Diagnostics for Pandemic Preparedness

Primary healthcare facilities in peri-urban areas of Sub-Saharan Africa don’t have the tools needed to accurately diagnose diseases, a problem which is exacerbated during a pandemic. Patients must travel for tests in central facilities, though many choose not to seek care at all. 

 We equip peri-urban facilities with a suite of affordable, accurate, tech enabled diagnostic tools, which can capture everyday illnesses as well as symptoms typical of emerging diseases or critical underlying conditions. 

Our diagnostics are underpinned by a tech platform with a ‘plug and play’ model. As we grow, we connect new diagnostics, remote care and communications tools, designed to strengthen the facility’s patient care offering, even during a pandemic. 

If scaled globally, our solution will strengthen primary healthcare facilities, decentralizing diagnostics so facilities are prepared to respond quickly and efficiently to future pandemics, ensuring improved and consistent delivery of care. 

Primary healthcare facilities in peri-urban areas across Sub-Saharan Africa currently lack the diagnostic capabilities needed to detect everyday illnesses, emerging diseases or underlying conditions. Our solution tackles four key challenges: 

Access: Good quality healthcare is reliant on functioning diagnostic tests. (Quest Diagnostics 2014) However, in Sub-Saharan Africa many clinicians don’t have access to the right diagnostics. Patients are treated based on symptoms alone, leading to inaccurate diagnoses and inappropriate treatment. COVID-19 has also demonstrated that continuity of care drops off during a pandemic, individuals are reluctant to seek diagnoses, leaving conditions unchecked.  

Cost: Cash flow constraints hinder healthcare providers’ ability to obtain essential diagnostic tools even when they are financially sustainable in the long-run. Where services do exist, they are cost-prohibitive to the patient. 

Technical Expertise: While traditional equipment is available in some areas, there is a severe shortage of specialists able to operate this machinery across the continent. 

Patient Histories: Healthcare providers don’t always have the means to collect detailed patient histories that collate diagnostic results. For patients who are fortunate enough to be able to access essential tests, some may never receive results, and others require duplicate testing before treatment. 

We strengthen decentralized networks of peri-urban healthcare providers. We provide them with a suite of tech-enabled, affordable diagnostic tools, fortifying frontline response to disease outbreaks in peri-urban communities.

Key Diagnostics: Our suite of diagnostics screen for infectious diseases, metabolic and cardiovascular conditions, and include imaging equipment for routine screening like obstetric ultrasounds or lung scans, and soon, visual acuity tools, respiratory devices, and cancer diagnostics. These diagnostic tools are smart devices and offer AI or telemedicine functionality

Attractive Payment Schemes: Providers bypass initial costly investments and can quickly adopt devices through flexible financing with either fixed, monthly subscription fees or variable payments based on device type and usage. Our diagnostics come with insurance for continued utility and the opportunity to upgrade. 

Low Complexity: Our diagnostics are user-friendly and tech-enabled, allowing them to be deployed by nurses and clinical officers, circumventing the need for expensive laboratory equipment or high-level technical specialists. 

User-Friendly Platform: All of our devices are integrated into one platform that receives and stores test results and other patient data. We engage with patients through the platform, providing continued health management, and drive health-seeking behaviour change to generate demand for new services. 

Our customers are peri-urban healthcare providers (clinics and pharmacies), currently in Kenya. We carried out market research with over 1300 healthcare providers in 2019 which demonstrated that they are not able to meet their patients’ diagnostic needs or drive their revenue growth as they don’t have access to the right tools and technology. Our solution ensures that these healthcare facilities can offer the right diagnostic tests, and use them in a way that will be profit generating and support further growth. 

Many people in these areas live on as little as $3 per day and are unaware of underlying conditions due to a lack of testing. At the patient level, we exist to ensure that these individuals can access affordable diagnostics locally, vital during a pandemic when central facilities may be overwhelmed. With diagnostics, patients are able to understand and respond to any underlying conditions that may put them at greater risk of a disease outbreak. 

By strengthening the first point of care, we enable millions of individuals affordable access to diagnostic testing, improving the care they receive and accelerating time to treatment. 

We are strongly aligned with the Health Security and Pandemics Challenge. 

Strengthening primary healthcare systems: We strengthen decentralized networks of primary healthcare providers. 

Proactive Response to Pandemics: We ensure facilities can offer accurate diagnostic testing to patients, make rapid diagnoses and offer continuity of care during a pandemic.

Affordable Care: Our testing is more affordable than most tests offered at a standard private facility, and in some cases cheaper than a public facility. 

Disease Surveillance System: Our platform receives and securely stores test results and patient data which can be aggregated and shared with relevant stakeholders to understand disease spread. 

Whilst diagnostic distributors exist, Ilara Health facilities can access a suite of diagnostics that truly work in a low resource context all underpinned by an integrated tech platform. Our approach is a game changer for facilities serving low-middle income individuals. 

Affordable, compact, and user-friendly: Existing distributors (e.g. Philips, Siemens) offer expensive, bulky legacy devices, prohibitive in cost and size for the facilities we target. Our tools are affordable; for example, our ultrasound device, the ButterflyIQ, has 80% of the functionality of a traditional imaging machine at 25% of the cost. 

Closed-Loop Patient Management Platform: Our diagnostics integrate into one platform, and also comes with custom software for improved disease detection, patient help tips, and other disease management tools. This type of platform is non-existent across other distributors. 

Subscription service: Existing distributors do not offer their devices as a service. The core of our business is a flexible subscription model that enables healthcare providers to access the latest developments in diagnostic technology at a low-upfront cost. 

Partner Model: Existing companies build their own facilities from the ground up (MDaaS - Nigeria). Instead of competing at the local level, we partner with existing facilities across a large geography in order to empower them to offer the best possible care. 

Closing the Gap: Other companies focus on rapid tests at a pharmacy level (Redbird - Ghana). Diagnostic needs in SSA goes beyond rapid tests. We strive to address all diagnostic gaps, and work across disease areas and medical facility types. 

We identify and partner with manufacturers of high tech, compact diagnostic devices who are disrupting the diagnostic device landscape. We integrate these into our tech platform. 

Our diagnostic tools include: 

AliveCor - KardiaMobile: Portable ECG monitors to identify underlying cardiovascular disorders 

iXensor - PixoTest: Facilitates diagnosis of metabolic conditions including diabetes

Butterfly Network - Butterfly iQ: Ultrasound device

Hemocue - white blood cell count 

Hemometer - Strip Based Haemoglobin Testing System

Crucially, we are not having to build new technology, we are using and adapting existing technologies to reach an underserved target group with tools designed to suit their expressed needs. Our platform is built using industry-leading software engineering and computer science concepts. The platform itself is built on Twilio. When a patient has a diagnostic test, their results are sent directly to the platform and can be accessed by their physician. Moreover, we use SMS and WhatsApp to reach clients with patient help tips, disease management tools, and follow-up consultations. Finally, Ilara Health can manage devices remotely, supporting troubleshooting and training. 

In terms of the platform itself, Twilio, WhatsApp and SMS are all widely used and proven technologies in telemedicine that enable clinics and physicians to communicate with patients. We have a proof of concept that demonstrates when a client undergoes a test, the results are sent to the platform. We are rolling out a pilot this month that will assess how willing patients are to engage with a remote care platform. 

Regarding the devices, they are either FDA approved, CE marked or have received approval from other internationally recognized and accredited regulatory bodies and are already used in other markets. 

 Some further detail on some of our devices: 

Janacare

Kardia

PixoTest

Butterfly IQ

Our work is underpinned by a belief that investment in diagnostics will improve quality of care in Sub-Saharan Africa. Research by Sayed, Cherniak et al. argue the same; lab medicine is an essential component of a functioning health-care system and inadequate investment to date has led to increased morbidity and mortality in low-middle-income countries requiring more diagnostics focused interventions. 

Finally, we posit that demand generation techniques will increase patient numbers. This is supported by a study by Cherniak that shows how demand generation techniques can significantly increase patient volumes. Demand generation led to a 6x increase in patients visiting clinics in Uganda to receive ultrasound scans, shifting health-seeking behavior to promote life-saving screenings that were previously undervalued. This study shows it’s a win-win for clinics and patients, improving the care they receive as well as boosting clinic revenue.

Activities/Inputs: We provide affordable, tech-enabled, life-saving diagnostic tools to local peri-urban healthcare providers, combined with flexible financing, underpinned by a tech platform that integrates all tools and supports demand generation and remote care. 

Outputs: New partner facilities are onboarded. Patients receive essential tests. Facilities have increased revenue. 

Outcomes: As a result of speed and accuracy in diagnosis, patients are able to receive appropriate treatment more quickly. Clinics see an increase in patient numbers. 

Impact: Quicker access to treatment leads to improvements in patient health. During pandemics, facilities are able to respond to the emerging needs of their communities, identifying patients at higher risk who have existing conditions. 

www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31052-9/fulltext 

www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30459-8/fulltext

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175440

Since 2019 Ilara Health has built a network of 70 clinics, which we serve with at least one diagnostic device. By the end of 2020, we aim to be active in 500 clinics, leading to a reach of 8000 patients. As we expand, by 2025, we will be in 10,000 clinics, reaching 12 million patients.

We plan to target markets where diagnostics are currently unaffordable or inaccessible to patients, making all underdeveloped markets needing tools for better quality care potential targets for our product. 

By Q4 2020 we are targeting 500 Kenyan facilities, and 5 key priority health areas. By Q4 2022 we plan to expand our services to 2,000 similar healthcare outlets in Uganda and Ethiopia serving an average of 10,000 patients annually. 

By 2025, we see Ilara Health as a pan-continental, decentralized diagnostics network present across 10,000 medical clinics and pharmacies, in Kenya, Uganda, Nigeria, Tanzania and Ethiopia. Our network will diagnose tens of thousands of patients per day across a wide range of diseases, from ophthalmology to oncology, reaching 12 million patients annually. 

It is estimated that over 500 million sub-Saharan Africans are currently struggling to access even a basic blood test. But in these same markets the health facility ecosystem includes over 500,000 peri-urban and rural clinics. Our current 8 diagnostic tests alone already translate to a $1b market.

1. We are seeing increasing default rates, especially during COVID-19. Facilities commit to purchasing a device but struggle to pay the monthly fees.

2. Some facilities that we serve have low patient flow, which makes it difficult to drive enough revenue to finance the device through generated cash.

3. Patients that are served by our partner clinics often have financial constraints and would like to receive more tests but simply can’t afford them. 

4. Health-seeking behaviour is not the norm in our initial market. Individuals are often reactive rather than proactive. 

5. As we provide the diagnostic devices on a 24-month contract to our partner facilities, we need to pre-finance the devices which is capital intensive. 

6. As we scale, low population density in most parts of East Africa except the large cities makes logistics expensive and reaching the customer difficult.

7. While we are working at full capacity to maximize operations and strategic decisions for full market saturation, there is always the risk that we are executing too slowly, and we will miss market opportunities/ our assumptions will not be validated.

Reducing default rates: We are putting measures in place to evaluate the credit risk when onboarding new facilities. The framework is already created and about to be rolled out.

1. Increasing patient flow: We are helping healthcare facilities to increase their patient flow by offering demand generating services such as sending bulk SMS to advertise certain offerings

2. Low purchasing power from patients: We work together with NGOs, and international development organizations to make offerings more affordable for the wide public

3. Low health awareness: On this front, we are also working together with different donor organizations, as well as large corporate organization to create awareness, especially for lifestyle diseases

4. Asset intensity: We are in discussions to raise debt to more affordably finance our assets and are making good progress on that front. 

5. For now, we focus on the peri-urban areas of large cities, which have a large market size. However, as we expand we will need to build the logistics and infrastructure to also reach more remote areas.

6. We have plans to pivot if decisions fail to gain traction. We build secondary decision trees and a strong team that can master a number of challenges in the case that our assumptions do not hold.

Full Time: 38

Part Time: 5

Ilara Health was founded by entrepreneurs and investors passionate about our mission with multidisciplinary skills in medicine, distribution, software and sales. Key profiles below: 

Emilian Popa Co-Founder/CEO Emilian is a hands-on company builder, investor and entrepreneur. He was an investment professional with DiGAME (Digital Growth Africa), an Africa focused subsidiary of Zouk Capital, which makes growth-stage equity investments in technology-enabled companies across the continent. Emilian has over 9 years’ experience of successfully launching, fundraising, growing, exiting more than 20 technology ventures. Emilian has 7 years of experience with leading consulting firms in Europe, USA and Africa. He holds a joint MBA from Columbia Business School and London Business School. 

Maximilian Mancini Head of Strategy Maximilian has an extensive finance and healthcare background, having spent 3 years at Lazard as a healthcare M&A banker. Prior to that, he graduated from Columbia with a BA in Economics and a concentration in Philosophy, having also spent 1 year studying at St. Peter’s College, Oxford University. 

Sameer Farooqi VP Operations Sameer started his career in financial services, working with SNL Financial for 3 years. He later joined Careem and handled various functions including growth, operations, and performance/incentive design. He then expanded the logistics infrastructure for Daraz where he built 14 logistics hubs and a team of 200 people in 5 months. He then moved to a role where he managed the marketplace for Daraz in its five countries. He holds an analytics-focused MBA from the University of Iowa.

Ilara Health has partnerships with the following stakeholders: 

Healthcare Providers: We are already partnered with 70 healthcare providers in Kenya. These clinics have implemented Ilara Health’s existing diagnostics suite which includes diabetic marker analyzers, portable EKGs, and point-of-care ultrasound devices. 

Public Sector: We have engaged the Kenyan public sector with early-stage talks to get expedited regulatory support for our COVID-19 readiness package. While the public and private sectors in Kenya operate separately, we believe public sector backing will also facilitate roll-out in private facilities across the country.

Device Partners: We currently source our suite of diagnostic tools from the following diagnostics manufacturers: Butterfly IQ, iXensor, AliveCor and Jana Care. 

Research: We’ve partnered with Columbia University in New York for research support on how accurate diagnostics impact healthcare in East Africa. 

Scaling Partners: We have partnered with KMET SACCO, a large existing network of clinics and pharmacies (~350 facilities) for accelerated scaling.

Education: We’ve partnered with St George’s, University of London and FutureLearn to develop an online, free COVID-19 preparedness course geared towards the primary care provider in Africa. We hope to use this approach for clinic-focused targeted learnings in the future. 

We think of our business as a service model that can be covered in 3 key steps:

• We source medical devices from third party manufacturers. Our devices are digital and possess different forms of connectivity. Through the relationships we are building with these device manufacturers, we are able to integrate these devices into the tech platform we are building through API access

• The second step is to place these devices at the clinic and pharmacy level, expanding our network and increasing our patient reach. What we do is essentially enable medical facilities to have complete access to these devices whilst paying monthly subscription fees for 24 months. At the end of these contracts, we either replace or upgrade the device, allowing our customers to be at the forefront of the diagnostic technology evolution. We also give our customers the option to purchase, at a small fee, the relevant device at the end of the contract.

• Our final step is what we call closing the patient loop. The data generated by our devices feeds into our platform, generating a patient EMR. We then use this data to provide our patients with disease management tools, including tips and reminders and referral systems. When additional medical support is needed, we use this platform to send our patients back to an Ilara facility.

Our main revenue comes from cash flows generated by the various point of care (PoC) devices we provide to our partner facilities on a subscription agreement with monthly fees. To address the need for diagnostic services that cannot be offered at the point of care, in April 2020 we launched our first semi-distributed lab, creating what will become a hub (lab) and spoke (PoC facility) model. 

As a capex heavy model, we require asset financing support to fund our working capital cycle and purchase diagnostics assets to reach about 200 small facilities to operationally break even by Q3 2020.

We continue to seek grant funding to subsidize the costs of diagnostic equipment for healthcare providers serving the base of the pyramid, and to support the costs of piloting new devices, behaviour change models, and other similar activities.

We believe that MIT Solve is the perfect opportunity for us to leverage our existing solution. In particular, we see value in the following fields:

Regulatory Support: We are looking for experts and potential partners in our target markets who can support and guide us through the regulatory landscape and make introductions to potential partner clinics and networks in-country. 

Software Development: We are seeking support in developing our tech platform and associated software solutions. As we intend to move into remote care and automated care, we are seeking further technical support. 

Grant Funding: We’re also looking for in-kind contributions that will allow us to subsidize our offering to clinics, particularly those offering services to patients at the base of the pyramid. 

Health Partnerships: We are also looking for other health companies to find synergies and potential partnerships. We’re looking to build our network with health stakeholders on a global level. 

Distribution: As we move into more rural areas, we are looking for partners who can support us in building out a distribution model that will work for the last mile. 

We are seeking new partners at the forefront of medical technology and looking to equip clinics in Sub-Saharan Africa with tools that will dramatically change the level of care they are able to offer. We are seeking advice in building out a distribution approach that will suit clinics in more rural areas.

We would be interested to be connected with other Solvers in Sub-Saharan Africa working in health: 

E-Heza: We see E-Heza as a potential partner as we move into Rwanda and other markets. Their approach to managing electronic health records forms a starting point from which we could connect our suite of tools, including those that can be equipped for maternal health e.g. the Butterlfy IQ ultrasound. 

Lifebank: Lifebank is the connection between facilities and life-saving products (blood and oxygen) and vaccines. We see the organization as a great partner to connect our facilities with on-demand blood and oxygen. 

We would be interest to partner with several Solve members including:

Novartis Foundation: The Novartis Foundation vision to support the healthcare needs of low-income individuals in Sub-Saharan Africa with a tech-based approach aligns directly with our vision. We serve low income individuals with tech-based diagnostic solutions. This would be an ideal angle to partner with Novartis Foundation to bring our service offering to their focus countries in SSA, and pilot new diagnostic tools for NCDs.  

The Intuitive Foundation: The Intuitive Foundation is active in technology research for the purpose of promoting health. As we build out our tech platform as a tool to manage health remotely and drive healthcare seeking behaviours, we would be interested to pilot a few approaches with the Intuitive Foundation. 

We believe that Ilara Health is a strong match for the Elevate Prize for Health Security. We strengthen a decentralized network of primary healthcare facilities across Africa to proactively respond to pandemics. 

Our solution equips primary healthcare facilities in peri-urban Africa with lifesaving tech-powered, point-of-care diagnostics, underpinned by a tech platform that supports patient health management and allows for remote care. We provide flexible financing to ensure facilities can access this technology from day one. 

Quality diagnostics are the cornerstone of strong health, and primary urban healthcare facilities can play a crucial role in pandemic response if only they have access to the right diagnostic tools, both to identify those who are infected and to identify those who are at greatest risk of a disease outbreak. 

Furthermore, our platform can be utilised to securely share aggregated patient data with relevant stakeholders to understand disease spread and inform public response. 

With the support of the Elevate Prize, we will be able to equip 120 clinics with the tools they need to proactively respond to pandemics and take up a strengthened position on the frontline. In the next 5 years, we intend to equip 10,000 clinics, resulting in 12 million people benefiting from improved access to quality healthcare.

We believe that Ilara Health is an excellent fit for the Future Planet Capital Prize due to the potential of our solution to significantly impact millions of lives in Sub-Saharan Africa. Currently, millions of people struggle to access even a simple blood test. Primary healthcare facilities in peri-urban Africa simply don’t have access to the diagnostic tests their patients need. They’re too expensive and require technical expertise to deploy. 

Our solution equips healthcare facilities in peri-urban Africa with tech-powered, point-of-care diagnostics, underpinned by a tech platform that supports patient health management, remote care and patient health tips. We provide flexible financing to ensure facilities can access this technology from day one. Combined with demand generation techniques led by Ilara Health, facilities can see an increase in patient numbers and revenue. 

Our solution is financially sustainable and will break even in Q3 2020. We generate revenue through monthly subscription fees for the diagnostic devices, in addition to revenue from our semi-distributed labs. Overall, we intend to reach 12 million patients by 2025. 

With financial support from the Future Planet Capital Prize, we will be to reach 80 clinics with our suite of tools.