NaYa, a health safety net during crises

Poverty and lack of government supported-universal health coverage in Central and western Africa contribute to women and chronic disease patients’ worst health care outcomes. The large scale COVID 19 pandemic has worsened women’s ability to have access to care in the region, in a context where 80%  of women in West and Central Africa derived their pre-pandemic revenue from the informal sector negatively affected by COVID lockdowns, further reducing their ability to pay for pay upfront for critical care and achieve good health. Similarly, in in Cameroon, a West African country where 75% of medical expenses are borne by private households, patients with complex diseases and parents of children with chronic diseases have seen disparities to care access increased during the pandemic, rendering them unable to access critical care and maintaining access to life-saving treatments.

While communities outreach to primary care providers has been helpful in identifying women and chronic patients for punctual aid during the pandemics, solving the issue of maintaining financing of their care and accessing data on their current care needs remains in the absence of an integrated institutional health information system.

Linkage between a tech-enabled get care now pay later health disbursement model and patients‘ health records at primary healthcare providers facilities can strengthen healthcare systems and maintaining vulnerable populations access to healthcare in time of crises.

In Cameroon alone 80% of the population possess a mobile phone, in West and Central Africa that figure increases to cX%..

Leveraging the high adoption rate of mobile phones in the region, our solution is a universal cashless digital health credit coupled with a health records capability which serves both patients and providers. 

To patients, the solution offers access to "buy and pay later" deposit-free financing for health expenses from their mobile phones at any time in Cameroon and beyond. Using feature phones or internet connected-phones, individuals can access healthcare provider services through our service chatbot via SMS or Telegram. Approved individuals can use their health credit, which works as a line of credit, to get their care at any of NaYa affiliated medical providers when they need it the most, regardless of their disposable income, and pay off at their own pace later. The extended payment period is adapted to the cyclic nature of the intermittent revenue cycles characterizing the informal work sector and health crises, like Covid. Acting as a health safety net for women and patients with chronic conditions.

 To medical providers: through our service chatbot primary medical care providers including pharmacies can now accept payments from patients-whom they would not have served before- as well as capture related patient-health information at the point of service using smartphones. Very much like a line of credit, the repayment of this cashless health credit is flexible with split payments options over time through mobile money wallets offered by local telecommunications companies. A unique advantage of our service is that our health credit service is accessible to people a)regardless of the economic status, b) with and without internet access right at the tip of their finger across West and Central African countries. In addition, our platform empowers medical service providers to serve a larger universe of patients in fragile economic situations than ever before while strengthening their health documentation infrastructure at no cost. 

 Driven by patient urgent care needs, informed by healthcare professionals, this digital health credit solution is an effective data warehouse hosting patient verified-health related data supported by real-world patient critical health needs. 

Our target population is: healthcare providers and patients with chronic diseases working in the informal sector in Central and West African countries with no universal health coverage. Learning from our pilot phase providing digital health credit to uninsured people in Cameroon, representing  80% of the country's population, we’ve established  that:

• over 70% of our clientele comes from the informal sector with the two third being African women market. 
• Similarly, our Covid medicine donation campaign helped us discover the early adopter patient population with chronic diseases whose health outcomes are most impacted by treatment pause. 

Lack of effective universal health care coverage is a barrier to access care for people who live in poverty and bear 75% of the cost of their care, most of it is payable upfront in Central and Western African countries like Cameroon. Not only the lack of funds of those patients reduces their access to care but it also limits the extent to which the supply of healthcare services can be made available to address current demand. 

 By making available our cashless digital health credit to resources constraint patients at medical providers facilities we address at once:
 a) the issue of health financing for cash-constrained patients living with chronic diseases,
b) provide a revenue stream for providers which serves as an incentive for them to capture critical medical records at the point of care with patient consent and at no cost to them.
Thereby serving both healthcare providers and the patients with our solution ensures the availability of critical data for public institutions, communities aid groups and patient to ensure the continuum of care during crises and beyond, while allowing  patients facing health and economic crises to maintain access to their care.

Born and raised in Central Africa (Cameroon), with an international and African experience in health care innovation and finance, our founding team members have the cultural understanding of the preferences, perceptions of the targeted population vis-à-vis innovation.
Our team lead has experience building strategic partnerships with healthcare stakeholders (patients, providers) to  accelerate the adoption of health innovation: growing the network of local medical key opinion leaders 4X from the pilot phase.
Through the combination of routine providers and patient association engagements - achieved through weekly liaison agent visits and advisory boards- the team has been able to uncover and address health care needs at a time of crises, the COVID pandemic, in Cameroon. Informed by our local stakeholders communities, the Team successfully leveraged health data, local doctor's insights and patient association leaders to maintain access to critical medicines for geographically dispersed pregnant women and chronically ill patients during the COVID outbreak. Delivered with the collaboration of frontline pharmacies, this donor-sponsored program administered through the NaYa's platform provided three-month access to life saving medicines to pregnant women and chronically ill children. 

Additionally, building on our proof-of-concept phase for our digital health credit, our local team representatives has the field experience of working and gaining adoption of informal workers for digital health financing tools, which insights are necessary to achieve market fit. 
Therefore, to insure the design and the implementation of our solution is guided by real target population's insights we have three key processes in place:
1. A survey system of our target at providers facilities 

2. A North Star Metric centered on customer satisfaction of top expressed pain points.
2. Forming strategic partnerships with opinion leaders and institutions with established social capital to better reach our target population

Moreover, NaYa managing team has complementary expertise in financial/investment services, team building, health care products launch, partnerships and Data analytics in Africa and North America.

Usage statistics from the NaYa's digital interfaces per 1.01.2023                           

• Registered and pre-registered users: 1400
• Medications accessed: 300
• Affiliated pharmacies and primary care providers: 5
• Patient associations and captive community: 100
• Health records (medication history): 600
• Socio demographic records:4470

We tested our solution with a selected group of medical providers, pharmacies in Yaounde (Cameroon's capital),  and a portion of our target population identified via self-declaration. To implement the solution through strategic partners distribution channels and recruit more providers we would need:  

1. Partnership-focused introductions with NGOs, credit unions, pharma industry, and government agencies to establish market access dynamics which can drive impact locally in Cameroon and at scale in the Central African region.
2. To ensure the solution sustainability in targeted markets we need advisory services from business strategists with experience in African Fintech in the following domains:

• • Technology and AI innovators 
  • Legal requirements 
  • Pricing: for the development of license agreement for data access
  • Access to in-kind resources in marketing as well as media exposure

By design, our digital cashless "care now and pay later" health credit focuses on people facing crises, destabilizing events preventing them from accessing healthcare. Our solution is unique in that its an affordable end-to-end infrastructure for planning, financing and maintain health supply.

Planning and maintaining distribution of patient's health -generated health payment data at time of crises.

1. Allows the generation of real-world  health data to identify and plan care distribution for vulnerable populations in fragile contexts unlike cash medical loans issued by financial institutions which are disconnected from care delivery.
Due to the fragile contexts they patients live in- precarious economic resources with no universal medical coverage or -  primarily people facing financial crises will seek our solution to gain and maintain access to critical care. Thus, Triggering  the collection, via our solution, of their health data by medical providers in the process of care delivery.
Unlike financial institutions - cash loan for medical assistance our solution provides the identification of critical care needs related to medical payment, allowing public health agencies and the international community to plan and maintain care distribution based on real-world health need gaps from the local population anytime.

2. Removing cashflow barriers to care access in time of crisis:
Our solution is responsive to people's immediate critical care needs and economic challenges in  destabilizing events (health emergency financial crises, loss of care access due to pandemics). Our Cashless digital health credit facility removes the burden for patients to pay in full upfront medical care costs before accessing critical care. Unlike medical insurance there is no recurrent monthly premium as a prerequisite for care access.

3. Highly responsive solution fitted for healthcare disbursement in   emergency without life-threatening time delay. The digital linkage of our cashless health credit to partner medical providers eliminates the time loss due to delays in cash disbursement for providers' payment often seen in traditional cash loans issued by third-party lenders. 

 4. Insures steady health care supply chain. The flexible repayment structure of our repayment of care now pay later health credit, provides providers predictable cashflows to source and maintain affordable high quality medication and healthcare services supply. 

1 year impact goals:

• Establish access to essential medicines for uninsured patients in Cameroon's main cities: Yaoundé and Douala.
   Impact metric: growth in the number of uninsured people using the digital health credit to access essential medicines (i.e: anti-malaria, anti-hypertensive and pediatric medicines for infections and diarrheal diseases).
  Malaria, diarrheic diseases and  hypertension are leading causes of death in the country as per....
• Secure the continuum of care for patients through increase completeness of patients' health records
  • Impact metric: semester over semester growth in the percentage of patients with linkage of their medication history data and doctor- reported  patient medical diagnoses and symptoms. 

5 year impact goals:

• Increase access to essential medicines for all patients via  embbeding of our  digitalized infrastructure into government supported care-subsidies  in Cameroon, DRC.

Be the real-world data provider for international aid organizations in measuring progress in care and medicines availability for the most economically -challenged and informal workers in region.
Impact metric: reference in Cameroon health expenditure review

Progress indicators are listed against goals below and are indicated with the letters a, b, etc...

Goal. Establish access to essential medicines for uninsured patients in Cameroon's  and DRC:
Progress indicators:
a. Partnerships with credit unions and local '' African tontines''
b. Coverage of treatment interventions for chronic diseases and preventative Central Africa-endemic diseases (malaria, diarrheic diseases)

c. Proportion of women who have their needs in reproductive healthcare services and pregnancy satisfied with our "buy and pay later" deposit-free health financing solution

d. Financial inclusion. The number of previously underserved individuals whom would have declined healthcare previously, and who are now able to access healthcare services due to the availability of affordable payments through our health financing facility.

2. Goal. Secure the continuum of care for patients through increase completeness of patients' health records
a. Have 50% of our registered doctors entering patient symptoms and diagnoses data
b. Access and availability. Adoption rate of our solution by clinics and pharmacies in Cameroon's main cities and and targeted cities in DRC.
c. Partnership/customer agreements with governments and NGOs, e.g., MoH and World Bank cash transfer program by Q4 2024.  

d. Track the cost savings achieved by healthcare providers through the reliable and affordable payments facilitated by the solution. This metric demonstrates the financial benefits for healthcare providers and their ability to offer services at lower costs to patients.

e. Assess the quality, quantity, and relevance of the data collected, and evaluate its impact on planning and maintaining healthcare for populations who traditionally cannot afford it.

We believe that our solution can make a positive impact on the problem by addressing the barriers faced by financially challenged individuals in accessing healthcare. In developing economies like Cameroon, many people struggle to afford healthcare and lack universal access to necessary services, which prevents them from achieving a healthy life. This not only affects individuals but also the entire healthcare system's ability to meet the population's needs.

By offering a cashless digital health credit system, we can provide vulnerable populations with a way to pay for healthcare without financial constraints. This will empower them to access critical care when they need it, thus improving their health outcomes. Additionally, by integrating health data records with the financing system, it will benefit the healthcare system by generating real-world data on the specific healthcare needs of these populations.

This data will be valuable for healthcare planning and cost-efficient strategies. Currently, the demand for healthcare is misrepresented because economically challenged populations cannot afford it. By addressing the cost barrier, our solution generates insights into the critical healthcare needs of vulnerable populations, allowing for more accurate planning and efficient supply chain management at an affordable cost.

Furthermore, our solution also benefits healthcare providers by generating cashflow inflows. This strengthens the local health circular economy and enables providers to maintain steady healthcare services and sufficient medicine stocks.

We can see similar positive effects in other programs, like the World Bank's cash transfer program and cash payments provided by the government in Canada during the COVID-19 pandemic. These programs have shown that providing financial assistance to vulnerable populations can help them access essential needs and support the local economy at time of crises and beyond.

Overall, By implementing our health financing solution, we aim to address the lack of universal access to healthcare and affordable health financing. Strengthening the economic power of vulnerable individuals with our solution will not only benefit individuals but also contribute to:

• building resilient communities and ensuring efficient,
• affordable access to care in economically challenged regions, even during crises like the COVID-19 pandemic.

Our multifaceted digital health financing and health record system integrates:
a. A patient and provider facing -chatbot app for health financing requests and data capture
b. SMS technology for patient education and offline access to health financing
c. Artificial intelligence and data analytics powered website for providers and patient visualization of health history and related-costs.

Equity and diversity are at the heart of our operations and leadership approach. 

1. Our managing team is woman-led and with a local team composed of different ethnic tribes representing the social diversity of the country where we we operate. 
2.  In our operations, we've establish a patient care satisfaction survey to collect data to benchmark health equity gaps in the patient experience at partner health facilities. 
3. Understanding that care costs is, for our human talent living in countries with no universal health coverage, we provide health coverage support to our local staff in form of prepaid in-pharmacy /hospital digital credits and paid time-of for family emergency.
4. In our business model, to increase access to treatments and reduce costs to patient, we've made accessible free resources for patients to find medicine costs, allowing them to discuss treatment affordability transparently with their caring team and family caregivers. 

We provide service to three customers types: Individuals, medical providers, and institutions ( NGOs, MoH, Medical insurance).

1. Individuals: pay as you go service fees when using the digital health credit with differed payment. There is no charge for holding or requesting a pre-approved health credit which makes is attractive and affordable for individuals customers who are cash constrained.
2. Medical providers access the free-subscription allowing them to serve a new customer universe with the promise of stable revenue  inflows at no costs. In addition, they benefit from a free digitalization of the pharmacy and care interventions records helping them understand costs of care and plan health care service supply and availability.
3. Institutions will access health data through licensing. Incentives to buy licenses from NaYa for those institutions include:

• NGOs and MoH:  
  • Obtain current population heath data to reach the right populations with the most relevant interventions.
  • Achieve efficient care planning : launch sustainable affordable care distribution in the region . 
  • Achieve cost-saving with knowledge on number/type of intervention to launch and size of population to serve. 

• Medical insurance: design competitive micro insurance products  which address vulnerable patients' affordability levels and personalized local care needs. 

We plan on becoming financially independent by:

1. Entering customer agreements with:
   1. Informal communities savings groups known as ''tontines'' and offer a fee-for-service health financing ( digital health credit) to their members.
   2. NGOs and the World bank programs addressing vulnerable populations' basic needs

2. Offering licenses to NGO's, MoH and health insurance companies to access anonymized geographic- relevant population health data.

3. Market-linkage-based partnerships with medical providers and government social security agencies 

3. Grants

1. The founding team: self-funding over the past 5 years contributing towards  capital investment: $75 000
2. We secured pay later agreements with medical providers in Cameroon 
3. We provided access to 300 medicines to low-income patients (pilot)
4. Grants:
   1. ORANGE Cameroon Social entrepreneur 1st and women's prizes: $ 6000
   2. OLIN Competition and crowdfunding: $4190