An interview with Enzi Health CEO, Fadhili Chacha Marwa.

last-mile healthcare provider

Tell us about your innovation. What is the problem you are solving and what is your solution? What populations are you serving?

Enzi Health Limited is a last-mile healthcare provider combining healthcare provision and healthcare financing in one continuum. We serve people including those near the bottom as well as up to the middle class. Only about 20% of targeted outpatient visits are made annually, which means there's too many people who do not seek medical care from formal providers. Instead, most people self medicate, visiting pharmacies and chemists as the first line of care. Even when people do visit medical providers, they sometimes seek out more informal providers because of the lower costs. Choosing the most “affordable” treatment can result in unqualified providers treating them and the potential of receiving substandard products and services. This becomes a cycle that contributes to perpetual poverty, because when an illness is not treated in its early stages, it can become much worse and more complicated, reaching the point of needing expensive medical care. 

Eighty percent of the disease burden in Kenya is due to preventable, treatable illnesses such as malaria, typhoid or dysentery. The fact that people often forgo medical care in the early stages of an illness is what we are trying to change. The reasons why people do not seek medical care fall into three broad categories. (1) Out of pocket expenditure, which includes all direct medical costs. This is the cost of service itself and any copay required to receive medical services. (2) Indirect medical costs, such as the cost of transportation to and from a health facility. In Kenya, the average distance to the nearest health facility is about five kilometers. (3) Lack of convenience, which is the opportunity cost. This is the time a patient has to wait in line, for example, which means they are not spending this time on their business. 

Our solution addresses these three categories of barriers to accessing healthcare. Enzi delivers healthcare to homes, offices, and workplaces, sending our healthcare workers to where the client is. The interaction between the patient and Enzi is via mobile phone and then a doctor or nurse will respond and actually go to the patient. Our services include everything from consultation to prescription, performing point of care and rapid tests, delivering medicines and other health commodities. We provide home based care, treatment of wound dressings, administration of injections, routine visits for chronic diseases such as HIV or diabetes, antenatal care, vaccinations and immunizations. 

We have a model that includes membership and digital integration. We encourage our patients to prepay for healthcare because we know this is much cheaper than paying at the point of need. In so doing, we pull the financial resources together and operate with a capitation model. The average of what people pay in a month is 600 shillings for the very basic cover and 2500 for the most comprehensive cover. Members can pay on a daily, weekly or monthly basis. Our digital backend is able to facilitate the patient–doctor interaction, monitor payments, and store and organize quality medical records. We believe that we definitely are improving the quality of care and improving the livelihoods of the people we are taking care of. 

"Enzi is pushing the needle in the primary healthcare space by offering accessible, quality healthcare at your doorstep. Their services have become even more relevant post-COVID. At Villgro Africa, we believe that personalized, tech-driven, on-demand healthcare will be a key driver to attaining Universal Health Coverage." Wilfred Njagi, Villgro Africa Co-Founder and CEO

What is a recent example of progress? What are you currently celebrating?

We have recently signed a partnership with Minet, one of the largest insurance providers in Kenya, with 800,000 members. With this partnership, we are offering Mile Healthcare, with the intention of bringing down the cost of treating patients and expanding our services to be closer to the patients who need it.

One of our other exciting advances is related to our hub and spoke model. The hub is a central brick and mortar facility and then the spokes are the motorcycles that the clinicians use to go out to reach patients. So after teleconsultation, we pack the miniature lab, medicines and other necessary supplies and a doctor or nurse goes to the home or workplace of our patient and treats them there. So one of the other things that we are celebrating right now is that we've opened four hubs in different locations (Ukunda, Malaba, Kakamega and Kilgoris). So with that, we're able to dispatch many medical professionals into the homes and workplaces of people reporting to those hubs. We are glad to have seen immediate results, all of them have taken off and right now we are equipping each of those hubs with the motorcycles that the clinicians can use for the outreach program. 

What are the primary challenges you’re currently facing?

I think the biggest challenge we have faced along our business journey is that we have learned that healthcare has a lot more to do with trust than anything else. When you are new in the healthcare space, everybody treats you with suspicion. We had very few patients at the beginning and those few patients were basically coming to check us out to see if we were genuine or not. This means that, especially at the start, it’s difficult to make any money, but it’s necessary to open and keep running in order to establish legitimacy. From our experience talking to other healthcare entrepreneurs in Kenya, that period of waiting for people to trust you lies somewhere between two to four years. So one of the hardest things that we have had to do is continue on without making much revenue, but still financing the company so that we can become trusted in the eyes of our clients and patients.

What is a lesson you have learned that stands out and that might help other innovators?

The biggest thing we have learnt is that what we started with is not what we have right now. We had to iterate and change our business model over time. We've learnt flexibility. You have to be very flexible and listen to what customers want. It can be very painful to change. We even had to close some facilities that we had spent a lot of money on. It can be challenging to get reliable market data, so a lot of growing the business and providing for customers has to be experiential. So it’s important to moderate on spending, but make sure that you maximize on trying to get what the market really needs and be willing to fail fast and pick yourself up and move on. 

How has Villgro impacted your growth?

I'll be very frank and say that we would not be where we are today without Villgro. They have held our hands from inception when we were trying to just crystallize this whole idea, have taken us through the incubation process and have helped us refine our business model. They have brought in experts to train us on selling, marketing, presentation, and how to prepare our pitch decks. They've also helped us to do things like financial modeling, pointing us to grants, and they became early investors in our business themselves. So we would say without question and without fear of contradiction that Villgro has been there in every moment on the path that we've walked the last six years as Enzi. 

Partnership is a central feature of Villgro Africa’s work. As we are just one stakeholder filling a particular role among many in this large and diverse sector, collaboration and cooperation is key. One of our fruitful partnerships that has grown over the past several years is with the Kenya National Innovation Agency (KeNIA), a parastatal with the mandate of driving Kenya’s national innovation agenda. They do this through fostering linkages, catalysing innovation and supporting the commercialization of ideas. 

KeNIA links academic research to the market. Outputs from the National Research Fund become inputs for KeNIA and they then work to determine how to transform those results into products and services. KeNIA creates programs and fosters alignment between the various other actors, including Villgro Africa. In health, the actors are regulators, asking whether the regulation supports or detracts from innovation. KeNIA works to create alignment between regulation and innovation. 

Our partnership with this important parastatal is only growing. Dr. Robert Karanja, one of Villgro’s co-founders and our Chief Innovation Officer, was recently nominated to the KeNIA board.

"KeNIA plays a crucial role in the shaping of Kenya's innovation and startup ecosystem. I am honoured by this opportunity to contribute in a small way to the new movement of innovation-driven development that KeNIA is spearheading to transform Kenya into a knowledge-driven economy that harnesses the power of innovation to create jobs and wealth for our posterity. My experience at Villgro demonstrates that this is indeed doable and I look forward to bringing this insights and experience to bear during my time with KeNIA. I am grateful to the appointing authority for this opportunity to serve together with the other board members." Dr. Robert Karanja, Co-Founder and Chief Innovation Officer of Villgro Africa

Along with past partnership such as the Assistive Technology funding call and pitching event, Villgro Africa is also a primary partner for the upcoming 2022 Kenya Innovation Week, KeNIA’s flagship innovation forum, which will take place in December. 

"Villgro Africa is one of the partners that aligns well to KeNIA's agenda of building a strong innovation system. It takes private sector partners, particularly venture builders and funders to scale promising innovations. Villgro brings on board a strong proven methodology, networks, and capacities that are translating to tangible results. We are proud to work with Villgro Africa" Dr. Tonny Omwansa, CEO of KeNIA

Dr. Karanja is excited to continue pushing the KeNIA agenda as a board member and Villgro Africa as a whole are ready to continue partnering in order to foster collaboration between sectors and increase the level of innovation both within Kenya and beyond its borders. 

An interview with Lucy Enset co-founder and CEO, Dr. Addisu Fekadu Andeta.

Lucy Enset's enset product is now available in the Ethiopian market

Tell us a little bit about your innovation. What is the problem? What solution are you offering?

Our innovation addresses the issue of food security. There is an indigenous food crop in Ethiopia called enset which is underutilized and we noticed was an untapped resource. We have many of these plants in the highlands of Ethiopia, but it's not being used as a cash crop. Previous use of the plant had a very labor-intensive process, the quality of the resulting products were poor and did not address the needs of the market. Therefore, we had high unmet demand for enset-based food products due to poor quality from the traditional method. 

So we are working to fix this issue. Our proposed solution is to commercialize high quality enset-based food products, which are produced using innovative technologies. So, while in the past it has been processed using basic tools, we have developed new enset processing machines, have introduced a new fermentation method and have also developed a well-defined starter culture to enhance the fermentation process. Using this innovative processing and fermentation technology, we now have high quality, value added products derived from the enset plant.

Dr Addisu and his colleagues at Lucy Enset are a great example of how research and innovation can solve local problems. They have developed a process that converts highly perishable enset pulp into flour. It will now be possible to mass produce a traditional staple that could previously only be processed and consumed at household level. This will lead to the creation of thousands of jobs in rural areas as more enset plants are grown. It will also be good for the environment. Their commitment to ensuring their new flour is affordable means that everybody wins as they tackle hunger in Ethiopia. – Moses Waweru, Senior Program Manager 

What is a recent example of progress? What are you currently celebrating? 

Even though I’m a CEO, my team and I are scientists and do not have as much leadership experience. Because of this, I applied for the Mandela Washington Fellowship Program and out of 2,300 applicants I was one of the selected candidates. It was very exciting to be selected and the program has given me many insights on how we can manage and grow our startup. 

There are also several things within the business that we are very excited about. Last month we took the product into the Ethiopian market for the first time. We also have received all our patent certificates. We have around five products that were registered for a patent under the utility model and all of them were approved and registered with our name. We also have received collaboration requests from several different stakeholders in Ethiopia, including Purpose Black, which is a large company that has its own farm and operates under the principle of farmer to market. Their CEO came to visit our processing plant, and they officially requested to work with us. The only question is what form our collaboration will take, which we are now discussing with the Lucy Enset and Villgro Africa teams. 

What are the primary challenges you’re currently facing? 

As a startup company that is doing something completely new, we don't have skilled manpower already in the market, so anyone we hire we also need to train in order to give them the necessary knowledge. We can’t simply hire the right person from the market, so we have been very busy training those we have brought on board.  Resource mobilization is another primary challenge. As a startup company, we need to have resources for equipment, vehicles, personnel  and more.

What are lessons you have learned that might help other innovators?

Running a startup company is a challenge, but if we collaborate, if we have a strong network with other scholars and innovators, we can have a very good result. It’s important to prioritize collaboration and professional networking. Many startup companies are struggling with the same issues, so if you collaborate with the right professionals and have a network, you can solve challenges together and learn from each other. 

Secondly, we have learned the importance of teamwork. We have a group of scholars from diverse fields, but we are working toward the same goal. The teamwork skills represented at Lucy Enset are a really good example for other startups, because we are all working toward the same goal. Our team is vibrant and we have a strong bond, and other startups can learn from this.

How has Villgro impacted your growth? 

To be honest, if Villgro Africa had not supported us, for sure our company would not be here. They provided financial support with 20,000 USD, but have also given technical support, which has been incredibly important and encouraging. They have made our success a priority and we share our challenges and progress with them regularly. I would really like to thank the whole Villgro Africa team.

 

Villgro’s incubation program is designed to help startups realise their full business potential as they develop beneficial healthcare innovations throughout Africa. One key feature of this program is to match our innovators with a mentor who has personal experience in the health innovation and startup space.

One of these mentors, Ankit Jhanwar, has supported Villgro innovators since 2020, listening to their needs and giving feedback as they navigate the ups and downs of the entrepreneurship journey.

What Does Mentorship Look Like?

Although every mentoring relationship is slightly different, Ankit generally holds a regular fortnightly call. His first priority is to understand the innovator he is supporting: What is their business? Where are they struggling? He asks them for data, including what sales are taking place, who their customers are, what money they are spending and where. Based on this information, he then works to bring focus to their work and advises them on how they can make some short-term wins before their next call. 

Ankit is very action oriented in his mentorship. His goal is for the founders he works with to make actual progress as a result of their conversations, rather than just receiving advice that they could find on the internet. Even after the official mentorship period ends, Ankit often keeps in touch with the companies he has worked with on an as-needed basis.

Matching Mentors with Innovators

Although Ankit has worked with startups in every area of the health sector, his primary specialty is in the area of medical device development because of his own personal experience. He was on a team that developed an affordable device for treating birth asphyxia, where a baby is unable to breathe, risking the cutoff of oxygen to the brain and the possibility of resulting brain damage. Although technologies already existed that addressed this issue, the cost was prohibitive for most low-resource countries at around $30,000 each. Ankit and his colleagues developed a device that performs the same function, but reduced the cost to less than $4,000.

The journey for this device from start to finish was not simple. Ankit was involved from the research and development stage to awareness raising and market sensitisation to eventually launching it globally. Because he was involved in every step of this complicated and arduous process, he has been able to relate with the Villgro incubatees, encouraging them along the way, and warning them about the potential pitfalls they might face. Ankit is offering to Villgro's innovators something that he did not have during his own process. He says, “I wish we had somebody to tell us how to avoid some of the challenges we faced on our journey.” 

Common Challenges

Throughout his many dealings with emerging businesses, Ankit has noticed a few primary challenges that almost every innovator faces. Startups often focus solely on the product, but don’t think about how they will eventually sell what they are creating. Because many of the innovators he works with come from a technology background, the alignment towards commercial interest is often lacking. He insists that, while innovation is vital, it is important to have a balance between the two. Innovators need to consider why they are innovating and how they will sell their final product. Almost all of his mentorship has revolved around aligning the innovation to the commercial side of things. 

Early stage entrepreneurs also have a tendency to continually focus on the next thing rather than seeing what is working right now. Businesses run on profits and cannot rely on outside funding forever, so if an innovator has something that is sellable, they should focus on that as a smaller goal and bring in cash. This will allow them to be more relaxed as they continue to complete their more long-term objectives. Ankit recommends that startups think about what they have to offer right now and how they can make money from it rather than waiting for the ever-elusive perfect product or perfect service. 

Why Mentor?  

Ankit mentors for several reasons. He enjoys working with innovators who are taking a risk in order to offer something that benefits society. If he can support them in a way that increases their chances of success, he is very happy to do so.

Additionally, he views mentoring as a learning experience for himself. He carries out the everyday work of his business, but it’s only when he takes the time to explain what he does and why he does it that he becomes clearer on the reasons and rationale behind his activities. As he advises others on their businesses, it also helps him implement things more effectively in his own business. 

Do you want to learn more about our current mentors? Read about them here. And if you're interested in learning about the incubation program, you can find more information here

An interview with Photo Kabada co-founder and project lead, Moses Ochora

PHOTO 2022 06 02 11 59 05

Tell us a little bit about your innovation. What is the problem? What solution are you offering?

Photo Kabada provides a remotely monitored, hybrid phototherapy machine designed to solve the problem of inadequate access to effective treatment for jaundice, a common illness for newborns. When jaundice becomes severe, it can cause permanent brain damage, resulting in conditions like cerebral palsy, developmental delays or the inability to hear and/or speak. If jaundice is solved early using phototherapy, we are able to avert most of these complications.

In our setting, we have too few machines for very many babies. Additionally, the machines that are available in the market, though they work effectively, are very expensive to buy and to maintain. They are also not very efficient, treating only one baby at a time and serving only one purpose: treating jaundice. When more than one baby is sick, medical professionals are faced with incredibly difficult choices. Sometimes we have to put several babies in the same machine, increasing their risk of infection and reducing the effectiveness of the treatment.

And, again, these machines only treat jaundice, so if a child has jaundice and they also require oxygen, then we have to take them out of the machine to provide the other care that is more urgent. Our product is designed to provide a ‘one stop centre’ to treat a sick newborn with jaundice. It will also provide oxygen, warmth, and monitoring of the child’s vital signs, along with the treatment of jaundice.  We also have designed it to treat more than one baby at the same time. Our device is designed to be hybrid, in that we can use both normal power of the national grid as well as solar powered battery that can run for at least 12 hours. We think this device has great utility in rural settings in places like Uganda, but also in many other places around the world.

What is a recent example of progress? What are you currently celebrating?

About a year ago, we were stuck. We conceived the idea for Photo Kabada in 2018 as a group of friends and clinicians and engineers who were working within a hospital setting. We identified the need and got together and began coming up with a design and a market strategy and also look out for seed funding. We were able to get seed funding initially from CAMTech and from the Ministry of ICT that pushed us to a level where we had Version 1 of a prototype. After that, we went to the field and collected some information, which was vital. It actually made us almost completely overhaul the initial design. That is where we came to interact with Villgro Africa.

Ever since we've been in the Villgro incubation program, we’ve been able to grow in several ways. We were able to get more funding to move forward from the initial prototype version 1 to a more futuristic, robust and human-centred design. We’ve also been able to receive several trainings in how to put together a requirements traceability matrix. We've received mentorship on several of the business aspects of our device and the engineers have been regularly in touch with the technical team at Villgro. With that help from Villgro, we’ve been able to move forward. Right now, we have an almost functional prototype that just needs a few final touches.

“Photo Kabada’s greatest asset has always been their team. From an early stage they have had a very dedicated and talented team of clinicians, engineers and academicians that’s ready to contribute in any possible way. The growth they have shown since joining Villgro Africa’s incubation program is tremendous. We believe that their phototherapy machine will soon start making a difference, for treatment of jaundice, in Uganda and the larger East Africa.” - Edwin Osora, Portfolio Manager

What are the challenges you’re currently facing?

One challenge is related to attracting the right human resources during the height of COVID 19. It was really difficult for us initially to find the right people for the job and we had to go through several iterations. Additionally, some of the materials that we require for our product are not easy to find, especially when supply chains were severely disrupted during COVID-19. Availability of finances was also a major challenge for us. With funding, we would be able to get technical help and get all of the necessary materials immediately but because of limited funds, we are going slower and are required to compromise on some things. But also, the medical innovation ecosystem in Uganda is just starting. There are many gray areas in terms of regulation, intellectual property, and streamlining the industry. It can be challenging to get the right advice because the field is still a bit new.

What is a lesson you have learned that might help other innovators?

We have learned three primary things. Firstly, there is power in networking and collaboration. Secondly, teamwork is essential. And thirdly is how to have a vision and work for it within a specific timeframe.

How has Villgro impacted your growth?

Villgro has impacted our growth in a really big way. They have provided us with funds worth 20,000 USD that has enabled us to make a functional prototype for Version 2. They have given us technical support, especially in the areas of engineering, design and software. Right now, we're working on how to set ourselves up well to enter into the market. Through Villgro, we have learned how to work in a way that honors deadlines. The constant communication and a constant tabs that Villgro keeps on us to be able to work within deadlines and also be able to move faster. Villgro has built built our team in terms of both intrinsic and extrinsic ways.

We think that Villgro is a force to be reckoned with when it comes to promoting innovations in Africa. They have a vision that all startup innovation companies would benefit from tapping into. We have really progressed since starting with Villgro and we hope that we can continue to strengthen this bond.