Complete Health

Africa is experiencing faster rates of premature mortality from non-communicable (NCDs) than any other region.  Four key chronic diseases (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) are responsible for 82% of non-communicable (NCD) deaths. In Nigeria, with a population of 200 million, specifically 20% of the population aged 30-70 are dying prematurely from NCDs. Given the high prevalence of hypertension, mental illness and the growing incidence of overweight, obesity and diabetes,  low-income people experience a great share of the burden. We provide a high-tech high-touch solution called CompleteHealth where we provide virtual coaches to people with diabetes, hypertension, obesity and cancer to support them in digital nudges that focus on lifestyle modifications such as exercise and nutrition, smoking cessation and more, in-person health hubs where people can track their metrics, meet coaches and join exercise, nutrition classes.

In Nigeria, the most populous country in Africa, the prevalence of hypertension and Type 2 Diabetes Mellitus is high, with the country widely reported as having Africa’s highest burden of hypertension and diabetes with a prevalence of 35% of hypertension abd 4% of Diabetes, according to WHO with wide variation across urban areas (up to 11%). Nigeria in particular, is experiencing the fastest rate of urbanization globally, with over a third of the population currently residing in urban areas, and this is expected to increase to about 45% by 2025. Given the increase in globalization, urbanization and unhealthy lifestyles, approximately 30% of Nigerian adults are overweight with 36.9% of women  overweight and almost 10% of adults being obese. At an average fasting plasma glucose (FPG) concentration of 5.1 mmoL/L, many people across Nigeria may  be approaching the prediabetic states. An mDoc survey of over 1000 people in Nigeria, revealed that 54% of the population surveyed either had a chronic disease or had someone in their household with a chronic disease and yet only 15% of chronic disease patients have primary care providers.  For people at risk for or living with chronic disease, understanding how self-manage their health is critical. 

Majority of our member population are low-income Nigerians making less than 40,000 NGN a month. They reside in peri-urban and urban Lagos.We have integrated human-centred design principles in all of our work. Our members are constantly working with us to help us make iterations. When we first started out, we had a smart-phone based solution only which we soon realized through our members, was difficult for them because of the costs of data. We then integrated sms-based capabilities to make it more accessible to our lower income population.

We harness a 4-pillar approach: (1) Connect patients with virtual coach led care teams who support them on co-creating personal health goals and provide digital tools such as  risk assessment, which helps inform them their risk of getting a chronic condition or a serious complication of a chronic condition, a patient health portal for a one stop shop for patient’s health data, reminders on when to visit care providers and medication, education and self-help tools to help individuals achieve their goals. (2) In-person health hubs where they can track their metrics and meet and learn from their peers. (3) Help citizens navigate quality care through a geo-coded navigation system to support them in finding in-person quality healthcare when needed e.g. behavioural health counselling or centres trained in diabetic foot care (4) Train (virtually and in-person) health providers so they are more likely to provide person-centred, evidenced-based care when they see patients. 

We are reaching populations that have had minimal support or education on how to self-care or self-manage their health. We support people the 99.9% of the time they are out of a facility and help them understand how to work in an environment that is not particularly enabling to make lifestyle modifications in exercise, nutrition, smoking cessation and alcohol intake that have measurable impact on their lives. We have created a high-tech high-touch solution because we saw that digital only is less effective because of a multitude of barriers.

We've created a web and mobile based digital platform, Complete Health that houses a personal health record, trackers, chat capabilities and more for our members.

Our model is firmly rooted in an integrated chronic care model where a scalable innovative model of chronic disease screening and management in convenient community based hubs and hubs in health facilities  that are linked by a peer coach, a digital health platform and a learning collaborative network of capcitated providers will drive behaviour change in individuals around the modifiable lifestyles such as nutrition, exercise, medication adherence, smoking cessation and alcohol intake.  Through partnerships, a scalable innovative platform of awareness creation, screening using non-traditional community-based Blood Pressure and Glucose check points, and coupled with coach-led  and digital management and support for people with chronic disease in Nigeria will drive improvements in population health outcomes - reduced obesity, improved blood glucose control and more. This integrated and collaborative ecosystem of capability building and innovative service delivery will enhance access to care, empower patient-driven self-management and improve care delivery in a scalable and sustainable way. The resulting improvements in lifestyle modifications, medication adherence and clinical care seeking behavior will lead to improved health outcomes 

We are currently serving over 1050 members. We plan on serving 12,000 in one year and 427,000 in five years. 

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 digital platform allows us to achieve scale, at the same time our in-person hubs allow us to reach lower income populations, who are unbanked, who don't have the financial means to own glucometers or blood pressure monitors or scale and can actively monitor their health. They join exercise classes and nutrition classes that they might never have had access to and learn how to make small behavior changes in the reality of their living situations. Our goal in the next year are to standardize our services and refine them, expand our SMS/USSD/offline option to reach more people, particularly women (who we are finding are more likely to have basic phones) and enhance engagement.  In five years, we expect that we will have a critical mass of over 400,000 active users who have measurable improvements in their weight, blood glucose and blood pressure and more and will have reached over 1mm in outreach and more. 

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 change.

Technology: We piloted low cost hubs as a way to create a safe space for in person onboarding on the platform. We are also using peer champions, those in the community who have learned how to use it and are effectively using it to improve their health to teach others.

Legal: We are working closely with Ministry to remained aligned and integrated as the landscape evolves.

Market: We've instituted nutrition and exercise workshops and more at our hubs and shown the power of preventive behavior on blood glucose and blood pressure levels. However we are working to test different reward mechanisms to drive engagement and also to understand the different end-user profiles where there is greater resistance.

Full-time Staff: 8

Part-time Staff: 2

Interns: 1

My father was a hard-working Nigerian MIT-educated middle-class  lecturer who wanted two things in life: 1) To transform the technology landscape of Nigeria and 2) To spend more time with his family. Unfortunately, my father died from complications from a massive stroke that he had at the age of 53 largely because he didn't have access to a team of health providers to support him in managing his uncontrolled high blood pressure in Nigeria.  More than 28 million people in sub-Saharan Africa died prematurely from chronic diseases such as high blood pressure and diabetes and that number is expected to more than double if the status quo remains. mDoc is working hard to change that. Our organization is structured along Clinical, Operations and Quality, Data and Engineering and Finance. I am 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 like to partner with micro-finance organizations so that we can integrate a health financing option for the members we support. We are teaching the power of prevention and the importance of behaviour change. At the same time we need to cultivate a health savings/health insurance culture so that they are protected from financial risk and we would like to integrate this with our service offering.

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.

According to WHO, Non-Communicable Diseases (NCDs) represent the biggest threat to women’s health worldwide, increasingly impacting women in developing countries in their most productive years. NCDs account for 65% of women’s deaths globally, with 75% of these deaths occurring in low/middle-income countries, due to cardiovascular diseases, diabetes, preventable cancers, and chronic respiratory diseases. In Sub-Saharan Africa, NCDs are at least as common among the poor as they are among the more affluent. Pop­ulation growth, globalization, ur­banization and changing lifestyles have driven rapid growth in NCD burden in Africa. In Nigeria, over 40% of women are overweight or obese putting them at high risk for chronic diseases. 

NCDs and maternal health are closely linked.  Pregnant women with diabetes, obesity, hypertension and depression are at higher risk of developing serious complications. Nigeria contributes the greatest burden of maternal mortality globally after India. To date, over 75% of our member population is women. We've designed our solution hand in hand with our members to create a women-centered solution. All of our coaches are women, working in the communities where they live because they know the daily challenges that make healthy behaviours so difficult for those living with NCDs.With the prize, we would refine our basic phone offering (sms/ussd) and aggressively reach more lower income women as we harness the CompleteHealth solution to empower women to increase their self-efficacy and ability to self-care to reduce the maternal morbidity and mortality burden we are seeing from chronic disease in Nigeria.

According to WHO, Non-Communicable Diseases (NCDs) represent the biggest threat to women’s health worldwide, increasingly impacting women in developing countries in their most productive years. NCDs account for 65% of women’s deaths globally, with 75% of these deaths occurring in low/middle-income countries, due to cardiovascular diseases, diabetes, preventable cancers, and chronic respiratory diseases. Pop­ulation growth, globalization, ur­banization and changing lifestyles have driven rapid growth in NCD burden in Africa. In Nigeria, over 40% of women are overweight or obese putting them at high risk for chronic diseases. 

NCDs and maternal health are closely linked.  Pregnant women with diabetes, obesity, hypertension and depression are at higher risk of developing serious complications. Nigeria contributes the greatest burden of maternal mortality globally after India. To date, over 75% of our member population is women. We've designed our solution hand in hand with our members to create a women-centered solution. All of our peer coaches are women serving the communities where they live. We would use the prize to further build off our results-driven work where we've improved blood glucose and blood pressure levels in women and expand to reach more communities so that more women will benefit.