On the global healthcare index, Nigeria’s healthcare ranks as one of the five worst in the world. The health industry is in such dire straits that 40,000 of the 75,000 registered Nigerian health practitioners now work overseas.
In the last decade alone, Nigeria has witnessed outbreaks of infectious diseases like cholera, meningitis, and monkeypox. In 2018, there were six different outbreaks of communicable diseases, primarily in rural areas.
When these outbreaks occur, the country’s medical infrastructure is unable to manage—with the notable exception of the handling of the Ebola crisis in 2014.
In June 2017, Madam Rose, a staff of Kaltungo General Hospital, Gombe, told All Africa News that she watched a pregnant woman named Linda die because the hospital did not have any blood. “All she needed to survive was a few pints of blood but there was no blood available in the hospital’s blood bank. So, she was left on the delivery couch just as helpless as the doctor who wanted to help but couldn’t.”
Nigeria lacks sufficient blood bank facilities, so accident victims and pregnant women who need transfusions often do not get them. “Linda’s bleeding didn’t stop, and it became rather profuse. The hospital’s blood bank was not functional and she died of a cardiac arrest following excessive bleeding,” said Madame Rose.
Linda’s case is not unique, and Gombe State is not the only afflicted. Nigerians need at least 1.8 million units of blood per year, but only 66,000 units are available.
No surprise then that even our president seeks medical help outside the country.
But as the sector struggles to cater to the health needs of nearly 200 million people, an innovative technology scene has birthed a cluster of start-ups focused on combating challenges in Nigeria’s health sector.
They are Nigeria’s health-techs.
$95 million worth of investment flowed into Nigeria’s tech scene, making it a top destination for investors in Africa. Some of this funding was designated to businesses solving problems across the health value chain.
Of these, Helium Health, founded in 2015, raised $2 million, making it the best-funded new generation health-tech.
21st Century processes
Helium health is expanding the digitisation trend by helping medical institutions store patient information electronically.
While working at the Lagos State Aids Control Agency (LSACA) in 2016, Tito Ovia, Co-founder of Helium Health, realised that health institutions operate obsolete models of storing vital details. “I had to work with all the general hospitals while I was at LSACA. If you’re in the monitoring and evaluation department, for example, you have to fill in the intake forms of hundreds of patients a month. Then you have to put all of their information and test results in a handwritten register,” she explains. “There’s also a monthly register and a Lagos state form to be filled. All the international organisations have their forms too. It is a lot of paper,” Ovia finishes.
Like many public institutions, public hospitals love paper. Filling forms and registers have long been a Nigerian sport, and if walking into a public hospital, there is a good chance you’ll find an employee manually filling in paper records or skimming through a heap of files to access patient medical records.
In April 2016, Idowu Emmanuel told Vanguard News that he was denied surgery at the General Hospital, Broad Street, Lagos because the nurses could not find his case file. Despite arriving at the hospital’s surgical outpatient department at 7 am for his procedure, Emmanuel was kept waiting for hours. “It took about four hours before the records officer opened an emergency file for me. Worse still, I was given a completely new appointment date,” he complained.
The frequency of stories like Emmanuel’s has motivated Helium Health. The start-up uses electronic medical records (EMR) to help health care institutions digitise their operations and patient records. Instead of manually filling forms and storing handwritten patient information, they provide management software that computerises all of the data.
The hope is that digitisation would help hospitals manage their records, which would be vital to facilitating information sharing between hospitals, a necessary step in preventing outbreaks. So far, Helium Health has worked with over 70 health institutions across Ghana, Liberia, and Nigeria, including 7 states in Nigeria.
Nigeria’s medical infrastructure is unable to deal with these outbreaks when they happen, so the best approach would be stopping them pre-emptively.
InStrat global health solutions, another health-tech, has designed an early Warning Disease Outbreak Recognition application—EWORs for short—that allows early detection of diseases.
“The application is mostly used by general hospitals across the country, and it sends out alerts of elevated disease activities in affected areas,” explains Damilola Ogunnupebi, Communications Manager for InStrat.
EWORs uses algorithms that can detect potential threats by analysing location data, previous occurrences, and monitored syndromes. Ogunnupebi tells me that it is currently being used in approximately 110 health facilities across the country to collect data on diseases like Malaria, Typhoid and Diarrhoea.
Blood, Telemedicine and others
Another area that health-techs have penetrated is telemedicine. There are only about 23,000 hospitals in Nigeria. The World Health Organisation (WHO) recommends that a country has one doctor for every 600 patients; Nigeria has one doctor to 4,000 patients. Doctors are supposed to see at most 20 patients a day, but in Nigeria, they see up to 150.
Clearly, doctors are overstretched, and that is why start-ups like Mobidoc and Hudibia are electronically connecting patients to doctors. With Hudibia, users cut the long queues and outdated processes at health institutions and can consult with a doctor on a live stream. User records on the app can also be securely transferred to another healthcare provider if the need for it ever comes up.
Telemedicine start-ups like Hudibia are the most popular health tech start-ups in Nigeria, but some problems cannot be solved virtually—like blood.
Nigerians do not donate blood regularly, and we don’t have enough blood banks. Temie Giwa-Tubosun, Founder of LifeBank, connects donors with those that need blood. In a Guardian interview, she explained that her motivation to kick start the start-up came from her personal experience during childbirth. “My son’s birth was a difficult one, and that forced me to look deeper into maternal mortality in Nigeria. I found that blood shortage is a major cause of death for mothers.”
“Finding blood when available and moving it to where needed is the main thing. So, I built LifeBank to increase the blood available in the country through our app that reminds and schedules donor appointments,” she said.
Ezinne Anyanwu, a US-trained nurse and founder of Efferent Services Health, is excited about the current fusion between healthcare and technology in Nigeria. Efferent offers advisory services to healthcare organisations and hospitals. The team helps them understand the impact of technology and the improvement it can have on their practices.
“One of the reasons I moved to Nigeria was because I figured that health care was going towards technology. I saw that there were conversations about tech here, I wanted to be a part of those that contribute towards the conversation,” Anyanwu enthuses.
She adds that in the next ten years, she expects that innovation and technology would have staged a major takeover in the country’s health sector.
But can health tech solve all our health care problems?
At the moment, the Nigerian government does not finance the health sector enough.
In 2001, members of the African Union (AU), including Nigeria, signed an agreement to commit at least 15% of their annual budget to solve the challenges in their various health sectors. 4% of Nigeria’s ₦8.6 trillion budget was allocated to the health sector in 2018, even lower than in previous years, and much smaller than the AU agreement.
Put simply, the money needed in Nigerian healthcare far outstrips the money that is put in. And just as the government struggles with funding, health-techs do too. Olanrewaju Odunowo, Editor and Researcher at Tech Cabal, tells me that these start-ups find it more difficult than others to handle funding and regulation.
Odunowo argues that investors don’t understand the health tech sector and don’t find it as attractive as Fintech. “One tech entrepreneur described it this way: She said the only time they get funding is when there’s someone (an investor) that understands the sector in the room.”
Anyanwu agrees. “There isn’t a lot of funding because VC’s don’t understand how to monetise health start-ups,” she says. This begs the question of how health-techs can scale without funds.
It is also important to note that health start-ups don’t have clear regulations to help them thrive. Unlike Fintechs that have a framework with the Central Bank of Nigeria (CBN), health techs are not within any regulatory environment. No regulation means that there’s no law that establishes a standard or checks the activities of the sector. That may contribute to why investors consider the sector to be riskier.
“The federal ministry of health has a document that explains its plans for digital health for the next four years, but fails to address the regulatory pitfalls and gaps that exist in this document,” Odunowo explains.
The challenge is unenviable and the conditions are unwelcoming, but health-techs have already made a mark. A recent TechCabal report suggests there are just over 75 health-tech start-ups. They may be small, but they can make a big difference.
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This article was edited on 21 February 2019: The number of health institutions Helium Health was inaccurately reported as 58. The correct number is 74. Also, Helium Health has worked with health centres in Liberia, not Libya.