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Enterprising digital health models for sustainable change

Philips Foundation icon
Feb 14, 2022
By the Philips Foundation team
Health kiosk of Estación Vital installed in a mall in Nicaragua
Digital technologies and data offer enormous opportunities to transform healthcare for better outcomes and improved access. The broad scope and the relatively early stage of the digital health transformation result in a dynamic landscape with a wide diversity of initiatives and digital tools. Although this environment stimulates enthusiasm, acceleration, and fast learning, many of the initiatives are short-lived or have limited impact, as outlined in a WHO study on digital interventions for health system strengthening [1]. Philips Foundation believes that social entrepreneurs who strive to combine positive social impact with sustainable business models can be important drivers of change. Although there is a growing consensus that social entrepreneurs are needed now more than ever [2], social relevance and a sustainable business model remain key indicators of their enterprise’s success and long-term outlook.
In December 2021, while taking part in Digital Health Week [3], Philips Foundation convened a webinar with social entrepreneurs who leverage digital health solutions to solve access to healthcare challenges. The aim was to discuss how they combine health outcome benefits with sustainable models and scale their solutions. Key learnings and recommendations from this webinar are shared below. For more information on our webinar series, click here.

“I look at myself as a humanitarian with a business model,” said social entrepreneur Claire Barnhoorn, as she compared the role of a social entrepreneur to that of a typical commercial enterprise on the one hand, or that of an NGO or aid organization on the other. At the age of six, Claire decided to become a humanitarian after seeing a poster at school that told the story of two kids affected by the great Ethiopian famine in 1983. 

 

She stayed true to this decision, and after studying International Development Studies, she joined Doctors Without Borders and worked there for many years. Apart from the large and continuous need for humanitarian support, she was struck by something else: the vast inefficiency and waste in the aid sector, especially due to poorly functioning procurement and supply chain processes. Determined to change an inefficient system, Claire Barnhoorn founded Solvoz – a digital platform that provides procurement support for organizations in low and middle-income countries. 

 

Make way for an entrepreneurial mindset


As Claire highlighted, the potential impact of improved procurement efficiencies is massive. In 2021 alone, over 235 million people needed humanitarian assistance, and over ten million NGOs operate in this domain. Their budgets combined correspond to that of the world’s 5th economy, and 65% of these budgets are spent on purchasing. All of these NGOs run their own procurement departments and processes, costing a lot of overhead and still with sub-optimal results because it is simply not their speciality. What’s more: 80% of these NGOs are small local entities that have difficulty accessing funding opportunities merely because they lack the required processes.

I look at myself as a humanitarian with a business model

Claire Barnhoorn

CEO and Founder of Solvoz

UN woman at work with semi-manufactured goods

Meanwhile, large international NGOs currently fly in two-thirds of aid supplies when they respond to a humanitarian need because they do not have a good way of leveraging local supply chains.“We believe there is huge efficiency to be gained here, and that is what Solvoz wants to provide,” said Claire.

 

The Solvoz platform consists of two parts: On one hand, an open-access catalog of solutions that can be used for free by anyone, providing an informed, guided process to build a total solution to a problem while optimizing for costs and needs over the required lifetime. The second part is a curated tendering platform, where Solvoz helps match the NGO’s needs with suppliers. The tender platform is subscription-based and provides the income Solvoz needs to invest in the continuous upgrading and expansion of the catalogue. 


Where inefficiencies drive Claire Barnhoorn in procurement, Mohammed Dalwai’s motivation comes from the realization that doctors are often left alone to make important life decisions for their patients without having all the necessary information. According to the World Health Organization (WHO), a major problem is medication errors, which can be as high as 50%, leading to costs of over USD 40 billion a year [4]. 


Grown-up and educated as a doctor in South Africa, Mohammed experienced firsthand disparities in healthcare providers’ access to the latest medical information. Frequently changing new medicines, treatment guidelines, and recommended protocols lead to sub-optimal practices, prompting people to look up guidelines on Google or follow treatment recommendations poorly.


To tackle this issue, Mohammed and his co-founder, Yaseen Khan, started Essential Medicine Guidance, or EMGuidance in short, with the aim to provide free information to African medical professionals. They created a digital platform with a wide range of health information modules – realizing that global, generic information is insufficient. Instead, healthcare providers need more country-specific information on the availability, formulation and correct dosage and strengths of medication. The same applies to local protocols and guidelines.

 

The mission of EMGuidance is ultimately to make it easier for healthcare professionals to find locally relevant information that will help them make better decisions for their patients.


The entrepreneurial mindset as the engine for sustainable change


Driven by that mission, EMGuidance was first set up as a non-profit organization (NGO), where Mohammed and his team spent much of their time searching for donors to support their purpose. Although they succeeded in obtaining regular funding – which proved the validity of their model – they also realized that by relying on donor money, their impact would remain small, simply because not many donors have the resources to fund sustainable implementation at scale. Mohammed and Yaseen decided to pivot EMGuidance into a for-profit company and look for sources of income that would allow them to grow.

User-application of EMGuidance for healthcare professionals to find locally relevant information
We all have very specific approaches to particular issues, but each of these represents great humanitarian challenges

Mohammed Dalwai

Co-Founder of EMGuidance

Essentially, they found that pharmaceutical companies like to engage with healthcare professionals to help train and support them with the latest drug information. They were willing to work with EMGuidance to do just that.


Today, EMGuidance offers local pharmaceutical companies a platform to ethically inform healthcare professionals at the point of care about the use and safety of their products and services. “Pharmaceutical companies are happy to spend a portion of their medical and marketing expenditures for this purpose, which provides EMGuidance with the means to keep the platform free for its users”, Mohammed explained. Since that move, EMGuidance has grown rapidly and is now the largest medicine information platform in South Africa, with over one million consultations per month – while expanding to other Sub-Saharan countries.


The transition from non-profit to for-profit ultimately led to a success story that even Mohammed had not anticipated. Best of all, his passion for work that helps build a better world never had to be compromised. Quite the contrary, in fact, and the same is true for Marcos Bosche Lacayo. 

Customer sees received patient data through health kiosks of Estación Vital

Marcos Lacayo grew up in the US and fell in love with how technology could improve health outcomes. A fervent activist against the ‘obesity pandemic,’ he believes that preventive healthcare combined with empowering people with knowledge and understanding of their health is the best way to achieve better health for all. Marcos sees obesity as the root cause of all health problems – from diabetes and chronic non-communicable diseases to mental health problems – affecting more than 40% of the world’s adult population [5] and even more in Latin America. All these ingredients drove him back to his home country to establish the social enterprise, Estación Vital.


Digitization as an enabler of business growth – and empowerment for well-being


Estación Vital has created a platform with nutritional and psychological tools that help people with their internal dialogue to change how they see themselves and reduce the addiction to consuming high-calorie and high-fat foods. Self-management and coaching are available through a dedicated app and kiosks set up in high-traffic shopping centres in Nicaragua.


The digital app offers essentially the same service as the physical kiosks but has the advantage of being reviewed anytime, from any place. Estación Vital charges customers a small subscription fee to provide free services through the kiosks to those who cannot afford the paid service or do not own a smartphone. This is a powerful example of how profit is used to deliver services to people who do not have the means to pay for them.

The best starting point for digital innovation is to start with technology that your target customer is already using and then build incremental innovations on top. For us, it was communicating with our patients via Whatsapp

Rama Siva

Chief Product Officer at Penda Health

Offering quality services for a reasonable fee is also the growth model of Penda Health in Kenya. A fast-growing network of 21 primary care clinics across Nairobi, Penda Health now serves over 30,000 patients per month. Rama Siva, chief product officer at Penda Health, explains the current healthcare system challenge that Penda Health wants to address: 


“There is a shortage of well-qualified healthcare professionals across Africa. As a result, they have little incentive to improve quality, reduce cost, or be patient centric. This makes quality healthcare expensive or non-existent. The result is a low trust of consumers with the healthcare system, and we see that many people turn to a pharmacy instead of a clinic to try to seek medical advice.” Ultimately, Penda Health wants to bridge the gap by offering quality healthcare at an affordable price to as many people as possible.


Technology is both the enabler and the customer attractor of Penda Health. A fully digitized, paperless electronic medical record system as a basis for all patient interaction, data storage and quality assurance. “As a result of our technology enablement and city-wide presence, we have one of the best patient satisfaction scores in the industry”, says Rama. “Achieving this level of quality at scale is what makes us unique.”

Health worker in India makes use of mobile health technology during counseling

“The standardization of workflow across our operations allows us to replicate our clinics quickly and handle the increased patient volume in an orderly way,” Rama explains. “We have also built a clinical decision support system that helps our doctors to make decisions through automated recommendations generated by the standardized triage protocol. Decision tools now support over 90% of our clinical encounters. We continuously use our doctors’ feedback to improve both the algorithms and our staff’s trust in the system, and their willingness to adhere to the advice. This leads to standardization of care and very little variability between different doctors, which gives us confidence in the quality of the system to scale further without the need of hiring a lot of quality managers.”


Connecting the dots


Digitizing primary care and community-based clinics is also the core business of AfyaPro. This social enterprise has developed an integrated intelligent hospital information system that connects all the dots of services and data to avoid fragmentation, increase performance and improve trust. Nic Moens, Director of AfyaPro, illustrates how it concretely outlines care for diabetes patients to help them manage their condition:


“We take a care path approach, mapping out what kind of support patients, families, professional caregivers, and clinics need and bringing this together in one system of connected digital tools. For the patient, it means an app that supports self-assessment, provides health advice and education and sends reminders for medication or consults. Nurses and specialists are supported with dedicated modules that guide intake, assessment and diagnosis, creating a treatment plan and organizing tasks. If caregivers are in different locations, remote collaboration can also be facilitated.”

 

Nic sees the AfyaPro solution in the first place as an enabler of local innovation by the health workers themselves. 

Local healthcare workers working with AfyaPro software

“We help hospitals use our system to develop new practices for better clinical outcomes. For example, task shifting, protocolized care, telemedicine, remote care and clinical decision support can be facilitated by connected systems and the use of data. A particularly powerful way of driving progress is by setting up data-driven continuous improvement cycles with clear, short term objectives and desired outcomes. It can be around anything the local team wants to improve: from patient satisfaction, cost of care, clinical outcomes, staff functioning to performance of the health facility itself. This creates a social construction of change, powered by local ownership, true willingness to change and direct handles to act. It makes change happen and can range from small step improvement to complete system change.”

 

Big enough, strong enough


Five social entrepreneurs active in low- and middle-income countries, innovating very different areas of digital healthcare – what are their shared visions of what it takes to be successful? And how is it different from pure commercial entrepreneurship? 


Social entrepreneurs are driven by the shared desire to make a positive humanitarian impact.

 

Mohammed: “All entrepreneurs want to solve something for someone. But in low- and middle-income health systems, the problem is vast, so thinking you can solve everything for everyone is pointless. It would be best to be very specific about the niche you want to address and then come up with something that brings in your unique expertise or solution and solves it better than others can. But on the other hand, you need to choose a big enough scope to be relevant. You see it in the five of us: we all have very specific approaches to particular issues, but each of these represents great humanitarian challenges: procurement inefficiencies, medication errors, the obesity pandemic, quality and affordability of primary care clinics.”

 

Certainly, the needs and opportunities for improvement in low- and middle-income settings are complex, but how can we address these complexities with limited available resources and competing priorities? Is there a willingness to invest in digital innovation?


Rama: “Low- and middle-income countries are usually not early adopter markets for innovation, that is true. They are thin markets. Therefore, the best starting point for digital innovation is to start with technology that your target customers are already using and then add incremental innovation on top. At Penda Health, we want to offer a better patient experience by bringing in digital. We realized that a lot of people already use WhatsApp. So, we have chosen that as our main means of engaging with our clients throughout the patient journey. We have fully integrated WhatsApp with the electronic medical records of our clinic, so people can make direct queries or receive medical advice from it. This led to very quick adoption, with more than 3,000 people using it within three months of introduction.”

 

Nic adds a similar observation: “The purchasing power of our customers is limited. People want low-cost solutions and immediate impact, with little tolerance for added costs for quality assurance over time. At the same time, they rightfully ask value for money, and we often have to cope with fragmentation and lack of trust in technology. This is where we need to strike the right balance and make sure the innovation is strong enough to bring about what is needed and become trusted.”


Releasing the power of local innovation


It is well known in the innovation landscape that an initial lagging behind can turn into an advantage, as not having to integrate with a legacy system can free up room for leapfrogging and trying new things. How relevant is this in the case of the social enterprises featured here – and can high-income countries learn something from innovations in low- and middle-income environments?

A inside look at one Penda Health's private clinics

For Rama Siva, it is clear that the need to reduce the cost, and burden of a scarce healthcare workforce, while maintaining clinical value is everywhere. But for low-income countries, it is essential for survival. Therefore, finding innovative solutions, such as task shifting, is more evident, and high-income countries can learn from this.

 

For Nic Moens and AfyaPro, it’s all about stimulating local innovation.

 

Nic: “I see a lot of original thinking and room and willingness to take bigger steps. It’s not a coincidence that digital payment systems like Mpesa first took off in Kenya, not in the Western world. With AfyaPro, we want to enable local ownership of innovation. We don’t come in with ready-made processes but rather coach the local healthcare professionals on how they can use the richness of data in our system to create their improvement cycles. That creates ownership and adoption and in the end much more relevant innovation than we could devise from outside.”


Claire Barnhoorn of Solvoz agrees. “We want to empower local responders with the capacity to be able to act to meet humanitarian needs in their areas. It doesn’t make sense that this power is underutilized now, simply because they don’t have the means to get on the radar of funders or large NGOs.”


Finally, Marcos Lacayo adds agility and adaptivity to speed up local innovation. “We all operate in unique, complex and sometimes unpredictable ecosystems. We may find out governments or legislation eventually don’t support our innovations or delivery models. So, we need to pivot and quickly adapt to what is working. In the end, that’s what entrepreneurship is all about.”

We need to pivot and quickly adapt to what is working. In the end, that’s what entrepreneurship is all about

Marcos Lacayo Bosche

Founder of Estación Vital

Philips Foundation continues to explore what is needed to achieve greater scalable impact and remains committed to strengthening primary healthcare, which is the basis for universal access to quality healthcare for all. In our next webinar of a series, we explore how to improve awareness and access to prevention, diagnosis and treatment of heart disease in underserved communities.

 

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