• Startups
  • What's preventing eHealth adoption in Africa?

    African countries are converging under a common desire: to transform African healthcare through technology. But they also share a common frustration: African healthcare's slow and unsteady embrace of new technology. 

    Why do so many seemingly great technologies fail to penetrate the health care system?

    This was a question I asked myself while undertaking my master’s research. I hope the following answers shed some light on the realities of technology adoption in healthcare. 

    1. Many eHealth innovations don’t address the real problem 

    eHealth innovators start by discovering a useful technology. Later, they figure out how people can use it. eHealth should not only address a problem, but needs to be goal directed. Meaning, innovators should start with the goals of the end-user. The solutions come next. When the order is reversed, the results usually disappoint.

    As an example, the introduction of wearable health tech has excited innovators in the industry. These wristbands, watches, sensors and headsets can obtain and transmit large amounts of data on heart rhythms and blood pressure. However, there’s little evidence those wearing them overcome abnormal heart rhythms or elevated blood pressures better than those who don't. 

    2. No one wants to pay for new technologies 

    Creating an innovative technology to help doctors and patients isn't enough. Patients, doctors, healthcare facilities and insurance companies long for the benefits and value that these technologies provide, however, each thinks someone else should pay for it.

    Furthermore, new technologies that lowers costs and reduce patient visits discourage doctors and healthcare facilities from embracing these technologies because they work on a fee-for-service model instead of a fee-for-value model.

    3. The infrastructure to share information is underdeveloped 

    The introduction of the electronic health record (EHR) allows healthcare providers to share patient information and collaborate across different specialties to provide holistic treatment plans for the patients.  However, in Africa the supporting infrastructure, policies and standards for data sharing across multiple platforms and geographies are lagging.  Several African countries have started investing in strategic working groups to address this challenge.

    4. Technology slows down users

    For many healthcare providers, entering data into an EHR takes longer than keeping a paper record.  The structured format of the EHR also frustrates healthcare provider when the application prevents them from skipping steps or leaving out clinical details. 

    Frustrating as it may be, the added information reduces the risks of medical error, avoids redundant testing, and facilitates easier access to test results.  The benefits to the patient are clear, but less so for the healthcare provider. Getting healthcare providers to embrace these more effective approaches is the next big challenge for innovators to overcome.

  • Is a freemium model the way to go for eHealth apps?

    The proliferation of medical apps for disease prevention and health promotion has made healthcare ever more accessible. It is further facilitated by the ubiquity of smart phones and demand for better healthcare.  

    The number of digital health apps available in the market has reached over 300,000 apps on the top app stores worldwide, almost double the number available in 2015. Over 200 apps are added daily.  

    Sadly, many of these apps aren’t sustainable for more than a year, fail due to a number of reasons, including poorly structured revenue models.  A number of the businesses I evaluated during my master’s research relied on fragmented funding from various sources such as donor organisations to support development of their products.  When this funding is depleted, other revenue models need to be put in place to ensure sustainability. 

    Freemium is a popular model in which the basic application is free for users to download and use for as long as they like, though enhanced functionality is available at a price. Eventually, some of these satisfied, non-paying users will want to upgrade to a better version of the app or make in-app purchases, and hence become paying customers.

    In order to generate revenue from freemium apps, these three attributes need to be fulfilled;

    Capture high market share - the market strategy needs to revolve around capturing as much of the market share as possible because only a small percentage will become paying consumers and support the cost of non-paying users.Have a strong competitive advantage - the free offering must fulfil a need for the user in order to create a positive buzz, and the paid version has to create added value for customers to induce them to upgrade.Continued value creation - the freemium product should continue to add value as the user uses it over time in order to encourage non-paying users to switch over, and to maintain a consistent base of paying users.

    This model works well for innovations that are highly adaptive and iterative. Motivation to become a paying consumer relies on the value that the product adds for the user.  As soon as the value diminishes, interest in using the app wanes as well. The challenge for these companies becomes staying ahead of a rapidly evolving and innovative industry.

  • Why eHealth needs business modelling

    A substantial number of businesses and start-ups pursuing opportunities to bridge healthcare challenges with eHealth technologies are often confronted with “pilotitis” or failure to implement their technologies in a sustainable way.  In my last article, I described some of the challenges eHealth businesses face. 

    Constructing a business model during the development of eHealth technologies can guide a value-driven evaluation of what is necessary and what is not, in order to overcome implementation failures. A review of the literature suggests that the business model canvas proposed by Osterwalder is a suitable business modelling tool for the eHealth industry.

    The one-page canvas consists of nine building blocks that provides a conceptual framework to describe the business’ activities from four perspectives;

    Value offering – what need is being fulfilled by the business?Value communication and transfer – who are the customers and how does the business communicate with them?Value co-creation – what are the business inputs, including collaborating partnerships? Value capture – how does the business maintain profitability?

    A key observation in my master’s study was that there is a strong focus on the value offering and value capturing activities of the business model, although little focus on value co-creation and value communication and transfer activities.

    While eHealth businesses are aware of the importance of these activities, challenges of the environment create barriers to prioritising these activities. To overcome these challenges, transformation is required in both the micro and macro eHealth environment.

  • Successful eHealth needs better business models

    eHealth is a complex business type, integrating many stakeholders acting across interwoven networks. Yet the characteristics of successful business models remain understudied.

    Despite the promise of eHealth to overcome healthcare access challenges, reduce costs and improve quality , successful implementation is low, especially in developing countries.  In fact, over 50% of eHealth businesses find it difficult to sustain their implementations sustainably beyond the pilot phase. I have been investigating these dynamics and will be sharing them over the next few weeks in a series of eHNA pieces.

    Recurring challenges of eHealth include;

    Financial institutions unwillingness to fund eHealth start-upsHigh start-up costs and ongoing maintenance costsRegulatory legislation that lags behind technology developmentResistance from end-users to adopt new innovationseHealth technologies lack user experience designPoor scalability of eHealth technologies after their pilot phasePoor ICT infrastructure in the environmentLack of leadership and political supportLack of research.

    To overcome these challenges, change is required in both the micro and macro eHealth environment. I’ll be sharing ideas on what changes are needed in my next piece.

  • Biggest financial support achieved by Egyptian start-up Vezeeta

    Start-ups need a financial prop in their early years. They often need a second wave to finance expansion. A report in Disrupt Africa says Egyptian start-up Vezeeta has raised US$12m. It’s the largest single investment ever received by an Egyptian start-up. It builds on its US$5m support achieved in 2017, as reported in Disrupt Africa. 

    Set up by its Ceo Amir Barsoum in Cairo in 2015, Vezeeta’s eHealth enables users to find and book appointments with over 10,000 doctors. It’s available in Jordan and Saudi Arabia too. For the region, it manages three million bookings for 2.5m patients. It also provides Software as a Service (SaaS) solutions using cloud computing and big data for patients and doctors.

    The financing round was led by the Saudi Arabia-based STV Capital. It included existing investors BECO Capital, Vostok New Ventures, Silicon Badia and CE-Ventures. Vezeeta’s will deploy its extra finance to two initiatives.

    One’s to continue its expansion in Saudi Arabia. The other’s to develop new products. 

    Will a subsequent investment phase turn Vezeeta’s attention towards the rest of Africa? For this, it may need expanded commercial opportunities driven by large numbers of users.

  • eHealth start-up Redbird can expand access to rapid diagnoses across Ghana

    Africans suffer from diabetes at more than twice the global average. Resource constraints mean that millions lack proper access to healthcare to help them manage the disease. Launched this year, July has been a month of swift advances for Redbird Health Tech (Redbird HT) to try to bridge the gap.

    Chronic diseases, such as diabetes and hypertension, account for half of Ghana’s healthcare activity. Responses require treatment and long-term monitoring and management. Travelling to a hospital and waiting was the only the services for chronic disease patients. Risks of patients ignoring their conditions, either by necessity or willfulness, are very high. Consequences can be devastating.

    An interview  with Patrick Beattie, Redbird’s CEO, in Disrupt Africa, says his team could leverage existing, approved, under-utilised Rapid Diagnostic Test (RDT) technology to create convenient health monitoring points for routine health questions and, alleviating pressure on overburdened physician. Redbird secured funding from Gray Matters Capital an Atlanta-based impact investor. Redbird’s success with third place in the Ghanaian round of the DEMO Africa Innovation Tour seems to have helped its case.The solution develops a network of locations for primary care diagnoses and personal health monitoring to offer patients local access to healthcare at minimum disruption and cost. Existing national networks of pharmacies are part of the service. Redbird supplies them with verified RDTs, health monitoring software, and trained staff to interpret RDTs’ data.

    Having secured finance, Redbird’s plans to expand its pharmacy partnership from two to thirty in the next three months. The project’s scalable, and could become regional. Eventually, it could expand across all Africa’s health systems.

     CureAid pharmacy in Adenta advertising Redbird health monitoring services. Image from the Redbird website.

  • HearX Group makes hearing screening more accessible

    In 2015, eHNA reported on a South African start-up, HearX Group, founded by Prof De Wet Swanepoel and Dr Herman Myburgh.  They developed a low-cost smartphone app that detects hearing loss and connects patients to health services.  

    The product uses a smartphone and headphones along with a custom-developed software application to detect hearing loss.  This inexpensive alternative to conventional screening is 50-70% less expensive and can be administered by non-specialists and screeners with even basic literacy and low digital skills.

    Today, the company boasts a suite of apps and mHealth devices geared towards improving hearing screening in underserved and remote communities, and especially among children.  Other products included in their collection include hearZA, mHealthStudio, hearTest and hearDigits, as well as a partner product in vision called Peek Acuity.  

    Now, HearX group has taken their solution beyond Africa.  A recent collaboration with the American Academy of Audiology saw the launch of America’s first-ever intensive hearing screening mobile app, hearScreen USA.  This was launched at the Academy’s annual conference April 2018 and is freely available on smartphone devices.

    In many nations, the general awareness of hearing impairment is low and shortage of resources has caused a lack of screening programmes.  HearX Group could soon be turning this into a problem of the past with further collaborations in Africa, Europe and Asia.

  • Cape Town’s eHealth accelerator programme offers opportunities for graduates

    Many of us have good ideas. Turning them into action is often harder.  Cape Town's Accelerator Programmes aims to help. It offers opportunities for graduates to access finance and work experience to turn their ideas into a viable business.

    There are two pilot programmes. Accelerator two opens for applications on the 15th March 2018. Accelerator one has announced its eight finalists. They participate in a ten week online programme and have face to face interactions with their mentors. 

    Business coaches in eHealth started on the 23rd January 2018. The course extends over 10 weeks. There is one topic each week taking about ten hours. Finalists take part in discussions about health problems and solutions. Strategic planning, alignment to health-care environments, defining and marketing proposals are the main themes.  Discussions on topics relevant to running a profitable and beneficial eHealth business are included too.

    Finalists are :

    Petrus Van Niekerk :  Udok allows doctors to interact with patients who are far away as well as administer treatment and monitor patient careDr William Mapham : Vula Mobile is a system which allows doctors to refer patients to specialists in tertiary hospitals Dr Anuschka Coovadia : HealthAtHome is a company that will provide patients with the best care from the comfortability of their homes at an affordable price. Brighton Khumalo : ConnecTB is an online tool which allows health care providers to register and monitor TB patientsNicole Van Der Merwe : GeneCare Molecular Genetics will provide patients with access to customised diet plans as well as exercise programmes which will be accompanied by educational video coachingDr Musaed Abrahams : Aviro Health has developed an app that will mentor nurses in primary health care to efficiently treat patients with HIVSuretha Erasmus : GC Network  has developed a pregnancy screening app that educates pregnant mother of their individual risk for a chromosome abnormality as well as provides detailed information regarding available prenatal testing which will help the mothers make informed decisionsVere Shaba : RAR Group VRHEALTH is a company that created a virtual yet realistic world for substance abuse patients who have been placed in a rehabilitation to develop new behavioral patterns through the virtual world Is the programme a model for Africa’s other health systems? It offers a smart way to encourage and develop Africa’s budding eHealth entrepreneurs. 

  • EMGuidance web-platform to simplify medication look-up in South Africa

    Since the launch of their clinical support platform in 2016, EMGuidance has become one of the most popular medical apps in South Africa, even extending to other parts of the globe.  Its popularity is largely due to the comprehensive, up-to-date and locally relevant clinical guides and protocols made easily available to health professionals.

    In fact, the response from health professionals has been so great that EMGuidance is now available as a web-based platform.  The web-based platform essentially functions as a Google search engine with a twist.  This niche search engine only returns locally relevant information – fulfilling a great gap in clinical support tools in South Africa.  Health professionals will now be able to search for relevant South African therapies by trade name, active ingredient or registered indication. 

    Realising the potential for other African countries, EMGuidance has launched a slim-line version of their tool in Sierra Leone.  The positive response from the local community has spurred plans to expand to Kenya, Tanzania and other African countries.  It’s activities and initiatives like EMGuidance that will springboard eHealth in Africa to first-world healthcare delivery.

  • Are Africa’s eHealth start-ups on the move?

    Africa’s health systems need a vibrant eHealth start-up environment that provides local solutions. It’s good news that the number of Africa’s eHealth start-ups is rising. Most don’t leverage mHealth.

    The report from the start-up portalDisrupt Africa High Tech Health: Exploring the African E-health Startup Ecosystem Report 2017, identified 115 eHealth start-ups in 20 African countries, about 37%. It reveals the need to stimulate eHealth start-ups in the other 63%.

    Investment’s increasing too, especially finance for businesses growth. The combined eHealth start-up investment’s exceeds US$19 million. Most eHealth start-ups in the report don’t use mHealth. It’s about 44%. 

    Niche solutions are an important component of Africa’s eHealth investment. As demand and opportunities expand, especially for mHealth, the scope for Africa’s eHealth supply side can expand with it. A report in Standard Digital summarises the landscape using data from the 20 countries over three years from Disrupt Africa, it says about 73% of Africa’s eHealth ventures provide mHealth solutions. Local eHealth innovators are emerging in Uganda, Ghana, Egypt, and Senegal. Start-ups launching across Africa has increased over three years. Investors are starting to support start-ups planning to grow expand.

    Africa has an estimated 115 eHealth start-ups. About 28%, 32, are in East Africa. Nearly half of these, 15, of East Africa’s eHealth start-ups in are in Kenya, about 13% of Africa’s total. They may be confronting challenges in attracting finance, unlike reported significant investment in other countries in the region. Does it mean that the available finance’s being spread more evenly, or is it because better investment opportunities are emerging from other countries?

    Total investment in eHealth start-ups over the period is estimated at US$19 million. Kenya start-ups raised US$379,600, under 2%.

    Africa.com has a different perspective. Its report identifies Tunisia emerging as the next eHealth hub. It says there are more than 300 African tech start-ups, 54, 18%, in South Africa , 27, 9%, in Kenya, 23, 8% in Nigeria and 15, 5%, in Tunisia. After creating a successful incubator in Kenya, Merck will launch a start-up incubator in Tunisia by 2019 to collaborate with innovative eHealth start-ups.

    It’s not all rosy. Several challenges to growth are seen as access to finance, uncertain policies, competition from established brands and finding and recruiting talent. 

    Africa’s eHealth strategies need to parallel these initiatives. They’re creating opportunities to improve health and healthcare.