Houdini

Primary Healthcare (PHC) is the foundation of the healthcare system for all individuals globally, where non-emergency, preventative health issues are managed or resolved and should ideally be accessible to all on a need basis and free from any geographical, social, or financial barriers. However, in Nigeria, the current state of the PHC is frankly shocking, with significant room for improvement. Recent reports show that only about 20% of the 30,000 PHC facilities across Nigeria are fully functional, and a majority still require a notable level of performance improvement to provide satisfactory services to patients. With an approximate population of over 200 million and 40% living below the poverty line (The Guardian, 2022), PHC remains out of reach for millions of Nigerians as a result of cost factors. This compounds on some of the issues already faced by many of the centres, including poor staffing, poor distribution of health workers, poor quality of healthcare services, poor condition of infrastructure, and lack of supply of essential drugs. As a result of poor PHC services, patients continue to flood secondary and tertiary healthcare facilities across the country, creating a ripple effect of growing hospital queues and worse patient experiences. Additionally, the Nigerian government contributes significantly to the setbacks faced by the healthcare sector in Nigeria, with less than 4% of its budget being utilised in the field, leading to heavy reliance on donors and NGOs (Devex, 2021).

Despite the presence of strong performance measurement standards globally, there are still limitations in performance measurement processes. Current data collection methods often lack comprehensive purpose, and could even sometimes be lacking in quality and inconsistent. This makes it difficult to interpret data to provide insights into practical performance that will help in making informed decisions that will lead to performance improvement.

Our solution, Houdini, is built to address the challenges of aggregating both primary and secondary data and making adequate, insightful interpretations with improved measurement methods that can allow Primary Healthcare Services to make decisions pertaining to the performance improvement of the services they provide to patients. The creation of a centralised system will allow data systems to communicate with one another and help to streamline data collection and data interpretation for the purpose of generating actionable insights.

Houdini PHC (Primary Healthcare) is a realtime online user experience application or online survey Mobile Application service that will allow PHC users deliver concise and real time feedback frame which gives direct User Service accessibility and experience feedback within local environment, thereby generating direct primary data to make informed decision on arms of productivity and service improvement to deliver state of the art services and service improvement of the PHC. The primary data collection for Houdini will be conducted in two ways that will allow flexibility and inclusivity for different types of devices and bandwidth connectivity. Users can provide intermittent feedback for different categories of their experience through either a mobile application requiring low bandwidth internet connectivity, or through an SMS text message application. Users will be incentivised with healthcare vouchers for discounts at pharmacies et al, with the discount vouchers in turn being supported by health goods companies seeking sales, thereby ensuring the sustainability of the platform. 

In addition, Houdini also aggregates data from secondary sources of PHC service improvement data. This is in a bid to improve data richness and streamline data interpretation to provide impactful, accessible and actionable insights that will help with PHC performance improvement. Such secondary sources include realtime big data aggregation bodies such as The World Bank, United Nations (UN), Nigeria Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO) and more.

These aggregated data will be cross referenced with various PHC measurement indicators to determine  “wellness score” on an individual, community, and PHC Center level. The wellness score will be used in determining how well a service is being rendered in a bid to indicate improvement areas to PHC centres.

Our solution seeks to provide meaningful insights into what is working well and where improvements are needed within the Primary Healthcare system in Nigeria. Such a solution would directly impact, first of all, the performance of PHC centres and their working medical staff in terms of how they are able to successfully deliver services to those in need. This would in turn positively impact the ways users of PHC services receive treatment for their needs, giving them better, more efficient healthcare service delivery from the improvement areas identified and actions taken by the centres. Currently in Nigeria, the performance and operations of a large majority of PHC centres is underwhelming and insufficient to cater for the needs of patients due to the poor conditions, facilities, staffing, quality of the services being rendered, and more.

LoftyInc Allied Partners Limited prides itself as an innovation development company that delivers social impact projects across Africa and in different sectors including Health, Education, infrastructure, and more. With offices across 4 States in Nigeria and experience in delivering projects across all parts of the country, we are well positioned to serve Nigerian communities in helping them improve their access to Primary Healthcare Services. Monitoring and Evaluation is one of the services we provide at LoftyInc. Recently, our team of enumerators and M&E experts conducted an evaluation of over 70 healthcare centres across different parts of the country to understand the needs of communities in healthcare. The evaluation included Surveys, Key Informant Interviews, as well as Focus Group Discussions in a bid to fully engage these users and understand their needs. This helped our team collect meaningful, first hand data from the users of healthcare services, which allows our team to make useful interpretation and recommendations about the healthcare services being provided. These insights gained from the interpreted data help shape the solution we believe will make a difference towards improving Primary Healthcare Services in Nigeria. 

The Challenge would significantly help in overcoming a financial barrier of implementing such a solution on a national scale. Large amounts of data will be collected both from primary and secondary sources, which would require a tremendous amount of software support and cloud storage solutions to preserve data for many years to come. Additionally, such a solution would require some form of publicity to raise awareness of its existence and benefits to the masses. The Challenge can support this financially through publicity campaigns, training workshops, and other support mechanisms that will drive the adoption of such a solution nationwide.

Our solution, Houdini, largely provides a more refined approach to streamlining data collected on the performance of PHC centres, whilst also obtaining real-time information from primary sources as they relay their experience with a PHC centre. It seeks to aggregate data from different sources and interpret them into a uniform ‘wellness score’ that will be easily recognisable across the board, easing data analytics and providing useful easy to understand insights that can prove helpful towards improving Primary Healthcare in Nigeria. We believe that our solution will enable broader positive impacts from other key players such as the National Primary Health Care Development Agency in Nigeria that will help in refining data collection processes toward a more unified system.

The primary impact goal of Houdini is to provide actionable insights into PHC performance improvement through the aggregation of data from primary and secondary sources into a defined ‘wellness score’ for individuals and communities. Through this creation, we forecast a positive impact in the way Primary Healthcare is delivered to patients in Nigeria, leaving them with better health and a better experience overall. For the next year, we seek to complete the solution prototype and deploy it to a target two States in Nigeria: The Federal Capital Territory, Abuja and Lagos States. This will serve as the public beta, where we can obtain feedback and make refinement to our solution for optimised results. A year-on year increase in the number of States covered by this solution is expected, while we are targeting a full, nation-wide coverage across all 36 States and the Federal Capital by the end of the 5th year. Through constant improvement of the service/solution, raising awareness and providing ease of access to actionable data, Houdini would have a notable positive impact on a significant portion of Nigerians.

There are two main indicators that we are using to measure the progress of our solution and the impact it would have on communities nationwide. Firstly, The solution collects data on the frequency of visits to PHC service centres, which would help inform our team on any performance improvements these service centres may have gained as a result of the insightful, actionable data provided by Houdini. Secondly, Feedback data on expenditure is also collected as part of the process in a bid to monitor how much individuals and communities spend on PHC, which can be attributed to more or less frequent visits depending on the expenditure trend.

Houdini is designed to bridge a gap in how data is collected, aggregated and interpreted to support performance measurement improvements in Primary Health Care. By helping to streamline secondary data and obtaining consistent, real-time continuous primary data, Houdini is expected to derive actionable insights that are reflective of the performance of PHC service centres. We believe that it will have an impact on the problem of performance measurement as it will serve as a central data bank providing near real-time information on the performance of the Primary Health Care system.

Our solution combines three main technologies to provide the best possible experience to users from all backgrounds, whilst also interpreting data from different sources to provide the best actionable insights. At the core, the interface for data visualisation comes in the form of a web application. This application integrates APIs (Application Programming Interface) to retrieve data from other sources where they can be streamlined and categorised, before being put through a machine learning algorithm that will determine the ‘wellness score’ of patients and communities for insights. Primary data collection will be done through either a mobile application, where users can fill feedback forms each time they visit a centre, or through SMS technology in cases where users do not have access to smartphones. These sources of data collection are especially ideal as they do not require a high level of bandwidth connectivity.

Primary Health Care data collection will be done via both primary and secondary collection means. Secondary data will be obtained through the use of APIs (Application Programming Interface) on our solution to access data from other websites where permissible. Primary data will largely be collected by the users of Primary Health Care Services. Primary data collection will be done through either a mobile application, where users can fill feedback forms each time they visit a centre, or through SMS technology in cases where users do not have access to smartphones. These sources of data collection are especially ideal as they do not require a high level of bandwidth connectivity. Users are incentivised by receiving healthcare vouchers for discounts at pharmacies, clinics et al, which are in turn supported by health goods companies seeking sales to ensure sustainability for the solution.

LoftyInc is an organisation committed to inclusion, diversity and equity. The main purpose of the Houdini is to provide a platform for all people's voices to be heard equally with regards to their experience with PHC services. Our solutions team consists of several individuals from different backgrounds and with varying experiences. Additionally, in past completed impact projects, LoftyInc emphasised the importance of diversity and inclusion by involving the stakeholder community through project life cycles to ensure their needs are being heard and addressed adequately to solve their problems, as well as by creating a working environment that promotes respect and understanding. With this challenge solution, we aim to replicate such acts and go even beyond what we have achieved previously in terms of diversity, equity and inclusivity.

At LoftyInc Allied Partners Limited, our mission is to contribute to the enhancement of lives by creatively investing in ideas, while positively changing the broader society through social impact projects. The Houdini initiative is an extension of these intentions to further expand our capacities into making a high social impact in the Nigerian Health sector, benefiting both the advantaged and disadvantaged, and bridging the equity and access to healthcare gaps in the country. The business model around Houdini leverages on the experiences and feedback from PHC users, and adds value to their experiences by providing access to discount vouchers for healthcare services, as well as informed and actionable insights into how service providers can make their lives significantly better through performance improvements. These would help PHC users spend less on healthcare items given the growing rates of poverty and rising inflation while getting better value for their money, thereby making PHC services ever more accessible and satisfactory. 

As users of Houdini are incentivised by receiving healthcare vouchers for discounts at pharmacies, clinics et al, these vouchers are in turn supported by health goods companies seeking to grow their sales nationwide. Through this effort and partnership deals with the aforementioned companies, we believe that Houdini will generate revenue that will ensure continuous operations and sustainability for the solution. This will work in combination with grants and donations from other parties that are seeking to fight for the cause and make a positive impact.

LoftyInc is yet to start raising funds for the full development and deployment of the Houdini platform. The current work done has been by our internal staff members of the product department and they are still responsible for the current development efforts being carried out. However, we intend to raise funds as the product develops further as we push towards the pilot and growth stages.