Lend an Arm

In the USA, we can’t imagine a future without “911”, or healthcare without blood from the Red Cross, yet, this is the reality in sub-Saharan Africa where emergency services are underdeveloped and fragmented. Everyday in Nigeria, 145 women of childbearing age, and another 150 victims of Road Traffic Accidents lose their lives because they could not get blood, an ambulance, often both. Patients who suffer heart attacks; or have Sickle Cell crisis, don’t get lifesaving transfusions, defibrillators, and other interventions, because there is no coordinated way to mobilize emergency services. The Ministry of Health estimates a demand of 1.8 million units of blood. However, the National Blood Service is only able to raise ~25,000 units with a deficit of up to a million units yearly. This deficit leads to astronomically high maternal mortality rates (Nigeria contributing to 14% of the world’s maternal deaths). 60% of annual donations in Nigeria are commercial donations, 30% from replacement donors and just 10% come from voluntary unpaid donors. Furthermore, the National Blood Service noted a consistent year-on-year decline in the number of voluntary donations across the country from 2015 to 2019 when data was last published.

A lack of access to supporting health services in an emergency contributes to a crippling disease burden in Africa. Nigeria is ranked second highest in the rate of death and disabilities from road accidents and other medical emergencies among 193 countries of the world according to WHO. The WHO says the average time between an emergency occurring and help arriving should be 15 minutes or less, in Nigeria the average response time in the National capital is 35 minutes, while in other states, and outskirts, it is up to 4 hours. Only 1 state (Lagos) in Nigeria has a fully operational central emergency response system, yet, the emergency response rate from this one system is just 36%. The lack of access to emergency services in Nigeria is felt by the citizenry in 2 major ways inter alia, and significantly impacts our country’s health indices.

• Poor access to ambulance and pre-hospital care: with the absence of fully functional emergency response system in 35 of 36, and emergency helpline in 19 of 36 states; less than 40% of cases requiring emergency medical care in Nigeria receive such care, with deficits in number of publicly available ambulance units and fragmented private ambulance fleets with different call numbers. In non-traumatic medical emergencies, less than 5% of heart attacks for example have a defibrillator used in an attempt to resuscitate.
• Limited access to emergency laboratory services: according to the Nigerian FRSC, over 50% of deaths from these emergencies are due to complications of bleeding (~10,000 deaths/year). This access gap is most pronounced in maternal care. Nigeria has a high maternal mortality ratio — 877 deaths per 100,000 live births; the leading cause of these deaths is postpartum hemorrhage — the loss of too much blood within 24 hours after a woman has given birth.

The problem of emergency care in Nigeria is driven by 4 factors – poorly coordinated emergency response systems with multiple simultaneous parallel solutions; under-trained emergency response personnel; unclear access routes for patients who need it (“not knowing who to call” was the  biggest cause of non-utilization of ambulance service according to the LASEMBUS); inadequate equipment, and poor supply logistics.

Lend an Arm is a wholistic solution aiming to solve the severe gap in access, and quality of emergency services for vulnerable patients (pregnant women and accident victims), caregivers and health workers in Africa. It systematically addresses root causes of the problem via a three-pronged approach:

TRAINING

• Sensitization: Lend an Arm runs as a blood donation awareness campaign and serial blood drive with use of media in both English and Yoruba to sensitize people on the importance of voluntary blood donation, addressing misconceptions, myths and questions about voluntary donation. Donors in Lend an Arm are recruited and trained to become blood donation advocates and campaigners (called ‘Heroes’)
• Basic Life Support (BLS) training: working with the Nigerian Red Cross, Lend an Arm freely trains members of the public to become certified BLS providers with the aim of training 15% of Nigerians by 2025

SOFTWARE

1. The Lend an Arm app is an emergency department on a smartphone, it provides access to emergency services for doctors, patients and caregivers at the push of a button
   • Donors have access to health information, can chat with one another, create their own blood drives, join existing drives, send out SOS alerts for help
   • Hospitals can make instant blood requests, pay for it, with GPS mapping, to the nearest blood bank, and have it delivered to the bedside.
   • An “Uber for ambulances”, people in emergencies can request for an ambulance at the push of a button, exactly like they would order a ride, with GPS mapping, the nearest ambulance unit is dispatched to them. Our app for the first time, creates coordinated access to ambulances nationwide, without cramming access codes.
   • An optional integrated EHR for digitising care records and processes at partner hospitals.
2. Asake is an AI bot built with the core functionalities of the Lend an Arm app and specifically made to guide the public on how to administer first aid. She functions on Instant Messaging apps – WhatsApp, Telegram, Messenger; and offline via SMS – thus massively improving access to emergency services including in the absence of a smartphone and internet.

EMERGENCY LOGISTICS

• Drone-powered blood delivery: we use medium-range VTOL drones to deliver blood in emergencies from banks to patient bedside in combination with our app, we ensure transfusion within 30 minutes of alert [over 50km].
• Flying Defibrillators: with less than 0.5% trained in BLS, and severe access limitations to defibrillators 1.75 million cardiac deaths occur in Nigeria yearly. Our drones fly defibrillators (Philip Heart Start HS1) to cardiac emergencies at the push of a button, once requested by emergency personnel.

How does our solution incorporate digital technologies? 

LEND AN ARM APP

• Blood Donation: Our App has chat forums where users can interact, form partnerships and strengthen their mutually shared behaviour of blood donation. It can be used to create drive events; other users can be invited to these events. Users can also join already existing events. This way, donors are more involved, they can create their own blood drives, support one another in organizing and can instantly invite us or partners. Using push notifications, the app sends reminders to donors when they're eligible to donate and shows them the nearest facility.
• Blood Request: with Nigeria lacking a central repository of ancillary hospital services, we created one, our app geolocates blood banks across the country allowing hospitals deliver instant blood requests to them with one click, based on proximity
• SendHelp: this function provides an ambulance-on-demand service, mapping ambulance fleets in the database, our app in real-time connects victims to ambulance units, like they would connect to a taxi on a ridesharing app. Simplifying access.

ASAKE

• Asake is a multi-award-winning IBM robot that uses conversational AI to interact with users on social media. She provides all the functions of the app – blood request, drive booking, Q&A etc. and also, she teaches administration of basic first aid through simple chats with her Natural Language Understanding and Processing capabilities.

BLOODY DASH

“The Bloody Dash” – is our integrated blood delivery plan utilizing two point-of-care technologies (HemoCue Hb 801 & Erycard 2.0) internet-of-things, and VTOL delivery drones to ensure delivery of blood in <30 minutes in emergencies. It works as follows:

• A Doctor at a partner hospital makes a clinical assessment of severe blood loss
• S/he performs a point-of-care Hemoglobin (Hb) quantification using a Hb 801 device and gets a result instantly. If Hb <6.5g/dL, the device remotely pulls a blood request to a lab via the app or Asake. This request will require the patient’s blood group to execute.
• The Doctor performs a point-of-care blood grouping using Erycard cards we supplied as well and gets a result in 4 minutes then inputs the result, executing the request.
• The request arrives at the lab where staff check for compatible units of blood in the database. The matching blood bag numbers are identified and loaded onto a drone.
• Our delivery drones deliver the blood units to the hospital

Total time = 20minutes (over a 20km radius)

1. PREGNANT WOMEN: 34% of pregnant women who die during labor here, die from complications of bleeding and a lack of safe blood for transfusion specifically. Lend an Arm directly reduces the incidence of maternal mortality at childbirth, especially in rural areas due to our far-reaching network of agents, motorcycles and drones in Nigeria. With Lend an Arm, rural hospitals and health centers are now directly connected to urban-located blood banks, and can make requests in seconds, and have blood transported to them within an hour. Lend an Arm fulfils an average of 1000 rural blood deliveries each year in Nigeria alone.
2. LOCAL YOUTH: To save lives we follow a Youth-led approach: 

   
   

   • AWARENESS CAMPAIGNS RUN BY LOCAL YOUTH CLUBS: Our awareness campaigns, which have sensitized over 11,000 people, are volunteer-driven, with 1211 volunteers being a part of it. These youth are students of secondary and tertiary institutions in our host communities, who are part of local volunteer clubs (Hamstrings, Red Cross & Junior Chambers International) whom we recruit. Thus, we’re empowering local youth to be change agents, doing good, and influencing others, like a herd.
   • DONOR TRAINING FOR ADVOCACY CALLED “THE HERO PROGRAM”: After each drive, registered donors in contiguous locations who consent are recruited for a blood-donation advocacy training. These trained ‘Heroes’ are then given badges as community advocates for voluntary donation, helping recruit new voluntary donors.

I have sadly lived through the gruesome experience of death and loss due to blood shortages in Nigeria. I founded Lend an Arm while grieving in medical school in 2017, I lost my best friend Gbenga, a cadet of the Federal Road Safety Corps in Nigeria. Gbenga was known to be G6PD deficient. He developed a febrile illness while at work in May, 2017 and couldn’t reach me for advice as I was in school. He wasn’t getting better on the medication given at the Corps clinic and decided to self-medicate, unfortunately, the drugs he took triggered a catastrophic episode of hemolysis, by the time Gbenga was taken to the emergency room by Corp members his pcv was 11%. Try as we might, we could not get enough O-negative blood, nor donors (I was O-positive). Gbenga died following a cardiac arrest. This incident triggered the birthing of a solution in my mind. I received medical training at the foremost medical school in sub-Saharan Africa and I’m in my fourth year of clinical practice. I completed my internship at Nigeria's biggest hospital, the University College Hospital. during which I voluntarily took up special rotations in emergency medicine, obstetric emergencies and neuro-critical care. These exposures helped me to understand the dynamics that affect the decision to transfuse a patient, the time frames often at play, and the pain points in transfusion medicine on the demand-side & supply-side. I have 9 years of experience in volunteering and grassroot advocacy in Nigeria, having worked in 13 states as a volunteer, including each of the 5 states we currently serve, entering my first volunteer role in 2011 with the SOS Children’s Villages International, Family Strengthening Program, working with rural children in vulnerable situations (single and double orphans). Since then, I have taken up leadership roles on the boards of volunteering movements in Nigeria with the Hamstrings Club, CHECK medical missions, Vincent Jason Foundation and S2L missions – organizations dealing with rural healthcare access gaps. Lend an Arm is a spawn of 5 years of consultative meetings and self-funded research in 31 rural communities in 7 states in Southern Nigeria. Furthermore, I'm a self-taught computer programmer with proficiency in web development technologies (HTML5, CSS3 and JavaScript), and Artificial Intelligence (proficient in using IBM Watson cloud infrastructure and Artificial Intelligence Markup Language). Finally, I have gained practical experience implementing social solutions over the last 4 years from founding my own social ventures, and providing consultancy services that help grow social solutions into early-stage businesses, the latter I do via a firm I started called Kreative Doyens Foundation. All of these skills and experiences have equipped me to lead Lend an Arm and deliver on our mission to solve the problem of death from absent blood supply by 2030 in Nigeria.

The MIT Solve is uniquely poised to accelerate us at Lend an Arm as it systematically addresses barriers to our success.

FINANCIAL

The funding exposure provided by the prize will help get us in front of investors who would help finance the expansion of our service to 2 new countries within the next two years and help us complete the Research and Development of our Machine Learning blood screening tool "Blood Safe".

LEGAL

With connection to influencers and regulation experts, the MIT solve community provides us resources to navigate the process of licensure for drone operations in Benin and Ghana (nations we will be working in 2 years).

CULTURAL

Our project runs on a model similar to the MIT Solve community – positively shining light on an action to encourage a larger audience to ape it, a concept known as herding. Hence, the invaluable positive media coverage and increased exposure our project receives from the MIT Solve community, not only increases our reach, but directly influences members of the communities in which we work by giving us an even improved visibility/credibility/legitimacy, helping to directly address the social barriers of desirability.

MENTORING

Tackling this menace has been a huge learning curve. Our executive team is young, with an average age of 24. Furthermore, this is the first time many of us will be running a venture, our mentoring need is enormous. The connections to seasoned experts as mentors demonstrates the catalytic value of the MIT Solve to us and our work, with our team in need of mentors with experience in public health & last mile logistics.

At Lend an Arm, our motto is, “invent the future, and be proud of it, but never satisfied”. This captures the lifeblood that runs through us. We are aiming to tackle this perennial shortage of blood in Africa by using methods that massively improve the status quo, constantly innovating.

• PIONEER USE OF CONVERSATIONAL AI: hitherto, most technological solutions aimed at the blood problem in developing countries have been software applications (e.g. Google Play Store currently has over 500 blood apps). An analysis we did showed the average download/app was 300 – a very low uptake. We realized the software application approach is becoming saturated and scales poorly alone – so we adapted, creating Asake, a cognitive virtual robot. Asake massively improves our reach. She’s built to live within apps users already utilize often, eliminating the need for caregivers, donors or doctors to download/learn a new application. Asake functions on Telegram, WhatsApp, Facebook, Twitter and even Google Assistant. With combined users numbering over 90 million on those platforms in Nigeria, we are successfully democratizing access to blood banking for everyone – a first anywhere. We expect this new application of technology to spark adoption in other sub-sectors such as in non-prescription medication ordering especially as teleconsultation uptake begins to rise.
   

• PIONEER USE OF DRONES: the use of drones is fast gaining pace, but in Nigeria, the revolution is slow, largely due to lack of know-how. Working with partners, Lend an Arm will be the first outfit to deploy drones for blood supply logistics, massively improving the supply chain as it circumvents the road network challenges in the hinterland, improves delivery speed, and allows express delivery round-the-clock.

Our vision is to make blood transfusions available and safe for all people. Our Lend an Arm app started as a small forum app and has now been expanded into a full native application featuring chatting and medical records. Asake, first-of-her-kind, is fast becoming an industry-leading piece of technology too, these deliver on the former vision.

On the latter, we’ve completed proof of concepts to deliver vital solutions over the next 12 months. “Blood Safe”, a feature in-development, stands as the first-ever point-of-issue blood screening tool. It is an AI/ML algorithm that helps identify blood fit for transfusion based on clots, hemolysis in plasma, leakage of bag and hue of RBCs. It tells doctors/nurses whether a unit of blood is safe from a picture taken with their phone.

In addition to launching “Blood Safe”, in the next year we aim to commence operations in Benin Republic, delivering 9000 units of blood to 200 hospitals while increasing our donor base from 4740 currently to 10,000. Our monthly awareness campaigns are projected to sensitize 30,000 new people over the next year, while our hero training programs will create 350 new community advocates.

The above activities combine to help us achieve our aim of reducing maternal mortality in West Africa by 1 percentage point by 2025

Following our model of asset-light, agile systems ready for export, in 5 years we will be operating in 5 countries in West Africa – Ghana, Republic of Benin, Ivory Coast, Cameroon and Nigeria, with our projected donor population at 1 million donors across 5 countries – delivering 500 units of blood daily across West Africa.

We are constantly evaluating the effectiveness of our intervention following 4 core indicators

• PERCENTAGE OF BANKED BLOOD WASTED = blood units collected that expired/total blood units collected x 100%
• FACILITY-LEVEL BLEEDING-RELATED MORTALITY RATE = number of deaths due to hemorrhage per 100 deaths from all causes in the facility
• ADJUSTED TIME-TO-DELIVERY = Time elapsed between request submission by doctor and blood box delivery to the hospital premises, adjusted for variance parameters (time of the day request was made, method of delivery [drone vs bike], the distance travelled, Google traffic report for that route at journey’s start, Air Traffic Control clearance time)
• ADJUSTED TIME-TO-RESPOND = Time elapsed between when ambulance request was submitted and its arrival at the scene for pick-up, adjusted for variance parameters (time of the day request was made, city of request, the distance travelled, Google traffic report for that route at journey’s start).

PILOT PROJECT RESULTS

• At the end of our pilot phase in Oyo, Lagos and Ogun States, we had worked with 16 blood banks across over 1000 blood bags delivered. Historical percentage of banked blood wasted was 19% (Range = 3% - 26%) across these facilities (2015-2018 data) before we implemented Lend an Arm. Average percentage of banked blood wasted after, was 4.4%, important to note that the range after Lend an Arm was 0% - 11% (meaning Lend an Arm improved blood bank efficiency, reduced waste in all contexts). Furthermore, Lend an Arm achieved 0% banked blood wasted in 6 of our 16 partner banks.
• We collected data on facility-level bleeding-related mortality for 20 hospitals during our pilot [counting at least 100 deaths in each hospital]. We recorded an average 3 per 100 all-cause deaths with Lend an Arm coverage (contrast with 17/100 (2015-2018)). Range = 0 - 13; Mode = 0. Lend an Arm brought bleeding-related death down to 0 in 8 of our 20 facilities by the end of pilot phase, and it remained so for 6 months post-pilot

Lend an Arm is a social venture that is run on an evidence-based implementation model. Our project activities/interventions deliver lasting change following a research-backed theory of change.

THE PROBLEM

An inadequate supply of safe blood in sub-Saharan Africa, starting with Nigeria, causing preventable deaths of mothers, children, trauma victims and other vulnerable populations.

DRIVERS

• Low prevalence of voluntary unpaid donation stemming from low awareness on the importance of voluntary blood donation, misconceptions and myths about blood donation, poor access to blood donation facilities.
• Inappropriate use of blood by health professionals
• Poor quality control measures, screening and storage practices with disregard for the cold chain.
• Poor funding and government support for national blood services
• High access barriers to blood donation with few independent, community-driven interventions such as blood drives/campaigns.
• Loss of confidence in the healthcare delivery system by the general public
• Poor transparency in the pricing of blood and blood products leading to extortion of patients in need.

With an understanding of our chosen problem and its drivers, below is our theory of change to deliver lasting impact.

UNDERLYING ASSUMPTIONS [Activities =>Outcomes]

• Media campaigns improve perception on blood donation, promoting first-time donations.
• SMS reminders modify compliance behavior positively
• Media coverage influences perception & behavior among the population.
• Social gatherings of people with a common interest leads to formation of relationships and reinforcement of the shared mutual interest.
• With reduced barrier to access, participation in an event increases.

UNDERLYING ASSUMPTIONS [Outcomes =>Goals]

• Improved knowledge and attitude towards blood donation increases donations.
• Motivated individuals become repeat donors.
• Improved knowledge among health professionals reduces the incidence of needless transfusions.

UNDERLYING ASSUMPTIONS [Goals =>Impact]

• Adequate blood supply reduces maternal mortality and child mortality
• Complex surgeries are more likely to be done by surgeons when they are assured of a stable blood supply.

ASAKE: AI bot built using NLU/NLP services API of IBM Watson and conversation design of Xenioo Cloud. Built to perform two roles – A blood bank porter and BLS information provider, and integrated into social media channels – WhatsApp, Telegram & Facebook Messenger [using their respective Bot APIs]; and offline via SMS channel [using Twilio APIs]. As porter, she executes blood requests, collects payment, schedule donations and blood drives; and times blood delivery, using APIs (Paystack API to process payment; Toggl API for timing delivery; Integromat, Airtable, and Firebase Cloud Firestore for scheduling, storing and retrieving donation booking, requests and related information). As BLS information provider, provides information on what to do as first aid in emergencies, on-demand. She pulls relevant information from the Red Cross Society BLS training manual on our Xenioo Cloud database, providing interactive real-time instruction to first responders.

LEND AN ARM APP: A mobile application written in Blockly and runs on the Android OS.

• For requests, the app takes doctor’s live location and then follows an algorithmic sequence 
  • Arranges the blood bank database from closest to farthest with respect to the doctor’s coordinates 
  • Arranges the blood bank database from banks with the most units of blood type needed, to those with the least. 
  • The top 2 banks when I and II are combined (i.e. the closest banks with highest number of blood type requested; along with their coordinates) are sent to the Lend an Arm dispatch team along with request details. The team uses this to set coordinates for drone flights, or send the motorcycle rider. Our Airtable database has banks mapped and their stock levels updated 2ce daily.
• Automated calculators such as – blood volume in children, fluid and electrolyte resuscitation algorithms in children, burns patients, and massive bleeding. These calculators are built-in to minimize physician error when responding to emergencies.
• Social Media for blood donors – we built a chat room feature exclusively for voluntary donors, using firebase chat SDK allowing instant messaging between donors.

DRONES: We are pioneering the use of long-range Fixed-Wing VTOL electric drones for blood and blood product delivery in the last mile. Our Rigi Eiger and Yangda FW-320 VTOL drones are capable of carrying up to 5kg (6 blood bags) over a 130km range BVLOS on a single charge fully autonomous. We need no launch or landing gear, and can set-up flight operations anywhere in 30 minutes.

At Lend an Arm our vision embraces an equitable and diverse future and this desire to be so has been from inception. We are a founding team of four innovators - two women and two men. We have been colleagues for 9 years, and together worked on Lend an Arm for 5 years. Our founding team is supported by a team of 10 other full time staff of which 6 are women and 4 are men. Our solution itself was built following consultative meetings and self-funded surveys conducted in 31 rural communities across Nigeria -  advised and informed by the very people for whom this problem we are trying to solve affects. This approach has seen our solution adopted rapidly and with open arms in host communities where our competitors have failed and been forced to pivot. We firsthand have discovered the power of inclusivity in every step of solution development - ideation through implementation and we feel this is the only sustainable way to proceed with scaling Lend an Arm even in future. We also understand that minority groups indeed bring insight to the table that is often lost in the crowd thus we massively respect the voice and vision of everyone.

TARGET MARKET & VALUE PROPOSITION

Our target market is the secondary and tertiary levels of the healthcare industry as blood transfusions mostly occur at these levels. Our typical users are public/private hospitals who have an in-patient service for the care of patients and routinely perform blood transfusions and surgeries but do not have their own blood bank. Thus, they patronize private blood banks. However, unlike our network, these blood banks do not transport blood, breaking the cold chain by making relatives come hunt for blood themselves. These banks are hard to reach and are slow. We provide these hospitals a safe, reactive supply of blood within the shortest time.

Furthermore, we speed up service delivery at partner hospitals by integrating electronic medical records, point-of-care technologies and process automation, allowing healthcare workers focus on patient management. We improved patient turnover and satisfaction by up to 15% in 1 month and 33% in 6 months respectively at our partner hospitals.

DISTRIBUTION CHANNELS  

Our mobile application, and Asake are the ways through which existing and new customers can access our services. Payments for customers is simplified, easy and can be done seamlessly through any of the aforementioned routes. Transportation of blood and blood products to customers from our center is inside cold boxes mounted on delivery motorcycles secured by Bluetooth smart padlocks with one-time-passwords (OTP) remotely shared with receiving institution in elective cases of blood delivery, and via unmanned drones in emergency cases.

REVENUE MODEL: We have two major sources of Revenue

1. We charge hospitals a commission fee billed for functioning as a blood banking-as-a-service venture. We charge a $5 commission per pint of blood delivered to the patient's bedside.
2. We also offer hospitals a full-suite Electronic Medical Records Software which we charge a monthly subscription fee for.

REVENUE: Lend an Arm currently generates $1000 in Monthly Recurring Revenue ($3500 in average monthly total revenue - Q1 2022). 

GRANTS: Healthbotics Limited has received grant support totalling $30,000 from The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), The US Chamber of Commerce, The WHO, The IT Industry Development Agency of the Government of Egypt, The International Telecommunications Union (ITU), The Resolution Project, and Wharton Business School.