Harnessing the power of health data, connectivity, and innovation
Data and digital technologies are revolutionizing industries around the world, and they have the potential to transform healthcare systems in sub-Saharan Africa. When connectivity, such as through mobile technology, health data, and finance are merged, there is potential to facilitate the provision of quality healthcare while empowering patients.
At PharmAccess, we believe there is an alternative to traditional healthcare systems, and we are creating and trialing innovative value-based care models across the region. By proving these approaches work, we provide the evidence healthcare providers, insurers, and governments need to make real change happen.
Putting the patient at the center of their care journey
We envision a world where citizens are at the center of their healthcare journeys, and in control of their health data. Over the past several years, we have been following patients through their healthcare journeys and developed new digitally enabled, patient-centric models that can be integrated across the public and private sectors.
Our value-based care program MomCare has already shown that this is possible. With the mother at the center of her care journey, connected to providers and payers on her mobile phone, the quality of care improved at more predictable costs.
The impact of such trusted, patient-centric data exchange reaches far beyond the primary process. We cannot break through the vicious cycle with fragmented information, low trust, and limited risk pooling. It requires an enabling environment for information sharing. Fueled by the massive transformation that the information revolution brought to various markets (from M-PESA to Netflix to generative AI), it is a widely held belief that better information exchange has an important role to play in achieving universal health coverage (UHC). Effective primary use of patient-centric data will improve care delivery (more emphasis on health outcomes, better referrals, less waste); effective secondary use will improve learning and prepare for the opportunities that AI will bring.
Healthcare systems remain highly fragmented and supply-driven, resulting in massive inefficiencies and scaling of innovative (digital) health programs has proven to be difficult. As a patient, you only exist when you go to a healthcare facility; when you leave the facility, you are no longer connected to the health system. The health information about patients is in fragmented systems (or paper) held only by the payer or provider. This is a global problem, apparent both in high-income countries like the Netherlands and in low- and middle-income countries (LMICs). The information is very fragmented and is certainly not re-used and analyzed. We want to prepare for a connected world and be ready to harness the opportunities AI will offer.
To scale solutions like MomCare, data must be interoperable and independent from software systems to allow for information flow. If we are moving to an increasingly connected world, how we manage and own data is more critical than ever. To democratize healthcare, data needs to be owned by citizens – the originators of the data – and user rights must be assigned to their interests over time. Enforceable data contracts need to lay out who can see what information under which conditions. Data needs to become part of our public good.
Using our approach of "start private to grow public", we work on demonstrating how patient-centric health data use can be achieved in LMICs to benefit citizens, with acceptable cost and low technical risk. We do this by focusing on high-volume diseases, starting from the primary care need, that require multiple coordinated patient visits: mother and childcare, and NCDs (specifically hypertension and diabetes).
Innovating with MomCare
Over the past several years, MomCare has provided proof of concept for value-based care, and we are using the results of over 50,000 pregnancy journeys to refine and build on the model.
Providers were reimbursed for the cost of care delivered to these mothers and received bonus payments related to the quality of care based on a comprehensive Journey Score from 1 to 5. The wallets were combined with various elements for quality improvement, patient engagement, and operational support tools. In Hanang, Tanzania, we demonstrated a new lightweight financial incentive system called ValuePoints related to journey adherence, timeliness, and quality of care. Clinics doubled their ValuePoints score over the course of only six months and the system fostered a new collective sense of responsibility for high-quality pregnancy journeys. The simplicity of the new system allows for rapid implementation and increases willingness for adoption, which we will demonstrate in Kisumu in 2024.
Based on these learnings and the proven concept in Kenya and Tanzania, we are now focusing our efforts on scalability. In Tanzania, we created the first technical demonstrator to allow platform-agnostic scaling. In Kenya, from Nairobi to Kisumu, we are now working on various private and private-public programs. Specifically, CarePay is working with local private insurers to develop and test a commercial bundle for mothers based on the Mom Care proposition and lessons learned.
At the same time, we are evolving the solution, focusing on interoperability to make it accessible to the mass market and preparing for data to be reused beyond the primary process. PharmAccess and CarePay are working with private providers to connect mothers to health solutions and create a data pool. We set up a data lab to test solutions that become possible in a world where mothers and care providers are connected and the value of data flows back to the mothers. Data is captured via WhatsApp and stored in a shared health record. This is standardized and sharable with various data systems, so that the data can be exchanged between stakeholders and used to improve primary care delivery, as well as being reused in the patients’ interest.
In 2023, more than 3,000 mothers and babies participated. This is projected to grow to 15,000 mothers and babies in 2024 and 2025.
+ The African Population and Health Research Center (APHRC) recommended in a research article that the MomCare concept should be replicated "in settings with similar maternal and child health challenges in sub-Saharan Africa and beyond"
Tackling sub-Saharan Africa’s biggest disease burden
Noncommunicable diseases (NCDs) like diabetes, heart disease, and cancer account for the highest proportion of the region’s disease and burden, and they are expected to overtake communicable, maternal, neonatal, and nutritional diseases combined as the leading cause of mortality by 2030. Currently, about 30% of Africans have an NCD, yet there is no financing allocated to these diseases.
Due to the nature of NCDs, the required care is expensive because it is often lifelong and not covered by the region’s fragmented healthcare funding. Bundled care packages could be a viable solution for more effective and affordable NCD care, as they empower patients to change their behavior and give them the agency to take control of their care journeys.
We are working on initiatives to demonstrate the viability and impact of these innovative care models. In Ghana, we are exploring the potential to scale a healthcare platform, developed with one of the leading care-at-home platforms from the Dutch company Luscii, as a remote patient management model to lower the threshold for seeking care, while improving efficiency. So far patients have adhered to the program, and 50% now have their blood pressure or blood sugar under control.
Together with CHAG and the NHIA we co-designed the Value Based Care pathway. The project integrates advanced digital healthcare tools with established community healthcare methods, specifically designed for low-resource and low-connectivity settings.
In Nigeria, we started an innovative program together with AXA: a connected primary care network where NCD-patients get access to care through pharmacies.
Our efforts in 2024 will focus on how these programs and the data they generate can become fundamental to bringing more money into the system to pay for NCD care. We are exploring the valorization of data reuse with various parties, which can then help finance health access for low-income groups.
Connected Diagnostics
Diagnostics is a key element in healthcare in general and VBC in particular. Although diagnostics account for around 10% of healthcare costs, the information it provides supports 75% of medical decision-making.
Connected Diagnostics (ConnDx) facilitates community-based healthcare with digital diagnostic tests for providers to use at the point of care and patients able to self-test. We have demonstrated that it can provide targeted, better medical services and financial access to the right patients for the right disease at the right time.
In 2024, we will explore further how connected diagnostics can contribute to effective diagnostics and disease monitoring, focusing on malaria.
Read our academic research on the benefits that connected diagnostics hold:
The architecture for data as a public good
In 2023, we started to demonstrate the technical feasibility of how a platform-agnostic shared health record (SHR) for mothers can be created and exchanged so that it can be implemented using any locally preferred software system.
In the district of Hanang in Tanzania, connectivity is severely limited, and clinics are mostly paper-based, with data entry considered an operational burden rather than a valuable undertaking. With a limited budget, we implemented the lessons learned from MomCare to create a VBC approach using a lightweight data set, platform-agnostic data capture, and a simplified reward system. The system provided actionable feedback for healthcare providers, and combined with the financial rewards, increased their agency to improve maternity care. This approach will inform the scaling of MomCare principles across other regions.
We use the openHIE-framework as a technical architecture, being the most generic and commonly used health information interoperability framework. This framework has largely been adopted by sub-Saharan African countries, including Nigeria, Kenya, and Tanzania. The de facto standard for clinical information exchange in the healthcare sector is FHIR. The recently announced collaboration between HL7 International (the governing body of FHIR) and WHO exemplifies this trend. However, to date, the lion’s share of FHIR-related projects in LMICs focus on achieving openness and interoperability at the level of Point-of-Service systems. Beyond its value in this context, we propose to adopt FHIR as the elementary standard for realizing the shared health record (SHR) component that is specified in the OpenHIE framework.
Building on this technical demonstrator of interoperability, we started expanding the demonstrator to create a small ecosystem based on the Open Health Information Exchange architecture. Innovative local software companies – Intellisoft, ONA, turn.io and CarePay – are combining their technical expertise to build a patient-centric data structure by connecting patient data from different sources in a shared health record. Various (front-end) systems are and can be connected (e.g. telehealth solutions like Malaica and HealthX). In this ecosystem, it becomes possible to access and govern data, give information back to citizens and providers, and show the benefits.
In 2024, we will increasingly focus on how to institutionalize data governance in this context. Currently, we are exploring governance structures, amongst which data cooperatives, with thought leaders like Barbara Prainsack, a professor at the University of Vienna and Director of Governance of Digital Practices.