Ask the Doctor

The worsening burden of non-communicable diseases (NCDs), its consequences to individuals, their families, and the healthcare systems in low- and middle-income countries (LMICs)

Non-communicable diseases (NCDs), such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, are a rapidly escalating public health crisis globally and worse in low- and middle-income countries (LMICs). An estimated 1.3 billion people globally live with NCDs, and these diseases account for over 41 million annual deaths globally, with 86% of these deaths occurring in LMICs. LMICs often have critically low doctor-to-patient ratios as extreme as 1:10,000 in Africa. This shortage severely limits access to qualified medical professionals crucial for NCD prevention, diagnosis, and management. Myths and misinformation surrounding NCDs are widespread in LMICs. This leads to harmful delays in seeking treatment, reliance on ineffective remedies, and poor adherence to recommended management plans. Even when care is available, LMICs grapple with issues of poor quality care, misdiagnosis, and inappropriate treatment regimens delivered by nonphysician clinicians. These factors contribute significantly to sub-optimal treatment and adverse outcomes. Fragmented healthcare systems and financial constraints in LMICs lead to high rates of patients lost to follow-up. This is worse in African countries like Uganda which don't have community health insurance systems in place. Financial constraints undermine continuous NCD management, resulting in severe complications and increased mortality.

The escalating burden of NCDs in LMICs has devastating consequences: as they cause immense suffering, disability, and premature death (primarily due to sub-optimal treatment thus, faster progression of disease), devastating individuals and families. treatment costs push households into poverty, further exacerbating health inequalities. NCDs place enormous strain on already fragile healthcare systems in LMICs, diverting resources from other vital health priorities.

At Ask the Doctor, a flagship program of Usahihi health group, guided by our learnings from the past 2 years, we have narrowed down to provide 3 key services to people living with NCDs i.e. Free 24/7 consultation using WhatsApp app(whats app has the highest penetration in Africa), Easy medication refill over whats app, SMS, and our web app, and Social support through our strong community comprised of doctors, other healthcare professionals, and expert clients(individuals who have lived with the disease, they have been through our program, and have learned how to manage it by themselves)

It typically includes features such as appointment scheduling, medication management, symptom tracking, and tools for communication between patients and healthcare providers, such as video consultations and secure messaging.

Ask the Doctor platform also includes educational resources, and testimonials such as articles and videos, to help patients learn more about their condition and how to manage it effectively. We also offer support services, such as counseling and nutrition coaching, to help patients achieve their treatment goals.

We help patients stay healthy and manage their care effectively, even when they cannot visit their healthcare provider in person. By providing patients with access to the resources and support they need, Ask the Doctor improves treatment outcomes and patients’ quality of life.

Ask the Doctor targets patients with chronic conditions and those who have difficulty traveling to see a doctor in person. These patients are currently underserved by a lack of access to qualified healthcare providers, and specialists, and transportation difficulties. Currently, they rely on nonphysician clinicians who often provide sub-optimal treatment for these conditions thus accelerating the progression of disease. Ask the Doctor addresses these needs by providing patients with a way to connect with licensed doctors and other healthcare providers remotely, monitor their conditions, and manage their conditions proactively. Also, patients get access to social support through our communities - currently only online communities, but we are looking forward to establishing physical counseling spaces. Our WhatsApp app communities, educational resources, and support tools improve patients' understanding of their conditions, helping them take a more active role in their health management. There is enhanced patient-provider communication, through secure messaging view whats app, SMS, phone calls,  and video consultations, which fosters easier and more frequent communication between patients and their doctors.

Our team boasts a strong foundation of healthcare professionals across various specializations. This ensures the platform delivers medically sound guidance and diverse support services. The presence of a software developer, even part-time, indicates an ability to create and maintain the digital platform, which is crucial.

We regularly conduct in-depth interviews, surveys, and focus groups with target patients to understand their pain points, preferences, and how technology can best support them. Of the recent survey we did in 2023, we understood the main reason some of our clients were nonadherent to medications was socio-economic. “.......if I am struggling to even buy food on a daily, how do you expect me to have a budget for medications” - Participant AB

We are also taking advantage of expert clients from our communities who act as representatives to provide ongoing feedback throughout the design, implementation, and evaluation phases. This ensures we're meeting their needs. Expert clients are individuals who have gone through our care and have learned to effectively manage their condition, at least they have achieved their treatment goals. The expert clients help educate new individuals to care, they also give them social support as they show them their lived examples. This motivates many to continue with treatment as they can see examples of how other people are living close to their normal lives despite having an NCD.

We understand our shortcomings currently are in technology leadership, we acknowledge our budget for now can not sustain a robust technology team, however, we are looking forward to bringing more technology experts on board including Machine learning Engineers, UI/UX designers as we are looking forward to incorporating AI-powered chatbots into our whats app and web app platforms.

Over the past 2 years, our team at Ask the Doctor has worked tirelessly to raise awareness and help improve the care of people living with chronic noncommunicable diseases like diabetes and hypertension

We've successfully established WhatsApp groups and communities for patient education and query response, achieving: 400+ active users across our WhatsApp app groups and communities. Our response rate to queries is within 72 hours. This is slower than the initial response time which was within 30 minutes when we just launched the Whats app communities.

We've learned there is a high demand for accessible healthcare support and an immense opportunity to use digital tools like WhatsApp for community engagement effectively. We've collected valuable data on NCD-specific information needs and patient communication preferences. We have also learned that our current reach is mainly the younger age group 18-35, leaving out the young adults and elderly 35-55 and >55 respectively

Currently, we're facing limitations in response time due to manual communication, and limited access because we have to send the link manually to the patients who would like to be part of our community. It is a tedious task to keep records of patients on WhatsApp. We need different ways to reach the elderly i.e. SMS, community agents who can be empowered with a smartphone to capture the patient's data, and community outreaches in the form of medical camps. We still need simpler ways to enroll patients into care or book consultation (i.e. less internet intensive) i.e.; Whats app self filled forms, USSD Codes, SMS, or Community Agents - who will be empowered with smartphones to gather patients' records. We aim to find ways that patients can take a proactive role in their care.

Nonetheless, I feel proud to be part of this talented and dedicated team and am looking forward to continuing to advance our understanding of NCDs and contributing to combating the global burden of NCDs.

Currently, we're facing limitations in response time due to manual communication, and limited access. We are looking forward to implementing an NLP AI-powered chatbot tailored to the NCD domain that will be incorporated into our WhatsApp app platforms, and web app that will help us provide preliminary responses to simple patient Queries, keep track of every patient's self-reported symptoms, analyze them, and offer preliminary responses before connecting to a specialist doctor. This will free up doctors' time to respond to only complex conditions hence allowing for maximum reach and utilization of the limited human resources within our continent. Remember our doctor-to-patient ratio currently is very low i.e. over1:5000, falling short of the WHO recommendations

Our web platform is not robust enough thus we need to upgrade to the latest web technologies to securely protect patients' data. 

We truly need technical guidance and support regarding the development, implementation, and use of AI tools for patient management given the lack of a strong regulatory structure around AI currently.

These together sum up our sole reasons for applying for the MIT Solve Challenge

The combination of preliminary symptom analysis (using bare basic linear models, we are working to incorporate robustly trained models in the NCD domain) followed by access to expert doctors is what sets the platform apart. It streamlines the triage process, potentially saving time and resources for both patients and providers, while still ensuring the essential element of personalized medical care. Our ability to provide tools for symptom tracking, educational resources, and support services promotes active self-management for patients. This shift towards empowered patients can lead to better health outcomes and reduce strain on the healthcare system. Furthermore, with our focus on the removal of the financial barrier to doctor consultation for individuals with NCDs and ease of consultation by use of multiple models including SMS, phone call, WhatsApp (text, voice note, voice call, and video calls), google meet, or zoom removes location barriers thus making care more accessible to those in underserved areas, those with mobility issues, or with busy schedules. This is helping address disparities in healthcare access for individuals living with NCDs. Our additional support services like counseling, social support, and nutrition coaching, recognize the holistic nature of healthcare, addressing both physical and mental well-being.

Potential for Broader Impact and Market Change

Our successful use of AI to augment, not replace, human medical expertise can inspire wider adoption of similar models. This could improve efficiency while maintaining the quality of patient care. Furthermore, our focus on patient education and self-monitoring could encourage proactive health management, potentially leading to a shift towards preventative care and reduced healthcare costs over time. Also "Ask the Doctor" can further normalize and expand the use of telehealth services. This could pave the way for greater innovation in remote healthcare delivery models. The platform has the potential to integrate with other health-tech solutions (e.g., wearable devices, and electronic health records) to create a more comprehensive, data-driven approach to healthcare.

Our theory of change is based on evidence-backed solutions. Increased healthcare access through WhatsApp, convenient medication refills, and strong support networks are proven to improve disease management for NCD patients. These directly contribute to better long-term outcomes - reduced complications, enhanced well-being, and a higher quality of life. We believe this comprehensive approach will lead to significant positive change in the lives of those living with chronic diseases.

We offer free 24/7 consultations over WhatsApp, the most popular messaging platform in Africa, ensuring easy access to medical advice. Medication refills are streamlined through WhatsApp, SMS, or a web app, promoting treatment adherence. Finally, our strong support community of doctors, healthcare professionals, and experienced patients tackles isolation, providing guidance, motivation, and practical knowledge for managing chronic conditions.

We aim to achieve the following transformational goals for people living with Non-Communicable Diseases (NCDs) in Africa:

1. Reduction in NCD complications and hospitalizations among our users.

2. Empowered patients with the knowledge and tools to effectively manage their NCDs independently.

3. Improved overall well-being and quality of life for individuals living with NCDs.

Measuring Progress:

To track our progress toward these goals, we will utilize a combination of indicators:

1. Improved Health Outcomes:

Metric: Reduction in NCD-related hospital admissions and emergency room visits compared to a baseline period.

Data Source: We will collaborate with clinics to access anonymized patient data.

2. Increased Patient Empowerment:

Metric: Increase in user engagement with educational resources, medication reminders, and self-management tools within the Ask the Doctor platform.

Data Source: We will track user activity data within the app and web platform.

Metric: Improvement in patient-reported health outcomes through surveys measuring self-management confidence and disease knowledge.

Data Source: Conduct regular surveys with Ask the Doctor users.

3. Enhanced Quality of Life:

Metric: Increase in patient-reported satisfaction scores related to disease control, symptom management, less hospitalization, and overall well-being.

Data Source: Conduct regular surveys with Ask the Doctor users.

Ask the Doctor leverages a combination of modern technologies and accessible communication channels to reach our target audience in Uganda:

Web Platform: The core technology is the Ask the Doctor web platform. This user-friendly interface allows patients to consult using their preferred medium(SMS, Phone Call, Whats App, Google Meet, Zoom), refill their medications, and connect with the support community.

WhatsApp Integration: Recognizing the high penetration of WhatsApp in Africa, Ask the Doctor integrates consultations seamlessly through this widely used platform, making it convenient and familiar for users to access healthcare services.

SMS Technology: SMS is another accessible channel for medication refills, ensuring patients can manage their prescriptions even with limited internet access.

While Ask the Doctor doesn't currently utilize advanced technologies like AI or blockchain, it focuses on utilizing a combination of established and widely accessible technologies to reach a large population in Africa with limited internet access. 

Four core team members, one part-time software developer, fifteen partner medical doctors, three partner pharmacists, twenty partner nurses, two partner physiotherapists, and five partner medical laboratory technologists. We are continuously growing our tea as the demand for the services increases.

We have been working on this solution over the past 2 years, our  team at Ask the Doctor has worked tirelessly to raise awareness and help improve the care of people living with chronic noncommunicable diseases like diabetes and hypertension

I feel proud to be part of this talented and dedicated team and am looking forward to continuing to advance our understanding of NCDs

We acknowledge the importance of a diverse team that reflects the communities we serve in Uganda.  For the past 2 years, we have been tirelessly putting in place structural systems to create a well-rounded team that can understand and address the specific needs of our patients. To date, our team is still predominantly medical as we still cannot have a large team with all the required expertise.

We compensate for these limitations by offering flexible part-time work arrangements, for tech teams when we have a task to accomplish.

We are putting in place measures that foster a work environment where everyone feels valued, by promoting open communication. 

We operate on a community-focused social enterprise model which involves 4 steps; we actively reach out to communities with medical camps to screen for NCDs, during which time we capture the contact information of those at risk and those with active disease, we encourage them to join our what's app communities from where they can freely consult with Doctor, schedule appointments, ask drug refills, and access our 24/7 online communities for social support. We have seen over the past 2 years that at least 2 in 10 people who consult freely with us enter into long-term plans, during which time they need drug refills, some opt for regular physical check-ups, physiotherapy, or even home-based care, which are all monetizable services.

Ask the Doctor's social enterprise model includes offering a free Doctor consultation for people living with NCDs (Diabetes, hypertension, etc) in ways convenient to the patients (i.e. WhatsApp, SMS, phone call, Google Meet, or Zoom). The doctor makes a correct diagnosis and discusses with the patient to come up with a long-term treatment plan that helps the patient thrive, at the end of the consultation he prescribes medications for the patient. We keep the written prescription. 

The patients can choose to continue their care plan with us which comes with the benefits of 24/7 access to doctors, drug refills, and 24/7 access to online communities for social support. The patients pay for their drugs

Our online communities are made up of people living with NCDs and healthcare professionals. We pride in our utilization of expert clients i.e. individuals who have gone through our care and have learned to effectively manage their condition, at least they have achieved their treatment goals. The expert clients help educate new individuals to care, they also give them social support as they show them their lived examples. This motivates many to continue with treatment as they can see examples of how other people are living close to their normal lives despite having an NCD. 

Until now we have  received support in grant funding of $600 from Aspire Insitute to improve our web app streamlining it to 3 main activities i.e. consulting with doctors, drug refill, and access to online communities 

Our initial launch has seen steady growth in engagement over our simple WhatsApp app platform, indicating a demand for our services. We've secured $600 grant funding from Aspire Institute which was focused on social impact using innovations in digital healthcare. This demonstrates validation of our concept and support for our development.

Till now, our only payable offering is drug refills (the medications themselves). Paying for an online consultation is not appealing to the people we serve. Our assumption for now is people value tangible products (feel, touch, see) over intangible ones. This presents an opportunity for laboratory and pharmacy services. We have also learned services like physiotherapy and home-based care are more appealing to older clients or those who have developed a complication already; However, this applies to individuals who have a regular source of income. For individuals without regular income sources, we need to find ways to help them pay upfront when they get a lump sum of money. All these learnings are guiding us on ways to sustain the enterprise using services that people are willing to pay, and how they are willing to pay. Subscription for example is not appealing to a bigger portion of the individuals we are taking care of. We still have much to learn to create a sustainable social enterprise. Nonetheless, our active engagement with the community is giving us the chance to find what will work.

We are looking forward to experimenting with many ways to help us sustain our services including;

Pay-Per-Consultation: An option for patients with acute ailments who may not want a subscription, paying only for individual consultations. This offers flexibility.

Partnership with Insurers: Collaborate with health insurance companies to offer "Ask the Doctor" as a value-added service, potentially improving patient adherence and outcomes.

Partnership with employers: Offer our platform as an employee wellness benefit, promoting proactive health management.

Strategic Advertising: Discreet, ethically-aligned advertising within the platform (e.g., from pharmaceutical companies dealing in NCD drugs, in Uganda this is mainly Micro Labs Limited) can add a revenue stream without compromising patient experience.