Bull Session

mHealth in Africa

April 30, 2015          

Episode Summary

In this episode of The Digital Life, we talk with Niti Bhan about the highly active entrepreneurial space around mHealth in Africa, her perspective on human centered strategy for digital health, and the unique and innovative methods developed for Africa’s emerging healthcare consumers.

Jon:
Welcome to episode 101 of The Digital Life, a show about our adventures in the world of design and technology. I’m your host, Jon Follett and with me is founder and co-host, Dirk Knemeyer.

Dirk:
Hey Jon, it’s good to hear your voice but I’m really excited that we have another person on the line with us today.

Jon:
That’s right, with us today is our old friend, Niti Bhan and if you’d like to learn more about Niti, you can check out the link to her background and website, which you’ll find on thedigitalife.com suffice it to say she is an expert in emerging markets and technology and we’re delighted to have her with us today on The Digital Life. Welcome Niti.

Niti:
Thank you Jonathan. Hello Dirk.

Jon:
So today our topic is one that’s near and dear to our hearts, I think, the mobile health sphere and specifically how that is playing out in emerging markets like Africa which Niti is very well experienced. I wanted to que up the conversation today by saying that mobile health, at least in the first world, is being depicted as something that is scalable and helpful. So doctors can’t necessarily scale to take care of hundreds and thousands of patients but we’re all starting to have these mobile devices in our pockets, these smartphones, and these rich applications that come along with them and the premise is that when we have these phones, we’ll be able to better manage our own health in conjunction with our doctors. And this becomes even more important when you’re talking about emerging markets where there might not be very easy access to healthcare.

Niti, I wanted to pose the question to you, how are you seeing mobile health play out, in your experience, in the African continent?

Niti:
Okay, first I should say, I’ve been watching it but I haven’t yet had firsthand experience with it. With regard to design or design research, my most recent experiences have been to do with energy and with money, of course — mobile money. It’s more of as an observer on the ground from the infrastructural point-of-view, from the operating environment point-of-view, and also from observing trends in what’s going on.

As you said when we started the conversation, mobile health is seen as something that’s scalable and probably affordable in the developed world. Which has more infrastructure both in terms of bandwidth, connectivity, affordable devices, and healthcare infrastructure. What I’m seeing, and I’m speaking now from the context of sub-Saharan Africa, rather than broad emerging markets which tend, these day to encompass Latin America, India, Southeast Asia. From the African context where it’s getting interesting is while wellness seems to be the focus of- and health, since I’m calling in from Europe, for example in Europe the emphasis is on fitness, on diet, nutrition, and of course, monitoring. That’s particularly for those who may already have an existing disease or for the elderly. There’s a lot of applications, in fact there’s going to be a European mHealth summit in the middle of May in Latvia.

So it’s moving forward, in Africa I’m seeing it in three broad spaces. One space is supported, meaning two of these spaces are broadly supported by the GSMA which is the mobile operator and mobile industry association, the GSM association. Their mHealth initiatives focus on a large variety of elements, it could include data gathering, it can include monitoring, like you said the device has become ubiquitous. The penetration rates in sub-Saharan Africa are now, in some countries, let’s say Ghana, Nigeria, South Africa, Kenya, within a point or two of the penetration rate of the US, just to give you context. These are not backward countries and mobiles are definitely in everybody’s hand. Even smartphones and iPhones, just for a side note the numbers have it, they’re reaching one-third of the phones are smartphones, affordable smartphones at the sub $100 level have come in, Android phones are there. You’ve got the technology, now how best can we use it, is the next step.

We’ve got infrastructure and support services, data and statistics as you know, is a huge gap in Africa. There’s that whole cluster of activities, it can be things like monitoring maternal health, monitoring child mortality, that entire space. Then there’s the space of start-ups, a lot of the previous stuff that I mentioned, the ones supported are what falls under M4D, Mobile For Development. They may be donor funded programs or they may be not-for-profit solutions or large scale top-down solutions. The next space that I’m seeing a lot of activity is the start-up space.

I don’t know and maybe that’s a conversation for another day, but start-ups, particularly on the mobile platform are generating like weeds. And the large hubs for this clusters are Lagos in Nigeria, in fact Mobile West Africa just finished in Lagos then Nairobi, of course, in Kenya. South Africa has some amount of cluster and Ghana. These are the larger, better known ones then you’ve got smaller, incubators and accelerators coming up in Rwanda and Cameroon. It’s all over the place. The point is, there’s start-ups happening, some of them may be plant supported, they may not be pure VC plays or pure profit plays, that’s always the case in environments like this where social enterprises or the need to provide services for those without is as much of a driver as monetization. These two things are often held- their intention, this couple of nice chats, if you want, I can share them with you, particularly from the healthcare services angle, I don’t know if it’s mobile specific but certainly it maps out the tension between needing to do good and needing to be a sustainable business. They’re very often not pure commercial enterprises.

One top-of-mind that comes of such a start-up, one example that comes to mind is TotoHealth from Kenya, primarily because, I’m based here, in Helsinki at the Startup Sauna which is the Finnish version of the incubator and accelerator for the start-up ecosystem. It’s out in Otaniemi which is kind of where GSM and GPRS and SMS and all of those things were invented. It’s the closest thing we’ve got to a mobile Silicon Valley, if I may be so bold as to say that. TotoHealth was selected by Startup Sauna, last year to join their program and I did meet them, they’re focusing on maternal healthcare and child mortality. The solutions differ so you can have 20 different start-ups or pilot programs focusing on maternal health and they’ll all be under that topic, but they’re not all doing the same thing. It ranges, it can range from the monitoring, as I mentioned earlier, to reminders to information services, sometimes as simple as reminding mothers it’s time to vaccinate your child. May I take a moment to share a really cool invention, in this space?

Jon:
Please do.

Dirk:
Of course.

Niti:
Okay, it’s basically this guy, Benson Wamalwa, Wamalwa and I’ll provide the links. Dr. Benson Wamalwa of Nairobi University, I think, in Kenya has invented a solution rather than invented a technology, where it’s a simple barcode reader using an app on a smartphone except that it not only remind the mums that it’s time to bring the kids in for the next dose of vaccination but because he knows that many times, now this is where in depth knowledge of how things really work at the grassroots level makes a difference when you’re designing a service or solution, is that he knows that many times the reason why mums miss appointments or miss completing the vaccination program is due to the time it takes to get to the nearest clinic, the cost of getting to the nearest clinic, because you’re taking a bus so you’re taking a motorcycle taxi or whatever. And all of those schillings matter. And taking her away from some kind of income generating activity, whether she’s working the land to grow the tomatoes to sell them, whatever it is.

What it does is it also rewards mums with bonus points, so it almost acts like a loyalty card, like you’d have at the supermarket which then gives you discounts when you’re shopping or whatever.

Dirk:
You know what’s interesting is you talk about that, is that mHealth the role that it plays in Africa, in the places in Africa that you’re talking about, the roles could be similar in the United States, however, in the African context, that you mention, it really is a necessity whereas in the United States it’s more of a convenience.

Niti:
It’s a lifeline, it’s the last mile of delivery, it’s not even the case as it is in India where there is still a certain amount of healthcare infrastructure through the government and whatever. I’m sure you all have your neighborhood Indian doctor. And from Africa a lot of medical tourism or rather said because doctors aren’t available, because healthcare isn’t available and there may only be a hospital in the big city, there’s a lot of people who even go to India for cancer care or larger operations. All of Nairobi may have, and maybe I’m pulling this data out of my hat, it’s as an example, but all of Nairobi may have only one MRI machine, to give you context of lack of infrastructure.

Dirk:
Yeah.

Niti:
That’s why, and I will follow up with a link to the GSMA health case that tracking all these pilots and these programs. And I looked it up just before coming on the call, there was about 1,750 different pilots and solutions.

Jon:
I’d love to know what your impressions are of the survival rate of this large number of start-ups that obviously there are many entrepreneurs that are entering this mHealth field, but it being so new and the fact that start-ups have their funding is unsure in the best of situations. I’m curious what the possibility is for success for these many entrepreneurial endeavors that you’re seeing.

Niti:
Okay, I’d like to clarify that probably of the 1700 GSMA or solutions that the GSMA is tracking, I’m thinking that it’s going to be a minority of them are start-ups by entrepreneurs or ventures. These are what I call mPilots which are mostly Mobile For Development initiatives, donor funded or grant funded. Their future, very honestly, we have yet to see something scale significantly in the top-down Mobile For Development arena. Ironically, that’s the best funded space, they’ve got the money, they’ve got the grants, they’ve got pilots running all over the place doing different things but because they don’t tend to take the user-centered approach and most of these solutions are designed in the isolation of developers sitting somewhere going “Oh I know what we really need to do is this school thing to save poor African mothers.” Most of them get the funding because their initial grants are raised under the aegis of international development or helping the underprivileged but don’t really become sustainable.

Now from the start-ups, because any reasonably viable start-up, these days at least in the key centers, like I mentioned Lagos and Akra and Nairobi, because there are now numerous hubs and incubators and accelerators, the ecosystem for start-ups is being nurtured. If a start-up is even reasonably viable and they get into one of these programs, more likely than not they will be nurtured into viability. It’s still early days, nothing’s gone wireless as far as I know but I could be wrong because these things are coming out everyday. I might not have the latest information but I know that in the example of TotoHealth, they were focused on health, they were doing something different but because the basic concept was attractive, after having been through mLab which is a World Bank initiated, I guess it’s an incubator I don’t know the right wording, but a support system in Nairobi and then through the Startup Sauna here in Finland, they’ve evolved into something more viable and most recently they just picked up, either it was another award or a grant that helps them take things further. With the start-ups we’ll see what happens.

Analogy would be agriculture based start-ups, which took a few years, they looked like they were sputtering but now you hear of iCow and mFarm really stabilizing and becoming sustainable and scaling. If these healthcare start-ups follow the same type of path, there will be the good ones, the viable ones, the ones that pivot and evolve and respond to the needs in terms of their business model and the service, I’d say I see them scaling. On the other hand the social enterprise coming from the outside top-down development orientated ones, they stumble and I have yet to see anything scale and I would love to be proven wrong, if one of your listeners would like to send something in say “here it is”, I’d like to be proven wrong. But there’s no user-centeredness going on there. Coming back to Dr. Wamalwa’s invention, it was an innovation. The pilot phase was funded by a grant because it was viable but it’s scaling and it’s growing. It increased the uptake of vaccination services from 55% to 95%. We can see this scaling. It’ll probably be picked up either by the government or by a healthcare program of some sort and it will scale.

Healthcare in these markets can’t afford to be private sector, insurance driven to the degree that it is in the United States. I don’t know if I’m saying which is blasphemous or which is heresy because I am sitting in Finland and the Nordics are famous for state supported healthcare, I don’t know if I’m risking anything by stepping into any ideologies here but from the very pragmatic point-of-view there are public goods. Too much of the population lives on too little for these things to ever be completely privatized.

Dirk:
I thought it was very interesting that you mentioned that there are a lot of blended companies, so it’s not strictly entrepreneurial and it’s not strictly governmental, it’s more cooperative. Why is that more common in Africa than it is here in the United States when it’s almost always one or the other?

Niti:
I would say you would be surprised to notice that there are a lot of social enterprises even in the United States, they may not be called that but there is actually a registration, a business registration category between an LLC and a registered charity, there is actually a category called social enterprises. There is something I wanted to add of the third cluster and that’s the business opportunity space that you were referring to. It may not emerge right now from the start-ups unless the start-ups are acquired by the Telcos but what’s happening and especially in East Africa, actually even in West Africa is that the Telcos are rapidly evolving way beyond the mandate that you would see in the United States or even in Europe. They’re starting MVNOs with banks, they’re offering savings facilities, they’re looking at, mobile money is a big thing but with that, the Telcos are also moving into things like micro-insurance and now into healthcare. And that is a pure profit play.

Jon:
Niti, thank you so much for joining us on the show today to talk about mHealth in Africa. If listeners want to learn more you have a Twitter handle they can follow.

Niti:
If you’d like to know more and keep on top of what’s happening in Africa, then follow my African news timeline hand-curated, hand-selected news bits on enterprise innovations, start-ups, entrepreneurs @prepaid_africa

Jon:
Listeners, remember that while you’re listening to the show you can follow along with the things that we’re mentioning here in real-time, just head over to thedigitalife.com, that’s just one “L” in thedigitalife and go to the page for this episode. We’ve included links to pretty much everything mentioned by everybody so it’s a rich information resource to take advantage of while you’re listening or afterward if you’re trying to remember something that you like. And if you want to follow us outside of the show, you can follow me on Twitter @jonfollett and of course the whole show is brought to you by Involution Studios, which you can check out at goinvo.com, that’s goinvo.com. That’s it for episode 101 of The Digital Life. For Dirk Knemeyer, I’m Jon Follett and we’ll see you next time.

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