What do you know about the African healthcare market? (Moka Lantum)

their listeners welcome to faces of digital health a podcast about digital health and how healthcare systems around the world adopt technologies I am your host Josh azide and I'm currently working on a podcast series about the Asian market it's planned to be published in the following months but because it requires a lot of focus and research I'm not publishing a new episode today but sharing with you the discussion about digital health and health care in Africa with Mo Kelantan which was first published in early 2018 I still find it very inspiring because mochas insights illustrate how important the culture is in solutions design and scaling since the discussion was recorded in the past it is edited to only have information still relevant today you will hear from a fantastic serial entrepreneur who I seriously suspect learned how to freeze time going backwards with his CV he was nominated as 2016 top 100 global thinker by foreign policy magazine for his work as founder of the nonprofit 2020 micro clinic initiative that recycles t-shirts into baby clothes and donates them to low-income mothers to promote safe delivery and quality postnatal care in rural Kenya when it comes to his background in education he obtained his Doctor of Medicine training at Faculty of Medicine and biomedical sciences in Cameroon he has a diploma in nutrition and international child health from Uppsala University in Sweden and that's not all he also holds a doctorate in pharmacology from the University of Rochester New York and he's a graduate of the Masters in health care management at the Harvard School of Public Health the person I'm talking about is Moe Kelantan we discussed healthcare IT and digital health adoption in Africa enjoy the conversation and please if you like the podcast take a few seconds to rated in iTunes leave a comment or review so others interested in south korean digital health will have an easier way of finding it I think we're ready yeah let's let's try so MOCA I guess you know I did a little bit of research on mocha with written with ch and we all know you know it's coffee and chocolate how big of a fan of coffee and chocolate are you oh my goodness I I love coffee it's a it's it keeps us going and good coffee also it's comes from Cameroon my birth country so you know I certainly do enjoy coffee I even love chocolate even more and it's also good for the for the health that's what I was just about to say you know it's a perfect combination of a positive effect on the cardiovascular system and some happiness with territory out of chocolate well definitely you know having the two does it good it's good it's good for the body keeps the mind sharp you know and sometimes I like tea as well because once as I take too much chocolate and I mean and coffee my brain is just on fire so I'm also a tea guy you know but but your your name actually has a different meaning in your local language right yes so mocha comes from the the dialect in Cameron back query and it means hidden character it well it the name translates into the roughness of a house so they wouldn't work that supports the roof you don't see it and that's why it represents hidden characters so it's you you it's a beauty strength of the house but you never seen and that is what mocha stands for in the language and that maybe is more reflective of my personality kind of understated but I'm there you're a serial entrepreneur and you're very involved in building solutions for healthcare you also have a degree from public health in from Harvard maybe we can start there how did you decide for this area of expertise and what perspective did going to the u.s. give you I believe very strongly that we are born with a certain calling and I certainly feel social entrepreneurship is more of a calling than actually a job if you look at my past I have always been the person to set trends that always been the person to look for opportunities to make change change that affects lots of people I have never done anything just to make myself feel good you know it has to have a bigger meaning ever since I was a kid also I think it's important to recognize that my mother was or is a women's rights activist so being an activist she brings that oh she sort of inculcated in us the desire to really change things that we don't like if you don't like it you know you try to make sure that you change it be part of the change you want to see but also my father is a global health expert so I grew up in a house where global health issues were very much discussed malnutrition family planning and then you know public health systems how to implement public health systems at scale so those two I think influenced my choice professional choice and also my bias towards entrepreneurship in health care now going to the United States really forces you to think about I can do it I can I can be the change that I want to be so you take off an active role where as many economies discourage entrepreneurship they want you to have a steady job they want you to be you know be guaranteed a salary for the next 50 years whereas when you go to America your identity forces to say Who am I and really what do I want to be known for and that forces you to be more entrepreneurial than than otherwise so all those factors put together I think have conscious to where I am today and I believe very strongly that our generation is a generation of entrepreneurship our fathers came out of big government where they set up government systems in the Africa market our generation must bring entrepreneurship as a tool to transform economies and bring development you know for those who need it the most many entrepreneurs see Africa and countries in development as a very good market to go to because there's so much potential for things to be built there and a lot of these markets Kenya including our the the services there are paid out of pocket so the private market is big and Kenya is if my information is correct is attributing only 2% of the GDP to healthcare so how do you see the opportunities that you have and the possibilities for building new things I guess this also goes to how difficult it is to get funded for whatever you want to do maybe you can draw from how you started building your different solutions and what solutions do you have there yeah the Africa market is ripe for for Entrepreneurship is ripe for investments it's ripe for innovation I tend to define the climate based on need and based on our the the access to channels now the need is there and so that's why it's a very attractive market you can put it together a business case and there is a possibility of killing the business in conscious like you know Kenya South Africa Nigeria and stuff some of the African countries are too small where once as you do your business model and you look at your potential market it is very difficult to do however if you are in the health education agricultural space the issues transcend and go go beyond the boundaries of in country say a well-designed solution has the potential to scale the second thing is that access to the customer is the most difficult thing to do in the market why because you do not have formal channels that is what makes the market difficult in developed markets you can promote very easily on Facebook you can do TV ads you can do newspapers you can do a lot of things in that market to reach your customer there is almost no direct path in most cases so how do you do it and how does that go together with the idea of Africa especially in Kenya being very mobile driven so Kenya is the land of where investor was born the mobile banking so that's where the idea of the opportunity also comes from sure definitely the mobile money and the tech ecosystem all those are enablers but the fundamentals of business remain the same you must be able to reach a customer you must be able to segment them you must be able to quite a convert the customer that costs now if you are in certain sectors here for example if in the developed market all you need to do is get one insurer and you're in business in the Kenyan market you have to work very hard to acquire your customers and that is why you see many businesses end up wanting to get the customer base you through many products at that customer and so you hardly see a start-up or an early growth company just offering one little niche product because you won't maximize your channel as much as possible because of the customer acquisition cost and so so you have to innovate in the African market at three levels you must in have a good product no question about it you must innovate at the business level perspective and you must innovate in your channel strategy if you don't innovate in all those three you would not have a variable business in the African market and that is why many people come with very great ABS very great solutions but they don't scale because they forgot to innovate on the business model and got in a bit on the channel strategy so how many of these solutions these apps are coming from the Kenyan market and how many of them are from the outside because I imagine that a lot of foreigner foreigners have the wrong idea of what the market needs whereas the local developers are the ones with the advantage of actually knowing what could work well I see the development of apps not necess but I said to for certain transactions to happen so I think it's okay to have many apps and coming from anywhere now we do have certain technologies that are developed for systemic issues like uber is doing very well in Kenya does a time uber Kenya was the fastest growing city in or Nairobi had the fastest growing number of uber riders now there are also certain solutions that have to be very localized and I think the local innovators and entrepreneurs it is a man it is the they are the ones who should lead the charge to design solutions for very local needs but the global market the Kenya and the Afghan market is also part of the global market for certain other needs and it's very fair to have innovators from around the world address those issues it is easy to do software development it is very difficult to get human beings to adapt their behavior around a new software you can you can draw from your experience here what kind of solutions have you designed so far how did you do the scaling and how did you deal with the issues around implementation that you just mentioned when we started this work in 2010-2011 you can say that the government was the primary buyer of services and that is quite true in out say easily 60 to 70 percent of the African economies so at the end of the day if you have a technology if you have to scale you have to always think about the government would have to procure the services and give that means there's a certain cost of capital there's a certain timeline that you have to think about as a default however over the last five six years we're seeing diversification of the economies where privatization is becoming very strong there is a more urgency around the time value for money what does that mean is that people are looking for services and are willing to pay independently for services people are beginning to value time as as an asset which you know in a government real driven economy it's not the case and so with that it creates it opens up the market for very interesting businesses and amazing things are happening in the African market it's important at the end of the day that if we're designing technology for healthcare we must have a very clear framework in terms of how it is saving people's lives technology for data collection technology for health records management is not sufficient there is no patient out there wanting to pay for their health record to be stored digitally there's none that I've met there is no doctor who will who is willing to pay for that data to be archived that I've made but people would pay for the value-added experience that comes from the digitization that happens in the market so you know so our solution and our strategy is to make sure that we are thinking about the ecosystem end-to-end from when you leave your home or you could you seek to when you get into the doctor's office we need to make sure that you know where you're going you know your cost and when you're buying you at least know the opportunities to save we in a very material way when you're shopping for healthcare so basically what you're saying is that what sells is a good user experience and because there's no regulation that would require let's say health care providers to have good EHR systems EHR systems are more of a nice to have not need to have things consequently not being as fast we adopted as we would expect that's very correct yeah we are yet to see policies that mandate the use of healthcare records they the national systems are not going to fund that and so it is going to be entirely dependent on the private sector to do that and and and so in the absence of that really data is about creating a customer journey that is dramatically improved over the regular customer journey you know in a in a non digitized system now what does that mean concretely that means you could do a lot of digitization and there is no value for the ecosystem or for the payer and that is why many vendors of EMR systems do not survive in the African market how did you deal with the whole marketing and scaling problem reaching the customers the question of scaling technology is one that is completely underestimated it is an expensive undertaking regardless of which economy you are in so how did you do it is it since you said that Facebook advertising and modern ways of reaching people through social media is not that prevalent here what did you do door-to-door leaflets what was the solution Oh even door-to-door leaflets is too expensive because if we are trying to make you know a commission on the sale and the same is is even let it ten dollars you know are we making 10 percent or 20 percent that is only $2.00 if you put a flyer that's $50 50 cents that's 25% of your margin right there so even flowers don't work for us it is about initially talking to people one-on-one and engaging customers directly I I believe and there is definitely proven that that is always a good place to start with technology you earn your customers one by one don't rush for the market the market you gain the customer and that's the least expensive way that is what a B and B did and Airbnb was successful they earned customers one at a time no mass marketing and then they have very our customers and very loyal users and that's what we're doing this is a certain barrier that we experiencing in health care because somebody may may be aware of I secure but not to be sick in two years so there's nothing for them to do on the application right you can this because of patient privacy you don't even know when people are sick so it's a very difficult strategy to pull out and have to be very humble in looking at your growth projections in healthcare and technology what about scaling beyond the borders of your own country in Africa stereotypically Africa is seen as this one blank page but if you know how many different countries how many different cultures are there what does that mean for you in terms of healthcare and spreading the solutions in other countries as well I think you know once you hit your sweet spot and with the right kind of financing it's quite easy to scale across different countries the big issue that you likely to face is currency fluctuations based on different countries and access to talent so you'd be do you use the local workforce and if you use the local work for workforce was the cost of labor and then what are the existing channels or what's the existing market you could chat tap into those are the big questions you really have to ask yourself but technology itself is quite scalable you could use I secure anywhere in Africa today but the question is do we have the channel strategy in it can we pull up the channel strategy in each country and that could be that something that we're looking at but I would say the ubiquitous nature of what we're trying to solve gives us the potential to to to get into many countries many many countries don't have access to affordable medicines one thing that we see now is that new technologies such as drones or telemedicine are very appropriate for develop the countries in development because you have the issue of people being in the rural areas where there is no health care facilities how many of these technologies do you already see in place and actually used that's the the paradox of innovation in healthcare where the need is greatest the ability to pay is lowest so we are not seeing telemedicine solutions really sucks being successful or teleradiology for that matter simply because we're the business case the the the logic behind those is to make sure that people who are in remote areas have access to the doctors but then the cost of that service is not low enough to support the deployment of that technology and pay for the services that are being rendered at the other end and so there is still no value proposition the technology exists there's nothing to innovate in telemedicine or there's really nothing to innovate at least it could get better but we but the business model doesn't hold water that's one of the problems that I see when it comes to digital solutions everybody is expecting them to save money but let's say for telecon cetaceans and services like that the payers are usually not very open to paying the same amount that you would pay for an in-person visit not really taking into account the investment that you need to make as a healthcare provider to do the service and that sometimes the the requires time for the consultation is not different than an in-person visit that's correct yeah so if you need if you need a radiologist the radiologist services would cost you something and if you don't lower the cost of the radiology surface then telemedicine or teleradiology has very little to offer and when you add the notion of you know the cost of data transmission and data archiving that adds to the cost of that particular service offering so it's it's it is important that we think about the business model innovation side as I mentioned earlier on because it's easy to do software it's easy to do technologies but many technologies are sitting at the gate fantastic technologies from drugs to diagnostic tests kids to telemedicine solutions to EMR solutions are sitting at the gate you as I mentioned you have a degree from public health from Harvard you know the US market you know the African market so Kenya is attributing 2% of the GDP to healthcare u.s. is you know a big an expensive system going to around 18 or even more percent of GDP for healthcare how much do you think this cost could be reduced if somebody would manage to change the prices of doctor services yes being a doctor is a good way to earn money in the u.s. they say certainly a tiered system and and in the church system they the time the billable time for a doctor is very well appreciated which is not the case in many other economies which makes you know the the opportunity to earn a high wage as a doctor less less likely now we sing the US model of high net worth or high high pay for for doctors happening so in Kenya and many African countries now doctors are charging you know pretty good dollars for their time which is appropriate is understandable but what that does is that it means that you know a lot of the populations are going to be excluded from from specialty care and so you know access to specialty care would be based on means you know or your the kind of insurance you have and that puts a lot of pressure on the government's to provide good primary and tertiary care and in Kenya for example they are doing that you know there was a 400 million-dollar medical equipment services program that the government launched to make sure that the way diagnostic services you know in a lot of the hospitals and that is great but the very there is a net shortage of providers of doctors in the healthcare professionals if you will and so yes you could invest in more buildings you can invest in more equipment that's the easy part building the the labor force to support those systems that is very difficult to do that's something that Cuba is doing very well but for Cuba to do that is because they have very tight policies around the movement of their doctors if you're training to buy you have to stay in Cuba and work whereas in mikania government they will train the doctors and the doctors leave to go work in other countries and so because of that brain drain the question is how much can you invest in building your workforce and you build a good workforce do you keep them or you lose them you losing 40% to 60% of the force workforce your training to other markets because of good better pay outside of the country then you have to ask yourself should I keep investing and that's why I think you know some of the work we're doing and for me social and put entrepreneurial perspective you see one of the kinds of service models that we can introduce in the market that guarantee quality and and at the same time guarantee a certain affordable rate the main two mortality causes in Kenya are HIV and communicable diseases do you see any good solutions addressing solving all those problems because it's it's here it's about education it's about the infrastructure it's not just about getting a cure for for HIV so it has to be addressed from a different angle the concern around you know communicable diseases is one that is recognized by the policy makers however it would be fair to say that the statistics are maybe garbage if you will bring a lot of accessories that are published I don't use them from a market studies because very clearly the statistics are are there because they address certain interests right and so you can look at any given number of public and you get a very different numbers so we really don't know embarassingly so the true drivers of mortality and mobility we don't conduct autopsies routinely that gnostic tests are not done so we are completely discounting death from chronic conditions like diabetes hypertension stroke cancer and those are still in the realm of mystery in many healthcare systems in the Africa market you know that that's a good point because when it comes to chronic diseases there's this hypothesis in in healthcare that some stress-related chronic conditions are less prevalent in less developing countries the so called hygiene theory where because in the developed countries we live in two sterile environment then the immune system doesn't really get strong enough but then the question of that statistic is are these disease is really not present in the countries in development or are they just not being detected we have to recognize that yes there's a shift a growing trend towards you know increasing incidence of non communicable diseases that's why we as a company we're investing in that and making sure that we are not only focused on a communicable disease side you must also recognize that the global health agenda has been quite centrally coordinated by a lot of the big development entities so there is a lot more data collection happening in the infectious disease space compared to the non communicable disease and you can also say and I think is a fair assessment that if you want more dollars for your programs you have to have were statistics right and so you're going to have if you will a buyers towards you know towards overstating you know the case in some instances why because we're people we choose to do the work is where maybe it's a hot spot for a disease that is not reflective of the refs rest of the country this is an opportunity for big data to really bring shed light and we as a company we are saying we want to bring onboard partners who can work together to leverage the data we have because I realized it's you can be good at collecting data you're not necessarily good at interpreting the data and you also definitely not necessarily probably the best person to make the data convert into sort of actionable items we from the developed countries perspective point of view we see the developing countries as the place that has the opportunity not to make mistakes in IT development that we did where a lot of solutions are burdening doctors you know and then because new technologies are popping up countries in development have the opportunity to leapfrog the development and adoption where do you see healthcare in in the future and are you missing a strategy that would address development more strategically Kenya has a vision 2030 document and planning but I'm not sure it's very specific when it comes to health and digital health and healthcare development that's a very good question I think you know out summarize it by saying that in the developed markets many things on a steady state what does that mean is that if you go to a hospital they have invested in connectivity they have invested in equipment they have training programs so if you come in as a vendor for EMR you're coming to drop your solution in a pretty steady environment with a lot of management in place policies in place you don't need to do that come to the African market you have to develop the deployment policy you have to train you have to do connectivity have to do equipment then you put your software then you maintain your software and then understand the use case and then get the do change management for the customer you see that the cost is very different right so what vision 2020 calls for is to say we need to figure out how to create an ecosystem where that brings us closer to steady state where individual innovations can thrive when I hear folks I have an EMR I said that's great but it needs to run on computers how you going to finance the computers it needs to run on connectivity how you going to finance the connectivity well if you expect the patient to the hospital to do that then guess what you just don't have a business why because by the time the by the computers by the time they do the connectivity then they pay for your license you beat you the third person to be paid they have ran out of cash the owners of hospitals and clinics do not see a priority investing in those infrastructure costs they love the software they want all their cost accounting to be done the one day inventory to be managed they want all your patient records every day but when you say ok to do that need to buy 50 computers do the cabling that is going to cost you $25,000 then here's my license and then you have to do maintenance every year for $10,000 of like I think we all pay with paper exactly but on the other hand we are kind of hoping that maybe computers are going to become obsolete with new technologies such as mobile phones and if everything is stored in the clouds and securely manage then I guess you can hope that computers are not going to be needed and that creates completely different requirements when it comes to infrastructure yes certainly as devices become cheaper and as we go to more certainly that was by venturi there are certain things that commissions do not replace so as I mentioned the training of the healthcare workers incentivizing them to use the whole the the software that you developed is really the big challenge right in the u.s. for that to happen the Accountable Care Act famously known as Obamacare had to put in place millions and billions of dollars in incentives to get healthcare workers to change the behavior and new software so what really Obamacare did was it created an environment for technologies to be easily adopted in the health care setting but before that only 30% of health care facilities invested in automation that is the United States and you talking about 2010 so what are you saying it's not just about innovation but we definitely are going to have to wait for smart for regulation to help encourage development of digital solutions in the in the healthcare sector we have to wait for smart regulation of regulations to force the conversations in the right direction and also we need to have a bigger appetite to invest in healthcare I think people are willing to invest in automobile movement railroad transportation and all of those things and Health Care's are always all were left for somebody else to do and I think that's why healthcare is lagging in many economies whereby you know you're not seeing the piece of technology adoption happen in healthcare in as much as there's a lot of innovation going through but the barriers of entry are just three orders of magnitude higher lower level willingness to invest in health care more regulation around data privacy in health care at the same time the patient doesn't want to pick up an additional bill worse in the other sectors you're seeing that people are willing to pay more for the experience the digital experience right in terms of we are all subscribed to netflix want to get our movies on time every day any time we are all have massive data we pay massively for data storage we are on Dropbox Google pay Apple the cloud and paying for that cost everywhere we go either through our phones and thrust off it is crazy it is insane that we are willing to to invest that kind of money from mobility and for social digital usage but not for healthcare usage because healthcare is not fun that seems to be the case and that means we have a lot more work to do to to make sure that technology meets as promised in healthcare so what keeps you going what keeps you from still insisting in the industry and being optimistic you could innovate endlessly in healthcare you could have an app for anything you could do it at the end of the day if you want to run a business then you must figure out how to get somebody to pay for that there is opportunity for for business there's opportunity for for growth and so we would continue to be you know stay sharp on our tools to figure out you know what is the experience that creates maximum value for patients at the same time gives us a fair return on the investments of our or that we're doing you've been getting two phases of digital health stay tuned subscribe to the podcast and share the episode if you liked it with your network you

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