Photo: Instrat GHS
By Stephanie E. Buck
September 20, 2017
In April 2015, a strange illness began spreading in Ondo State in Nigeria. Dozens of people started experiencing blurry vision, headaches, blindness, and loss of consciousness. Around the same time, people in nearby Rivers State began to suffer the same symptoms, sending communities into a panic, and claiming the lives of 66 people. Rumors of Ebola spread, but proved to be wrong. Instead, the mysterious disease was linked to methanol poisoning as a result of a pesticide-contaminated batch of a locally brewed gin, called Ogogoro. In total, it took more than six weeks to contain the Rivers State outbreak.
But in Ondo State, while 18 people still died tragically, the outbreak was contained in two weeks. Why the difference?
Primary health centers and local governments in Ondo State were using a tablet-based app to collect and analyze real-time disease data to map and identify the cause of the outbreak. This resulted in more effective and efficient disease-control activities, and translated into fewer lives lost.
This represents the dream that Okey Okuzu has to help his home country, and why he keeps coming back. “I always had the motivation to go back to Nigeria,” Okuzu says. “I saw the haves and have-nots, but with my exposure from international travels, I saw ways to address imbalances that may not have been visible to those within.”
With an MBA from Columbia University and more than a decade leading business development, strategy, and innovation at major pharmaceutical companies in the U.S., Okuzu saw the real impact that having accurate health data has on healthcare quality. And he saw its untapped potential, especially in lower-resource settings, like Nigeria.
Health informatics, or the capture, storage, and retrieval of healthcare information, makes coordination between different providers easier and more efficient. At an individual and systems level, it can lead to more lives saved, better care, and help countries meet global healthcare goals like reducing the number of women dying in childbirth. As mobile technology started making inroads, Okuzu’s inspiration and vision for change in his home country grew.
Nigeria has been making steady progress in terms of life expectancy and quality of life over the years as its population has grown to approximately 182 million. Nigeria spends approximately 3.7% of its GDP on health. Nonetheless, life expectancy at birth is still only 52 years for men, and 54 for women, according to the WHO and World Bank (links). Maternal mortality has also decreased over the past two decades, but it is still high: 814 out of every 100,000 live births result in a woman dying while trying to give life, or shortly thereafter. For context, in nearby Ghana, that number is 319 per 100,000, in the United States it’s 14, and in Norway that number drops to five.
In the country’s 36 states there are 34,000 health facilities, of which 66% are owned by federal, state, and local governments. Primary health centers are meant to be just that: the main place where all Nigerians can go to receive basic healthcare. But inequality persists. Many people, especially in rural areas do not have access to healthcare at all. And wealthier Nigerians will often go to secondary or tertiary health care centers, where care might be more specialized, but it’s more expensive and out of reach for much of the population.
But as mobile technology started to become cheaper, easier, and more ubiquitous, Okuzu saw an opportunity to fill significant infrastructure and information gaps in the Nigerian healthcare system, specifically at primary health care centers.
To start out, Okuzu invested a significant portion of his own money to start Instrat Global Health Solutions (Instrat GHS) in 2010. His first attempt at health informatics in Nigeria involved an SMS-based app. “This app allowed patients with chronic diseases to record their data and transfer important health measures to a database that would track trends and inform their health care givers and family members when things like blood pressure, blood sugar, asthma peak flow readings, etcetera started to spike,” Okuzu said. And it was well received by patients, doctors, and ministry of health workers. It was then that he knew he must be on to something.
As he sat down with more doctors, public health officials, and other important actors in the healthcare system, he realized that many problems they were describing could potentially be addressed by better health information. In other words, the healthcare gap was largely connected to information gaps.
And so Okuzu went in search of Western health technologies that were ideally designed for low-resource settings like Nigeria. Through that search he formed a fruitful partnership with Vecna Cares, who had just developed a tablet-based solution for improved health information and data-sharing systems in Nigeria, called CliniPAK.
With any innovation, context and timing are important. And with Instrat GHS, Okuzu took advantage of the opportunities that greater mobile penetration, particularly the 3G network, was providing in his home country. The upward trend in mobile penetration in Nigeria had already begun: in 2016 83% of Nigerians had mobile phones, and in December 2017 that number will reach 86%. Computer technology was also becoming better, cheaper, and going mobile in the form of wireless 3G-enabled tablets.
And so, with great enthusiasm, Okuzu put his proposal for the pilot program forward to several key actors in Nigeria, including the government. And got nowhere; not because the government didn’t like the idea, he says, but because it appeared too risky. They needed more proof that it would work first. Okuzu knew that he could address the execution and adoption risks, as well as the adoption hesitations that the government and local investors were concerned about. “It was a tough period,” Okuzu stated. “The value proposition was so clear in my mind, and I couldn’t understand why it wasn’t as clear for others.”
Fortunately, private corporations were interested, and Qualcomm® Wireless Reach™ was able to provide support to get a pilot program off the ground and into public primary health centers in Nigeria. The goal was to change hand-written data collection methods to electronic ones, so that information could be collected, stored, shared, and used to make better decisions, faster.
According to a baseline study conducted by Instrat GHS, it would take an average of 14 – 15 days to collect the data from the service point at the primary health centers, send that data to the local/state governments, and then have the government verify and validate all of the information sent.
CliniPAK reduces that time from two weeks to a matter of minutes. By making health data electronic and storing it in a remote server that can be accessed at any time, they’re changing the game. This data can be used to review patient history and make recommendations based on a more complete healthcare picture, and to provide real-time data to the Ministry of Health for policy and planning decisions.
From the beginning, the Instrat GHS team knew that proper training would be a vital ingredient to their success. Beyond being in the right place at the right time with a viable business model, if the healthcare workers didn’t use the technology, CliniPAK would never reach its full potential.
First, they had to make the software user-friendly. The fact that CliniPAK is tablet-based already made it more accessible than desktop or laptop software. Touching and swiping on a screen proved easier to use than a keyboard. And as more Nigerians were getting used to smartphones, the case for tablet-based health information solutions became even stronger.
Second, beyond the interface, Okuzu and Vecna Cares worked hard to make sure CliniPak mirrored government workflows and health questions. If they changed too much too soon they risked losing clients. And with people’s lives on the line, there was too much at stake to risk overwhelming healthcare professionals with new questions in addition to a new tool.
Third, Okuzu knew they needed local staff to conduct the training sessions. Hiring people from the local area helped instill a greater sense of trust and confidence than anyone else could, even if they were just from another part of Nigeria. Their training also required a lot of hand-holding. When Okuzu describes their first training workshop, he says that they were so nervous. But in addition to keeping the information they were seeing on the tablets the same as what they were used to seeing on paper, a small group setting that encouraged peer-to-peer learning also proved effective. Okuzu’s team showed the group how to use the software, and then would ask one member of the group to demonstrate one particular function of the software, and then would ask others to demonstrate other functions. Before long, the whole group was cheering each other on. “This shows the power of the human capacity to learn,” Okuzu said.
Instrat GHS and Vecna Cares started the CliniPak pilot with Qualcomm Wireless Reach support in September 2013 with two primary health centers in the Federal Capital Territory. In 2014, they were operating in 14 health centers in three states. In 2015 they expanded to 50 healthcare facilities in four states. By 2016 they were operating the software in 150 facilities in six states, and as of July 2017 they have improved health care for nearly 200,000 women and children. They also have continued support from Qualcomm Wireless Reach and funding – mostly from state and local governments – to reach 1,000 centers in 12 states in Nigeria. One health worker in Ondo State stated that ClinikPAK makes their work faster, makes it harder to lose documents, and makes it easier to find information about clients.
But it’s not just about the growth of this product for Okuzu and the Instrat GHS team. It’s about the impact on the lives of real people, and changing outcomes for everyone their product serves. For Okuzu, there are so many success stories, but stemming the methanol poisoning outbreak, as described earlier, is one that truly stands out in his mind. They were able to use a derivative of CliniPAK to control a disease outbreak, and save more lives.
The possibilities for this kind of data, and training people in its use, analysis, and to inform and encourage behavior change is endless. And Okuzu hopes its use will continue to expand and improve. So far it is. Even the UK Space Agency is taking note, contracting Instrat GHS to put satellite technologies in 84 healthcare facilities in three states in Nigeria that have previously not had internet connectivity. For Okuzu, this is a huge deal: “This could mean bringing health informatics into any healthcare center in Nigeria regardless of where it is. Solar energy can provide the power, and satellite can provide the internet.”
Okey adds, “Getting that initial grant from Qualcomm Wireless Reach made all of this possible.” When Instrat GHS began implementing the CliniPAK360 program with Vecna Cares in 2013, the company consisted of Okey and one staff member in Nigeria. Now they have 25 people on their team, and are growing at a rate of two to three people per month. “I feel accomplished because, as I tell my staff, my goal by the end of (2017) is for Instrat to be fully autonomous so it can run without me.” He adds, “Health informatics has become a reality in Nigeria, and it’s not going anywhere.”
This story was made possible with the support of Qualcomm® Wireless Reach™