Innovator Spotlight: Lishe Living Nutritionists

An interview with Lishe Living founder, Sharon Olago.

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

At Lishe Living, we use technology to create dietary prescriptions for patients and health seekers, and set up medical nutrition departments in hospitals. Nutrition services are barely offered in hospitals, and when offered, tend to be unsatisfactory, not personalized to the patient or backed by evidence. Patient care has traditionally been centered on medical therapy with less attention given to disease causative factors such as nutrition and lifestyle. We solve this problem by making it easier for hospitals to offer medical nutrition therapy, and for patients to afford the service. By dietary prescriptions, I mean evidence-based nutrition therapies. Currently, if a patient goes to the hospital, the probability of receiving medical nutrition therapy is as low as 10%, meaning approximately 90% of patients who need medical nutrition therapy are not referred to a nutritionist. This is an area of healthcare that is necessary to reduce the high mortality rate of lifestyle diseases.

When we talk about nutrition, we often think about general preventative-health nutrition, such as the need to eat healthy, drinking enough water, getting enough nutrients and so on. But medical nutrition therapy relates to patients who need nutrition to cure illnesses, like diabetes, cancer, gout, thyroidism, and so on. Our technology provides evidence-based nutrition recommendations and automates meal plans, supporting nutritionists to provide nutrition therapy for patients that is based medical research. Our nutritionists align food recommendations to the patient’s palate and localize the meal recommendations to respond to foods that are accessible to them. 

So far, we have nutritional solutions for 54 health conditions based on research, and we provide mothers, infants and young children nutrition advice. Lishe Living technology tabulates and recommends a whole list of all the nutrients that a patient is supposed to be consuming, not just the type of nutrient but also the quantity, and the nutritionists has an option of using the technology to automate a localized meal plan. Our main customers are hospitals and insurance companies – anyone who aggregates patients, but the end client is always the patient. We work on a revenue sharing model with his hospitals, insurance companies as well as doctors.

Food is medicine, but there is so much focus on the pharmaceutical industry that we can forget this aspect of treatment. Of course, medications are important, but they are not as effective without the right nutrition while treating diet-related problems and diseases. 

"Lishe Living’s technology enables nutritionists to conduct diet assessments and deliver evidence-based, disease-specific, diet recommendations to help their clients live healthier lives. The effectiveness of this technology is confirmed by numerous clients who share testimonies of weight loss and reduced blood sugar.

Non-communicable diseases (NCD) such as cancer, cardiovascular diseases and diabetes are currently responsible for 37% of deaths in Africa and Lishe Living is playing an important role in addressing unhealthy diets and physical inactivity which are key NCD risk factors. As Lishe Living scales across Kenya and Africa, it will help to stem the tide of NCDs, which are projected to become the leading cause of death and disease in Africa by 2030." - Moses Waweru, Senior Program Manager, Villgro Africa

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

We are now making traction in creating the right formulas for inpatients. If a patient goes home, they are given a meal plan, but some patients who are admitted in hospitals require modified foods, such as liquid diets. We work with hospitals to ensure that inpatients receive their optimal diets while they’re admitted. This includes screening the patient, and providing the appropriate feeding regime, be it a normal diet, enteral or parenteral feeds. Working to structure the inpatient medical nutrition therapy gets me excited about further product development of our technology.

We have also made exciting progress in our pricing model. We have discovered that we can charge 400 shillings to the patient and still make a profit at inpatient hospitals. This is such great traction not just for patients but also for hospitals, because our services become affordable for patients and profitable for hospitals. That is what we’re quite keen on doing. We don’t charge an upfront set-up fee to hospitals. We come in with a full revenue share model. This has really opened up the market for us because hospitals feel they're in partnership and we’re equally sharing the risk. 

What are the challenges you’re currently facing? 

Our primary challenge is the billing cycle. At the moment, we receive payment after the hospital receives payment, and the billing cycle of insurance companies can take as long as three months. One way we are trying to address this is by building direct relationships with insurance companies and raising seed capital to cover scale into hospitals. The seed capital will provide the cash flow buffer we require in the first three months of taking up a hospital’s nutrition department. 

Over the course of developing your innovation, what is something you have learned that stands out and that might help other innovators?

There’s something to patience that we do not take seriously. The whole process of growing a business and getting it to market takes so much patience beyond what one would actually expect. However, it's not passive patience. There is something to be said for just taking some time to listen to the market before responding. 

There’s also a shift in payment mode in hospitals, as more people are taking up insurance.  We keep making reference to a large number of out-of-pocket payments, however I think there's a shift happening in the Kenyan market as more people take up the National Health Insurance Fund (NHIF). As startups, we might have to think about how to work in partnership with the government, especially within the universal health care framework. We really need to incorporate the national insurance process into our thinking about how to better scale nutrition services to the whole of Kenya. 

How has Villgro impacted your growth?

I don't know whether I should call Moses Waweru my portfolio manager, my coach, or my therapist, but he has played the role of an anchor. As much as I run a startup, we are at that point where we need to start raising money to strengthen our management team. I don’t have a co-founder, so it’s been so important to have a person that I can call and run through thoughts about everything related to the business and ideas for growth. 

The funding we received from Villgro allowed us to test our business model, partly develop the Lishe Living Android app for patients, as well as test the clinical effectiveness of the medical nutrition services we provide through the Lishe Living web app. Villgro has been at the center of giving us the validation we required. Villgro support has benefited our patients just as much; through brainstorming sessions and open discussions, we were able to transform the company into a social enterprise.