In the last 10 years or so, Africa has experienced a wave of innovative efforts in the technology, agriculture and services sectors, which have immensely improved the lives of Africans. For example, MPESA, a financial services mobile transfer service, has improved the lives of millions of East Africans who previously had no access to mainstream financial services.⁽²⁾ Technology advancements in the areas of communications and information technology (IT) have improved the services sectors, further improving the efficiency of services offered by small and micro enterprises (SMEs) and larger businesses.⁽³⁾ However, Sub-Saharan African countries are still grappling with poor health status, presenting an opportunity for young entrepreneurs to devise innovative health solutions with the potential to improve the health status of Africans. Investments in the health sector have largely focused on hospital systems through the improvement of healthcare facilities and the quality of training offered to medical doctors, while overlooking other opportunities. Innovations in the health sector have the ability to transform traditional medical systems to more modern, well-structured systems that can respond more effectively and efficiently to the demand for quality health care on the continent.

This paper reviews key entrepreneurial efforts and innovations with the potential to revolutionise the African health sector. The innovations have been selected because they are home-grown, have the potential to address challenges of the health sector in the African context, and have received international recognition.

Innovations focusing on health services

In Africa, most public health facilities are affected by various institutional problems,which affect the quality of healthcare offered on the continent.⁽⁴⁾ In addition, private healthcare facilities offer healthcare services of a much better quality, though costlier than public facilities. The high costs of private healthcare often force individuals from lower income groups to seek care in public healthcare facilities and contend with the poor quality of healthcare in the public sector. This means that individuals from low income groups, the majority of which are women, have limited, if any, access to quality healthcare, a trend that perpetuates inequality in terms of health outcomes and, in general, quality of life. The two innovations described below are aimed at providing high quality health services to women from low-income groups who otherwise cannot afford expensive services and products.

Penda Health (Kenya)

Penda Health, which was established in 2011 in Kenya, is a social enterprise providing health services designed for Kenyan women in the low- and middle-income bracket. Penda Health offers quality healthcare options, replacing the dismal options available to its target group.⁽⁵⁾ Penda Health noted that middle- and low-income Kenya spends US$ 1.2 billion a year on outpatient healthcare, which is estimated to reach US$ 2 billion by 2018, although this market is completely ignored by healthcare providers. To improve access, Penda Health’s chain of clinics provides high quality reproductive health services in areas where women from low income groups are found in large numbers, such as informal settlementsand industrial areas.⁽⁶⁾ Penda Health has plans to expand and roll out about 50 healthcare facilities across East Africa. In recognition of its efforts, Penda Health won the November 2012 Bid Network Global Entrepreneur of the Year Award.⁽⁷⁾ This award exposed them to international funders and investors, who may provide funds and technical support, as well as help develop the brand message.

Iyeza Express (South Africa)

Long queues are a common phenomenon in public hospitals in Africa; it is not unheard of for patients to die while waiting in queues for healthcare services. In South Africa, a young entrepreneur, Sizwe Nzima, noted the gap in healthcare services after reading a newspaper article about clinics struggling to cope with patients who queue for hours to pick up chronic medication in the Western Cape Province.⁽⁸⁾ Nzima subsequently started a business that resolves the issue of overcrowding, while improving the lives of people who rely on chronic medication. Nzima’s Iyeza Express collects chronic medication from local clinics and delivers them by bicycle directly to patients’ homes. Clients pay a small fee of ZAR 10 (US$ 1.1) per collection. These medicines are collected from Michael Mapongwane Hospital and the Site B District Hospital in the Western Cape. Nzima hopes to expand his business after obtaining official approval from the authorities at Khayelitsha clinics to collect and deliver medication to patients. The Provincial Department of Health has given him permission to conduct surveys at health facilities so as to determine public opinion on his services and identify ways in which his services could be improved in order to better meet the needs of the public. Nzima won seed funding at the SAB Innovation Awards in October 2012, and was also the joint winner in the Cape Town Entrepreneurship Week ‘Top 5 Youth Entrepreneurs competition in November 2012.⁽⁹⁾ This innovation has the potential to be scaled up to other African countries, where long queues are part and parcel of the public health system.

Ruby Cup (Kenya)

The Ruby Cup is an alternative menstrual hygiene product which was developed in Kenya by three Danish women. The Ruby Cup is a menstrual cup targeting girls and women in developing countries who cannot afford quality sanitary products.⁽¹⁰⁾ The product is sold to organisations and distributed through a network of female entrepreneurs to women from low income groups. This approach also fosters an intimate space where women can educate other women and girls about menstrual hygiene.⁽¹¹⁾ Due to its uniqueness, the Ruby Cup has attracted international recognition; it was the winner of the Global Social Entrepreneurship Competition March 2012, Venture Cup June 2012, a selected Sustainia100 Solution, Finalist in Ben & Jerry’s Join Our Core 2012, and second prize recipient of the Future Impact Award 2012. The Ruby Cup is made of 100% medical grade silicone approved by the United States’ Food and Drug Administration (FDA), and can be re-used for up to 10 years; thus indicating its potential to improve the lives of millions of women and girls all over Africa who cannot afford sanitary towels.

Innovations focusing on technology

Health sector investments are often concentrated on capital expenditure such as the purchasing of hospital equipment, and recurrent expenditure such as paying salaries, leaving health information systems under-funded. Seamless systems that can save time, improve efficiency and meet patients’ expectations of public healthcare could be invented. According to the World Health Organisation, Africa is poor at generating evidence for policy and decision-making because national health information systems do not produce good quality and timely information.⁽¹²⁾ It has since been recommended that African countries establish national observatories that capture health information from the top (national level) to the bottom (community level). While most African countries are set on improving their national health information systems, entrepreneurs have not been left behind, as shown in the two examples below.

eHealth (Nigeria)

According to Adam Thompson, founder of eHealth Nigeria, lack of an accurate and timely health information system in Nigeria affects service delivery, from the delivery of supplies, to the reaction to an outbreak of cholera and identification of communities affected by polio. eHealth Nigeria combines hardware, software, power (solar and conventional electricity), training and communications infrastructure, such as mobile phones, into easily accessible packages for health providers to use. eHealth Nigeria provides services in a range of areas (HIV, maternal health, nutrition, polio, etc.), which can involve deploying software solutions, alternative energy solutions, providing data centre services, or organising survey and data collection services. The federal government of Kano and selected health facilities have benefited immensely as eHealth Nigeria, through the support of the Population Council, regularly trains traditional birth attendants (TBAs). These TBAs receive training on the use of cell phones for reporting maternal and child health events by texting vital maternal and child health events into a server, which then sends text message alerts to local doctors and midwives, who can then respond appropriately to the situation.⁽¹³⁾ eHealth Nigeria has expanded outside Nigeria, and also provides eHealth and mHealth tools and services to government agencies, non-governmental organisations (NGOs), private hospitals, and other health agencies around West and Central Africa.⁽¹⁴⁾ Another innovation based in Nigeria, founded in 2011 by Tosan Adams, is known as MedicRAM (Medical Records and Management). The system captures patient medical histories and prescription data. These data are then analysed to enhance treatment procedures and preserve patients’ medical records.⁽¹⁵⁾ MedicRAM implements one repository for the medical records of all medical practitioners and patients, and it ensures information security through the deployment of biometric data-access control solutions. Biometric data-access control secures personal medical data, ensuring that only approved personnel can access the data through the use of bio-metric identification systems like eye-scans and facial recognition.

Medical Diagnostech (South Africa)

Africa is greatly affected by communicable diseases such as tuberculosis, malaria, cholera and HIV/AIDS. To detect and treat them, they all require good diagnostic techniques. However, quality diagnostic kits are expensive, rendering them unaffordable to many. Noticing the gap, Ashley Uys, an innovator and entrepreneur from South Africa, and Managing Director of Medical Diagnostech, develops and markets affordable and reliable medical test kits for malaria, pregnancy, syphilis, and HIV/Aids for South Africa’s rural poor.⁽¹⁶⁾

In 2008, Medical Diagnostech won ZAR 200,000 (US$ 22,272) in prize money and a further ZAR 125,000 (US$ 13,920) in grant money from the SAB Kickstart Competition. With the cash flow generated from distributing the kits, as well as the cash won through SAB Kickstart, Uys was able to start buying laboratory and injection-moulding equipment to manufacture his own products, until he was able to afford his own factory space. In 2011, Medical Diagnostech exported more than 2.5 million malaria test kits to Pakistan, Papua New Guinea and other countries via a distributor to the World Health Organisation. The company also supplies these to local pharmacies. According to Uys, the new factory will allow him to manufacture about 20 million test kits a year, and once the International Standards Organisation (ISO) accreditation is approved, new HIV kits will be shipped to the rest of Africa.⁽¹⁷⁾ The kits have the potential to improve diagnoses in African countries that cannot afford expensive, complex diagnostic kits.

Concluding remarks

The potential for entrepreneurs to come up with innovations that can transform the African health sector is immeasurable. Before embarking on this, it is important for aspiring entrepreneurs to identify the most pressing health needs that affect the quality of health service delivery in a given region, and introduce simple solutions informed by local settings. Good ideas alone are not enough; therefore entrepreneurs need the encouragement and support of governments and donors through the provision of grants, accreditation and training for example, by protecting and enforcing intellectual property rights and commercialising products with the aim of expansion to other markets.

Written by Janet Mugo ⁽¹⁾

NOTES:

(1) Contact Janet Mugo through Consultancy Africa Intelligence's Public Health Unit ( public.health@consultancyafrica.com). This CAI discussion paper was developed with the assistance of Tsholofelo Thomas and was edited by Liezl Stretton.
(2) Nowick, M., ‘M-Banking: A model for growth in the financial services sector’, Joint Migration and Development Initiative, Brussels, 9 May 2009, http://www.migration4development.org.
(3) Ochieng, L., ‘Africa leads Europe, US in economic growth, thanks to mobile phones’, The East African, 22 December 2012,  http://www.theeastafrican.co.ke.
(4) ‘The hospital strategy project for Africa’s public hospital system’, Solidarity Foundation, http://www.solidary.org.
(5) ‘Penda health – Kenya’, BiD Network, http://www.bidnetwork.org.
(6) Ibid.
(7) ‘Penda wins 2012 BiD network global entrepreneur of the year!’, Penda Health, 28 November 2012, http://pendahealth.wordpress.com.
(8) Hartigh, W., ‘Meds on wheels for positive change’, Mediaclub South Africa, 19 November 2012, http://www.mediaclubsouthafrica.com.
(9) ‘Another winner! Sizwe Nzima from Iyeza Express’, Raymond Ackerman Academy, http://www.ackermanacademy.co.za.
(10) Sande, W., ‘“Ruby cup” – a superior alternative to sanitary pads now in Kibera slums’, Voice of Kibera, 5 September 2012, http://blog.voiceofkibera.org.
(11) Ibid.
(12) Mbulo, E., ‘Poor evidence generation affecting policy decision making in Africa, says WHO’, Key Correspondent Team, 22 November 2012, http://www.keycorrespondents.org.
(13) ‘AMD helps eHealth Nigeria build a system designed to improve healthcare’, Advanced Micro Devices, http://web.amd.com.
(14)Van Vugt, B., ‘eHealth Nigeria: Technology solutions to transform the African health care sector’, Venture Capital for Africa, 15 February 2012, http://vc4africa.biz.
(15) Ibid.
(16) ‘About us’, Medical Diagnostech, http://www.meditech.co.za.                                                                
(17) Timm, S., ‘Science innovation passes business test’, Business Day, 10 December 2012, http://www.bdlive.co.za.