Innovator Spotlight: Enzi Health

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.