NaviHealth

The Nigerian healthcare system is characterized by sub-optimal health outcomes and poor quality of care; driven by a number of systemic constraints including a lack of reliable information about healthcare service/provider availability, accessibility, and state of quality.  To date, there is no comprehensive database on healthcare services and providers that renders trusted information on location, availability and service quality such that health consumers can make informed choices about where to go for care. Indeed, an mDoc survey of 1000 citizens in 2016 found that most health consumers make decisions about where to seek care based on family and friends’ recommendations, yet they are eager for an accessible mobile platform by which they can easily find trusted, accurate information about health services availability and provider quality. We spent the last few years building a geo-coded android repository of all healthcare providers, services and facilities in Nigeria. 

It is often said that the common thread that connects all citizens of Nigeria is the lack of access to quality healthcare services.  One critical driver of this is the concurrent lack of access to information about location and availability of licensed healthcare services that will provide reliable quality care. Our team has spoken to Nigerian citizens, regulatory agencies, and providers and have found a dearth of information on the availability and location of healthcare services and providers. There is a cohesive desire for a fully accessible service that highlights service/provider availability and signals service quality which in turn can motivate provider and regulatory responsiveness and citizen-driven improvement. Our conversations with regulatory agencies revealed they have limited effectiveness at governance/enforcement in part because budgetary constraints have inhibited their ability to identify and register all provider/facilities.  Similarly, our discussions with citizens and providers reveal that providers face challenges in referring patients as there is no reliable database and this leads, inevitably, to patient harm. Citizens reveal they have limited knowledge on where they are more likely to receive quality care and desire the ability to not only receive information but also contribute to a trusted ecosystem that activates consumer engagement.

We believe that access to healthcare is a fundamental human right for all citizens and therefore we do not discriminate in the population we serve. However, we have found that those who make $5.50 per day and below are particularly susceptible to a lack of access to information on healthcare as they do not have the referral networks necessary to find the right care.  In 2016, we conducted a survey of 1000 citizens across various socio-economic levels and discovered that health consumers require access to a trusted repository for care. We leverage user design principles from the onset involving key stakeholders, users, providers, facilities what features would be important for them to find the platform useful and drive engagement. We held design workshops, user design parties and focus group discussions to understand the key elements for the platform and determine what the key elements of the wireframe should be. Post building the wireframes, we brought a select group together again and had them click through the wireframes and then developed the designs. We provide a feedback mechanism for users to ensure we are constantly iterating and are responsive to the needs of the population we serve. 

Solution:We have developed a solution for a democratized platform for health information to address these issues. Over the last year we have built a database of geo-coded facilities and services in Lagos State during the pre-scale phase and have launched on the Android platform. Our team has gone door to door of healthcare facilities, culling information from providers on types and availability of services as well as registration and licensure status. This information has been triangulated with data from both the Google Maps API and from implementing partners. Our data team has collected data on over 8000 healthcare facilities in Lagos (approximately 40% coverage) during this phase. So far, with minimal marketing, we have a user count of 600 and growing. During this phase we have also prioritized government linkages. 

The real value of the platform in driving use and responsiveness from citizen, provider and regulator is through the comprehensiveness and reliability of the data and the ease of use of the platform which we would like to focus on in the next phase – the test-of-scale.

How it works: A user navigates to our page/application – navihealth.ai and is greeted by a search box where she can search via name of provider, type of service, type of procedure or a free text of what she is looking for in the search column. She would then have to input the location i.e. Lagos, Nigeria or Uyo, Akwa Ibom and then hit the enter key. A list of results will be displayed in a results page and she can further filter the results based on a number of elements such as type of insurance offered, proximity, gender of provider, types of services and rating of the provider/facility. One she determines what she is looking for, she can drill down further to see additional information on the provider/faculty to help her make her decision on the care she is seeking. We have also built in a feature that helps the user navigate to 

Technology: We are leverage React JS for the front end and a mongo data base. We also use additional security measures to protect the data we have collected.

In Nigeria today, there is no single repository that provides its citizens with a database of healthcare services that is backed by government, has by in from physician and provider groups and uses design centered principles to drive engagement. We believe we have done this and brought seemingly disparate groups together to serve a common goal.  We leverage a combination of principles that coupled together make our offering particularly innovative.  We leverage elements of user centered design that have helped us build and develop with the user at the center to ensure that we have a sticky product that will be used and iterated upon. We leverage the power of social to have users, providers and facilities alike engage with the platform and contribute to its growth. 

We leverage the power of social also to drive accountability and activate provider and facility responsiveness with reviews and ratings. We leverage the power of government to ensure that the providers and facilities we have on the platform are licensed and credible. Using design principles, we have made NaviHealth a platform that providers, governmental agencies and facilities alike would want to engage with. We have designed for scale at the onset and have a clear plan to scale the solution across sub-Saharan Africa. 

Technology is interwoven at the core of our solution. As earlier mentioned, we leverage modern programing architectures to deliver our solution. We have both a web platform and a native android platform. Given that the results need to be severed to our users in a very quick manner, we have leverage React.js, a JavaScript library for building user interfaces for our front end and Node.JS on the backend. 

Also, we leverage  MongoDB given its unstructured nature to house our repository. We also use additional security features from third party providers to protect the user data and protect the platform for DDOS attacks etc. For the mobile application, we use a native android solution given we need access the location services for the device. 

Our theory of change is rooted in the belief that creating a crowd sourced reliable directory of services layered with objective quality measures will drive quality improvement and motivate provider transparency, increase access and drive for a fully accessible system that highlights service availability and quality. 

Current users: Our beta solution, NaviHealth 1.0 has over 1000 active users with no active marketing or public engagement. 

In 1 year, our goal is to drive this number up significantly by 10x to 10,000 active users. We intend to do this via the power of social media, referral networks and network effects. 

In 5 years, we will have served over 1 million users with our solution. We have designed for scale at the onset and have built a modular solution that allows us grow as out consumer base expands. 

We have an ambitious but attainable goal to become the largest repository for healthcare information for users, providers and facilities alike backed by governmental agencies to provide licensure and verification status. Over five years we intend to impact over 1 million lives and grow the geographical focus to key markets across Africa. 

We plan to have transformational impact on millions of lives across Africa. To achieve that, we must ensure contextualized service offerings with minimal variation in our person-centred focus to our end-users. The navihealth platform allows us to achieve scale, at the onset. Our goal in the next year are to standardize our services and refine them, expand our SMS/USSD/offline option to reach more people,   In five years, we expect that we will have a critical mass of over 1million  active users who access to the platform to find the services that they need. 

Technology: The mobile penetration rate in Nigeria is 87%. This means there are over 172 million subscribers. However we have found that mobile phone penetration is not a proxy for digital literacy. A major reason for creating the high-touch aspect of our solution through in-person 'nudge' hubs was to create a space for us to actively teach people how to use their phones to help manage their health. This will continue to be a major barrier to uptake.

Legal: Right now, Nigeria's current e-health landscape is being further developed and so regulation is not fully conducive to telehealth.

Market/behavior: We lack a primary preventive culture in our healthcare systems and amongst citizens so this requires great culture

We are part of mDoc Healthcare and NaviHealth is one of our service offerings. mDoc is a digital health social enterprise that integrates proven methodologies in quality improvement, data and behavioral science with web and mobile-based technology to help people live longer, happier and healthier lives.

Full-time Staff: 8

Part-time Staff: 2

Interns: 1

Our organization is structured along Clinical, Operations and Quality, Data and Engineering and Finance. My background is in engineering and finance and have over 14 years of experience that spans healthcare and technology sectors. I have critical leadership, technical and financial management skills and have led multi-year engagements for mDoc in our operating countries. Prior to mDoc,  I was General Manager for Wananchi Telecom, the leading cable company in East Africa, where I successfully led the origination of new business valued at $1.2MM in yearly revenues. The relationship management skills developed to forge alliances at Wananchi and reduce risks and operational costs is essential to mDoc’s success. Given my investment banking experience, I understands the financial elements of running a business. Prior to Wananchi, I was an engineer at Comcast Corporation and   led the development of the technical platform for mDoc. My co-founder, is a pediatrician by training, and an engineer with years of experience on the business of healthcare through my time at McKinsey and prior to mDoc led the Africa portfolio for a US-based NGO where I grew operations across Africa and raised over $25 million to do that. My co-founder, an engineer, also has a solid background in Finance. Our team members have extensive experience in their collective fields. Our coaches are largely sourced from the communities in which they live.

We fundamentally believe there is no silver bullet for transforming Nigeria’s health system and to that end, one of our core values is to partner "across boundaries". We are working with like-minded partners who understand our values and are laser-focused on impact:

Patients: We partner with patient associations such as the Diabetes Association of Nigeria to help us reach more people with diabetes (and high blood pressure) and to identify peer coaches.

Government: We partner with the federal MOH as well as state MOH (Lagos and Abuja). We also have a MOU with one of the regulatory agencies. We are partners with public hospitals - the Nigeria Police Medical Services and Ikorodu General Hospital where our hubs are located.

Private: We are partners with retail clinic Quick Clinic to provide our digital management platform as well as in person coach at the clinic to their patients. We are now partnered with corporates to provide cancer digital patient navigation.

NGO: We partner with University of Mexico Project ECHO and Healthcare Leadership Academy of Africa to reach more providers and health system leaders through in person and tele-education modules.

We harness a B2B2C model. We target organizations e.g. the Nigeria Police Medical Services and other employers and we also target individuals. We offer a monthly subscription service for Complete Health which is access to the coach and platform as well as in-person coaching, blood glucose/blood pressure monitoring or attendance at any workshop at our hubs. Users pay in cash or via a point of sale machine (many of our users are unbanked hence the cash payment is taken at the hub). Organizations pay a per member per month fee for their members.  We also generate revenue through our training program. We train health providers, hospital CEOs in quality improvement (as well as chronic disease management). The image below highlights our current business model.

While historically we have relied on bootstrapping and grants to build the business, we recently started charging last year for the CompleteHealth service and look to aggressively grow our customer base to ensure that this drives majority of our revenue. To be able to do that, we have to standardize and refine our service offering, understand how to optimize member engagement. Individual members (not organization members) currently can only sign up in person at a hub and pay with cash or card. We are building out our pricing options for those members who only want to access the service online or who do not live near the hub. Our subscription fees are low and majority of our current base is low-income but we are also building a premium service option so that we can follow the path of Aravind and leverage the premium-base revenues to fund the service for bottom-of the pyramid members. We have enhanced our services to attract people with basic phones but we are finding a significant poor illiterate population, particularly women, who need more in-depth self-care support.

We are a very small social enterprise, and we rely deeply on partnerships and collaboration to learn, to grow and to get better in service of our members. We are at a critical point, where we've tested and demonstrated the impact on health outcomes in a small cohort of people but we need help.  We need help with understanding how to differentiate price points or service offerings for low-income vs middle-income populations. We need guidance on our scale strategy and on optimizing our operations more efficiently given we have such a lean, thinly stretched team. We need support on our technology particularly building the USSD solution for those with basic phones and thinking about how to more effectively reach illiterate poor women and we'd like to partner to provide health financing models.   We have made a commitment to be evidence-based but also to curate and disseminate the evidence we generate. We'd like to partner with academics to do this. At the same time, we believe we have so much that others can learn from to apply in their respective areas and we are keen to share. To date, we have had MIT externs working with us through the MIT Africa program and it has been phenomenal. We are keen to build on that and tap into the extensive ecosystem that MIT has to 'partner across boundaries' in pursuit of a healthier, happier, Africa.

Today Africa only contributes 1% to the global research output. We want to change that. At mDoc, it is mandatory for every team member to submit an abstract of their work for a global presentation or publication. So far, we have had 5 abstracts accepted this year at global conferences. But we need help with designing our programs to demonstrate the evidence through implementation research and we need help with writing and publishing peer-reviewed articles.

We would also like to partner with academic universities such as MIT, specifically with professors and students to work with us on implementation research design, data analysis and publications.

We are also looking for impact investors with patient capital who understand the complex healthcare market in Nigeria.

We are looking to partner with organizations that measure quality such as the National Quality Forum to help us think about how to integrate quality measures.