The Addis Clinic

We link primary care providers to specialists for advanced diagnosis and treatment, alleviating staffing challenges and a global shortage of physicians. By training health workers to incorporate telemedicine and digital tools in their practice, they can provide their highest level of care while saving time and money for their patients.

Wade Munday, Executive Director

By 2030, the world will need more than 18 million additional health workers, mostly in low- and middle-income countries. (WHO, Scheffler, 2008) More recent analysis indicates that the trends predicted in 2008 are worsening. In Kenya, a lower middle income country (LMIC), The World Bank compiled WHO data showing that the country only has .2 physicians per 1,000 people - far below the recommended 1 physician per 1,000 people (2018). 

COVID-19 has severely strained health systems in LMICs such as Kenya. In 2020, health workers and doctors went on strike to protest wage theft, a nationwide PPE shortage, and the government’s overall mishandling of the pandemic. Dozens of physicians were fired by the government in 2021 or never returned to work. Patients are thus left with a beleaguered health workforce unable to attend to the health needs of 50 million people - Africa’s seventh largest country. 

342 of 100,000 mothers die during childbirth (2017) and 32 of 1,000 children die during childbirth (2019) according to data compiled and visualized by The World Bank. For comparison, the infant mortality rate is 5.6 and the maternal mortality rate is 14 in the United States.

Our program directly benefits providers and patients living in remote communities - patients without health insurance, patients living in a community without a physician or a physician specialist, and patients living on less than three dollars per day. Among the providers, we primarily serve clinical officers and nurses who are younger than 35 years of age and who work in a facility that does not employ a physician.

Since July 2019, we have trained 415 health workers and responded to 5,000 referrals. 830,000 patients could have access to a physician for a medical problem that their primary care provider could otherwise not handle thanks to our program.

Our program indirectly benefits families and improves population health. Physician and referrer collaborations result in quicker time to diagnosis and more efficient treatment. For families, this means that children are able to return to school and parents are able to return to work more quickly. At a local level, it serves to improve communication about public health and regionally, it serves to decongest the health systems that typically receive secondary referrals from counties that do not employ physicians.

The Addis Clinic provides greater access to healthcare for people living in medically-underserved communities, people living on less than three dollars per day, and people living in conflict areas. We can save money for public health systems by providing telemedicine staffing solutions and overcome staffing challenges in areas where there simply aren't enough physicians available to meet the needs of patients. 

Telemedicine can be a powerful tool to achieve equitable, affordable, and universal access to healthcare. International collaborations between providers can advance global health through ICT which offers uninterrupted support to users and facilitates meaningful and even lifesaving exchanges of information.

Moreover, we are working to advance national health strategies advocating for the use of telemedicine and disease prevention. The Kenyan government e-health strategy focuses on institutional capacity building and health system strengthening in order to achieve universal health coverage. Among The Addis Clinic’s key indicators is also to advance gender equality, health literacy, and economic empowerment.

Our solution has multiple layers of impact.  First, we provide clinical mentorship and education to the various frontline primary care providers who use the provided telemedicine platform and Volunteer Medical Corps.  These referring clinicians gain increased knowledge & confidence from every tele-collaboration that assists them in providing a higher level of care to all of their patients.  They also benefit from the real-time mentorship opportunities and lecture series we provide.  All users are automatically surveyed 21-days after they send a case to our platform and 96% of respondents report receiving an educational benefit from the physician’s reply.

 Second, patients receive timely and accurate diagnosis from expert physicians.  95% of survey respondents report that tele-collaborations assisted with management of the patient, 90% reported improvement to the patient’s symptoms, and 93% report that tele-collaborations clarified the patient’s diagnosis.  Additionally,  patients save money, because they receive a diagnosis or treatment plan at their first primary care appointment in their community. For example, this means a patient will not spend money for transportation or fuel from Migori County Referral Hospital, which does not employ a physician, to Kisii Referral Hospital which does. This equals a savings of 29 GBP per patient.

After having conducted a successful pilot program in Migori County and then offering our services to more providers in five other counties, we will scale up our approach in more communities to benefit more people in the second half of 2021. We have relied on philanthropic revenue and in-kind services and support from the Volunteer Medical Corps, but our plan for sustainability includes a shift to revenue generated from subscription agreements with ministries of health, county governments, health facilities, and other NGOs. This will result in 1,500 users of our services by the end of 2021.

After investigating the U.S. healthcare market, we will replicate our business model and offer our services to U.S. health facilities and providers of healthcare. Profits from our U.S. based operations will fund research initiatives into the efficacy of telemedicine, an under-investigated but timely topic in light of the COVID-19 pandemic.

The Addis Clinic monitoring and evaluation framework is guided by an underlying results framework using SMART objectives. We monitor and evaluate every stage of the work that we do to ensure maximum operational efficiencies and impact. These activities include applied research, quantitative and qualitative data analysis, and program evaluation surveys delivered to the Volunteer Medical Corps, health workers, and patients. 

A few of our measurable goals related to our strategic impact goal to create a nationwide network of telemedicine users include the following:

By the end of 2021, we expect 1,000 users, up from 415 today, directly helping 500 patients per month, up from 250 last month, through referrals. Maintain higher than 95% user satisfaction. Ensure that 100% of all users complete our telemedicine training program.

1. Ongoing COVID-19 pandemic and associated mitigation measures and travel restrictions. Our long-term model of connecting local clinicians to global experts using technology has allowed us to be immediately responsive to the challenges of the COVID-19 pandemic. Despite the COVID-19 pandemic, we expanded our operations by 600% between 2019 and 2020.  

2. Internet data costs. We recognize the personal cost frontline clinicians incur when using data to send teleconsultations, even if the consultations themselves are free of charge. Our Data Reimbursement Program provides an opportunity for users to recoup these costs if they meet certain eligibility criteria. 

3. Adherence to using telemedicine. 45% of clinicians trained and equipped with telemedicine by The Addis Clinic in the last year submitted 2 or more tele-consultations in 2020.  This is an increase from 39% in 2019.  The use of digital tools in clinical care remains a challenge in remote and low-resource settings. To overcome these challenges, The Addis Clinic has produced a digital telemedicine training program available to all of our clinical partners, and also conducts in-person training conferences when not constrained by the COVID-19 environment. Additionally, our Healthcare Recruiter workforce maintains constant communication with our frontline clinicians in order to provide ongoing support.

The Addis Clinic, Kenya

More than 150 Kenyan hospitals and clinics with signed use agreements

We are applying in order to accelerate our organizational impact, specifically our transition from a volunteer base of physician specialists to an in-country network of paid physician consultants. Winning the Trinity Challenge would enable this transition through funding and by connecting us with peers and experts with experience transitioning from a philanthropy model to an impact-driven revenue service model.

Funding can be used to modify and tweak our design and user experience so that we can continue to increase telemedicine adherence. It can also help us to strengthen our COVID-19 protections for our users in the country through the purchase of PPE from existing, unallocated funding sources.

By winning the challenge and connecting with peers in the field and the country, we can learn about other ways that we can participate in COVID-19 vaccination and other recovery efforts in Kenya and East Africa.

Partnering with Zenysis or another data visualization and analytics platform can help us gain greater insights into the information we are capturing and reporting. It can help with our daily and long-term strategic decision making.

Other corporate partners would include companied with strong AI product integrations which can help us to understand AI systems management that fit into our current workflow.