Unlocking health data and technology to improve community health

Healthy Entrepreneurs, which deploys a network of 5.000+ micro community health entrepreneurs in Uganda, Tanzania, Kenya and Burundi, unlocks GIS and health data to provide essential basic health services for hard-to-reach, remote communities. Deploying entrepreneurs at the right place with the right health services will effectively address (future) pandemics.

Joost van Engen, CEO and Founder of Healthy Entrepreneurs

Traditional community health programs in Sub-Saharan Africa suffer from performance, retention and sustainability issues. During the COVID pandemic, health information did not reach the last-mile, hard to reach communities in rural parts of the country. The lack of health knowledge and information, reliable and affordable health products, scarcity of doctors and other qualified health staff pose a great threat to screening, diagnosis and assurance that people receive the necessary treatment. 

Community Health Workers can be the solution to identifying, screening and treating people affected by a (future) health pandemic. However reliable data that can support decision making on where to deploy community health services based on access to services and high disease burden are not widely used. The lack of real-time data on the health status of rural communities, creates challenges for early detection of new outbreaks or continued spreading of diseases. 

A poorly organized supply chain and flow of medical products further weakens the coping mechanisms of disconnected communities to tackle the health crisis at hand. 

Currently 600 billion people are living in remote areas of Sub-Saharan countries, making it a challenge of massive scale.

Our final target audience are the families living in remote, rural areas of Sub-Saharan countries, who lack access to health information and health services. Our solution currently serves 6,25 million people through our network of 5.000 entrepreneurs and aims to reach 125 million people by 2030. Especially during a pandemic, health information will mostly remain in (peri) urban settings and does not reach the last mile, as does the flow of essential prevention, diagnosis and treatment commodities. By its model, Healthy Entrepreneurs is in close contact with these families as they are our customers. Their needs and demands are reflected in the services and product basket offered by the entrepreneur. Constant engagements with our end customer allow us to update our data insights, and deployment of staff at the right place and with the right health services at the right time. During the life span of this program, both the rural families and the entrepreneurs will be constantly consulted on new data insights gathered by our proposed solution.

Access to basic health services for all, is seen as a strong public good and a critical need to ensure that we reach Universal Health Coverage (SDG 3). Data translated into informed deployment of (new) services allows hard-to-reach, rural communities to sustain and improve their health conditions even under threat of a new pandemic. Building resilient health systems is key improve health care in Sub-Saharan countries. Therefore, Healthy Entrepreneurs works closely with national and local governments to supplement the public health system. Our network of community health entrepreneurs supports task shifting and reducing the burden in health facilities and hospitals. As we are working closely with all stakeholders, Healthy Entrepreneurs believes that the insights generated from our solution should be made publicly by publications and data reports provided to governments to build a resilient health system. We can provide capacity building on geospatial data preparation and use of AccessMod, so that Ministries and technical stakeholders are able to run additional or update existing accessibility analyses. All in all, the most important part of our solution is to unlock access to basic health services to every (rural) corner of a Sub-Saharan country.

As shared earlier, data generated from public, open source + generated by us, will translate into new and improved (access to) health services in rural communities. The target population of rural families who spend around $100 annually on health care save 55% of their costs because of not having to pay for travel to reach far away health services. At the same time, they receive quality health information (on a new pandemic) + commodities to protect against transmission or treat them in case of an illness. 

In our activities we generate and analyse data to improve the health services of our community health entrepreneurs (output) which will in return translate into better health outcomes for rural communities. In a study conducted by the Erasmus University we saw a doubling of the use of contraceptives in comparison to a 'normal' community outreach, substantially more knowledge on maternal and child health, HIV and other STI's (+52%), as well as a better use of improved water sources (+35%) Research.

With the proposed solution, Healthy Entrepreneurs is able to further strengthen its targeted and tailored approach offering a complete package of health products and services in the remote and hard to reach areas.

Healthy Entrepreneurs trains existing community health workers to become micro entrepreneurs providing health information and essential health commodities to the last-mile communities. We are currently active in Uganda, Kenya, Tanzania and Burundi. In the coming three years our network will grow to 25.000 entrepreneurs in the current and to be onboarded countries. Every entrepreneur has 250 families/ 1250 people in his/her catchment area. Our data solution will allow us to provide timely and needed health services through a reliable and regular supply chain of commodities, and optimize it geographically. After the 3 years our entrepreneurs will reach over 31 million people living in remote areas of Sub-Saharan countries. Through our hybrid financing model of investments and grants, we are able to scale our impact. The proposed solution will further strengthen our data-informed decision making while building and complementing a resilient national health system. The revenues generated by our entrepreneurs will provide an income and sustain their micro business. The revenues allow the supply chain to function and continuously supply the entrepreneurs with health commodities. In times of a pandemic this is a gamechanger allowing for continuous access to health services.

We will monitor the implementation of our work by the following indicators:

• Number of deployed community health entrepreneurs based on the GIS analysis
• Number of health services provided and products distributed based on the data generated on the identified diseases or pandemics (e.g. PPE during COVID, malaria treatment, HIV self-tests etc.)
• Number of consultations made by our entrepreneurs and telehealth solution with specific disease or pandemic enquiries

Our data and the data generated by the Ministries of Health will be used for impact assessment, assessing our impact on the lives of people living in remote areas. We will assess the knowledge level of families in rural areas on health-related issues compared to a baseline. At the same time we will measure improvement in access to health services in these rural settings by conducting qualitative data collection. 

To measure the success of our data solution, we will monitor progress by the level of integration of data analytics in our operation, generated data insights used by other stakeholders and the number of publications/ presentations made. We will make sure that all lessons learned shall become available to the wider public allowing for impact beyond Healthy Entrepreneurs' operation. 

For the implementation of our solution we foresee the following  barriers to overcome:

• Lack of local in-country capacity for data collection, analysis and modelling with AccessMod and other GIS tool for implementation use. We will partner with universities to tap into and enhance the local capacity of stakeholders to become autonomous in producing the needed accessibility analysis
• Low level of data availability. Especially in Sub Saharan countries relevant data sources are not always available or accessible. We will leverage on our network of like-minded organisation, Ministries of Health and universities to access the relevant data sources and overcome the barrier 

Besides barriers in data, Healthy Entrepreneurs as a social enterprise should overcome certain barriers: 

• As we want to deploy more entrepreneurs to effectively implement health services, a barrier is the management of a large-scale operation. We will overcome this barrier by introducing solid procedures and expand the team with the necessary skills to manage our large network.
• Integrate use of the data solution in daily operations. As this is a new way of working, we will train staff on including data informed decision making in the operation. 

• ASHOKA
• Philips Foundation
• AMREF
• Aidsfonds
• Simavi
• Boehringer Ingelheim
• Erasmus University Rotterdam
• VU University Amsterdam
• University of Geneva
• Makerere University
• Palladium
• Grand Challenges Canada
• Fase
• WOFAK
• NAFOPHANU
• Dutch Postcode Lottery
• Ministry of Foreign Affairs Netherlands
• Dutch Good Growth Fund

The Trinity Challenge can support Healthy Entrepreneurs by becoming a strong data-informed service partner to build a resilient national health system. By using the Trinity Challenge (partners) expertise in data processing, we can immediately improve the access to basic health services in remote areas of Sub-Saharan Africa. Our network of entrepreneurs is available, however deployment and service delivery can be strongly improved by using the right data, at the right time, at the right place. We believe that the Trinity Challenge will collect brilliant ideas to further recover from the current COVID pandemic, by integrating data technology and analytics to improve protective interventions for vulnerable populations. In addition we believe that Healthy Entrepreneurs will be an added value to the Trinity Challenge as it can pro-active and quickly move on new insights derived from the data. This allows for quick responses in case of new pandemics or diseases occuring. At the same time our solution is building a resilient health system which can run without the need for external donor funding, making it a solution fit for the future.

We are keen to tap into the expertise of the Trinity Challenge members. We expect that the Bill and Melinda Gates Foundation through their worldwide programs, have extensive access to relevant health data sources in Sub-Saharan Africa. Optum has deep expertise, advanced analytics and innovative technology  which could help our operations to drive sustainable health economics and more personalized care. The University members may have relevant data technologies or insights that can support the deeper understanding of access to basic health services for rural, hard-to-reach communities, which can benefit the implementation of Healthy Entrepreneurs. Concluding, Healthy Entrepreneurs is enormously eager to tap into the expertise of the Trinity Challenge members, as we believe that the bundling of expertise on data with direct implementation will build resilient health systems that are better prepared to cope with future pandemics and disease threats.