Cliniva

We are solving the problem of lack of access to personalized, high quality primary care at an affordable price for women, starting in Kenya. The healthcare sector in Kenya faces serious challenges across access, quality and affordability. 30% of the urban population and 70% of the rural population have no access to a provider; this challenge is particularly acute with respect to women (who make over 85% of healthcare decisions in Kenya), with certain areas like menopause or mental health completely neglected, and others (e.g., fertility or gynaecological conditions) lacking specialists and unaffordable for over 98% of women. Women are also 50% more likely to be misdiagnosed and receive the wrong treatment than men.

Only ~3% of people in Kenya are insured and many households face catastrophic healthcare expenditures every year. The sector is extremely fragmented, with over 10,000 private sector clinics operating mostly independently with lack of clinical and quality standards; most patients have extremely low trust for providers and are constantly looking for better options to meet different needs (e.g., children's health vs. reproductive health). Scarcity of doctors in Kenya (2 per 10,000 people vs. 45 in Germany) makes the problem even more difficult to solve. 

Globally, over 2 billion women lack access to essential healthcare services. 

Our solution offers women highly personalized affordable healthcare with a focus on prevention and convenient access. We achieve this by integrating neighbourhood mini clinics and telemedicine for continuous and proactive follow up. Our model relies on highly scalable nurse led care: we create cohorts of highly trained nurses supported by carefully managed protocols and digital infrastructure. Initial patient encounters in physical clinics support the creation of trust-based relationships from the in-person interaction and lay the foundation for a continuous patient journey through telemedicine. This trust based hybrid model allowed us to pioneer the "whole woman" preventative long-term care approach that goes far beyond the transactional healthcare interaction. We have created access to care generally not available within the primary care system in Kenya (e.g., menopause assessment and support, fertility and pre-conception counselling, mental health assessment).

We are targeting lower- and lower-middle income women living in urban and peri-urban areas in Kenya. The large majority of our customers are informally employed and paying for healthcare out of pocket (uninsured). A small share are insured through their employers, or national insurance schemes. Currently, our target population are undeserved by the healthcare system in 3 main ways:

• They lack access to primary care either due to distance to the nearest facility, associated transport or waiting time cost (hours) that they cannot afford. 
• They are more likely to be misdiagnosed than men, or stigmatised for their health concerns.
• They face significant gaps in quality of care (decent quality is typically isolated at the high end of the price range).

We improve the lives of our customers by:

• Creating direct savings to women and their families from lower spend on healthcare and related time saving. Our cost of care is 30% lower than alternatives. A visit to Cliniva involves 80% less time spent across both transport and in-clinic waiting time.
• Improved health outcomes through creating access to women’s healthcare and better diagnosis and treatment.
• Better work and life productivity through improved wellbeing. We see 30% less sickness related leave due to focus on prevention and continuous care.
• Avoiding catastrophic healthcare expenditures (e.g., related to C-section) due to our focus on personalized diagnosis and wellness.

Our solution is focused on women and addresses significant gaps in gender inclusivity that exist in the Kenyan healthcare system. Our care model is designed to include women’s lifestyles and goals, behavioural preferences, social context and mental health to offer personalization for better health outcomes.

98% of our team, including me, are women who have experienced gaps in the African healthcare system first hand. Our nurse employees mostly come from lower and lower-middle income segment in Kenya and therefore are themselves part of our target population. All members of our team are current users of Cliniva's solution for their and their families' health needs. Beyond that, all our work is designed to be guided by the communities' needs and preferences, for example:

• our solution prototype was tested with several dozen lower income women in our first pilot community (Ngong town in Kenya). 
• we extensively tested various components of the service blueprint, and the offerings and price points at a pilot clinic, followed by continuous iteration based on early user feedback.
• our care model and proprietary clinical protocols were designed and are constantly updated to include personalization around women's preferences, needs, and social context. 
• we consistently collect feedback from customers through qualitative questions on satisfaction at different points of patient journey and in-depth interviews with selected customers.
• our customer acquisition relies on close engagement with community health workers who are employed by us to provide basic health screenings and assessments in the communities we serve and collect extensive data on community health.

Since launching to patients 18 months ago after designing and validating the solution with a few dozen customers, clinicians, and public health professionals, we have achieved the following milestones:

• Reached over 30,000 lives with our healthcare solution
• Achieved breakeven at the clinic level in July 2023, only 9 months after launch
• Expanded from a single clinic in Q3 2023 (2nd clinic launched in our 2nd community in Kenya)
• Achieved industry leading Net Promoter Score of 94 (compared to the average of -5 in Kenya).

Our model is ready for scale leveraging both our physical and digital infrastructure. The scale plan relies on i) high level of standardisation across clinical and non-clinical operations; ii) proprietary clinic in a box concept and design that allows us to fully setup and open a new clinic in 3 weeks and iii) scalability of nurse-led care. 

We have also raised our first equity investment round.

We would hugely benefit from support from MIT Solve in a couple of areas:

• Access to technology expertise and partnerships. In the next couple of years, we plan to significantly expand our digital infrastructure (with telemedicine, patient platform and AI assisted tools) as well as invest in data analytics of our rich patient database. To make it successful, we'll be looking for expert support, access to exceptional technical talent and partnerships with existing medical solution providers and data solutions. 
• Creating a robust impact measurement approach. The impact we have on our patients' lives is broad and spans across different aspects of their lives. We plan to create a robust impact measurement approach and would be seeking support around best practices and tools.  

Our model is innovative in a few main ways:

• There are no effective hybrid solutions for women's healthcare in Sub Saharan Africa. Solution providers either focus on physical structures (neglecting the need for continuous care journey and ongoing data capture) or on digital ecosystems (neglecting the need to build physical trust);
• We are the only nurse-led model in Africa, which allows us to tap into a talent base large enough to actually expand the availability of primary care (rather than just take market share relying on a very scarce talent pool of doctors);
• We pioneered the "whole woman" long-term care approach that goes far beyond the transactional healthcare interaction and promotes prevention. This allows us to create access to care generally not available within the primary care system in Kenya (e.g., menopause assessment and support, fertility and pre-conception counselling, mental health assessment).

Our solution is proving that nurse-led care is not only more scalable and less costly, but achieves better quality and superior health outcomes. If adopted by other providers, it can have a significant impact on solving the problem of access and quality in the system across Sub-Saharan Africa. Trust-based continuous care model that we have built has demonstrated a great effect on behaviour change in terms of seeking prevention and wellness services. If this effect is sustained at scale, our model will significantly change the nature of the market (from curing diseases and symptoms to long-term prevention for women).  

We enhance wellbeing of women through improved health outcomes and income and time savings by offering convenient access to highest quality physical care and telemedicine and creating trust-based relationships with clinicians. 

Details of our logical framework that supports this theory of change:

Activities and inputs: We provide affordable healthcare services for women out of our miniclinics and through telemedicine. We create clinical protocols that emphasise long-term prevention, and train our nurse clinicians to provide 'whole person' care and build relationships with customers. We build operational and quality control systems that minimize errors, reduce cost and improve patient experience (e.g., minimal waiting time with digital appointment booking system). 

Outputs: Women purchase healthcare services from Cliniva. They receive better diagnoses and treatment for their conditions, and spend significantly less time and money on healthcare visits. After a few initial visits, they develop deep trust with their nurse clinician, and increase the uptake of preventative services. 

Outcomes: Health outcomes for women (e.g., maternal health, reproductive health, diabetes) improve through better treatment protocols and prevention. Women's prosperity and wellbeing improve as they save money and time on healthcare activities, and their life and work productivity increases through better physical and mental health. 

There's overwhelming research evidence globally that primary care and prevention, and evidence-based care protocols significantly improve health outcomes, including reduced hospitalisations and mortality. 87% of our patients report significant time and income savings from using our services (based on our surveys). We have seen a 60% increase in the adoption of preventative services among our patients, and attribute it to increased trust and convenience based on interviews with selected patients. Our patient data demonstrate improved health outcomes, including:

• 35% lower C-section rates among our pregnant patients
• 40% lower hospitalization rates for diabetes and hypertension patients
• >87% adoption of modern contraceptive methods among our female patients.

Our fundamental impact goal is to increase the number of productive life years for women in Sub-Saharan Africa. Some of the specific impact indicators we use to track our progress are:

• Improved health outcomes across clinical areas (e.g., reduced maternal and child mortality rates, reduced rate of pregnancy complications, reduced hospitalisations, improved rate of adoption of modern contraception, decreased rate of postpartum depression, improved adherence to diabetes treatment regime). Currently, we have achieved 35% lower C-section rates, 40% lower hospitalizations, and 75% adherence to diabetes treatment among other indicators. 
• reduction in cost of care for patients (money saved). So far, we have delivered savings of >$100,000 to our patients.
• numbers of female patients reached with our improved care model. We have reached over 24,000 women by now. 
• number of highly trained nurses we added to the primary care workforce. 

3 main types of technology power our solution and model:

• Integration of software to deliver a smooth patient experience and high quality of care (including an electronic patient record system, e-pharmacy and stock management system, patient appointment booking and payments).
• Tech enabled digital protocols and pathways and clinician training (through blended learning modules at Cliniva Academy).
• Applied behavioural science in design of clinical protocols (to personalize them and incorporate needs and preferences of diverse patients), patient journey and patient communication to increase adoption of preventative care.

We are a team of 18, with 12 people full-time and 6 contractors.

We have been working on this solution for over 2 years (since starting the company in January 2022).

In terms of our current team composition, we are: 

• 89% women employees
• 75% women in management
• 100% women owners  
• 95% Kenyan and black. 

Gender equity in particular is embedded in our company’s mission and reason for existence. We are deeply committed to gender equality and women empowerment across our activities and policies:

• We are committed to creating better and sustainable employment opportunities for female nurses is Kenya. Our recruiting policies and processes are designed to support women through the recruiting and onboarding process. We consistently invest in training and upskilling our 100% female clinical talent and have achieved 100% retention among women employees.
• Our staff promotion approach focuses on internal talent pool to create better workplace advancement opportunities for women (e.g., nurses being promoted to clinical leads and team leads).
• We implemented a robust harassment and discrimination policy; our managers are trained on gender inclusivity in the workplace.
• We adopted a supplier and partner selection approach that intentionally prioritizes women-led organizations.
• We have intentionally prioritized women investors and advisors when selecting our investors and advisory board. We continuously monitor gender equity metrics (including recruitment mix, share of women in employment and leadership positions, customer and supplier mix).

We provide a range of healthcare services (including consultations, diagnostics and medication) through physical visits to our clinics and telemedicine to our customers. Our business model relies on:

1. Sales/fee for service (for both out-of-pocket and insured patients). The customer (patient) is charged directly if they are uninsured, and through the insurance cover if they are insured. Currently, >90% of our customers are uninsured.
2. Subscription fees (annual patient membership plan). Our annual subscription includes unlimited doctor consultations, basic diagnostic screenings, and discounts on medication, as well as personalised reporting. At $22 a year, many patients find this offering to be an effective and affordable substitute for an insurance product. 

We plan to fund our work through a combination of equity and debt funding and selected grants (e.g., to catalyze the development of our digital infrastructure). Our model has already proven positive unit economics and profitability at the clinic level, and we expect to reach company level profitability within 3 years. 

We've received equity funding from a range of prominent angels investors, including the Global Head of the Healthcare Practice at McKinsey, the Chair of the National Health Service (NHS) for London, and the Founder of Teladoc UK.