Tech-enabled Urgent Care & Nurse Dispatch

THE INFORMAL SECTOR LABOR FORCE SUFFERS FROM RARE DISEASES WHICH ARE COMPLICATIONS FROM DELAYED CARE. 

Informal workers comprise the largest segment of the working population in Sub-Sahara Africa. They share one thing in common, which is delays in seeking care when affected by common diseases. 

Affordability is a contributor. They are paid daily wages. Missing work for a doctor's visit is costly to their welfare. Neither can they afford private insurance. The majority self-medicate with medicines purchased in the open market. Exposure to low-quality counterfeit medicines or chemicals in foods or water further exposes them to neurological diseases. Coupled with malnutrition, delayed access to care causes treatable diseases to evolve into complications that manifest as rare diseases. Konzo is a seasonal irreversible paralytic neuropathy that affects children and women in cassava-farming communities. Aflatoxin causes liver tumors in peanut-growing communities. Delayed treatment of jiggers or cuts in school-aged children evolves into abscess formation, tissue necrosis, and gangrene. Lingering cases of polio and tetanus are associated with delayed vaccinations. The current model of facility-based fee-for-service care needs to be disrupted for Sub-Sahara to achieve Universal Health Coverage. 

Occupational hazards add to the rare disease burden. Over 15 million people in Kenya, i.e., 56% of the working population are informal workers. These are small-holder farmers, market traders, cab drivers, guards, house helpers, waiters, park rangers, mechanics, construction workers, etc who are at risk of rare diseases. Families of farmers are exposed to pesticides, fertilizers, and fine dust particles associated with poorly understood respiratory and cardiovascular diseases. Roadside mechanics and construction workers work without personal protective equipment and often complain of rare skin diseases. 

The National Health Insurance Fund (NHIF), which requires monthly premiums to be paid in NHIF branches or banks does not work for them. First, they are unbanked. Secondly, outpatient benefits under the national health insurance fund, which less than 5% subscribe to, do not cater to their needs. Routine checks for occupational diseases are not covered. As residents of slum areas, they are exposed to common infections, especially sexually transmitted diseases. In April 2023 workers in a Nairobi factory were offered an annual physical; 48% were positive for urinary tract infections, of which 95% were women ages 21 to 54 years, at risk of gynecological complications. Their enrollment in NHIF was below 5%. Less than 1% had done a medical checkup in their lives as annual checks are not covered by NHIF. Unaware of their health status they rely on curative services when severely ill hence the high rates of hospitalizations among blue-collar workers. The elderly who can't afford NHIF monthly lump sums, are also vulnerable. The informal sector and elderly thus lack access to quality diagnostics, a major disincentive to adopting the NHIF plans.

Other known barriers include long wait times, fear of discrimination, and discomfort when in large hospitals. Finding a reliable primary care doctor for themselves or their children means traveling long distances from their homes or workplace.

EARLY DETECTION AND TREATMENT VIA URGENT CARE AT HOME & WORKPLACE FOR EVERYONE. PAYING $1 PER DAY X 200 DAYS COVERS A FAMILY OF FOUR FOR 365 DAYS. FREELANCE NURSES ARE DISPATCHED ON DEMAND TO THE HOMES OF ACTIVE MEMBERS WITHIN 30 MINS. 

CheckUps is No. 1 in Urgent Care and dispatch medicine to informal sector organizations and their households. We are a hybrid brick-and-mortar and digital operation with a network of freelance dispatch nurses in 6 counties in Kenya and Juba, South Sudan. Our mission is to "Deliver fast, quality, and affordable healthcare in the homes, schools, and workplaces that serve families of blue-collar workers in Sub-Saharan Africa."

We achieve our mission through a technology-enabled nationwide Nurse dispatch service coupled with Urgent care centers in industrial parks, a member-per-day financing plan with deep discounts for groups of workers (B2B2C), and covers in-home and in-workplace care for 25 common conditions with standardized diagnostic protocols and a controlled formulary for treatments. 

DISRUPTIVE FINANCING MODEL: Being unbanked, informal workers, their households, and their elderly parents pay a daily premium of $1 to$5 per day via mobile money into the dispatch platform to keep their membership active and get care on demand. Benefits covered include an intake wellness check for the family, 2 to 4 nurse home visits coupled with remote doctor video-assisted teleconsultations, lab tests, diagnostic tests, and medication delivery worth $700 to $1700 per year per family if paid at walk-in retail value. 

BLENDED CAPACITY: Located within Nairobi's largest industrial parks, our 4 urgent care centers offer walk-in services to factory workers. Workers far from our walk-in centers are served at home or work by dispatch nurses 

CENTRALIZED OPERATION. Our network of freelance nurses is supported by doctors and specialists in our "Situation Room" through inbound requests and nurse-enabled video consultations once with the patient. Five Urgent Care centers are fully equipped with high-throughput labs and in-house imaging for elective X-ray, ECG, and ultrasound tests. Our mobile clinic also has a lab, X-ray, ECG, Ultrasound, and pharmacy for group outreach. Our fleet of 26 electric bikes is used for sample collection and medication delivery. 

END-to-END DIGITAL SYSTEMS: Upon receipt of a call, doctors' orders are loaded into the dispatch application. The case is then assigned to a dispatch nurse by proximity to patients. The dispatch platform allows for real-time visibility of doctors' orders, two-way conversations between patients and assigned staff, real-time visibility of the staff while in transit, billing details & member status, and past clinical orders or prescription details. Once the patient is served, the nurse fills in the details in the dispatch app based on a checklist for target conditions. The data feeds into the patient record in the EMR. Upon completion of the assigned tasks, the nurse is paid per visit.

Affordable diagnostics and treatment prevent complications that if untreated present as rare diseases. Home care in untapped markets is a rich data source for rare disease research and clinical trials.

Target market: Informal and blue-collar workers are the backbone of the family and the economy in Kenya. These are smallholder farmers, teachers and pupils in underserved areas, factory & construction workers, waitresses, taxi drivers, and market trades in rapidly growing urban low-housing estates. For these communities, a day off work is more expensive than the cost of care. A sickness episode in their households for themselves, their child, or their elderly parent back home, means borrowing money. Blue-collar workers are affected by a trifecta -1) they can't afford private insurance, 2) they can't afford quality private care, and 3) lose wages when served in busy public hospitals because of long wait times.

What happens when informal workers get sick?
1. Take a time off from work (or disappear) for 2 – 3 days. Factories report 15-20% lost productivity due to sick-offs for common conditions.
2. Borrow money to pay for care. Microfinance loan data shows that 75% of defaults in payments are due to medical illness.
3. Unsure which clinic will give them good care. Clients are uncertain about which facilities have good labs and medicines. Only 17% of facilities are fully equipped with lab and diagnostic equipment. 40% of the medicines in the open market are counterfeit. A 2022 study in Muranga Kenya reported that "in the surveyed health-care centers, no hospital use electrogram and only one had troponin test. No hospital stocked Isosorbide dinitrate and Glicerine trinitrate to prevent chest pain in patients with a heart condition." (Published online 2022 Oct 7. doi: 10.11604/pamj.2022.43.65.31347)
Knowing where to go for affordable quality care is a major challenge for informal workers 

WHY IS THIS MARKET KEY? Africa is undergoing a transition. THREE trends of note are

a) The rapid urbanization of Africa's major cities. 500 million people are expected to leave rural areas and move to cities by 2040. (McKinsey Global Institute June 5, 2023 Report)

b) Urban informal workers will increasingly become hard-to-reach populations, with a need for convenient access to essential services.

c) Alternative health financing solutions are needed. Informal workers can't afford private insurance. Informal workers can't participate in NHIF. For informal workers, sickness = High cost of care + Lost wages = uncertain financial burden. 

New demands for efficiency in the delivery of healthcare to families of informal and blue-collar workers in densely populated cities can't be overstated, lest the emergence of rare diseases, pandemics like polio, smallpox, and cancers are imminent. 

At the family level, our solution hits the pocket.  We eliminate long wait times through scheduled home deliveries. Clients do not have to lose 1-2 days of work. We save on transport costs; 200 – 600 Ksh is spent on transport which adds to the cost of care. Quality of medicines is guaranteed. Our clients avoid the local chemists, the major gateway for counterfeit drugs.

Our impact is systemic. Early diagnostics and treatment would engender an estimated 15% efficiency gains equivalent to billions of savings in health expenditure and increased productivity (https://www.mckinsey.com/mgi/o...)

CHECKUPS HAS HONED A CUSTOMER-CENTERED APPROACH OVER THE PAST 10 YEARS WHICH GUIDES OUR PRODUCT DEVELOPMENT AND COMMERCIALIZATION STRATEGY FROM INCEPTION TO DELIVERY. 

CheckUps started as a community-based initiative branded the 2020 MicroClinic Initiative in 2011. Our goal was to increase access to antenatal care and skilled deliveries in farming communities. Through interactive design thinking processes, the target communities helped us to identify an invisible gap that prevented women from going to the clinics when in labor. The lack of clothing for the babies engendered anxiety, shame, and a sense of discomfort. We developed an intervention, Operation-Onesie. Donated recycled t-shirts were converted into onesies, socks, hats, and blankets for newborns. Free clothing was given to women who were compliant with antenatal care.  Within 5 years, we had shifted the skilled delivery rates from below 17% to 64%, and zero maternal mortality in the 30 communities we served. https://www.mightycause.com/or... The lesson was innovations that focus on CUSTOMER EXPERIENCE is an untapped space. 
We added last-mile medication delivery systems and last-mile access to laboratory tests and diagnostics in 2015. Next, we set up MicroClinic Technologies, to commercialize the first electronic medical record system, branded ZiDi, to support real-time visibility of stock levels in rural clinics, a solution featured in a 2015 Harvard Case Review - https://store.hbr.org/product/.... This technology is what we use to date for our EMR and integrates with our Dispatch app for home service delivery. Thus our system is compliant with National Health Information standards. 
In 2017, we pivoted to a digital app to help clients directly access information on available clinics, labs, and pharmacies next door. The platform was branded iSikCure. After 18,000 downloads we pulled down the platform as the cost of maintenance of a D2C app far exceeded the return or cost savings to clients. Lesson: Digital first health apps are expensive and not sustainable with low-cost services and generic drugs.  
In 2018, we pivoted our strategy to a brick-and-mortar operation under the CheckUps brand targeting underserved communities through industrial parks, and in 2022 launched our D2C dispatch network to reach farmers and market traders who are dispersed in low-density settings or high-density markets, respectively. This approach has enabled us to scale to over 280,000 visits, 46% of which were virtual or home-based in 2022, thanks to the market shift in-home care due to COVID-19. CheckUps is now known as a brand that helps organizations control the cost of outpatient care. 

Experts from the insurance industry alongside thought leaders in microfinance services for informal workers then helped us design the managed care plan. We have partnered with Boda Boda IMS, an organization that offers financial services to 2 million boda boda riders to develop the $1 per day x 200 days product for riders. We have consulted with farmers' cooperatives to test the value offering and customer recruitment strategy.

In short, our innovation is the product of incremental gains from customer engagements over 10 years. Nurse leaders are now involved in the development of the freelance network.

THE HORIZON PRICE WILL HELP US RECRUIT, EQUIP, TRAIN, AND DEPLOY 300 FREELANCE NURSES AND TARGET HARD-TO-REACH INFORMAL WORKERS, AND ACHIEVE AN ESTIMATED 240,000 VISITS PER YEAR. 

Smallholder farmers are also most at risk for rare diseases. They are exposed to chemicals, dust particles, animal bourne diseases, and plant toxins. They require routine checks for early detection and treatment. They require medication delivery as the average farmer is 2 hours away from the closest medical facility with good medication and diagnostics. Our solution is the best fit to achieve early detection, convenience and quality, and cost savings for themselves and their families.

Furthermore, smallholder farmers are also financially risky for our $1 per day x 200-day plan. Their income fluctuates with the harvest seasons. Non-dilutive capital is needed to derisk the scheme. 

Third, integrating freelance service delivery, microfinance, and last-mile inventory tracking will require future investments in our dispatch app. With scale, the technology systems we have developed would need to be progressively optimized using blockchain, AI, and fintech solutions. We are thus enthusiastically looking forward to joining the MIT SOLVE ecosystem to enable us to leverage peer innovations that can enable us to scale without compromising quality or favoring revenue leakages. 

We also seek to contribute to the SOLVE ecosystem by virtue of the huge data we have collected that could be adopted by our partners to develop point-of-care solutions for rare diseases in the African market. Ministries of health lack surveillance systems for diseases at the home level. The lack of good laboratory data also limits the quality of data available for surveillance of rare diseases. Scaling our platform with the backing of the MIT SOLVE system will enable us to strengthen the quality of health data from Kenya's largest workforce. 

Lastly, being an innovation that is at the forefront of shaping private sector innovations in Universal Health Care, we would like to lean on the SOLVE network to develop Impact monitoring and evaluation systems that will demonstrate our impact on Blue Collar workers. Robust evaluation tools such as those developed at the MIT Abdul Latif Jameel Poverty Action Lab (J-PAL)  would be needed to demonstrate our impact on poverty.

We anticipate impact at the multiple levels 
1.     Cost savings to Informal workers and farmers and prevent poverty. We estimate that farmers lose an estimated $35 to $50 per day of business when sick. They also borrow $20 per illness episode. Hence, reaching 240,000 informal workers will prevent close to $60 million in lost wages over a year.
2.     School-based services will prevent a projected 18,000 kids from missing school per year. We expect most of the school cases to be young girls seeking care for reproductive health services, notably severe menstrual pains and period problems (irregular bleeding, etc.) and mental health conditions. We thus expect to impact learning for children of blue-collar workers.
3.     Increase access to WHO-recommended childhood vaccines for a minimum of 1000 children. More convenient distribution should favor access to vaccines at home.

MOKA LANTUM, MD, PH.D., MHCM, Founder/ CEO - CheckUps Medical

Ashoka fellow since 2013, two-time winner of Save The Children/GSK Healthcare Innovation awards, winner of the Sankalp 2014 Award in Health care, and 4-time awardee of the Pfizer Foundations Innovation in Healthcare awards, is a serial entrepreneur in Health IT, Service delivery, and Health benefits management. He launched two multimillion-dollar healthcare companies in Africa. Has a strong track record in strategic partnerships, and new market expansion with insurance partners in Kenya and South Sudan. Trained at the Universities of Yaoundé, Uppsala, Rochester, and Harvard. Held leadership roles while at Kodak and Excellus BlueCross BlueShield for 11 years. Expert-in-Residence in social entrepreneurship at Harvard i-Lab (4 years).  A tribal leader with the rank of Shufaay (sub-chief) in the Nso clan. These accomplishments, though indicative of his success as a social entrepreneur and leader in global health, pale in comparison to his work studying rare diseases in Africa. 

While a medical student in Cameroon, Moka was given a scholarship by the Swedish Missionary Council in 1995 to study International health and nutrition at Uppsala University. This opportunity placed him under the tutelage of Professors Hans Rosling and Thorkild Tylleskar, two Swedish Scientists leading the study of Konzo in Africa. Konzo was ravaging central and eastern Africa. It was a paralytic disease of sudden onset. Children aged 5 to 15 years and breastfeeding women would literally drop into full-blown seizures and after a few hours, would be paralyzed and unable to walk for life. The cause of Konzo was unknown. Health officials thought it was a virus. Professors Rosling and Tylleskar suspected toxins from the cassava plant, the staple food in the arid farming communities. Moka was assigned to the Cameroon-Central African Republic border to a deep rural village, Garoua Boulai, where there was an outbreak of Konzo in 1995. He spent nights and days collecting samples of urine and blood in the homes of affected children shortly after the outbreak. The samples were shipped to Sweden for detailed analyses. This research contributed to numerous publications on the role of diet, poor farming methods, and the rare disease Konzo. WHO recognized KONZO as a unique disease in 1997. Contributing to the identification and description of a rare disease in Africa is the highlight of Moka's career. 

Moka later worked on a transient paralytic disease outbreak in a girls' school in Southwest Cameroon. He then moved to the University of Rochester, NY, USA, to study how the over-chlorination of water causes rare kidney and liver cancers. These projects established an indelible bond between Moka and farming communities. Farming communities are exposed to environmental toxins which manifest as common or rare diseases. 

What if diagnostic systems were readily available in these communities? Would new diseases be discovered? How much longer can farming communities operate without proper monitoring of their health? These are questions that preoccupy Moka's pursuit of disruptive solutions in health care.

Even, while at Eastman Kodak Co (Rochester, NY), Moka worked on a project in inner city Rochester that sought to promote mammogram services for inner city minority women exposed to secondhand smoke. Moka passion for health disparities-related work blossomed. He then moved to Excellus BlueCross BlueShield (Rochester, NY), where as director of Utilization Management from 2006 to 2011, he initiated multiple initiatives to promote equitable access to health financing. A key accomplishment was improving the process for minorities to enroll in Medicaid and Medicare programs leading to over 5000 families joining. He also developed a program to reduce readmission rates for vulnerable populations in Upstate New York that saved the health plan $14 million in 6 months. 

The experience in the USA thought Moka one thing - health care as we know it is costly and inconvenient and Africa can't afford to fund a centralized health system as it has been done in the West. Africa must chart a different course powered by disruptive health financing and decentralization of delivery to close the health equity gaps. 

In 2011 Moka quit his corporate life and set up shop in Kenya. Today as CEO of CheckUps Medical, Moka is leading an organization that's No.1 in Urgent Care and Dispatch medicine in Kenya and South Sudan for informal workers. CheckUps helps thousands of blue-collar workers access affordable care at home, school, or farms during business hours. Workers save on transportation, and the direct cost of care while avoiding the cost of lost wages or lost business. Moka is committed to building the largest network of dispatch nurses who can be deployed to urban and rural homes to do wellness checks backed by the central pool of doctors, specialists, and labs. For $50 a year, a person can access a doctor and essential Lab from their home or workplace for 12 months. It's a game-changer. The model that Moka has built also opens a health financing gateway for Diaspora citizens to fund health care for their families back home. 

Moka trained as a doctor in Cameroon and then obtained his diploma in Nutrition and International Child Health and emergency response from Uppsala University, Sweden, a Ph.D. in Pharmacology and Physiology from the University of Rochester, NY, and a Masters in Health Care Management from Harvard School of Public Health in 2013. Moka is the recipient of numerous international awards for social entrepreneurship and serves on the boards of numerous organizations, including the Max and Marian Farash Foundation where he chaired the Audit and Governance committees.

Moka is married and a father of 2 boys. He mentors budding entrepreneurs through the Harvard iLab program of the Harvard business school. In Kenya, he mentors young entrepreneurs in Healthcare through his Rotary Club. 

Offering CONVENIENCE, QUALITY, and AFFORDABLE care for informal workers is the next frontier for UNIVERSAL HEALTH CARE (UHC) in Sub-Saharan Africa. CURRENT LEVELS OF SERVICE DELIVERY OR HEALTH FINANCING ARE INCONVENIENT, EXPENSIVE, AND EXCLUDE FAMILIES OF BLUE-COLLAR AND INFORMAL WORKERS WITH DELAYS IN CARE THAT FOSTER RARE DISEASE PREVALENCE IN SUB-SAHARAN AFRICA'S SWELLING CITIES.

Without access to convenient, quality, and affordable care, farmers and other dispersed city workers will be excluded from the national UHC agenda. 

INCONVENIENCE: Long wait times in public & private health facilities force informal workers to defer care. 

POOR QUALITY: Only 17% of the 6000-plus clinics in Kenya are fully equipped requiring patients to hop from one facility to the next to see doctors, do labs, or get medicines. Privately operated neighborhood mini-clinics in sprawling affordable-housing estates are poorly staffed and underequipped. Though within reach of informal workers, reports indicate 40% of patients are misdiagnosed at this level of care. The lack of advanced testing systems renders them inadequate for the diagnosis of rare diseases.

UNFAVORABLE HEALTH FINANCING PROGRAMS. 95% of informal workers are yet to subscribe to NHIF. Services that are reimbursed by NHIF are limited. Farmers complain that NHIF doesn't work for them. Outpatient benefits range between $6 to $15 per visit, which limits the tests and treatment that can be offered. For example, annual checks are not covered. Occupational disorders are not covered. Conversely, private insurance is expensive.  Less than 2% of blue-collar workers have private cover. The default option for informal workers and their families is self-medicating or traveling far and implicitly opting to incur business losses.

Our dispatch care model coupled with an affordable financing option responds to these gaps. Our model is novel in that it combines telehealth, tech-enabled nurse dispatch services, digitized distribution of medicines, labs, and diagnostic services, and health financing services to offer convenient, affordable, and quality care to the households that drive the economy. Our focus on wellness checks and the 25 conditions that affect informal workers also makes our service delivery unique and cost-effective.

Equipping 300 nurses with the dispatch app and supplies for effective home-based care will enable us to reach 240,000 homes in a year. If 240,000 patients pay $1 per day for 200 days, then our model will be sustainable without an undue burden on the informal workers' families.

With Universal Health Care defined as the “equitable access to quality health care services without an undue economic burden or loss,” the Government of Kenya is also seeking innovations that promote access to NHIF-subsidized services in a manner that also minimizes economic losses for the hustling low-to-middle income household, of which smallholder farmers form the majority. Hence our model has the potential to serve as a blueprint for a broader national initiative in Kenya and a blueprint for a social health insurance scheme in Sub-Saharan countries like South Sudan and Cameroon that are yet to offer their citizens a national health plan that is affordable and beneficial to the lower-income bracket.

THE IMPACT WE SEEK AT THE FAMILY, COMMUNITY, AND THE HEALTH SYSTEMS LEVEL IS EXPONENTIAL.

We seek to impact the livelihood of families, the nursing and informal workforce, and the health financing system in a manner that favors early detection and prevention of rare diseases, especially within farming communities that are exposed to environmental and occupational risks that predispose them to rare diseases. 

FAMILIES' WELLBEING AND IMPACT ON POVERTY (SDG3 & 1): Our estimates show approximately $35 is saved per illness episode using our model of care delivery. We thus impact family savings and prevent loss of business, prevent microloans for medical bills, and as a consequence, minimize the exacerbation of poverty due to medical illness. Affordable access to diagnostics and treatment will minimize the risk of complications and rare diseases, thus lowering the disease burden. Early detection and treatment will increase the life expectancy of vulnerable blue-collar workers who have the lowest life expectancy. With a 300-rich nurse network, we can deliver 240,000 visits a year and eliminate an estimated $60 million in healthcare expenditure for families. A partnership with MIT SOLVE will help us develop robust M&E methodologies to validate these impact objectives.

WORKFORCE IMPACT (SDG 8): Creating jobs for nurses is a key impact opportunity of our service model. Thousands of well-paying jobs can be created for nurses within their community using our model. Secondly, we minimize lost time and lost wages for blue-collar workers who risk leave-without pay and potential loss of a job when sick. Farmers should experience great productivity thus indirectly supporting food security. Dispatch to schools will minimize time away from schools for girls who are at risk of missing classes because of painful periods. 

EDUCATION IMPACT (SDG 4): Of note is that, our wellness checks school-aged children of informal workers for learning disabilities. Learning disabilities are currently underdiagnosed and thousands of children in low-income communities. Hayes et al (2018) estimate that 5% of the school-aged populations do not receive the requisite screening and in-school support in Low-income countries (https://www.ncbi.nlm.nih.gov/b...). Learning disabilities thus present as a rare disease for lack of early detection. The impact of in-school screening for learning disabilities is yet to be demonstrated, but market surveys show teachers and schools will be well served by our model.

ECOSYSTEM (SDG 9 & 10): Our financial product coupled with telehealth and home dispatch services creates a gateway product for the 12 million informal workers to adopt affordable private health coverage. If widely adopted, our model will drive a lowering of premiums in the market while improving the patient experience for informal workers' families, which should in turn reduce inequities in health care.

In summary, reaching and serving the informal workers unlocks multiple channels for impact and M&E partnerships. 

Consistent with our Theory of Change, we track input, output, process, and output measures. 

Short-term measures:
1. Train & equip the recently recruited 300 nurses.
2. Implement an evaluation and monitoring system for the freelance network.

Ongoing measures and target outcomes: Once fully equipped our goal is to
1. Reach 240,000 lives within 1 year. Each nurse would be expected to serve a target of 4 patients per day.
2. Reach 3,000 farmers. 10% of nurses (30) will be assigned to target 100 farms.
3. Reach 30 markets. 20% of nurses (60) will be assigned to target 30 markets. Each market is expected to yield over 500 lives.
4. Reach 60 schools. 20% of nurses (60) will be recruited to target 60 schools. Each school is expected to yield over 300 illness episodes per year (an avg. of 1-2 per day) and 5% of students having learning disabilities.
5. Reach homes to serve women, children, and parents - 50% of the nurse will be distributed in specific catchment areas based on patient demand.

Sustainability outcomes:
1. Reimburse $3 per visit per nurse = $12 per day per nurse = $300 per nurse per month - which is equivalent to the monthly wage of a nurse.
2. $50 to $200 subscription per household per year. Each household is entitled to 2 to 4 nurse visits a year with complementary labs for target conditions.

Input measures:

1. Number of nurses in the network
2. Number of families subscribed
3. Number of recruitment drives & wellness events.

Output measures

1. Compensation to nurses in the network
2. Revenue and savings for families subscribed
3. Number of families recruited.

Process measures

1. Number of nurses equipped and trained on the Dispatch SOPs & registered with the dispatch app
2. Number of families active vs inactive in dispatch app.
3. Number of dispatches per member per month

Output measures

1. Number of visits per freelance nurses in the network per month & year
2. Number of families subscribed per month and year
3. Rare disease prevalence and treatment provided

OVERALL THEORY OF CHANGE: Each nurse is trained and equipped for an estimated cost of $250. Each nurse will be able to respond to an average of 4 calls per day from her/his catchment area, which will in turn increase access to care for over 800 cases per year, which will, in turn, save lost wages and also lower the cost of care for households, and promote early detection of common conditions and identify persons with rare diseases. A great experience with the subscription will serve as a gateway to families investing further in private or public health insurance to get more benefits.

INPUTS by CheckUps:

1. Licensed Urgent care centers with full labs and diagnostic systems 
2. Mobile clinic offering advanced diagnostic and lab testing in the field
3. "Situation Room" staffed by general practitioners and specialists.
4. Dispatch & telemedicine platform integrated with the EMR system
5. Subscription financing plan with daily to monthly payment options
6. Freelance nurse network trained, equipped, and registered on the dispatch platform.
7. Protocols and diagnostic criteria for 25 target conditions with standardized treatment guidelines.
8. Marketing and advertising

Immediate Outputs

1. Enrollment and management of the network of freelance nurses
2. Enrollment and management of subscriptions
3. Intake wellness checks for every new member
4. Teleconsultations and dispatch nurse visits to homes of informal workers, schools, farms, marketplaces, factories, etc.
5. Lab analysis and release of results
6. Treatment or referral of cases based on medical needs.
7. Enrollment into NHIF for inpatient care benefits.
8. Storage and dispatch of medical reports to patients.

Longterm outputs

1. Medical savings for the families of informal workers
2. Early detection of diseases and prevention of complications
3. Identification and coordination of care for clients with rare diseases.
4. Increased impact on early identification of learning disabilities in children of informal workers
5. Increased impact of early identification of diseases associated with occupational hazards, notably pesticides, fertilizers, etc among farmers.
6. Lowering of insurance premiums due to pricing pressures from our pricing model.
7. Developed M&E frameworks for our Urgent Care and dispatch services and our health financing services.

Impact outcomes:

1. Number of children identified with a disease classified as rare, including learning disabilities

2. Number of adults identified with complications from a common condition or rare disease, notably, cardiovascular, respiratory, dermatological, gastrointestinal, neurological including vision, or hematological.

3. Cost savings achieved per member per month and aggregate care

4. Customer satisfaction scores from the subscription plan

5. Nurse evaluation of clinical efficiency for index conditions - Hypertension, respiratory disease (chronic cough of unknown origin), skin disorders, learning disabilities assessment.

THE CRITICAL TECHNOLOGY DRIVER OF OUR SOLUTION IS THE DISPATCH APP PLATFORM THAT IS AN END-to-END WEB APPLICATION WHICH WE USE TO ASSIGN ORDERS TO NURSES WHO ARE CLOSEST TO THE PATIENTS' LOCATIONS. THE PLATFORM ENABLES US TO TRACK ORDERS RECEIVED VIA PHONE CALLS OR WHATSAPP MESSAGES, TRACK THE DOCTORS' ORDERS, TRACK THE NURSES' LOCATIONS, TRACK THE NURSE WHILE IN TRANSIT, AND CAPTURE THE SUMMARY OF THE VISIT WITH THE PATIENT FEEDBACK. THIS SYSTEM IS INTEGRATED WITH OUR ELECTRONIC MEDICAL RECORDS SYSTEM AND OUR SUBSCRIPTION ENROLLMENT AND PAYMENT PORTAL FOR END-TO-END VISIBILITY OF PATIENT RECORDS AND MEMBER STATUS, RESPECTIVELY.

ORIGINS OF THE DISPATCH APP.  The application was developed in 2020 to track the home delivery of medicines for chronic patients. We then added in-house nurse dispatch services in Version 2. Version 3 allows for the enrollment and coordination of dispatch services via freelance nurses. 

SERVICE REQUIREMENTS. Upon receipt of a call, doctors' orders are loaded into the dispatch application from the Electronic medical record. The nurse can see the patient's complaints, medical history, diagnosis, and the list of tests requested by the doctor alongside any preliminary medical orders. 

The case is then moved to a dispatcher's dashboard who then assigns the case to a dispatch nurse by proximity to patients. The dispatch platform allows for real-time visibility of doctors' orders, two-way calls between patients and assigned staff, real-time visibility of the staff while in transit relative to patient location, billing details & member status based on how many days payment have been made out of the 200 days, and past clinical orders or prescription details. 

Once the patient is served, the nurse fills in the details in the dispatch app following a checklist for the 25 target conditions. The data feeds back into the patient record in the EMR. Details of samples collected and shipped to the lab are also recorded. Supplies used during the visit are also recorded. Upon completion of the assigned tasks, the nurse is paid per visit.

If given the opportunity to join the SOLVE community, we would seek partnerships that will enhance the platform using AI, GIS, Blockchain technology, and fintech solutions.

Full-time staff: 69 Kenya + 24 South Sudan = 93 total

Part-time staff: 16 Kenya + 4 South Sudan = 20 Total

Contract staff: 

20 nurses registered, trained  & equipped

138 Nurses registered & yet to be trained and equipped

142 recruited and yet to be registered, trained, and equipped.

Total FREELANCE network = 300

NB: 

Full time software developers = 1

Part-time software developers = 3

Number of years: 5 years

2018: Launched CheckUps 

2019: Launched home delivery of medicines

2020: Launched home nurse dispatch service (in-house nurses only)

2021: Added home sample collection & wellness checks + Mobile clinic operations

2022: Added Managed care subscription services

2023: Added Freelance Nurse dispatch network

DIVERSITY, EQUITY, AND INCLUSIVITY ARE THE BACKBONE OF OUR SERVICE OFFERING. WE STRIVE DAILY TO ENSURE THAT OUR STAFF, PROCESSES, AND OFFERINGS ARE DESIGNED TO CATER TO THE MOST DIVERSE CUSTOMER BASE POSSIBLE. INCLUSIVITY IS OUR BUSINESS HENCE OUR FOCUS ON A MARGINALIZED SEGMENT OF THE HEALTH ECOSYSTEM - INFORMAL WORKERS WHO ARE EXCLUDED FROM PRIVATE INSURANCE AND UNDERSERVED BY PUBLIC INSURANCE. 

Staff level diversity: Our staffing is predominantly female by virtue of the gender-preference nature of the nurse workforce. There is a healthy gender balance for none medical staff. Two of seven senior leaders with the rank of manager or director are women. CheckUps is a signatory to the Women Empowerment Principles. Ethnic and religious diversity is important in the Kenya and South Sudan contexts. We recruit from all ethnic and religious groups. 

Equity & Inclusivity: All our facilities are handicap accessible. We dispatch our staff to any and all homes without reservation, an approach that favors equitable access to care. Our $1 per day model is an attempt to offer the most inclusive health plan imaginable. The pay-per-day model ensures informal workers are included in the home health service model. 

Furthermore, by focusing on farmers, schools, boda-boda riders, and market traders, we foster inclusivity by geography, age, and income levels. 

Our presence in South Sudan is another demonstration of our commitment to inclusivity. We are dedicated to serving even in fragile territories. 

All in all, we are proud of a legacy commitment to diversity, equity, and inclusivity.

We have a hybrid business model: Fee for service and subscription

We track revenue via three streams:
a) Pre-employment tests to check for fitness for work. These are clients who need detailed physical exams for employment purposes. Food handlers pay $10 per test. Domestic workers pay an average of $75.95 depending on the medical review as per their employer. These fees for service are paid in Cash. We acquire customers through contracts with employment agencies or via referrals from other medical facilities.

b) Urgent care and Home dispatch services for acute and chronic medical conditions. These are clients who are unwell and request for services in the home or workplace. The services include consultation, lab tests, diagnostic tests, and medication billed at our retail rates. The average revenue per visit is $45. These fees for service are paid by private insurance, NHIF (60%) and the rest pay out of pocket. In 2022, 43% of the clients were served at home and 57% walked into one of our urgent care centers. We acquire customers through contracts with insurance companies or advertising. 

c) Subscription packages. Clients can purchase packages for $50, $100, and $200 per year packages and pay in 1 to 200 installments. The subscription service is provided to corporate customers, corporative groups for farmers, women's and men's affinity groups, and through direct-to-consumer marketing. The packages are billed for members alone up to members plus seven for larger families. Benefits include access to an annual wellness check, consultations, lab tests, diagnostic tests, and medication. 

Pricing strategy:
1. Pre-employment tests - Target 70% gross margins.
2. Urgent care and medication delivery - target 30% margins via aggressive pricing to help shift the market away from the status quo in favor of our more convenient and better-priced products. 
3. Subscription packages bundle telehealth and occupational checks as key benefits for workers. Each plan includes 2 or 4 complementary nurse visits per year targeting chronic patients. We project a medical loss ratio of 65%.

CHeckUps is post-revenue and broke even in 2021 and incurred a loss in 2022 due to the drop in demand for home care with the reduction of COVID-19 cases. We hope to return to breakeven and profitability by Q4-2023.

Our path to profitability is driven by the following factors.

1. Location of our Urgent Care Centers in industrial parks. The industrial parks are growing with more manufacturing companies setting up in Kenya's largest Export Processing Zone, where we are the sole clinic within the complex. The complex is host to over 58 companies with an estimated 35,000 plus factory workers. 

2. Expansion of our Freelance Dispatch network. The nurses in our network are a driver of growth. They recruit patients within their respective communities. The more nurses we have in the network the more scalable and sustainable we shall be. If honored to win the Horizon Prize, we shall re-invest these funds to rapidly scale the Nurse network, targeting farmers, which will fast-track our progress towards breakeven.

3. Accreditation of CheckUps Urgent Care Centers with the NHIF. Once accredited with the NHIF, CheckUps will be eligible for reimbursements from NHIF via the capitation pool and the fee-for-service pool. We shall promote the enrollment of factory workers to select CheckUps as their medical home. 

4. Accreditation of CheckUps as a testing site for Food Handlers. Workers in hotels, restaurants, and factories that produce foods and beverages must take some tests every 6 months. CheckUps has been accredited as one of five centers for testing workers in Nairobi, which gives us access to a pool of 250,000 blue-collar workers.

5. Growth of demand in South Sudan. CHeckUps is considered a Top 10 provider of outpatient medical care in South Sudan. Customer referrals and referrals from insurance companies are the main drivers of growth.

Overall, our strategy is gaining traction. Industry-wide recognition will be gained by winning the 2023 SOLVE Horizon Prize. This will bolster our strategy and crown our 5 years of relentless work to serve the largest underserved segment - the 12 million informal workers in Kenya.

CheckUps grew steadily from 2018 to 2021 with a progressive shift from grant-based revenue to majority revenue from operations. 

In 2018, CheckUps received numerous health innovation wards, notably, 

a) the Pfizer Foundation Health Innovation Award - three times, each in the amount of $100,000.

b) The Boehringer Ingelheim - Ashoka Making More health Innovation Award - $125,000.

In 2019 and 2020, CheckUps received convertible debt financing from:

a) Asia Africa Master Healthcare Fund in the amount of $500,000 USD, Japan

b) $100,000 from Lilas Blanc Family Fund, Netherlands.

c) $350,000 award from the Grand Challenges Canada Stars in Global Health program, 

d) $1,275,000 in debt from the Philips Foundation, Netherlands.

Over the years we have generated upwards of $10,000,000 in revenue from operations. 

We estimate that the network of freelance nurses could unlock an additional $50 million in revenue over 3- 5 years, which is a fraction of the total addressable market, estimated at $1.8 billion USD.

In summary, the prize would be a catalytic grant to help us rapidly scale our impact to informal workers as well as fast-track our path to sustainability.