Safe Affordable drugs for rural villages

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Safe Affordable drugs for rural villages: Mobile app ensures just-in-time supply of drugs to rural health workers.

NAIROBI, KenyaNAIROBI, Kenya
Year Founded:
2012
Organization type: 
for profit
Project Stage:
Growth
Budget: 
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Technology adoption in healthcare is slow. One consequence is health workers in low-income countries remain ill-equipped to manage stocks of essential drugs. Drug shortages and counterfeit abound. ZiDi™ is a mobile app for virtual monitoring and ordering of safe drugs, even in remote clinics.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if ALL rural clinics were e-linked to preferred drugs suppliers to ensure demand-driven access to safe affordable drugs and saved lives?
About Project

Problem: What problem is this project trying to address?

Rural clinics provide 80% of care in Kenya yet are ill-equipped to accurately forecast and efficiently order supplies. Current manual systems favor stockouts and the proliferation of counterfiet drugs. A ubiquitous mobile app for real-time tracking of drugs in rural clinics is of great moment, lest the burden of treatable diseases will remain a leading cause of child mortality. Without safe affordable drugs, both patients and providers suffer.

Solution: What is the proposed solution? Please be specific!

Health workers subscribed to our pre-paid service, Chama-Rx, have access to ZiDi™, a cloud-based mobile app that tracks every drug dispensed and autogenerates weekly orders. (Chama = club). Chama-Rx subscribers participate in pooled-purchasing of safe drugs at wholesale price and on demand and receive supplies via a just-in-time, bi-weekly, courier delivery system. Nationwide access to drugs for common diseases can thus be achieved cost-effectively without a huge investment from rural health workers. Subscribers get a percentage of the margins of drugs sold at the point of care and their clinics become more sustainable and profitable. Patients benefit from the lower price of drugs offered at the point of care.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Kasongo dispensary is a government-owned clinic in rural Kisumu County, Kenya. It serves ~500 patients each month. The clinic receives drugs from the Kenya Medical Supply Authority (KEMSA) every 90-100 days, if on schedule. The clinic runs out of drugs within 30-days post-delivery. Hence, over 1,000 patients are given prescriptions who then go to the open market where drugs are 3-to-5 times more expensive and 40% are counterfeit. The patients sometimes opt for a partial dose or delay care. The facility looses revenue to counterfeiters. With ZiDi and just-in-time access to safe affordable drugs, the clinic will have year-round supply even when the government supply is delayed. They will retain revenue from the 1,000 patients quarterly.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

SYSTEMIC IMPACT: Nationwide adoption of ZiDi™ in 4,136 facilities in Kenya via a public-private partnership with KEMSA and the Ministry of Health is envisaged. ZiDi™ will improve forecasting and supply-chain management, enhance accountability for supplies in public clinics, and eliminate the burden imposed on health workers who manage their inventory manually. With an adequate supply of subsidized drugs, which are given free or at very low cost to patients, we estimate that Kenya's rural homesteads would save a minimum of $33 million each year, assuming that 80% of the population spends $1 per year on a drug that should otherwise be free in the public clinics. However, accurately forecasting 90-day supplies is daunting given the seasonality of diseases and inefficiencies in the public sector. Without shorter delivery cycles, shortage will endure, hence the importance of Chama-Rx.

Spread Strategies: Moving forward, what are the main strategies for scaling impact?

By coupling ZiDi with just-in-time courier delivery through the pooled-purchase program, we are in essence filling the gaps of the public sector while creating savings for patients. With a pool of 1,000+ subscribers, we can secure drugs at wholesale prices and pass on the savings to the bottom of the pyramid, that is typically priced-out by the retailers' margins in the open market. Our model allows us to minimize warehousing costs and eliminate the typical costs of sale that bump up the price of drugs. Hence, armed with Chama-Rx, 1000+ rural clinics will become efficient and profitable.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

Our sustainability is anchored on our design and scalability. ZiDi™ can be used anywhere, everywhere. It is scalable for use throughout Africa. Once we enroll 1,000 users, we will be the 3rd largest distributor in Kenya and attract ALL major manufacturers into our two-point supply chain. Modest margins from pre-paid, on-demand distribution will attract patients, clinics, insurers AND ensure we provide safe, affordable drugs to the underserved.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Private sector drug distribution in Kenya is tightly managed from manufacturer to importer, distributor, wholesaler, retailer 1, retailer 2 and then user. Prices rise by 10-35% with each hand-off; 70% of users are thus priced-out. In parallel to this, public clinics receive ONLY essential drugs from KEMSA at wholesaler price; faith-based clinics (FBCs) are served by Mission for Essential Drugs (MEDS). KEMSA & MEDS receive 90-day orders to bulk supply. Areas without public & FBCs rely on informal suppliers, the gateway for counterfeit. Chama-Rx targets these underserved areas, >40% of market.
Team

Founding Story

Imagine if we saved every rural citizen in Kenya, i.e., approximately 78 percent of the 43.3 million inhabitants , ONE DOLLAR PER YEAR by improving the distribution of and access to ALL essential drugs. That would result in $33.73 million in retained income for those rural households. Each dollar saved can purchase one liter of milk and a 500g loaf of bread, 1 Kg of potato, 2 Kg of maize or wheat flour, 23 cellular phone minutes or 3 months worth of chlorine to disinfect drinking water. This was the founding vision that guided development of ZiDi and the Chama-Rx business model as a disruptive approach to improve supply chain in Africa, that's in the tight grip of price-gauging retailers. The "Amazon" of rural africa was thus born.

Team

I bring 20-years experience in health systems management. My partner brings 20-years of wholesale drug distribution experience in Kenya. We partner with a small business with 10-plus years in warehousing and supply chain management. MicroClinic Technologies has a team of 10 developers and 5 field coordinators that do outreach to clinics. Strategic partners are Microsoft for cloud services; microfinance lenders, and Yahsat for satellite.
About You
Organization:
MicroClinic Technologies Ltd.
About You
About Your Organization
Organization Name

MicroClinic Technologies Ltd.

Organization Country

, NAIROBI

Country where this project is creating social impact

, NAIROBI

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Impact
Full Impact Potential: What are the main spread strategies moving forward? (Please consider geographic spread, policy reform, and independent replication/adoption of the idea or other mechanisms.)

We will grow ZiDi™ in the public and private sector of East Africa. Our public sector strategy seeks to establish public private partnerships that include drug distributors, the Ministry of Health and funders. Our private sector strategy strives to establish partnership with large provider networks interested in a uniform platform for their clinics. We also seek partnerships with large drug suppliers & manufacturers. These partnerships will ensure access to ZiDi™ is partially subsidized for public and private providers in East Africa in exchange for data. MoH Kenya & KEMSA are onboard.

Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?

We anticipate 3 main barriers . 1) the status quo, notably, health workers reselling KEMSA drugs at the expense of the public and inherent competition from suppliers of paper registers who opt for current manual systems and resist change. 2) a high upfront investment in satellite connectivity and tablets is required for ZiDi™ to operate. This minimizes uptake of ZiDi™ by small private clinics. 3) Government financing is needed for scale-up. This is subject to legislative approval that could slow nationwide adoption of ZiDi™. Current buy-in from the Ministry of Health dwarfs these barriers.

Sustainability
Partnerships: Tell us about your partnerships.

We have established partnerships with KEMSA, Microsoft, Yahsat, and Mastek and hope to formalize a public private partnership with the Ministry of Health in 2014. KEMSA grants us access to their enterprise resource planning system. Microsoft provides low-cost cloud services and supports the Windows 8 version of ZiDi™. Yahsat gives us premium rates for satellite connectivity. Mastek provides low cost tablets.

Closing the Loop
How does your project primarily ensure that feedback delivers results?

Demonstrate how closed feedback loops can make a difference in people’s lives.

Please elaborate on your answer to the above question.

Access to safe and affordable drugs is an essential fuction of public health systems. Data on stock levels for essential drugs are currently inaccurate or unavailable. The MoH arbitrarily allocates drugs to public rural clinics. The clinics end-up under-supplied. Health facilities equipped with ZiDi™ track their supplies in real-time and the MoH responds before they run out. Patients will therefore not resort to counterfeit drugs if stockouts are minimized in their local clinics.

Languages: In what languages are you able to read and write fluently?

English, French.

2nd Round Questions
Thinking about your feedback loop; what information are you trying to get from whom, to whom, and to bring about what change?

Our feedback loops gets information on drug consumption at the point of care, i.e., clinics, even in the most remote villages. The information is transmitted in real time to suppliers of drugs, including the National medical supply authority or large private distributors. The authorities are then able to respond to the gaps in availability of drugs in shorter times.

What is the purpose of your feedback loop?

Improve quality of programs

If other, please specify
What mediums or mechanisms do you use to collect feedback? (check all that apply)

Website.

If other, please specify

via a mobile app interface

Could you briefly describe the way you collect the feedback?

We have developed a mobile app that tracks each drug as it is being prescribed. The information on what is being prescribed and the stock levels in the facility are then transmitted to the target drug supplier with access to a web portal where they can view the activity and stock movement in real time. The clinics are equipped with a tablet running our software and 3G or satellite connectivity to make this happen in any location in Africa.

What mechanisms are in place to protect people from retribution?

None

If other, please specify

The need for retribution is minimal, if not unwarranted, given that our model is a win-win for both the clinics and the supplier

What are the immediate benefits or incentives for people to provide feedback?

Monetary incentives

If other, please specify

users of the system improve their revenue by 20-40% given that fewer patients are diverted from the clinics for lack of drugs an

How do you ensure new and marginalized voices are heard?

Incentives (monetary or other) targeting specific groups

If other, please specify

The technology works in remote locations by design. Hence even clinics in rural areas can benefit from this technology and the a

What are the incentives for the intended recipient to act on the feedback?

Other

If other, please specify

The information collected is shared with the suppliers to enable a system of just-in-time on demand access to essential drugs.

How does the feedback mechanism close the loop with those who provided feedback in the first place?

Other

If other, please specify

the clinics benefit by receiving drugs on demand in the volumes that meet their exact needs.

How is feedback published/transparent?

On a website

If other, please specify
Give two concrete examples of how feedback loops have brought a program or policy more in line with citizens’ desires.

With our platform, the Kenya Medical Supply Authority (KEMSA) will for the first time in the history of the country know ahead of time what the gaps and needs are in public facilities in Kenya. They currently serve over 4,000 such facilities and the current manual process requires nurses to fill a form with over 1,440 cells. The errors and delays result in over supply of some drugs and an udner-supply of others. Secondly, the second largest supplier of generics in Kenya, i.e., the Mission for Essential Drugs (MEDS) is able to also use our system to track prescription patterns and stock levels in the 1,840 faith-based clinics they serve.

If there was one thing you could change to increase the impact of your feedback loop, what would it be?

The major challenge is that private clinics that really would benefit from the technology do not have the capital to invest in the system. We are therefore forced to raise money for them or encourage them to get a microloan from a Sacco (i.e, microlending institutions)
Rapidly expand our network to 1,000 clinics such that we can bargain better prices for the members of the program.

What are your biggest challenges or barriers in “closing the feedback loop”?

Lack of funding for feedback data collection

If other, please specify
Are you aware of The Feedback Store?

Yes, I am already on it

What are the main uses you can envision for the Feedback Store?
What is the one thing you would most like to see changed to improve the competition process?

It’s quite a brilliant process. I actually have been promoting the model to other organizations, e.g., the Center for Marketing Health Innovations and Africa Capacity Alliance. The process however feels drawn out and hence it’s easy to loose track of the value its bringing. Also, I was hoping to get more feedback that I did.

What are you doing to make sure that feedback providers know that they are empowered by the information they can give and that they know exactly what the information they are providing?

Lack of access to information on drug consumption patterns by suppliers of drugs as well as lack of awareness on what items are in stock in the suppliers’ warehouses is a systemic problem in the health sector in Africa. Our model empowers both parties to seek each other out, so that the clinic knows what’s in the suppliers stock room; and the supplier knows what is missing in the clinic and can better forecast demand