Frost Perspectives

Frugal Innovations in Africa Changing the Landscape of Primary Care

Aug 22, 2016

cfab3ab7ca0a98438647916ecc4328e7.jpgAfrican nations are not known for having healthcare services and facilities that are sufficient in catering to their vast, rising populations. The majority of the people are served by public health facilities, which are higher in number and offer more affordable services when compared to the private healthcare providers. Nonetheless, these services differ across the various facilities within the same category of public healthcare and are limited, by comparison. Public healthcare challenges are primarily due to the facilities’ poor infrastructure and unskilled personnel.

Further, owing to rampant poverty and the low number of institutes for healthcare education, the number of healthcare workers is far lesser than found in other continents. In Africa, for every 100,000 people only 15 doctors are available, whereas in France there are 322 doctors for every 100,000 people.

These are on-going challenges that require improvements across several parameters. In order to rank among the best healthcare setups (that is, comparable to the nations of Western Europe, the United States, Canada, and other developed regions), Africa and its nations would need to implement the following changes:

  • Improve infrastructure (roads and transport services) to support healthcare delivery
  • Create better facilities and opportunities for medical education, especially for the underprivileged
  • Increase the number of healthcare facilities, hospital beds (for primary, secondary, and tertiary care), and healthcare workforce per 1,000 population that is well-trained to cater to every health need
  • Manufacture medical equipment and pharmaceutical products locally
  • Ensure presence of well-equipped and well-staffed healthcare facilities for every member of the population for better healthcare outcomes

In order to realize these improvements to the traditional healthcare delivery models, greater investment is needed by government bodies and donor agencies, developments that will take significant time to establish. Yet neither do the national governments have sufficient funds available to allocate towards healthcare, nor are the donor agencies able to contribute such high funding requirements towards improving healthcare across the continent.

To mitigate the situation, non-traditional models for delivering healthcare are emerging via eHealth (or electronic healthcare) and its segments such as mHealth (or mobile healthcare) services, video telemedicine (store and forward method as well as real-time method), and electronic health or medical record services. Also, vendors are offering easy-to-use, self-diagnostic methods that reduce patients’ dependency on providers for determining their health conditions. Similarly, numerous examples of frugal innovations are being offered by the people of Africa to cater to the accelerating healthcare needs.

For instance, a urine malaria test (UMT) is being offered by Fyodor Biotechnologies in Nigeria. The UMT kit includes a test strip that is to be dropped into a clean container holding as little as 100 µl (5 drops) of urine. The strip has to be wicked up for 1 to 2 minutes, and then incubated at room temperature for approximately 20 minutes. If two visible lines appear on the strip, the test is positive; if one line appears, the test is negative.

In Tanzania, Apopo uses lab rats to detect tuberculosis through human sputum samples. These HeroRATs (name given to the rats) evaluate samples from 10 different labs in Dar-es-Salam, Tanzania. They sniff a series of holes under which human sputum samples are placed and detect if the TB bacteria are present in the samples. If they correctly identify the positive samples, they are rewarded with a food treat. The positive samples are reported to hospitals for follow up with patients. This TB detection program by Apopo is working towards further validation before full implementation.

Another noteworthy example for innovative healthcare is that of Community Health Africa Trust (or CHAT), a community organization that caters to primary healthcare needs of people living in remote/rural regions of Northern Kenya. CHAT has set up mobile clinics using various modes of transportation such as vehicles, bicycles, human couriers, and camels (depending on the terrain and infrastructure) to visit approximately 36 communities on a monthly basis. The mobile clinics provide a range of services from basic medical care to reproductive health, treatment for malaria and tuberculosis, counselling and treatment for HIV/AIDS, immunization for children, and health education including the dangers associated with female genital mutilation.

Healthcare is also being rendered by innovators that offer unique solutions for supporting providers during power-cuts, an on-going problem in Africa. Companies such as WeCareSolar have developed low-cost and long-lasting power back-up for emergency services. WeCareSolar offers Obstetric Solar Suitcases to help community healthcare workers improve the safety of home birthing in Nigeria, Uganda, Malawi, Tanzania, and Ethiopia. These kits have medical quality lighting, foetal monitors, headlamps with rechargeable batteries, and a foetal Doppler. Similarly in Botswana, a company called Deaftronics offers solar-powered rechargeable hearing aid batteries that can be used in a majority of hearing aids and last for 2 to 3 years. The company also offers the first solar-powered hearing aid unit, Solar Ear, a cost-effective and easy-to-use product that is available in South Africa, Zimbabwe, Angola, and other countries across the globe. In Malawi, Baobab Health Trust has developed low-cost computer systems with long-lasting power back-up to allow more than 1 million antiretroviral (ARV) therapy sessions that are used for treating approximately 18,000 patients. These computers offer registration of 800,000 patients and 160,000 HIV counselling and testing sessions. Baobab has also developed touch screen-based user interfaces designed for users with limited technology experience and low-cost information devices that stand up far better in harsh conditions than traditional computers.

South Africa also witnesses the success gained by the Unjani Clinic-in-a-Box, a concept that is designed to provide low-cost primary healthcare services for the under-privileged members of society. These clinics are established in 12-meter-long containers/boxes and provide consultations at approximately R180 ($14) per patient. The fee includes prescribed medicines. This is a very competitive rate in the context of South Africa’s private healthcare facilities. These clinics are well-equipped with facilities such as an outside reception area, an examination room, a medicine dispensary, a registered nurse practitioner, and an assistant. All Unjani clinics are managed and owned by an experienced and community-based registered nurse. The start-up costs are approximately $20,000. Currently, there are seven fully franchised units that are functional in different parts of South Africa. Each clinic has a foot-fall of approximately 180 to 400 patients on a monthly basis. The current network of 25 Unjani clinics has served upwards of 145,000 patients.

Female entrepreneurs are also offering specific solutions to improve women’s health. A group of students from Makerere University in Uganda has invented a test kit called BVKit to detect harmful bacteria that cause bacterial vaginosis, and many other infections in women. The kit consists of hardware technologies that determine PH levels in urine and share the readings with the (software) app by using Bluetooth connectivity. The software calculates the exact value of healthy or unhealthy vaginal bacteria to conclude the health status of the individual undergoing the test, and the application notifies users if the individual requires additional medical attention. The location of the nearest available doctor is also determined by the BVKit.

Healthcare giants such as Philips and GE have started offering small-sized, low-cost innovative solutions designed to cater to the needs of Africans. GE’s hand-held ultrasound device, VScan Access, has gained high popularity since its introduction in Nigeria in 2015. This device allows doctors and nurses to scan pregnant women in rural/remote areas and wirelessly transmit images of the foetuses to gynaecologists in faraway hospitals. Conducting ultrasound and regular ante-natal tests helps in determining whether mothers need to proceed to a hospital or a health centre for appropriate care. Every year, Nigeria witnesses about 10% of the global maternal, infant, and child deaths. In particular, the World Health Organisation (WHO) states that 45,000 women die in childbirth every year in Nigeria. VScan Access was co-launched by GE and the government of Nigeria through the Healthymagination Mother and Child Initiative, which is a $20 million joint venture that will offer access to prenatal screenings to more than 2 million expectant mothers across Nigeria by 2020 to decrease the high number of maternal deaths in the country. This initiative will target 1,300 midwives and prenatal primary health caregivers with 100,000 hours of training over the next 3 years in maternal and child healthcare.

Concurrently, Philips has introduced the concept of Community Life Centres that integrate the health needs of villages/communities by combining healthcare technologies that contribute to and support the healthy development of communities. A Philips Community Life Centre comprises the appropriate medical devices to fulfil primary healthcare needs with maternity care units, laboratories, vaccine cooling facilities, and eHealth solutions complementing patient care. The community healthcare workers are offered continuous training for community care, and they are monitored on a regular basis. In 2015, Philips launched a device named the Children’s Automated Respiration Monitor (or ChARM) that recognizes the symptoms of pneumonia in infants and young children.

Thus, it is evident that frugal innovations are accelerating the healthcare delivery services needed to bridge the gaps that have been left by the traditional healthcare models. These frugal innovations are economical, easy to access, and easy to use by the common person. They emphasize on the importance of preventive care thereby supporting the low capabilities of spending, especially for the majority of the African nations where out-of-pocket spending is very high. It is not only the small-sized market participants that are offering their support to this upcoming market, but also this trend is being explored by known, established brands functioning across Africa. Most importantly the positive response received for frugal innovations has encouraged local start-ups and inventions in healthcare, thereby increasing the rate of employment and subsequently improving the standard of living among Africans.

Given the socio-economic diversity, geographic difficulties, and significant healthcare needs of the continent, it is expected that in the coming years frugal innovations will disrupt the African healthcare industry. Indeed, integration of frugal innovations with point-of-care-testing in healthcare is paving the way for an improved healthcare scenario across all emerging economies of Africa. Healthcare vendors are advised to hop on the bandwagon and make the most of this emerging opportunity.

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