RUBI HEALTH

Wealth is a major determinate of health; the poor are less likely to access preventative and life-saving treatments, to use family planning, and to know their HIV status. This leads to unnecessary suffering and death from preventable and manageable conditions. Slum conditions exacerbate disease, where 100 families can share a latrine, just over half of homes treat their water, and registered clinics are rare.  Most health-seeking behavior at the base of the pyramid centers around waiting for conditions to exacerbate and medication is usually purchased from informal, unregulated chemists. Rubi Health is creating a chain of ultra-mini-clinics and water spots that provide standardized outpatient services targeting the extreme poor. Health technologies support operations and patient communication. This model lowers barriers to good health by bringing care directly to the doorstep of the people who need it the most.

The WHO estimates that 97% of the people of Bangladesh have access to water and only 40% percent have proper sanitation. But access to safe drinking water is still low at 34.6 per cent. With a staggering 60% of the population that has to endure unsafe drinking water, the nation is in danger.; an even larger number have no effective access to qualified doctors, modern diagnostic tests, or a licensed pharmacy without traveling to a city. Most rural communities instead rely on informal (untrained/mostly non-qualified) health providers (based on research, there are over 1 million informal health providers in Bangladesh), informal pharmacies that often sell fake, low potency or outdated medicines, and a total absence of modern diagnostic laboratories. The Rubi Health E-Hub model is designed explicitly to address these unmet needs, based on market research that showed rural households in Bangladesh spend an average of $ 35 per year out of pocket on (poor quality) healthcare and prior experience that shows they are willing to spend $ 20-30 per year for safe drinking water. 

The rural/peri-urban communities served by the company have the following consumer segments: 

1.landowners:at least 6% of village population, typically have automobile transport, can afford bottled water from urban areas. To this customer, RubiHealth water and health services represents convenience; premium services (water delivery, no waiting for doctors, phone consultation with doctors from home, etc.) may be required.  

 2. Dominant Middle (farmers, local merchants, family members working in nearby town/city areas, retired military): up to 65% of village population, upward striving.To this customer, Rubi Health water is aspirational, an urban-quality service, with better taste, healthier.  

 3. Poor Slum dwellers (day laborers, males of household often away): up to 70% of urban population. To this customer, Rubi Health water and healthcare appears very useful. Subsidies may be required to capture these consumers, most of whom have incomes below the official poverty line.  

There is a massive opportunity to reach the millions in poverty with a private, affordable, social health enterprise model. Despite common perceptions, there is a willingness to pay for health services at the base of the pyramid. This is evidenced by the prevalence of informal chemists profitably peddling medications in the slums, and the early successes of organizations around the world rolling out low-cost clinic models. More evidence is coming in through the Rubi Health pilot site. Technology is transforming the way medical workers and facilities diagnose diseases, manage conditions, and engage with their patients, and we use these to lower costs and improve outcomes.

Rubi Health is creating a chain of ultra-mini-clinics + water spot that provide standardized outpatient services and drinking water targeting the extreme poor. This model lowers barriers to good health by bringing care directly to the doorstep of the people who need it the most. Through community marketing and convenient proximity, patients are encouraged to have earlier, more frequent conversations about their health. Powered telemedicine, Each clinic has a registered nurse on site, supported by electronic health systems to manage patient files, stock, and communication. There is online consultation room with a doctor through nurse assisted video interaction, mini-lab, and a dispensary to fill prescriptions right on site. Patients pay small fees for each service, making the model self-sustainting.

There are many innovations in new diagnostics, products, and apps but there is a bottleneck getting these to mass markets. We are taking a completely different approach to healthcare by creating clinics and water spots in vulnerable populations, staffing them with qualified health professionals, equipping them with the latest health technologies and diagnostics, and linking to a larger referral network to handle advanced health needs.

The model is a private sector solution for poor markets, charging small fees for each service. Patients are offered a variety of health financing options to meet their small, irregular cash flows from pay-per-use products and services to bundled care packages to membership plans. We build on the existing community social infrastructure, through community health workers, savings groups, and schools, to promote our products and screen potential clients.

 Technology is the backbone of this vision, as all records are already managed electronically. Smart health systems will increase efficiency through saving space and reducing repetitive data collection, and improve outcomes through diagnostic protocols and treatment reminders.

Rubi Health model combines various existing and emerging technologies (like Broadband and Telemedicine , Electronic Health Records, Point of Care & Mobile Diagnostics, Reverse Osmosis based water purification) to deliver this unique business perspective primarily for underserved communities. While a variety of organizations are providing various components of Healthcare and Water services, we believe that The Rubi Health model is holistic, game-changer and a unique model that has put together multifaceted services for the low income communities , especially in rural.

Rubi Health’s integrated care model is in sharp contrast with on-demand models. When  patients consult specialists independently, or “on demand,” it creates  “silos” or “orphan events” in their medical histories which are
especially problematic where no electronic health records exist. The
integrated approach and collaborative model ensure continuity of care,
higher patient engagement and better mirrors ideal in-person care.
Regular interaction with patients’ care teams allow Rubi Health
clinicians to practice in a manner that reflects more traditional
face-to-face care while leveraging the increased flexibility and access
that technology provides.

The combination of the various standalone components as a service delivery model, using broadband for a doctor-patient interaction , combining preventive and curative services , bringing urban facilities to rural rather asking rural to urban has been a new contribution to the field. Thus Rubi Health is changing the dynamics with an innovative, effective, culturally acceptable, replicable, scalable and sustainable model to reduce health inequities and enhance human productivity .

Our long term goal is to transform rural and peri-urban healthcare in Bangladesh by showing the business viability , long-term sustainability and social impact of the Rubi Health mini clinic + water spot model at scale. In doing this, we would:

1) Establish in the first 5 years 250 Chains of mini clinic + water spot through which we would give access to quality healthcare facilities to 6 Million people and expanding access to clean drinking water to more than 10 Million people. 

2)It is projected that the mini clinic + water spot model would get mainstreamed into the Public sector health-care delivery mechanism 

3)Significant reduction in the number of unqualified medical practitioners operating in areas where mini clinic + water spot is present

5) Significant ROI for the communities

6) Generating direct and indirect employment for 15,000 personnel locally.

mini clinic + water spot by Rubi Health launched in 2018. We started with the provision of mental healthcare in low income communities of Nigeria through a nurse assisted video consultation. We however, noticed that the communities we serve needed more services, so we started the pilot of our  mini clinic + water spot. Rubi Health clinics and Waterspot is now present in 5 communities, serving more than 2000 people monthly and providing local access to affordable high quality healthcare and preventive measures (safe drinking water) that are otherwise unavailable in the rural communities in Nigeria where we operate. There is generally no alternative source of safe drinking water, no local source of diagnostic tests, mostly informal pharmacies with a high content of fake or expired medicines, and for access to a provider the alternatives are poor quality (often damaging) care from informal providers, very limited availability of care at government primary care centers (typically only 1 afternoon a week), or the necessity of travel to a city to seek private medical care (very expensive, so often put off). Thus access to our services 8 hours/day, 6 days/week (and every day for water) within walking distance greatly improves both access to care and the available quality of care. We work primarily in under-resourced, low-income communities, and our prices are affordable for most low-income households in rural Nigeria.

Our long term goal is to transform rural and peri-urban healthcare in Bangladesh by demonstrating the commercial viability , long-term sustainability and social impact of the Rubi Health mini clinic + water spot model at scale. In doing this, we would:

1) Establish in the first 5 years 250 Chains of mini clinic + water spot through which we would give access to quality healthcare facilities to 6 Million people and expanding access to clean drinking water to more than 10 Million people. 

2)It is projected that the mini clinic + water spot model would get mainstreamed into the Public sector health-care delivery mechanism 

3)Significant reduction in the number of unqualified medical practitioners operating in areas where mini clinic + water spot is present

5) Significant ROI for the communities

6) Generating direct and indirect employment for 15,000 personnel locally.

The risks in our model are around pricing and volume of patients that we are able to generate. To provide an appropriately high level of service, we have a certain amount of fixed costs and running costs, for which we already have a detailed understanding. To be fully sustainable we have to achieve a certain volume of sales at a certain price. We can make a very well-educated guess about the volumes of patients we see at the prices we charge, the percentage of out patients that convert to paid services, etc, based on our survey of other model -- but ultimately it is a guess that we have to be borne out in our first clinics outside Nigeria.  

The other challenge is ensuring that payments are made. If a patient comes to our clinic in pain, we cannot refuse treatment. So, we have to ensure that there is a way of recovering the cost of the treatment.

We are working to mitigate those risks by:

(a) providing financial training during our clients,

(b) options for advanced payment in installments (flexibly, to correspond with our targets irregular income in these settings);

(c) working with micro-insurance agencies and the National Health Insurance Fund to defray out of pocket costs for our patients.

Our plan is to pilot our model in Bangladesh with a single mini clinic + water spot unit, then once we have demonstrated that the model works, scale up to 30 clinics and water points across Bangladesh over the next five years.  

At the point of entry, we will carry out market surveys, develop the model, build partnerships, and engage volunteers and advisors. In the first quarter of 2020, we would do an extensive market surveys: focus groups with low income population in at least eight slums and peri-urban areas around Bangladesh, and data collection to overlay facilities and population data to identify areas that are poorly served. We will work with partners and advisors to flesh out a detailed business model and financials. 

5 Full time staff

3 Part time staff

I have over 8 years’ health management experience with WHO, and Ogun State Government. Our CTO has built healthcare and IT solutions for
over 11 years. Our COO has a 15 years experience in management consulting. CMO’s has 10 years of medical instruments  sales background. Our CFO 10 financial management background ensures we run our numbers smoothly, while making impact.

A comprehensive health initiative has many moving parts. Wherever possible, we do not want to reinvent the wheel, but rather work with the organizations who are at the cutting edge of each service and element of our model. For example, on the clinical side, we have partnered with Ignite Health for clinical protocols. We partner with organizations such as SFH on family planning, tertiary hospitals like St. Mary’s for referral etc. On the business side, we are partnering with micro-health insurance agencies like Microfinance Leadway Assurance, organizations like WebHouse who are looking at mobile platforms for medical records, decision support and patient outreach. Nigeria’s top architects at Planning House have been advising us on design.

Rubi Health builds and operates a network of e-hubs each containing 1 clinic and 1 Water Spot. Each e-hub provides five essential health services to rural/periurban communities: 

1. Consultation with qualified clinicians via high-definition (HD), nurse-assisted video-consultation using a cloud-based telemedicine system that includes Electronic Medical Records (EMR), online medical online referral system and application of peripheral diagnostic tools such as blood pressure sensors, pulse oximeter, e-thermometer, e-ophthalmoscope, etc. at $ 0.50 per consultation;  

2. Safe drinking water, produced onsite by Reverse Osmosis & provided to families daily via a prepaid monthly subscription for $ 1.50 per Household ;  

3. Fully equipped onsite diagnostic laboratory capable of 100 different diagnostic investigations leveraging on AI-powered devices, at an average cost of $ 1 per test;  

4. Licensed pharmacy stocked with 500 medicines & Over the Counter products, mostly low-cost generic medicines offered on price discounts to rural communities  

5. Referrals to secondary healthcare facilities in public and private sectors  

RubiHealth has the capacity to create 5-10 jobs per cluster for local inhabitants . The mission of Rubi Health is Our mission to provide high-quality, client-centered, affordable care to under-served communities at the highest standards.. 

Rubi Health mini clinics is a fee for service model and relies on use of modern technologies (including rural broadband, telemedical software, low-cost point-of-care diagnostics, and inexpensive water treatment methods. Rubi Health E-hubs are being recognized as a Disruptive Innovation providing bundled services at affordable price and hence a Gamechanger Solution for Low Income Groups across developing countries.  The mini clinic idea uses the existing technology platforms on an Open-source partnership basis and is demonstrating that this idea has the potential to positively transform healthcare Globally on a sustainable basis thereby generating high order social, economic and financial returns. In the next 3 years we expect to grow our revenue by having more 400 clusters providing access to 5 million people, and expect to treat more than 100,000 patients/month & also provide safe drinking water to more than 1,000,000 households/day. 

We are applying to the Tiger challenge to enable us gain access to equity-free funding which will scale our expansion to enable us operate in the Asian market starting with Bangladesh. We believe that the mentor-ship attached to the Tiger challenge can give us the know-how on how best to achieve our business objectives. Being a winner of this challenge will also give us access to a team of experts in the field of human centered design and social innovation who can provide valuable input on our technology solutions and connect us to partnerships which can help us to scale quickly while innovating locally.

We have identified the following kind of organizations:

•  Finance Institutions

• Healthcare Industry stakeholders

• IT Companies

• Foundations and NGOs