HLink - Refer with Confidence.

HLink provides up-to-date availability information of medical facilities and resources to healthcare providers for quick and efficient patient referral.

Jonathan Reinagel, Managing Director 

With a masters in management and leadership, Jon has relevant work experience in Africa and beyond and has spearheaded multiple technological innovations for years. 

Poor intercommunication systems in many African countries create faulty referrals that in turn lead to delayed treatments, hospital overload and greater risk of disease spread from lack of treatment and increased waiting times. According to the Nigerian Health Sector Market Report of 2015, 75% of patients self refer to the wrong place and of about 34,000 health facilities in Nigeria,  tertiary hospitals make up 0.25% but still take on an uneven distribution of the bulk of workload meant for primary centers. This picture is similar to our other base, Mozambique and the vast majority of Africa. 

The main barriers currently preventing people from receiving or making trustworthy referrals are: 

• Lack of access to information as well as adequate and shared data on specialty physicians and equipment, who and which are often shared between healthcare facilities due to a shortage in both talent and materials. 

• Lack of access to technology

• Lack of feedback loops and systems that keep reliable, shared data on patient information, testing and treatment, and outcomes.

HLink  sees the opportunity to directly overcome these through a system that leverages existing information, networks and simple communication tools to share inventory availability with healthcare providers that are the first responders.

Our target population of users are healthcare workers involved in the patient-referral process with emphasis on first responders such as the community healthcare workers in the informal health sector of Lagos, Nigeria and Sofala Province, Mozambique. We have an ongoing relationship with the Tradomedical Society of Makoko-Iwaya Waterfront Community, a network of CHW in one of Lagos’ largest waterside settlements. In our bid to understand challenges of the patient-referral processes in Lagos, Nigeria, the leader of this society has provided valuable advice and consultation towards the development of the application. From them, we found that patients are often not certain of where to seek help from in light of a medical challenge. In the same vein, we have met with organizations of physicians such as Ordem dos Medicos at Mozambique, as well as individual patients, who helped us better understand challenges frequently encountered. These feedbacks have been helpful throughout the development and redesigning of the product. Asides from self- referrals problems, we realized that often times providers themselves are not certain of where a particular service is available in order to refer a patient appropriately. Consequently, we are providing a platform containing these up-to-date inventories to support referral decisions. 

Hospital and clinic waiting rooms are always filled with the most vulnerable populations imaginable: elderly patients, pregnant women, immunocompromised, and already ill people seeking medical attention are crammed shoulder-to-shoulder on long benches for hours on end waiting to be seen. Using the pandemic as an example, when a person with COVID-19 symptoms shows up in this kind of a waiting room and is forced to sit and wait with everyone else, the results can be disastrous. Now imagine that person is indeed COVID-19 positive, and after finally being seen by a healthcare professional, they are told that the clinic does not have any tests, but they can try somewhere else. The cycle repeats, they contaminate another crowded waiting room, and even then they are not sure they’ll be helped. If the healthcare professional had access to HLink, they would be able to refer with confidence and diminish the number of vulnerable people exposed to the virus by making sure the symptomatic person reduces their exposure to other waiting rooms.

HLink also encourages the digitization of data in countries with prior poor data records and management. This paves a way for subsequent data-driven innovations to emerge for healthcare efficiency. 

The Tradomedical Society of Makoko-Iwaya Waterfront Community, as well as organizations of healthworkers approve of our work. As first responders integrated into society, community health workers provide for a large percent of vulnerable patients, some of who have poor health seeking behaviors and are further discouraged by the lack of awareness of where to seek help. Some of the patients self-refer and meet lots of obstacles that delay management when they go to the wrong place. This causes repetitive financial costs and efforts and increases exposure to infections. 

Leveraging on and improving the trust between CHW and patients mitigates these problems. Informally, within communities, appropriate lines of management can begin. Empowered with knowledge about referral options, CHW and other personnel can better provide for these patients with early and appropriate care not exceeding the required cost. 

Versions of this digital referral solution have been employed in other continents which have consequently shown improved health indices. Making this locally relevant by the integration of community stands a better chance in Africa as CHW have been shown to be a powerful workforce and influence in patient management. 

As healthcare is a necessity, our solution impacts people at all levels. In the short-term (one year), we aim to reduce the percentage of faulty referrals made in Lagos, Nigeria, and Sofala Province, Mozambique by 30%. Then, we will expand to other cities in Nigeria and Mozambique. By the end of 2025, we seek to reduce faulty referrals by medical professionals in Mozambique and Nigeria by 30%.

After setting the first version of HLink up and running at Lagos, Nigeria and at Beira, Sofala Provice, Mozambique, our ultimately goal is to expand to other parts of Nigeria and Mozambique and subsequently to other neighboring African countries, launching the second and third versions of HLink, which will include telemedicine features and improved communication channels. 

Metrics to measure our impact include:

• Number of successful referrals made through our feedback loop

• Patient’s satisfaction level of receiving treatment through referrals (measured by NPS)

• Improvement in average wait-time at healthcare facilities

• Improved operational efficiency at healthcare facilities (ratio of output gained to the input expended)

Our referral system is highly dependent on information regarding resource availability. We plan to use existing local logistics systems to acquire and circulate information. However, it is possible that the logistics systems refuse to share data on stock availability. In response, we have secured access to data on OpenLIMS from our partnership with VillageReach, and we are seeking authorization from the government for limited data usage. Also, HLink plans to start with locations that already have a strong openLMIS system before moving to locations where data collection is not as robust, building the case for clinics and partners to use openLMIS if they have not already.

Nigeria's recent political development has created an unpredictable working environment. But our team is actively monitoring the situation, especially the public distrust in their government which might impede our collaboration with them. Beyond that, we are interested in eventual diversification and are aware of large foreign healthcare players interested in African investments. We are confident of our knowledge of the local markets and systems as well as our ability to react to changes because of our relatively small size.

Islamic Development Bank (IsDB) - Top Thirty Innovations at the Transformers' Academy 2020 + Grant

Massachusetts Institute of Technology Africa Takes on COVID-19 Challenge (Hackathon where the team met)

 Equip Mozambique, a technological development company. (Now Contracted)

VillageReach (Partner)

Winning the Trinity Challenge will provide us with the global relevance needed to set our product on the stage. Here we will get the opportunity to learn from mentors and further get inspired by the experience of a community driven by the zeal to cause positive social impact. There is also the possibility of partnerships that may arise, ones that can help provide us with more data, governmental contracts, potential users and further chance for expansion. 

While we currently have access to IsDB funding for our pilot phase of the project, in order to fully implement in Lagos and Sofala, and invest in the company’s growth, we rely on additional funding opportunities, such as The Trinity Challenge. We hope to use this funding to gain market advantage, purchase equipment, hire contractors, partner with relevant stakeholders, reach potential partners including additional data storage and management platforms and reach our target goals, establish bases in Nigeria and Mozambique, secure the functionality of our application, and establish presence within the health technology scene in both countries. 

In line with materializing HLink, we have identified key influences and stakeholders within the healthcare ecosystem that are and will be useful to us including potential users health care providers and community healthcare workers (CHW), healthcare facilities (hospitals, pharmacies and laboratories), health technology data management organizations and governmental and regulatory bodies.

Examples include:

Bill and Melinda Gates Foundation to adopt our product, liaising with regulatory bodies in Nigeria and/or Mozambique for implementation in these countries, as well as generate high quality data and further evidence of performance

GSK - partnership with pharmaceutical franchises for product adoption

The Nigerian Ministry of Health for a government contract, limited data usage agreement, aid the process of digitization of data 

Center for Disease Control - product adoption

World Health Organization: global platform, product adoption

Health facilities and personnel organizations (such as the Nigerian Medical Association and Association of Resident Doctors) for digitization of healthcare data and adoption of product

Health technology companies willing to share data