Inclusion & health with medical identity

By 2040, 40% of the world’s population will live in slums. Vulnerable populations living in these informal settlements in low-to-middle-income countries (LMICs) are subject to many health disparities. Chief among them is the lack of personal identification that impedes access to healthcare and social services. Partnering with the Kenyan Ministry of Health (MOH), we are proposing the implementation of a unique lifetime identifier (ULI) in healthcare facilities located in the Nairobi urban slums of Kibera and Mukuru. By upgrading high-potential clinics into outposts for patient ULI registration, we can immediately reduce redundant healthcare costs for patients. This will eventually open channels for implementing an electronic medical record (EMR) platform, creating a social security net of insurance coverage, health and employment services for newly identifiable individuals living in slums (informal settlers). If successful, this model could be adopted for use in other informal settlements across Africa, Southeast Asia, and Latin America.

One billion people live in slums worldwide, secondary to urbanization, economics, and climate change. Roughly 100 million people, mostly informal settlers, are pushed into poverty annually from out-of-pocket healthcare expenditures and lack of medical insurance coverage. Kibera and Mukuru, two of the largest slums in Nairobi, are home to approximately 800,000 individuals. These densely populated settlements are plagued by a large burden of disease.  An increasing number of private healthcare facilities have opened in Kibera and Mukuru to meet the ever-increasing care demands unmet by public services. These facilities operate antagonistically, despite offering complimentary services that would benefit from a unified referral network. A lack of ULIs has forced residents to expend scarce resources registering at every facility they visit. Furthermore, without a ULI, residents are unable to apply for social assistance and health insurance, and thus are excluded from privileges enjoyed by broader society. Societal exclusion, resulting from inability to prove one’s existence with an identifier, intensifies the burden of illness and cycle of poverty. We believe that instituting a ULI in Kibera and Mukuru will enhance data exchange between facilities visited by patients while improving the quality of healthcare offered.

Our primary target population are the informal settlers living in Kibera and Mukuru that face high population density, poor air quality and sanitation, and almost no continuity of care. Without a way to register for a ULI, individuals living in slums are unable to access the social security net that could lift them out of poverty and are thus precluded from upwards social mobility. The EMR platform that we previously piloted was informed by focus groups and semi-structured interviews with community leaders, patients, clinic staff/management, and government officials. It also yielded two evaluation studies as well as an external evaluation by the Kenyan MOH, which advanced our understanding of local needs and has yielded a powerful partnership. We will continue to engage our target population with the aid of the MOH, which has signed an official memo calling on our organization, ICChange, to assist them in developing a nationwide healthcare identifier for Kenyans. An educational team will also be employed to work on education/sensitization in the clinics and with local residents.  This will benefit our target population by improving patient data tracking and reducing patient expenditures in the short-term, while progressing towards universal healthcare in the long-term.

The fundamental benefit of our proposed solution for ULI is the empowerment of individuals living within Kibera and Mukuru with a unique, verifiable identifier. By providing a medical identifier to informal settlers, a referral network of high ­quality health facilities can be developed. Moreover, we will be able to understand the geographical health context of the slum through epidemiological GIS integration, which will facilitate risk ­stratified and risk ­aggregated health insurance strategies through aggregate data models. Our solution allows these vulnerable individuals to apply for a multi-functional ID that reduces the cost of redundant healthcare registration and creates system-level opportunities.

Our solution is unique and innovative as it approaches the problem of health care access in urban slums in a novel manner. The competition in this market between software solutions serving either the slum/displaced population or clinics/private organizations is often limited to either disease specific software (focusing on HIV or TB care), or relatively small initiatives in East Africa and South Asia, spanning only a few clinics. By focusing on the patient as the holder of a medical identifier that they can use to access health services across various facilities, the software becomes a tool to connect patients to a referral system of high-quality clinics and to a social security net to support their long-term wellbeing. Furthermore, our solution is built on the recognized OpenMRS platform which brings significant added functionalities as well as primary care and Geographic Information System (GIS) customization. As such, our solution offers a much wider range of system-level functionalities over a large geographical range than existing software solutions.

The now inactive EMR system that was developed and initially piloted in 3 clinics in Kibera, was also developed with information directly acquired from needs assessments performed on the ground in Kibera with patients, healthcare providers, and legislators. As is the case with all ICChange portfolio projects, we co-created our solution with local knowledge, and will continue to do so as we work with the Kenyan government to equip vulnerable peoples with medical identifiers and redefine healthcare access in urban slums.

Our product is a medical identifier for the urban poor and displaced in the slums of Kibera and Mukuru. Fraser et al’s (2005) paper, “Implementing electronic medical records in developing countries”, demonstrated the importance, feasibility and benefits of introducing EMRs with unique identifiers in developing countries. ICChange developed, tested and implemented a proof-of-concept EMR solution through the Kibera Medical Records Initiative (KMRI) which served 100,000 Kibera residents annually and was built upon open-source software called OpenMRS (https://openmrs.org/about/). For the purposes of this grant, we are proposing the first phase of a second implementation of the KMRI platform - a collaborative effort to register as many residents of Mukuru and Kibera as possible with unique lifetime identifiers prior to reestablishing the EMR platform and other system-level interventions. Multiple studies have demonstrated the utility of open source systems in low resource settings, in particular OpenMRS, which has been implemented in over 30 countries. One of our own literature reviews by Badeia et al. (2016) on the use of EMRs in slums revealed a paucity of data in slums but also the high potential positive impact of identifier-driven EMRs in sub-Saharan Africa. A 2016 study by Pain et al on the use of EMR in Rio de Janeiro slums for tuberculosis  revealed positive outcomes for similar systems. Even before EMR implementation, equipping patients with ULIs will still provide immediate benefits, by facilitating patient data tracking and retrieval, even for clinics still using paper records.

The basic impact chain of this solution begins with residents of Kibera and Mukuru electronically registering for a ministry-backed ULI at one of our ten proposed outpost clinics within these two slums, with a non-prohibitively small, one-time payment. This input will translate into thousands of vulnerable individuals now having a medical identifier for both partner clinics and at the Kenyan government. The short-term outcomes include reduced healthcare expenditures from redundant registrations and improved access to patient records (paper or electronic) by clinic staff. The long-term outcomes for patients include inclusion in the federal census and policymaking due to presence in a federal registry.

The output of having a medical identifier also generates medium-term outcomes. That is, it would allow for the implementation of an EMR platform, which would link high-quality healthcare facilities into a referral network that benefits healthcare providers with increased business from referrals and provides patients with improved continuity of care. This medium-term outcome will evolve into several long-term outcomes. First, geographic information system (GIS) integration is possible through OpenMRS and will allow for epidemiological disease tracking for the geographical distribution of disease, particularly outbreaks of communicable, waterborne, or airborne illnesses such as cholera. This could allow for urban planning interventions to reduce the spread of communicable illness and therefore the burden of disease in Kibera and Mukuru. Second, having longitudinal healthcare data recorded in an EMR will provide sufficient data to actuaries for stratifying risk models for the normally difficult-to-reach slum populations, who will then have access to health insurance. Third, we envision a “Health Passport” system that tracks healthy behaviours such as exercise and smoking cessation as well successful chronic disease management through EMR data and incentivizes them as a way to provide other benefits to Kibera residents such as reduced insurance premiums. Lastly, several years of patient data recorded into the EMR system can, through natural language processing, be used to train machine learning models that output predictive insights for disease prognosis. This will benefit policymakers by providing evidence for health promotion strategies which will improve the standard of care for patients.

The proposed solution is the implementation of a ULI for vulnerable groups living in the urban slums of Kibera and Mukuru. As no streamlined identification system currently exists for this population, the proposed solution will serve as the first digital identification system accessible to these individuals. We are currently working with the Kenyan MOH to co-implement the technical infrastructure and accompanying policy framework for nationwide ULI registration. Specifically, our organization has been called upon to develop an alphanumeric or biometric medical identifier to be piloted  in informal settlements within the Nairobi area as the first step in the development of a National Integrated Identity Management System (NIIMS). The MOH has indicated to us that they intend for NIIMS to serve as a national personal identification database to be used in progressing towards their goal of Universal Health Coverage (UHC) as a part of the Kenya 2030 blueprint.

Currently, Kenyans living outside of informal settlements have access to a variety of personal identifiers that range from National Identity Cards, National Health Insurance Fund (NHIF) numbers, KRA PIN (Personal Identity Number) Certificates, driver’s licenses, passports, bank accounts, hospital record numbers, and school admission numbers. Despite all these identifiers, individual institutions have continued to apply different identifiers when offering services to the same individual. As such, the MOH specifically intends for our partnership to develop a ULI system that is accessible to informal settlers, while also consolidating the disjointed landscape of identification options that are currently circulating in Kenya.

The proposed solution will directly provide vulnerable patients with digital identification in the form of an integrated ULI. This platform, which has been previously piloted on a smaller scale, was developed with a focus on user-friendliness and applicability in low-resource environments. To ensure the product will retain its user-friendliness in practice, the software was developed using the OpenMRS platform. OpenMRS was designed to provide base code for software development that can be subsequently modified as required in a given environment. Crucially, OpenMRS remains strongly supported by an international community of developers. The platform is regarded for its simplicity, ease of installation and deletion, efficiency, modifiability, ease of problem troubleshooting, and its adherence to confidentiality standards. OpenMRS is also able to generate ULIs, and has the functionality to authenticate patient identity based upon the corroboration of multiple pieces of identifying information. For these reasons, OpenMRS was viewed as a compelling platform for its reliability, user-friendliness, and ability to be adapted to the urban slum environment. 

Importantly, OpenMRS was selected by the MOH as the platform that they will back and support for eHealth and already have implementation across Kenya. This familiarity will further help incorporate our solution into other existing digital identification systems. 

ICChange has a strong background of using and developing OpenMRS in both Kenya and Uganda in various settings. To ensure seamless adoption, we held focus groups and semi-structured interviews with administrators, clinicians and ministry of health data analysts, who would be using the software on a daily basis

Due to OpenMRS forming the foundation of our original EMR database and our ULI electronic registration system, our proposed solution complies with Health Level 7 (HL7) guidelines, an international standard for health information sharing. The ability to share data between various HL7-compliant systems is a substantial asset in Kenya, where there are many different options for unique identifiers and past and present patient records systems that operate in silos. Furthermore, the ability to collect healthcare data and then transmit it to where it can be methodically consumed and processed is central to the healthcare improvement cycle. Another benefit of OpenMRS that it confers to our solution is the incorporation of a java API as one of the layers of the system, thereby allowing developers to interact with the complex OpenMRS Data Model with common Java objects. As we are in consultation with the Kenyan MOH, we anticipate that API integration will be incredibly important for us to be able to transmit patient identifier data to state-owned servers while also allowing us to iteratively build new functionalities for the ULI registration system and eventual full EMR system, according to the needs of local stakeholders. 

The OpenMRS platform also is interoperable with various other systems, both open and proprietary solutions. It also aligns with and is supported by the Kenyan MOH and has a long track record in the country, making it an ideal backbone system to build and integrate other programs, solutions and interventions.

Our solution was designed specifically for implementation in informal settlements, where the infrastructure needed for stable connectivity may be lacking or inconsistent between individual health clinics. The reality faced informal settlements is that of frequent, sporadic power and internet outages, fuelled by an unstable national power grid as well as theft of hardware hence a data-security risk. In response to this reality, we use thin-client computers with minimal local storage. The OpenMRS solution has an “offline” working functionality so that during times of limited internet connectivity and power outages, it is possible to store encrypted data locally on a Local Area Network, with information uploaded to the cloud upon resumption of connectivity. In our first local implementation, we understood that levels of technological literacy would vary between individuals and clinics, as some clinics had access to computers and software and others did not. For this reason, training sessions were held for staff members to become fluent in the use of the program and confident in their ability to work independently and sustainably in the long term. We also needed to account for misunderstanding and misconception from the local population regarding the necessity and utility of storing their personal medical data, which was an uncomfortable and unfamiliar phenomenon for many. To remedy this, we engaged with local community leaders and held community sensitization programs to describe that the storage of their medical data could indeed be trusted and further, would improve their longitudinal healthcare quality and outcomes.

As of 2020, our pilot in Kibera clinics through the KMRI initiative has concluded with successful demonstration of proof-of-concept. During the implementation, the KMRI platform served 100,000 Kibera residents annually for 3 years, but it is currently not registering patients while we develop partnerships with the MOH and address the need for a ULI prior to scaling up. 

Since the conclusion of the KMRI proof of concept pilot, ICChange has continually been evaluating prospective hospitals and clinics for a scale-up/second implementation with the support of our strategic partners, as well as working with the MOH and other governmental branches, including the National Hospital Insurance Fund. In one year, we aim to have registered 150,000 users with ULIs, and reach 1,500,000 people living in informal settlements/slums in Kenya in  five years . 

By partnering with groups like Slum Dwellers International, which represent slums and borrowing groups in 33 countries, as well as other global partners, the reach of our initiative has been vastly widened. The proof of concept we are demonstrating will be able to be shared in other countries first in East Africa, then beyond. Our aim is to expand to informal settlements in other countries between years 3 to 5. As these slums are densely populated, we aim to add another 3.5 million people across East Africa. The 5 year impact for this initiative will be 5 million people from vulnerable populations living in slums.

Our overall impact goal is to transform access to health, social services programs and insurance coverage for millions of vulnerable people, especially in informal settlements. This will be accomplished by introducing a unique and portable medical identity that will allow vulnerable populations access to a network of high quality health facilities and services and gives them rights by registering them to a recognized digital identifier, recognized by the government systems. 

The first goal (Year 1 - 5)  is implementing a government approved digital clinic-based registration in vulnerable populations allowing patients to access quality recognized clinics in the slum and have a continuity of care and potential access to health insurance and social services.  The second goal (Year 2-5) is to introduce an electronic health record system into these clinics and allow referral between them to have a quality healthcare system. This system will also allow epidemiologic survey of diseases, such as COVID-19 and other infectious conditions that disproportionately impact these communities. The third goal is to prove the business model is successful and replicable, first across Nairobi then Kenya as a whole (Year 3-5). Once that is done, the fourth goal (Year 5) is the packaging of a replicable social franchise model to scale it up across East Africa and beyond. This model will be implemented by either our expanded team and also shared openly with aligned organizations that was to serve the communities sustainably while empowering stronger digital registration systems. 

The greatest barrier currently facing ICChange and our ULI initiative is financial, due to limited access to capital. Local capital is usually limited in an emerging economy such as Kenya, and given the current global economic downturn caused by the COVID-19 pandemic, we anticipate further difficulty finding local support. The largest capital expenses are in the early stages of developing and implementing the initial infrastructure and clinics. This capital is required to cover expenses related to software development and organizational operations costs of overhead and staff. Additionally in the next year, we will be faced with COVID-19 travel restrictions that will force us to complete more work remotely, which may slow down our pace of progress. From a legal standpoint, any eHealth implementation is deservedly scrutinized for proper maintenance of confidentiality. Specific to Kenya, we will also need to navigate legal hurdles presented by several civil ministries. There are also technical barriers, regarding infrastructure and connectivity within informal settlements. These short-term barriers will be compounded by the need to earn trust and local stakeholder adoption of our team and platform, as data privacy is as large of a concern as ever in 2020. In the next 5 years, the need for finances will decrease due to the business model generating revenue to sustain the enterprise, but other barriers, including identifying new National Hospital Insurance Fund (NHIF)-certified or -eligible clinics to progressively expand the deployment of our platform will be an additional ongoing challenge.

By forming cross-sector partnerships and strengthening ICChange’s internal network, we believe our organization can overcome the aforementioned key barriers. To address the urgent priority of access to capital, our organization has formulated a core team dedicated to fundraising, assessment of our operations, and the formalization of our various business models. For fundraising, we are exploring various grant and investment opportunities. To us, COVID-19 related travel restrictions have emphasized the need for local public and private sector partnerships, both for administrative and implementation support. Accordingly, we have formalized our relationship with the Kenyan National MOH, who have signed on to support us in this initiative and assist in navigating legal, cultural and confidentiality barriers. ICChange also has long standing relationships with other large non-governmental organizations, with significant local presence, including AMREF and Slum Dwellers International. To overcome technical barriers, we will perform a comprehensive review of clinic capabilities and technological capacity to select those with sufficient infrastructure and leverage our experience in upgrading select ones. Cultural appropriateness is at the core of our intervention, as mentioned. We will aim to foster community buy-in via awareness campaigning and through the valuable support of local community leaders. In the long term, we envision our initiative to become financially self-sustainable by collecting 1-3% of health-related expenses for patients as they set up their ULI and begin to utilize our broader electronic medical record and access to social services, with likely some support from NHIF further increasing access and uptake. 

In Canada, our solution team will include myself (Dr. Abdullah Saleh), 2 software developers (1 senior, 1 junior) and 6 part-time staff members composed of students and recent graduates who will work as business analysts and help with designing the implementation.

In Kenya, our solution team will include several contractors, including 2-3 members of an information and communications technology (ICT) implementation team, a project coordinator for project oversight, a health informatician to coordinate data with the Ministry of Health, and an education team of 2-3 people for public education and sensitization work.

The team, including contractors, will be 15-17 people.

Our multidisciplinary team has a proven track record of success, resourcefulness, and adaptability. Most of the team has been with the organization for many years and is familiar with the mission and philosophy. Over the past ten years, our group has been able to demonstrate a sound and replicable methodology for bringing sustainable solutions to improve the lives of vulnerable populations. Our team developed, tested and implemented a proof-of-concept, networked, OpenMRS medical record system in local clinics serving more than 100,000 people per year in Kibera, the largest slum in East Africa. This became a model for the Kenya MOH and underwent a complete monitoring and evaluation program to elucidate the lessons learned. Our team also sustainably implemented an OpenMRS based electronic registration system in a large referral hospital in Uganda. 

This group has the necessary capacity and diversity of disciplines and a broad network and connections that can be leveraged. Currently, we are collaborating with the MOH on a national health records system, a national trauma registry as well as developing a national trauma system and educational program with the American College of Surgeons. ICChange has also successfully developed, tested, implemented and scaled up a ceramic water filter technology, including building a manufacturing facility in Kenya, reaching over 130,000 people, along the distribution channels and financial sustainability. Currently this project is being further expanded to reach 1 million people across Eastern Africa. We have also developed and implemented high efficiency stoves for refugee communities in South-East Asia.

From the inception of our medical records initiative, our team has understood and emphasized the utility of securing local and international strategic partners from various sectors. During the implementation of KMRI, our OpenMRS platform was implemented in a clinic managed by Amref Health Africa, with whom we developed and have maintained a Memorandum of Understanding (MoU) for this and other development work. Particular to Mukuru, ICChange has played a significant leadership role in the Mukuru Special Planning Area (SPA), working on the board of multiple consortia but most significantly the Health Consortium. Through this work, our team has carried out a comprehensive analysis of the health infrastructure in Mukuru in tandem with several local and international NGOs and university departments. Our partnership with the SPA as a whole, and also its individual entities, will be critical in facilitating our entry into this settlement. As has been mentioned, we are working on this initiative with the express-written support of the Kenyan MOH, who represent our public sector partner. The University of Alberta, a Canadian post-secondary institution, has also remained a critical strategic partner in the development and customization of OpenMRS; OpenMRS as the host of our platform is of course an additional partner in this initiative. F12 Networks has acted as a consultant/adviser for networking requirements and system testing, and, lastly, we’ve also partnered with a local cloud provider to host our platform. 

Using the financial support from the Mission Billion Global Prize, we plan to absorb the costs for developing and implementing the infrastructure for the ULI. As such, we aim to equip an initial 10 clinics in Kibera and Mukuru as outposts for patient registration. These clinics will pay a nominal portion of the registration fees that they charge the patients, $1USD per patient, back to us to fund the expansion of the system to more outpost clinics and support the integration with government systems and infrastructure. Mukuru and Kibera have a combined population of approximately 900,000, thus representing an initial market size of close to 1 million dollars. It is widely accepted that there are between 3 to 3.5 million informal settlers in the Nairobi area, thus creating a total addressable market of up to $3.5 million USD from these initial registration fees alone. Once our solution progresses to re-establishing our EMR platform, long-term revenue can be generated by taking a small percentage off of services referred between healthcare facilities through the software, such as labs, imaging, and specialist referrals. We are providing value to our target population by providing them access to a medical identifier which comes with multiple benefits. Concurrently, we are also structuring and ordering economic opportunities for facilities that will then benefit firstly from a new service for which to charge patients, but also eventually from participation in a referral network that will bring higher quality and more referrals.

To kickstart this project, an infusion of startup capital is required. We aim to raise this capital through grants, such as the Mission Billion Global Prize. This will be combined with investment through angel partners we are currently in discussions with. As mentioned in our business plan, a fee of $1USD per successful patient registration (a figure determined to be non-prohibitive from prior market research) in an outpost clinic will be collected and used towards financial sustainability and future development. We aim to recuperate the cost of establishing an outpost clinic (roughly $2,000 USD per clinic) after 8 months from the registration fees, considering the very high population density in Mukuru and Kibera. The upgrading of clinics into outpost clinics also serves the dual purpose of upgrading them enough to meet standards for coverage by the National Hospital Insurance Fund (NHIF), which will be an attractive goal that clinics in these areas currently aspire to. Once our ULI registration system matures to the point of us being able to re-establish our EMR platform, new opportunities for charging small percentages (1-3%) of the clinics billings will be present, in exchange for improved connectivity, data tracking, and referral management. Our primary goal, as a social enterprise, is to generate enough revenue to sustain our system, so any net profits from our solution will be put towards improving the system, providing technical support and maintenance, paying our staff/contractors in Kenya, and potentially expanding our system to other areas of need.

For the development of our platform on OpenMRS and its subsequent deployment during the Kibera Medical Record Initiative (KMRI), we received funding in the form of grants, private donations, and operations/technical support. From Grand Challenges Canada, we received a $85,000 USD Stars in Global Health grant to foster the software development and cover operations and travel expenses between Canada and Kenya for several members of our team. Additionally, we received ~$45,000 USD from the International Development Research Center (IDRC) to support the production and launch of our software. Approximately $22,700 USD was also brought in via Mitacs matching funding for members of our team who were qualifying students at that time. The ICChange executive board, in the form of monetary contributions, raised an additional $37,800 USD. Outside of financial subsidy, we additionally received support from F12 IT Solutions (Canada) and the Galleria Mall in Nairobi. F12 provided technical expertise in the form of consulting, and donated computers and servers valuing approximately $37,800 USD to jumpstart KMRI. The Galleria mall facilitated a co-location of ICChange servers in their server room, an approximate value of $1500/month over four years, totalling ~$72,500 USD. We do not have any revenue to report.

In the next 6-12 months, we are seeking to raise another ~$205,000 USD for software development, team expansion and operations costs related to our project. We are aiming to do so via applications to various grants, including the 2020 Mission Billion Global Challenge, which would fuel our ability to deliver a significant upgrade to quality of life and healthcare systems for those who are the most vulnerable. On top of grants, we are evaluating opportunities for formal investment from parties external to ICChange in the form of debt or angel investment. Within our network, ICChange is raising an additional $37,800 USD in donations and member contributions and we are solidifying in-kind service deals from close partners that would provide at least an additional $37,800 USD value.

ICChange’s projected expenses for this initiative in 2020-2021 total to approximately $242,800 USD

1- Software and Host Costs: $80,000

• $10,000 for server costs
  
• $70,000 for software development

2- Clinic Implementation: $20,000

• $2,000 for hardware and wiring per clinic x 10 clinics
  

3- Personnel Costs: $75,000

• $20,000 for ICT implementation team that would do workflow assessments in clinics, determine where to put terminals and do the wiring and hardware (2-3 people)
  
• $20,000 for project coordinator on the ground for oversight and global project management
  
• $20,000 for health informatician to work with MoH, ensuring interoperability and connectivity with legacy systems
  
• $15,000 for an education team of 2-3 people to do education/sensitization work with clinics and local leaders
  

4. General Operations Costs: $30,000

5.  In-kind Contributions : $37,800

• Server hosting for 1 year - $18,000
  
• Business consulting - $5,000
  
• Legal services - $5,000
  
• Software design - $5,000
  
• Digital health consulting - $4,000
  
• Printing - $800

The most immediate benefit that the Mission Billion Challenge Global Prize can supply our organization with is capital. As discussed when overviewing the most acute barriers faced by this particular ICChange initiative, an infusion of financial support would directly aid us in refining our product, ensuring we are sufficiently staffed, and preparing to bring our platform to market. Furthermore, successful application to the Mission Billion Challenge Global Prize will significantly advance our organization’s problem-solving capabilities.That is, being a part of an equally as ambitious cohort of Solvers will allow us to collaborate and share knowledge with other Solvers, such that we can learn from problems that they have already solved, and offer our own learnings for their benefit. While our past activities have created many meaningful community-level and governmental relationships in Kenya, access to a worldwide network of like-minded social enterprises will be an invaluable asset for reaching our stretch goals for EMR implementation in slums around the world. Furthermore, our organization’s portfolio includes many other initiatives that overlap with key MIT Solve challenge areas such as Early Childhood Development, Circular Economy, and Sustainable Urban Communities. As such, we see many opportunities to gainfully collaborate with Solve Members and other Solver teams, once recruited into the MIT Solve Marketplace. Overall, the Mission Billion Challenge Global Prize would serve to directly address some of the most critical short-term barriers facing our team, while also facilitating opportunities for future opportunities for expanding both this initiative and others in the ICChange portfolio.

Our need for funding can largely be summarized as requiring start up capital to bring our solution to the point of financial self-sustainability. Strategic partnerships would be particularly impactful for us if they were to help us achieve connectivity between the various technical, political, healthcare and lay stakeholders that would be affected by our initiative. The success of our solution is largely dependent on achieving buy-in from all of these groups, and thus any support that can help us develop a partnership landscape is welcome.

The nature of the healthcare industry in Kenya and the diversity of identifiers in use in the country necessitate the creation of partnerships to consolidate many stakeholders into a unified medical identity system. One such stakeholder would be existing providers of EMR systems, such as Intellisoft Kenya. Intellisoft has repurposed Bahmni, an OpenMRS-like software into an EMR product. They do not provide service in slum environments and would thus not be major competitor for us in Kibera, Mukuru, and other per-Nairobi settlements. However, for the Ministry of Health (MOH) to successfully implement a nationwide identification system, service providers such as Intellisoft need to be engaged in order to engineer compatibility between their platform and our identifier. Partnerships such as this will ensure that the identification component of our proposed solution can eventually scale to the whole country and synergize with existing stakeholders. Furthermore, we are also seeking partnerships with government entities to compliment our collaboration with the MOH. For example, we would need to share data and technology with the National Hospital Insurance Fund (NHIF), as the informal settlers that we register into our system will only just begin to “exist” relative to the government, and clinics that we enrol will have new patients seeking coverage. As such, the NHIF would provide actuaries to stratify risk and calculate insurance premiums, which will aid in reducing the burden of healthcare expenditure on our target population, while also being a first step towards creating a social security net for them as well.