afya Bora's short messaging services (SMS) technology is promoting inclusion and equity to underserved women and children living in marginalized communities in Africa. Afya Bora's SMS has been an effective way to report a pregnant women and mothers with newborn babies and children facing maternal and child health concerns, as it allows anyone to send a free message to many healthcare service providers at the same time. The SMS sent to patients improve antenatal care (ANC) adherence and haemorrhage virologic suppression rates of early infant testing for any preventable diseases or chronic diseases of mother-to-child HIV transmission (PMTCT) retention and retention in maternal health and childbirth care.

Afya Bora interfaces directly with consumers who search for virtual medical care services including virtual medical bookings and virtual medical consultations, home or office visits and mental health education through short messaging services (SMS) on Afya Bora platform. Our business model is business-to-business-to-consumers (B2B2C) and business-to-consumers (B2C) based on a subscription and usage fees model. Afya Bora charge our consumers a pay-as you go model of USD $3.5, a monthly subscription of USD $14.5 and a yearly subscription of USD $75 to fully utilize our online healthcare services. Furthermore, Afya Bora charges USD $175 annually to fully utilize our integrated Elsa Health Artificial Intelligence (AI) to learn complex connections and specialist-specific medical information. 

Our primary customers are women especially pregnant women and mothers with newborn babies and people living with chronic diseases such as HIV/AID's, Asthma, Cerebral palsy, Ulcerative Colitis, Arthritis and Chronic Obstructive Pulmonary Disease (COPD) who are underserved and live in marginalized communities. It is crucial to note that the primary goal of prenatal care or antenatal care (ANC) is the birth of a healthy infant while minimizing maternal morbidity and mortality. Therefore, Afya Bora has demonstrated improved identification and healthcare service delivery for patients with perinatal symptoms of depression. In addition, our target populations needs Afya Bora because patients show an increased satisfaction and decreased pregnancy-related stress due to receiving care from home, access to an online community health workers and service providers support throughout their pregnancy and access Artificial Intelligence (AI) medical monitoring tools for fetal heart rate and blood pressure. 

Tanzania has one of the lowest doctor-to-patient ratios in the world (1:15,000), with about 80% of healthcare service deliverers reside and work in urban areas. This inequity means that pregnant women and mothers with newborn babies and children are significantly limited by their health outcomes and die unnecessarily of preventable health conditions. Therefore, Afya Bora is reducing the widening healthcare delivery gap that exist between patients and healthcare service providers by putting the patients at the center of the healthcare delivery system. With the assistance of Artificial Intelligence (AI), Afya Bora empowers both patients and healthcare service providers with data-driven algorithms for optimal decision making and outcomes. 

Afya Bora plans to become financially sustainable through our subscription-based model, medical prescription delivery, and venture capital funding. Our pricing model has kept our current recurring paying consumers stable while referring our services to friend, relatives and families. We give our users and consumers the opportunity to trial our services for at least one (1) month free; thereafter they are obliged to continue with our monthly or yearly subscription fees in order to easily access online healthcare anytime and anywhere instantly. Afya Bora focus on two pricing model which includes; (a) economy pricing model and (b) penetration pricing model whereby this strategy puts the services at a lower and affordable price in order grab or acquire more users and consumers over time. Both penetration and economy pricing strategy play crucial roles in convincing and returning users and consumers of Afya Bora in order for them to access healthcare services in a sustainable manner. 

The medical prescription delivery is another feature in the platform that make the business financially sustainable. It offers consumers the opportunity to buy and send prescribed medications from registered pharmacy stores in Tanzania. Afya Bora will offer patients with home delivery of medical prescriptions with contactless delivery based on their location, preference and specialization. This gives the business the opportunity to become financially sustainable through the establishment of business partnership and data management

Obtaining venture capital funding has the ability to provide our business with valuable resources for guidance and consultation to grow the business in sustainable manner. Raising capital funding will help the business to grow while the investors play a role in bringing a lot of business and institutional to the company for long-term goals. Therefore, raising seed capital is crucial for good and innovative startups, because the funds will help the business to recruit key human resources, conduct additional research and prepare our product for market. The seed capital will the business increase sales to pass break-even point and increase efficiency in a sustainable manner.  

In 2021, Afya Bora received USD $20,000 from HealthInc Amsterdam Accelerator program for 8% equity stakes in the business. Thereafter in late December 2022, the business received USD $5,000 grants from Tony Elumelu Foundation. 

For the past 12 months, the business has generated a total revenue of USD $28,000 from our subscription model, utilization of our Artificial Intelligence (AI) for hospitals, dispensaries and health laboratories and the delivery of medical prescription to patients in a sustainable manner.