Medical start-ups across Africa aim to plug service gaps

In 2017, Nigerian president Muhammadu Buhari spent over 100 days in the UK being treated for an undisclosed medical problem. Gabon’s president Ali Bongo suffered a stroke last year and sought treatment in Morocco. Zimbabwe’s former dictator Robert Mugabe died this month in Singapore, his preferred medical destination. Benin’s president Patrice Talon likes France; Angola’s ex-strongman Eduardo Dos Santos went to Spain.

The healthcare systems of countries across sub-Saharan Africa are woefully underfunded, ill-equipped and often understaffed — something the rich and powerful can get around by travelling abroad for treatment.

But start-ups across the continent are trying to improve systems on the ground, for both a burgeoning middle class and the masses of Africans who lack access to even basic healthcare services. The companies range from global businesses with Silicon Valley pedigrees such as Zipline — which earlier this year launched the world’s largest drone delivery network in Ghana — to small, locally-grown upstarts addressing local challenges.

Sub-Saharan Africa trails most of the world in both access to healthcare and health indicators, ranging from frequency of maternal and infant mortality to malnutrition. The continent contains just 2 per cent of the world’s doctors — with countries like Uganda and Cameroon having less than one physician per 1,000 people, compared with 35 in the Netherlands, according to the World Health Organization.

Dr Funmi Adewara is a prime example. Fifteen years ago she was one of the roughly 2,000 medical workers who leave Nigeria each year for the west. “I trained in Nigeria, and then I came to [the UK] . . . but I’m very passionate about changing this poor narrative, because I’ve experienced it first hand,” she says. “I’ve had relatives who have suffered from poor healthcare services and I’ve treated patients who have suffered from this.”

Earlier this year, Dr Adewara launched Mobihealth. It connects doctors — largely, but not exclusively, in the west — to patients in Nigeria via a mobile phone app. Those who can afford it pay a monthly fee of between $10 and $27, which covers everything from testing to prescription drugs. Poorer patients who may not have smartphones are served by clinics that travel to rural communities and connect to Mobihealth’s doctor network.

Babyl operates a similar system on a larger scale in Rwanda, where it has established a partnership with the government to provide consultations over the phone with doctors in its call centre in the capital Kigali. It has 2.2m registered users and does 3,000 telephone consultations a day — or over 600,000 since launching two years ago.

“Fifty per cent of the world’s population doesn’t have access to healthcare and 80 per cent have access to some kind of mobile phone,” says Tracey McNeill, who served as chief executive for three years before returning to the parent company in the UK this summer. The “vision is to put healthcare on a mobile phone and provide access globally”.

Babyl is an offshoot of Babylon Health, a company that has a contract with the UK’s National Health Service to offer patients in London and other major cities the option of an AI-enabled digital consultation instead of a GP visit. In August, the company announced a $550m funding round, valuing it at over $2bn. The company plans to expand its AI offerings in Rwanda, where it has begun using the technology for some consultations, Ms McNeill says.

Those who are building businesses are building them for those who can afford healthcare already

WHO’s African region — which encompasses most of sub-Saharan Africa — has access to just 1 per cent of the world’s financial resources for health despite “accounting for more than 24 per cent of the global burden of disease”, says the organisation. Health spending per capita in the region has doubled to $472 since 2000, but in more than half of its low-income countries, that figure is below the WHO-recommended $34.

Nigeria, Africa’s most populous country, spent just 3.9 per cent of its 2018 budget on health, far below the 15 per cent African Union members agreed to spend at a 2001 summit. The global average is 10 per cent, according to latest World Bank data.

“The biggest challenge we have in Nigeria is the historic underfunding of healthcare over the years . . . where if you need adequate healthcare you need to go to the private sector,” says Soga Oni, founder of MDaas, a diagnostics start-up. “The quality of healthcare in Nigeria is wholly dependent on how much you can pay.”

To solve that problem — and bring costs down — MDaas acts as a central diagnostic centre for dozens of healthcare facilities in the southwestern Nigerian city of Ibadan. The venture has seen 12,000 patients since launching its first centre two years ago. It hopes to double or triple that number by the end of the year. “We think that scale is the name of the game, so if we can get 20, 30, 40 facilities across the country . . . the price to provide healthcare to people would drop drastically,” he says.

Still, the healthcare tech ecosystem across the continent remains small. According to data from Partech Partners, a venture fund that invests in Africa, healthcare start-ups accounted for just $18m of the $1bn in venture funding that poured into Africa last year. A number of fintech start-ups — arguably the continent’s hottest tech sector — have raised that much or more individually.

But Roo Rogers, head of Founders Factory Africa, an offshoot of a London-based tech accelerator, says the opportunity remains vast — especially if entrepreneurs focus on the market that does not have access to healthcare services. His group received over 500 applications in the past few months to join the newly-launched health tech accelerator.

“The biggest difficulty in African healthcare is really that those who are building businesses are building them for those who can afford healthcare already,” he says. “That’s such a small market and I think that’s a missed opportunity.”

Real progress, he suggests, depends on such ventures expanding their reach to those who do not already have access to healthcare, “not just for social impact purposes but for business purposes. It just makes sense”.