Nextgen Health App

Non-communicable diseases (NCDs) have become a growing challenge both globally and in the sub-Saharan regions of Africa, particularly in low-middle income countries (Bigna & Noubiap, 2019). In Kenya, approximately 39% of deaths annually are as a result of NCDs, up from 14% in the year 2014. If no immediate action is taken, NCD-related mortalities will increase by 55% by the year 2030 (Cieza et al., 2020). The increase in NCDs in developing countries, such as Kenya, can be largely attributed to lifestyle decisions (Allyne et al., 2015), such as sedentary lifestyle and physical inactivity, elevated consumption of processed foods, and smoking and alcohol use (Guwatudde et al., 2015). The management of NCDs in low and middle-income countries remains biased toward short-term pharmaceutical interventions, resulting in a de-emphasis on longer-term solutions, such as lifestyle interventions (Ezzati & Riboli, 2012; Kontis et al., 2014). With an increasing focus on pharmacological interventions, the costs associated with treating and managing these NCDs are usually high and out of reach for most people (Suhrcke, Boluarte & Niessen, 2012). However, lifestyle medicine has been shown to be effective in addressing behaviours and unhealthy habits responsible for chronic conditions such as hypertension(James et al., 2014)(Mozaffarian et al., 2016).

Due to the huge smartphone penetration and internet usage in Kenya; in 2020, mobile phone usage among adults was 98% with 43% of the adults using the internet (96% of them on smartphones rather than computers) and 17% using social media;98% of them on smartphones (Kemp, 2020, experts are in agreement that mobile health technologies possess great opportunities to rehabilitate the healthcare industry while addressing the inequalities that have remained so prevalent (Bull, 2016). But even alongside these digital technological advancements, the prevalence of obesity and non-communicable diseases has continued to rapidly increase (Global status report on noncommunicable diseases 2014, 2022), leading to rising economic, social and healthcare costs (Wang et al., 2011). However, due to the accessible nature of smartphones and apps, mobile health applications have the potential to offer adequate and cost-effective health care solutions to manage the rising burden and prevalence of NCDs and have been suggested as an approach to promote health equity by facilitating persons suffering from chronic diseases with remote healthcare support, where barriers exist to in-person care (Ben-Zeev & Atkins, 2017; Holeman & Kane, 2019).

NextGen mobile health application will be used to educate and get people with NCDs to start & adhere to lifestyle modifications such as exercise, proper nutrition, sleep and mental wellness strategies through videos, audio and reading materials. The application will also monitor adherence to the lifestyle modification program and other health outcomes such as blood pressure, blood sugar, waist circumference and resting heart rate to determine if the program is improving health outcomes. 

People living with NCDs who have smartphones will be able to download the application and those without access to a smartphone or the internet will be able to use the Unstructured Supplementary Service Data (USSD) version to access the program. The application will allow for an offline mode for those who don't always have access to mobile data or WIFI. 

The people living with NCDs will be in charge of accessing the information and inputting their own health data so that they are able to take ownership of their condition and track changes in their health over time. Healthcare providers will be able to download the application, monitor patients' vitals remotely and communicate with patients. This is not common practice because most patients' vitals are collected in the primary health setting and are single-point readings which are not very accurate. 

This application targets all patients with NCDs in particular patients living with hypertension and diabetes because these are the two most common conditions in Kenya. The management of NCDs in low and middle-income countries remains biased toward short-term pharmaceutical interventions, resulting in a de-emphasis on longer-term solutions, such as lifestyle interventions (Ezzati & Riboli, 2012; Kontis et al., 2014). With an increasing focus on pharmacological interventions, the costs associated with treating and managing these NCDs are usually high and out of reach for most people (Suhrcke, Boluarte & Niessen, 2012).

Our solution aims to empower people to live healthy and sustainable lives & to reduce the cost of treatment of people living with NCDs through lifestyle medicine intentions using M-Health applications. Due to the huge smartphone penetration and internet usage in Kenya; in 2020, mobile phone usage among adults was 98% with 43% of the adults using the internet (96% of them on smartphones rather than computers) and 17% using social media;98% of them on smartphones (Kemp, 2020, experts are in agreement that mobile health technologies possess great opportunities to rehabilitate the healthcare industry while addressing the inequalities that have remained so prevalent (Bull, 2016). But even alongside these digital technological advancements, the prevalence of obesity and non-communicable diseases has continued to rapidly increase (Global status report on noncommunicable diseases 2014, 2022), leading to rising economic, social and healthcare costs (Wang et al., 2011). However, due to the accessible nature of smartphones and apps, mobile health applications (mHealth) have the potential to offer adequate and cost-effective health care solutions to manage the rising burden and prevalence of NCDs and have been suggested as an approach to promote health equity by facilitating persons suffering from chronic diseases with remote healthcare support, where barriers exist to in-person care (Ben-Zeev & Atkins, 2017; Holeman & Kane, 2019).

We run a health clinic called Nextgen Health & Wellness Clinic where we get to interact with patients with NCDs on a daily basis and we collect data and prescribe lifestyle modification programs through a mobile application for some of the patients. We have gotten the opportunity to understand the needs of members of the community and what they respond to with regard to treatment. 

Secondly, all of our team members live in Kenya and are of Kenyan Nationality which allows us to interact on a daily basis with people within this community and understand their needs at a deep level. Our team comprises people from both middle-income and lower-income backgrounds which are representative of the population that we aim to serve. 

We are currently doing a study entitled: 

"ATTITUDES, BARRIERS, AND FACILITATORS OF HEALTHCARE WORKERS AND PATIENTS TOWARD USING A LIFESTYLE MEDICINE, MOBILE-BASED,   CHRONIC DISEASE MANAGEMENT APPLICATION IN KENYA."

This will allow us to better understand the attitudes, barriers, facilitators and needs of the population from an m-health perspective as we enhance the usage of the application. Which will ensure that the application is using a human-centred design. 

Financial constraints have not allowed us to expand the program and we are currently utilizing a generic mobile application to run the program. We are looking for funding so that we can able to finalize the rollout phase of the application that we have created that has been customized to the needs of the Kenyan population. The MIT Solve award will also allow us to penetrate the market and allow the product to reach as many people living with NCDs in Kenya.  

Our solution provides three (3) new or significantly improved approaches to the problem because : 

1. Healthcare providers can now prescribe lifestyle medicine to patients living with NCDs and monitor adherence to the program remotely. Currently, most healthcare providers prescribe lifestyle changes to patients however there are limited facilities where patients can implement the lifestyle changes. Secondly, healthcare providers are never certain whether patients are compliant with a lifestyle modification program.
2. Healthcare providers can now monitor patients' vitals remotely with more data points which were previously not possible because patients have to come into the primary health setting to get measured.
3. Patients are empowered on how to modify their lifestyle in a sustainable manner which in turn allows them to reduce their reliance on medication and halt the disease progression which will consequently reduce the cost of treatment. 

Ultimately, the solution will: 

1. Encourage healthcare providers and patients to use lifestyle medicine instead of relying purely on pharmacological interventions which have been shown to be costly and have numerous side effects. This will be achieved through testimonials and outreach programs highlighting the results that can be achieved using lifestyle medicine.
2. Allow healthcare providers to embrace technology in health which can allow them to monitor patients remotely and track their progress because they will be able to receive more health data from patients during the review. 
3. Empower patients to take control of their health and track their health metrics using m-health applications. Through gamification, patients will enjoy the process of tracking their own health and improving their health.  

Within the next year, we expect to 

1. Help patients living with NCDs reduce their healthcare costs and reliance on medication through lifestyle medicine programs via the mobile application within Nairobi. This will be achieved by enlightening healthcare providers and patients on the power of lifestyle medicine in treating NCDs through targeted marketing and outreach programs.

Within the next 5 years, we expect to: 

1. Significantly reduce the burden of NCDs and the cost of NCDs treatment within the entire nation and surrounding countries. This will be achieved by: 

a) Having the app utilized in the major hospitals within the country by partnering with relevant stakeholders in health including the Ministry of Health (MOH) which will ensure that we have a wider reach to the people in the community. 

b) Partner with the National Hospital Insurance Fund (NHIF) and other insurance companies which will make the app more affordable and accessible to all people. 

Progress will be measured using the following metrics: 

1. Improvements in health outcomes such as blood pressure, blood sugar, HBA1C e.t.c 
2. Reduction in medication load. 
3. Reduction in healthcare cost.  
4. Reduced doctor visits and hospitalizations.  
5. Reduction in the total number of patients living with NCDs. 

The key activities include:

1. Lifestyle modification program: Exercise, targeted nutrition, sleep and mental wellness programs. 
2. Collection of health data and adherence to lifestyle modification programs. 

The outputs are: 

1. Patients are educated on proper lifestyle modification practices specific to their conditions. 
2. Patients engage in lifestyle modification practices. 
3. Patients track their health data. 
4. Healthcare providers track patients' health data and adherence to lifestyle modification and adjust treatment accordingly. 

The short-term outcomes are:

1. Enhanced Physical activity 
2. Improved nutrition
3. Improved sleep & Mental wellness 
4. Improved tracking of health data

Medium-term outcomes: 

1. Improved fitness
2. Weight loss 
3. Better sleep patterns 
4. Improved blood sugar control, blood pressure and other health markers. 
5. Consistent health data sets for healthcare providers.  

Long term outcomes: 

1. Reduced or removed medication load 
2. Fewer doctor visits and subsequent health savings. 
3. Remission or reversal of the chronic disease
4. Reduced NCD burden 
5. Improved health data collection in primary healthcare settings

Our solution will be using primarily a mobile-based application for those who have access to mobile phones and the internet. 

Those that are unable to access smartphones and the internet will utilize USSD and SMS technology to allow them to get education about lifestyle changes and input their health metrics. For the USSD feature patients input, a code on their phone dial-pad and they will be directed on how to input their daily values. They will be able to receive infomation and education about their condition and lifestyle modification program via SMS. 

The patients living with NCDs will collect primary health care data directly to their mobile devices. 

This will be done by putting their health metrics such as blood pressure at regular intervals via the mobile app or USSD.  Their adherence to the program will also be tracked via the app. 

Their incentive will be:  

1. Better insurance premium if they adhere to the program.  

2. Possible reduced medication load if they adhere to the program 

3. Possible reduced doctor visits and hospitalizations.  

As an organization that caters to the health and wellbeing of people from all walks of life; diversity, equity and inclusivity (DEI) are second nature to us. Nextgen is committed to fostering and maintaining a work environment where DEI is fully integrated into everything we do for the benefit of our employees and the clients that we serve.

Our leadership team is composed of both male (4) and female (4) staff members from different ethnic and religious backgrounds. We make every effort to provide our employees with equitable distribution of opportunities and resources as a way of promoting aspirational growth which ultimately begets organizational growth.

It is the policy of Nextgen to ensure equal employment opportunity without discrimination or harassment on the basis of race, colour, religion, sex, sexual orientation, gender identity or expression, age, disability, marital status, citizenship, national origin, genetic information, or any other characteristic. We believe that people should be treated as individuals, respected for their unique attributes and not excluded, harassed or bullied in any way, through unconscious bias, stereotypes or unlawful actions that may form the basis of discrimination, harassment, vilification or victimization.

In an effort to become more inclusive, we are exploring additional ways in which we can partner and employ staff that are differently abled within the Nextgen community. Currently, our facilities in Nairobi, Kenya are wheelchair accessible and have been fitted with apposite equipment to ensure the differently abled have easy access.

We are also keen on forging international partnerships with organizations and people of other races and religions which will broaden our scope of collaboration, sharing of information and professional cultural practices.

1. Segments 

• Beneficiaries: Patients living with NCDs & healthcare providers within Nairobi Kenya
• Customers: National hospital insurance fund, Medical insurance companies, private corporate companies and the actual patients living with NCDs.

2. Type of intervention 

• Mobile applications will be used to help patients track their health data and modify their lifestyles. 

3. Value proposition 

• Impact measures: Social impact will be measured by calculating the reduced cost of healthcare services due to reduced medication, doctor visits and hospitalization due to NCDs. Social impact will also be measured based on improved services to patients through the collection of health data. 
• Customer value propositions: Our customers want to reduce their reliance on medication and improve their overall health. Our customers also want to track their health data in a simplistic manner with limited resources. 

4. Channels 

• Digital Marketing 
• Medical insurance members' awareness 
• Private corporate awareness drives 
• Healthcare provider's seminars and workshops 

5. Key activities 

• Education on NCDs 
• Lifestyle modification programs
• Collection of health data 

6. Key resources 

• Funding to roll out and market the app 
• Access to decision-makers at the insurance companies  and corporates

7. Partners and key stakeholders

• National hospital Insurance fund 
• Medical insurance companies 
• Private corporates 
• Ministry of Health and Public Hospitals 
• Private hospitals

8. Cost structures 

• Biggest expenditure areas: Roll out of the app and marketing/awareness initiatives.  
• How they change as we scale up: The need for funding for the app reduces once we scale up and most of the money will go into maintenance and fixing any bugs. The main cost that will increase will be marketing and awareness. 

9. Surplus 

• We plan to invest the profits mostly into marketing, awareness and partnerships that will see the program grow to all regions of the country and other sub-Saharan countries.

10. Revenue 

 We propose to procure revenue from the following stakeholders as follows:

• National Hospital Insurance Fund: 50%   
• Medical insurance: 30
• Private clients: 10% 
• Private corporates: 10%  

The money to fund our work will be sourced through: 

1. Selling our services: Patients living with NCDs who can afford the service will pay out of pocket. This will mostly be the middle and upper-class members of society. 
2. Service contracts with medical insurance companies: Since it is in the best interest of insurance companies to have healthier clients we will source for contracts where their members with NCDs will be entitled to utilize the services as part of their annual benefits. 
3. Service contracts with private corporates: Private corporates have an annual allocation for health and wellness services and we will source for contracts with them to allocate some of that funding to their employees living with NCDs.  
4. Through sustained donations and grants: Even though this is not a guaranteed or sustainable method we will continue sourcing for grants that will allow the program to grow.

1. We have entered a partnership agreement with a company called  Intellisoft Consulting Limited which has funded the building of the mobile application. 
2. We have currently been using a 3rd party application called Physitrack as we await the completion of our main application. We have been charging our private patients at our clinic for the use of the applications and we have been making a profit from the subscriptions.