Clafiya

Improving community health outcomes in Nigeria through quality and affordable primary healthcare services utilizing low fidelity technology 

Jennie Nwokoye, CEO/Co Founder 

A major problem persists that there are many individuals who lack access to health services especially in semi-urban, poor urban, and rural parts of Africa, reflecting a structural social inequality that cuts across geography and income. As a matter of fact, 58% of Africa's population are unable to access primary healthcare. This is due to a myriad of reasons: inadequate health facilities, high medical cost, poor infrastructure, and lack of job opportunities for community health workers. Specifically, in Nigeria, with a population of 200 million people, it has a huge health infrastructure problem. There are approximately 700,000 registered Community Health Workers (CHWs) and 75% of them are underutilized due to lack of employment opportunities. In addition to this problem, 20% of Nigeria’s 30,000 Primary Care Centers (PHCs) are functional. As a result, many patients are forced to travel further to secondary and tertiary medical facilities where they experience long wait times and pay almost triple the cost for primary care services. 11 million Africans fall into poverty annually because of high out-of-pocket payments for healthcare. There is a need to develop a capability that will empower community members to be local health providers within their communities.

At Clafiya, we believe that everyone, everywhere deserves access to quality and affordable services. Thus, we created a platform that brings life-saving services to the doorsteps of people, especially those far from accessible care. Our goal is to promote an inclusive experience while seeking primary healthcare. Our target audience are people (particularly children, women, and senior citizens) living in semi-urban and rural areas seeking access to quality and affordable primary care services 

While building Clafiya, we conducted market research (128 interviews) in various states in Nigeria and collected qualitative data to understand the needs of both the provider and those seeking care. Using the findings from this research (and speaking to various individuals), we were able to better tailor our solution to their needs. One of the reasons for using a USSD platform was to ensure that users who may live in areas with limited internet service or network, can still have access to quality health services - which was one of the major feedback we received. Another insight we gained was the possibility to use Clafiya for emergency situations as Nigeria currently does not have a robust national emergency response framework “911”.

Increasing job opportunities for Community Health Workers to be the pillar of primary healthcare in their communities. 

We are reducing the barriers faced while seeking primary healthcare services in marginalized communities such as cost, distance, infrastructure by providing home based primary care services. We believe everyone regardless of socioeconomic status deserves access to primary healthcare. This entails making our services accessible and affordable (below the dedicated yearly healthcare expenditure budget of $250 per household in Nigeria). We are in a way introducing a quasi insurance model that caters to Nigerians at various stages; 

1. Pay As You Go - $4

2. Single - a subscription plan - $6.25

3. Maternity - a subscription plan $7.30

4. Family - a subscription plan - $10

Our solution provides primary care services to people with limited access to quality healthcare services. Our target population are people living in LMICs, specifically semi-urban and rural communities. When most Nigerians are seeking healthcare, they are seeking primary healthcare. However, its difficult to access due to barriers such cost, distance, and low human capital. Studies show that consistent access to primary healthcare reduces risks of other life threatening diseases such as diabetes and hypertension which are becoming common in the Nigerian community.  Through Clafiya, people are able to dial a simple code on their mobile phone and request for a community health worker to attend to their primary care needs. This helps in addressing existing barriers such as transportation, limited workforce, distance to facilities etc

Clafiya employs a systems thinking approach that leverages low fidelity technology - USSD (input) coupled with employment of CHWs (input) to increase access to affordable home based primary health care (output). Thus reducing the amount of time and money spent on transportation, and primary care at secondary and tertiary medical facilities (outcome) ultimately transforming patient access to care, positively impacting health outcomes, health care worker incomes and economic development (impact)

One year: Scale across various states in Nigeria including Enugu, Anambra, Edo. This will be done through partnerships with community leaders and government stakeholders who can vouch for Clafiya. This is approximately a reach of approximately 15 million people 

Three years: we plan to scale to other states in Nigeria including Kaduna, Delta, River, Imo, Abia, Akwa Ibom and Ogun states. We hope to scale to Ghana as well. This is approximately a reach of 55 million people. 

As USSD technology is widely available across African countries, adoption rates will be low.

Success for us is when Clafiya is the platform not only used among all patients seeking primary care, but ubiquitously used to create networks aimed at building primary health resiliency at the population level. Our core ethos remains that primary care programs have to adapt to individual health needs, integrate into current care practices and make optimal use of health system resources so as to improve health outcomes & reduce cost.

We plan to measure the social impact we are having through the following key metrics:

-Active users: The key metrics include the number and type of users that are engaging with the platform. This assesses the beneficiaries of our intervention.

-Healthcare services: Key metrics include the type and number of services provided. This assesses the impact we are having on increasing access to affordable primary healthcare services, building strong and healthy communities, and disease reduction. 

-CHW employment statistics: Key metrics include the number of CHWs employed, income generated. This assesses job creation for CHWs and the impact we are having on increasing employment opportunities for CHWs.

-Detect potential disease outbreaks with a 90% accuracy rate and alert officials within 48 hours of detection

A barrier to consider would be future technology expansion as the service grows after its expansion phase. The issue would not be the number of users, as USSD and mobile money technology has successfully reached hundreds of thousands of people, but rather any adaptations that the users would find beneficial. As technology develops, the team's technology SMEs and experience in the field will be able to inform any necessary changes, and potential partnerships with other ventures and technology resources should be able to support future changes.

Another barrier that could serve as a roadblock is access to funding. Although we have raised some funding for the initial development of Clafiya, we do not have enough funding that gives enough runway for 2 years to scale and refine our product. 

Finally a barrier to consider is not forming the necessary partnerships with government or multinational organizations to help serve as champions of Clafiya to boost adoption and scale. 

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Why shouldn't we apply? Its the Trinity Challenge. A lot of people encouraged us to apply. Perhaps they heard about the quick acceleration of  companies that go through this challenge. But really, its just that we truly believe we have what it takes to be in and succeed in this challenge. I have watched our team put a lot of dedication and heart into this life changing product. It’s a beautiful thing to see people from different walks of life come together and work on something that has affected all of us one way or the other. We deserve it as much as anyone else who has gone through the program. 

Additionally, applying gives us a shot at getting access to funding but most importantly the expansive network to grow, scale and realize the impact we would like to see on the continent.

Google & Microsoft - Cloud computing services 

Bill & Melinda Gates Foundation/Clinton Health Access Initiative - Implementing partners and funding 

McKinsey and Company - Pro Bono Consulting 

Palantir - Analytics 

Becton Dickinson & GSK - medical and pharmaceuticals supply for last mile distribution