Improve Healthcare and Enhance Surveillance In LMIC Primary Care

We will utilize advanced clinical technology to improve skills of healthcare providers and enhance quality of care provided.  We will focus on pharmacies where the vast majority of consumers in LMICs seek care.  The data collected will significantly improve syndromic surveillance for evidence-based decision-making about emerging health threats.

Barry Finette, MD, PhD, THINKMD’s Founder and Chief Medical Officer, has over 30 years as a clinician and is an expert in digital and global health.

In order to achieve universal health coverage (UHC), an additional 3.8 billion people need access to basic healthcare services.  Many of those 3.8 billion reside in LMICs where their first stop for healthcare is not a clinic or hospital, but a private pharmacist, drug seller, or health kiosk near their home. For example, the 2014 Kenyan Household and Utilization Survey indicated that small-scale shops and pharmacies provide over 60% of primary healthcare services and serve as the first point-of-care and treatment providers for between 40-70% of all pediatric fevers.  

The global health community frequently expects minimally-skilled health workers to accurately assess patients, administer simple medications and interpret diagnostic tests to delineate between a range of diseases. But the dire lack of necessary training and skill sets among the health workers who staff these private pharmacy shops represents a significant and ongoing risk to patient outcomes and a substantial barrier to UHC.

The COVID pandemic highlighted the need to improve monitoring of quality of care provided by these private healthcare providers. We’ve shown how innovative health technology could both improve care and collect valuable data that can significantly improve disease surveillance and population health monitoring.

With a focus on Nigeria, Kenya and Uganda, THINKMD’s solution supports both the private healthcare providers, specifically pharmacists, and the vulnerable patient populations that they serve. The solution and the data it collects will also serve the ministries of health in each of these countries. THINKMD has spent the last 5 years doing validation, usability and user-centered design studies with users in these markets to obtain user and stakeholder input as we continue to hone our solution. 

Ministries of Health: By implementing digital tools with real time data capabilities, MOH are able to more effectively monitor private healthcare providers, regulate quality of care and treatment consistently, and identify emerging health threats in real time.

Private Healthcare Providers: THINKMD’s solution increases the ability of providers to deliver reliable primary healthcare services in adherence to national and international protocols. This increases their ability to obtain and retain clients via credible service. Registered pharmacies in Kenya, Uganda, and Nigeria total 13,000, 1,029, and 21,892 respectively.

Vulnerable Patient Populations: THINKMD’s solution covers pregnant mothers, newborns, children under 5, and adolescents up to age 17. Based on the demographics in Nigeria, Kenya and Uganda, this age range covers 40-50% of the population.

THINKMD supports an ongoing internal research program that pushes our technology forward, while meaningfully contributing to the larger global discourse on digital health, health access and health equity. This research will continue to generate more publications in peer-reviewed journals in the coming months and years. In the meanwhile, see our 2019 publication here. 

Our project also provides a model for simultaneously decreasing cost of healthcare delivery, improving quality of care, and lessening dependence on donor-funded projects. This will culminate in lower costs of healthcare and significant progress towards universal access to quality care.

Although the data we collect is not a true public good, the insights derived from that data will drive improved public policy, population health surveillance, and regional public health decision-making. This will be instrumental in identifying emerging health threats and developing appropriate response interventions.

In prior pilots and research, THINKMD’s solution has been proven to increase user compliance with health guidelines and protocols (e.g. WHO IMCI), therein increasing  the quality of healthcare provided. If widely deployed with private providers in Kenya, Uganda, and Nigeria, we expect a marked increase in protocol compliance and clinical quality on behalf of these users, which will improve care for their beneficiaries. We believe a follow-on impact will be that this improvement in healthcare quality will not only be noticeable to patients, but will drive loyalty to these providers over time.  

In addition, when our tool is used at scale and integrated into the place where the vast majority of consumers seek primary healthcare in LMICs, the data collected will provide invaluable insights for government decision-makers regarding syndromic surveillance, the type and location of emerging health threats, and how to deploy essential resources such as PPE, diagnostic tests and essential medicines. 

Based on the last 4 years of technology implementation with partners in LMICs, THINKMD has a strong track record of being able to scale technology across different geographies and users. Within one year, THINKMD and our partners will be able to establish a footprint of several hundred private providers in each country (Kenya, Uganda and Nigeria). These will serve as our initial users to both prove the model and refine the solution. Within three years, THINKMD will be able to accelerate scaling up to several thousand private healthcare provider users in each country, serving a total population of beneficiaries in the millions. This population of beneficiaries would primarily be in urban areas and consists of pregnant mothers, newborns, children under 5, and adolescents up to age 17.

THINKMD uses data collected in assessments to measure its impact over time with each partner. The following provides a brief overview of the long-term impact the Company hopes to achieve, and which metrics THINKMD uses to measure key outcomes over time. 

Impact #1: Achieving Universal Health Coverage

Outcome: Increased healthcare access

Outputs:

1. No. of health assessments completed 

(Total / last 12 months)--2020: 186,623

2021[F]: 279,934 (50% growth)

2022[F]: 405,905 (45% growth)

2023[F]: 568,267 (40% growth)

2) No. of health professionals using THINKMD Technology 

(Total / last 12 months)--2020: 982

2021[F]: 1,473 (50% growth)

2022[F]: 2,136 (45% growth)

2023[F]: 2,990 (40% growth)

Impact #2: Reducing Disease Burden and Improving Response

Outcome: Increased Healthcare Quality and Response

Outputs:

1) Disease/Conditions addressed--2020: 106; forecasted growth per year: 20%

2) Number of patients (by triage)--2020: Standard:18,380; Immediate: 9,409; Urgent: 2,706; forecasted growth per year: same rate as assessment / year

3) Overall adherence to protocol--2020: 94%

4)  Increased time to identify disease threats and initiate response

Expanding into Lower-Skilled and Fragmented Markets-- Although we aim to engage these users over time, it will be challenging to engage smaller unlicensed drug sellers as our initial cohort of users due to the inherent fragmentation of the market and the large variability in skill sets.

Mitigation Strategy:  THINKMD will initiate this model with established partners like Goodlife Pharmacies and LifeStores, which targets lower middle and middle-income consumers.  Over time, once we have honed the technology offering and de-risked the commercial model, we will expand the model to engage small kiosks and unlicensed drug sellers, which target marginalized consumers and provide a significant percentage of the healthcare in low-income settings. 

Changing political priorities--Government buy-in from the Ministries of Health will be essential to achieve lasting change; however, elections and changing administrations and regulation can hinder progress and scaling efforts.

Mitigation strategy: THINKMD delivery model is to work with in-country partners who understand the political risks and who can more effectively mitigate this political risk.  In addition, as the THINKMD model begins to demonstrate cost savings to improve healthcare quality and to provide key information to government partners to improve disease surveillance, adoption of the model will be more sustainable.

Bill & Melinda Gates Foundation, UBS Foundation, Sorenson Impact Foundation, eHealth Africa, Save the Children (Kenya and Bangladesh), Mondia Media, Vodacom, Pfizer Foundation, IFC, Healthy Learners, Goodlife Pharmacies, Integrate Health, University of Vermont, Alight, CDC, icddr,b, DAI, FHI360, Audere

We are applying to Trinity Challenge because we believe that in order for pandemic response to be effective, it needs to be integrated into the health system.  Our solution not only improves primary healthcare where the vast majority of consumers seek care--pharmacies and drug sellers--but also provides essential data that can be used for syndromic surveillance by our partners and decision-makers at Ministries of Health in identifying potential emerging threats.  The Trinity Challenge will help THINKMD overcome our anticipated barriers in two ways:

1. Provide Financial Resources--the funding provided by the Trinity Challenge will allow us to expand our clinical API and fully incorporate the Audere computer-vision RDT image capture into our clinical decision support software. In addition, the funding will develop a comprehensive plan for how to extend use of the tool beyond current partners--Goodlife and Lifestores--and into the more fragmented market of less formal drug sellers.  

2. Leverage Trinity Challenge Network--Trinity Challenge has built an impressive network.  As we build out our expansion plan for our tool and the use of the data collected, your network could be very beneficial in securing initial buy-in with government decision-makers.  

THINKMD plans to partner with the following entities for this project:

• Audere is a health-focused engineering group which is working to improve the accuracy of our malaria risk assessments for children and adults.  The work has focused on developing new clinical workflows that are coupled with a malaria rapid diagnostic tests (mRDTs) image capture and computer vision test analysis.  This work will inform future image capture work such as analysis of rashes and skin conditions.

• GoodLife Pharmacy is a key partner on the IFC-funded project to test THINKMD technology in 37 stores in Kenya and Uganda.  

• Lifestores is a healthcare innovation company that offers a suite of tech-enabled pharmacy solutions to a growing network of owned and affiliate pharmacies in Nigeria.  Lifestores emphasizes upskilling their pharmacists to provide better quality care.  Lifestores will be a key partner in Nigeria implementing, providing additional testing and informing future improvement of the THINKMD tool.

• Ministries of Health in Kenya, Nigeria and Uganda--In every project, THINKMD coordinates with Ministries of Health and their partners.  For this project, the MOHs will be particularly interested in the data and how it can be used for disease surveillance and population health monitoring.