Leveraging local resources and mobile technology to reduce child mortality in Africa

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Leveraging local resources and mobile technology to reduce child mortality in Africa

Bamako, MaliParis, France
Année de fondation:
2007
Type d'organisation: 
le secteur de la société civile
Budget: 
$100,000 - $250,000
Website:
http://www.pesinet.org
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Sommaire du Projet
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Bref récapitulatif : Aidez-nous à présenter cette solution ! Fournissez une explication en seulement 3 ou 4 phrases.

Pesinet’s mission is to sustainably reduce child mortality by facilitating access to existing healthcare systems. We have designed a service for the remote medical monitoring of children under 5 using mobile technology and grassroots health agents. We deploy the service in partnership with primary community and public health centers in Mali and are currently extending activity to Burkina Faso.

About Project

Problème : Quel problème ce projet essaie-t-il d'adresser ?

Many countries in Sub-Saharan Africa face dreadful levels of child and maternal mortality. Yet most of these deaths could be avoided: children die mostly from benign illnesses that could easily be cured with the medical resources available locally. Mothers wait too long to bring the child to the doctor when sick, for cultural, financial and geographical reasons. As a result, complications develop from untreated diseases and become lethal, while under-used local health structures encounter economic difficulties. In many countries suffering from high mortality rates, lack of demand for health is at least as big an issue as the quality of available health structures.

Solution: Quelle est la solution proposée? S.v.p soyez précis!

Pesinet has designed and deploys a service for children under 5 that works as follows. Families enroll their child for less than 1 USD/child/month and are entitled to: - Regular visits from a Pesinet agent who collects and transfers data on the child’s health (weight, stools, cough, fever, etc) to the closest partnering health center via mobile phone. - Remote monitoring of the child’s health by the doctor at the center via Pesinet’s web platform that presorts children at risk. - Free medical examinations and 50% discount on medications for enrolled children.
Impact: How does it Work

Exemple : Faites nous découvrir comment cette solution fait la différence en utilisant un ou plusieurs exemples concrets ; en incluant aussi ses activités principales.

Pesinet’s mission is to sustainably reduce child mortality by facilitating access to existing healthcare systems. By addressing the issue from the demand perspective and reconnecting people with healthcare structures, Pesinet aims at generating a systemic change in the healthcare situation of Sub-Saharan countries. Our founding principles are: • Adopt a demand-driven approach to healthcare issues • Integrate the service into the local healthcare system • Use technology for more efficiency • Adopt a paying approach to ensure economic sustainability.

Impact : Quel est l'impact actuel de ce travail ? Décrivez aussi l'impact désiré dans le futur.

The independent impact assessment carried out in early 2011 on our pilot site demonstrates the positive impact of the service on populations and on the health centers: - Subscribers seek medical care twice as often as non-subscribing children in case of illness. - The rate of disease detection following a summons for presumed illness by the partnering doctor is 93%. - More than 50% of the medical examinations registered at the partnering health center are related to Pesinet subscribers. - 70% of medications prescribed are purchased at the partnering health center, thus increasing its revenues. There have been 3 deaths among the 1,000 children monitored by Pesinet during the pilot phase, when the national average child mortality rate in Mali is 176‰. Surveys among beneficiaries have shown that satisfaction is very high (96% are satisfied with the service). Moreover, 97% of families deem the service “very affordable” despite the fact that 90% say they have unstable revenues. This proves the success of our paying approach to preventative health in low-income communities.
Viabilité

Plan de viabilité financière : Quel est le plan de cette solution qui permet un financement durable à cette initiative ?

Growth timeline: - Ouagadougou: o By June 2013, official launch in 2 different health districts. o By December 2014, 1000 children enrolled in the new program. o By December 2015, double the number of subscribers to 2000. - Bamako: o By December 2013, 1400 children enrolled. o By December 2015, 3000 children and 800 pregnant women enrolled. Service launched with 3 new health centers. Key activities: - In Bamako, hire sales forces and further develop communication strategies. Design and launch a pregnancy monitoring service, in partnership with a large NGO. - In Ouagadougou, register with national authorities and build partnerships with new health centers, microfinance institutions, and grassroots women’s organizations.

Marché : Qui d'autre adresse les problèmes mentionnés ici ? Comment ce projet diffère-t-il de ces approches ?

Concerning the micro health insurance aspect of its offer, Pesinet could be seen as a competitor for some mutual insurance organizations. Instead of entering into competition with them, Pesinet is exploring ways to develop win-win partnerships in order to cut expenses and boost the number of beneficiaries for both. Some health centers in Burkina Faso mobilize volunteer health workers to pay home visits to families with young children, but this service is irregular and unprofessional. Pesinet often hires and trains these same volunteers as its home monitoring agents with authorization of the health center to complement their volunteer work in the community.
Equipe

Histoire de votre fondation

Staying late at the office one night to work on the Pesinet service model, Anne struck up a conversation with the cleaner, a Malian, whose cousin ran a health center in Bamako. Anne arranged to meet this cousin, who was passing through Paris, at Gare du Nord. Their conversation opened her eyes to the groundbreaking potential of integrating the Pesinet service into the Malian public health system.
Nom

Association Pesinet

A propos de vous
Organisation:
Bridgers
A propos de vous
Prénom

Elena

Nom

Bridgers

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Innovation
Expliquez en quoi consiste l '«innovation», par exemple, est-ce que c’est l'idée et / ou le modèle que vous utilisez pour accomplir votre projet, ou la compréhension de la population cible, etc.?

The Pesinet program is highly innovative both in its delivery model and in its unique combination of services designed to holistically address the geographic, financial and social barriers that families in West Africa face in seeking healthcare for their children.

Pesinet has radically redesigned the delivery mechanism for basic preventative health services for children in order to increase the efficiency of disease detection and prevent those complications too often resulting in death. Since most mothers lack the time and resources to bring their children to the nearest health center for regular consultations, Pesinet employs a network of grassroots agents who bring checkups to the homes of subscribing families and then transmit the medical information via mobile phone to the doctor at the closest partnering health center. Pesinet’s web platform then presorts cases of children at risk, allowing the doctor to efficiently review and summon those needing examination. This grassroots health monitoring system is combined with a micro insurance plan that covers the cost of consultations and 50% of prescribed medications.

The program reinforces (rather than competes with) the national health system by allowing primary health centers to generate more revenue and improve performance, while preventing costly emergency treatment in hospitals.

Décrivez comment votre modèle d'innovation est différent de toute autre organisation dans votre domaine?

Not only was Pesinet an original pioneer in the use of grassroots agents and mobile technology for home-based health check-ups, but we are also the only organization to date combining this type of mobile monitoring with a micro insurance plan in order to address both financial and geographic barriers to care.

Pesinet also distinguishes itself by its total integration into the existing healthcare system. Many organizations offering mobile health services refer towards their own private centers and risk drawing patients away from the public system, whereas Pesinet’s service is designed to reinforce that system.

Quel environnement et quels facteurs organisationnels internes font la réussite de votre projet ?

- Our integration into existing health centers, in total compliance with the organization of the local healthcare system.
- Our grassroots approach – hiring and training local women from the community to do the mobile health monitoring.
- The deep understanding of the local context and culture of the communities that we serve, acquired through research, a participatory design process for our service, and continuous feedback through dialogue with families.
- Our professional, business and result-oriented approach to the way we work daily, with objectives, management control, and results monitoring.

Comment vous assurez-vous d’innover sans cesse à la lumière des défis externes (potentiels), ou de votre plan de croissance?

We are a very outward-facing organization. We present our intervention model regularly at international conferences and workshops, allowing us to solicit external feedback, meet potential partners, and draw inspiration from like-minded projects.
We take full advantage of external resources:
- Through pro-bono technical assistance from our financial partners we benefit from expert advice on how to improve our business model, our software, and our impact on program beneficiaries.
- Employment of new interns/consultants to explore and develop targeted aspects of Pesinet’s program.
- Regular informational meetings with organizations working in the same sector or in our zones of intervention.
- Systems in place to capture regular feedback from our partners and beneficiaries.

Pays

, Paris

Modèle d'Entreprise
Le défi systémique que vous essayez de surmonter [sélectionner une seule réponse]

Apporter des soins de santé accessibles aux communautés dans les marchés émergents

Domaine de la Santé (marché cible) où le besoin est [sélectionnez une seule réponse]

Services de soins de santé primaires

Catégories de santé au long du continuum que vous couvrez [cochez toutes les cases appropriées]

Prévention, Détection.

Étape qui correspond le mieux à votre solution [sélectionnez une seule réponse]

Le démarrage et la croissance (le projet pilote est un succès et commence à se développer)

Stratégies de base de votre modèle d'entreprise [cochez toutes les cases appropriées]

Refonte du système de santé publique pour plus d'efficacité (en termes de processus, de structure etc.), Rôles nouveaux/redéfinis de prestation de services pour les soins de santé, Nouvelles approches pour la distribution des produits de santé et des services, Partenariats non conventionnels (entre les acteurs traditionnels de santé et ceux en dehors des soins de santé), Nouvelles stratégies de financement pour la santé.

A préciser
La plupart des outils pertinents que vous utilisez pour mettre en œuvre les stratégies décrites ci-dessus [ne sélectionnez que deux réponses]

Technologie, Éducation / formation, Autres.

A préciser
Quelle est votre proposition de valeur?

Pesinet offers to families:
A monitoring service that is professional and convenient:
- Home check-ups save families the effort of traveling to the center.
- The remote monitoring efficiently detects diseases. Families are reassured to know their children are monitored by a health professional.
- Families trust the agent - a women from their community – who acts as a social intermediary between them and the medical system.
The ability to save on healthcare expenditures:
- The monitoring system detects diseases before they become complicated and expensive to treat.
- The micro health insurance saves families money on consultations and medications.

Qui est votre client/quels sont vos clients?

Pesinet’s customers are families with children under 5 living in the zones around our partnering health centers. These are middle to low-income families, 90% of which are employed in the informal sector. Usually mothers decide to enroll their children, but the fathers pay for the service.

In Ouagadougou, Pesinet is targeting women who have stalls at markets on the outskirts of the city. For the launch of the service in Burkina Faso, Pesinet is partnering with microfinance institutions to help these women develop their income generating activities and enroll in health-savings plans, which will in turn help them pay for Pesinet’s service.

Quelles approches utilisez-vous pour atteindre vos clients?

In its current phase, Pesinet has two principle means of diffusing the service:

- Via our mobile health agents, who also work as sales-women, advertising the service from door to door in the zones where they work. In addition to a fixed salary, agents receive bonuses for the number of new subscribers they enroll.
- Via our partnering health centers, who promote Pesinet’s service to patients with young children who come for consultations and are not yet enrolled.

In Burkina Faso, Pesinet will also diffuse the service via the established customer base of its partnering microfinance institutions.

Quelles sont vos principales activités?

The Pesinet service is currently deployed in 4 districts Bamako, Mali, and its extension is underway in Burkina Faso. Primary activites at these sites include:

o Promotion of the service in the zones surrounding our partnering health centers.
o Deployment of Pesinet’s mobile agents for regular home monitoring of enrolled children.
o Transmission of the data collected during these visits to our partnering health centers.
o Alerting families once a child is summoned by the doctor via the Pesinet mobile agents.
o Education of mothers on best practices for keeping their children in good health.
o Collection of monthly fees by the Pesinet mobile agents.

Quels autres défis - individuel, organisationnel, ou de l'environnement - faîtes-vous actuellement face ou pourraient nuire à la réussite future de votre entreprise, et comment comptez-vous les surmonter?

Even though families recognize that paying for the Pesinet service will save them money in the long run, mothers often don’t have the cash on hand for the monthly fee when the agent comes to collect. To address this, we will launch the service in Burkina Faso in partnership with 2 microfinance institutions that have agreed to facilitate access to microcredit for Pesinet’s clients and assist them in developing health savings, which will provide a stable source of funding for Pesinet’s monthly fee. Launch is scheduled for June 2013. If successful, we will work on integrating the same services into the model in Mali.

Security in Mali is another major concern. We have trained the local team in Mali to be fully self-sufficient in case of repatriation of international staff.

Décrivez brièvement votre stratégie de croissance à l'avenir

o Improve the rate of penetration in all health districts where Pesinet currently operates and expand to new districts.
o Gradually transfer operational responsibility of the service to the partnering health centers.
o Continue to train fully autonomous in-country teams composed of local staff in order to free up higher management to launch the service in new countries.

Vers quelles dimensions de croissance vous orientez-vous actuellement pour votre innovation [cochez toutes les cases appropriées]

Groupe(s) de nouveaux clients , Nouvelle(s) région (s), Nouveau(x) marché (s) / pays.

Qu’est-ce qui rend votre entreprise "prête" pour la croissance?

- In Mali, Pesinet has partnered with National Federation of Community Health Centers and drawn up a standard legal partnership agreement in order to rapidly extend the service to new health districts.
- The program has proven its success in Mali by way of an independent evaluation and is ready to be replicated in new countries. Assembly of a “Replication Tool Kit” is underway.

Quels sont vos objectifs clés de croissance?

- Continue to double the number of enrolled children every two years in Mali and develop the service in Burkina Faso.
- Achieve and maintain a 20% penetration rate in all health districts where we operate.
- Diversify service to include monitoring of pregnant women.
- Adapt the model for deployment in rural areas.

Pays dans lequel /lesquels ce projet à un impact social

, Bamako

Impact social
Quelles méthodes pour la quantification de l'impact social demandez-vous (le cas échéant)?

- Measuring Impact on populations:
- We monitored the rate of resort to care of Pesinet subscribers versus control groups during an external evaluation of our pilot program.
- We tracked the delay between the doctor’s summons and consultation .
Measuring impact on health systems:
- We regularly monitor the revenue streams generated for community health centers by our subscribers to assess the increase (though medication sales especially)

Est-ce que votre solution peut fonctionner dans d'autres zones géographiques ou régions? Si oui, où?

In its current state of development, our system is replicable in any urban or peri-urban zone of any country where there is a high child mortality rate due to neglect of benign diseases and an underused healthcare infrastructure. This is the case in many sub-Saharan African countries.

Quelles sont vos prévisions en termes d'impact au cours des trois prochaines années?

1. Have significantly reinforced the capacities of all of our partnering health centers in Bamako and Ouagadougou (10 partners across all sites by December 2015), as measures by:
• Overall increase in the number of consultations for children under 5, and eventually of pregnant women
• Increase in revenue for these centers
• Increase in quality of service

2. Maintain the high rate of recourse to care that characterizes Pesinet subscribers today among a larger pool of beneficiaries (5000 children and 800 pregnant women by December 2015).
3. In the next 3 years, we will have a large enough cohort, followed over a significantly long time period to be able to report the project’s direct impact on child mortality rates.

Viabilité
Élaborer votre stratégie de financement actuelle.

In order to maintain a high quality of service while remaining affordable to the poor, we have adopted a hybrid financing strategy that combines revenue streams from the monthly service fee paid by subscribing families with subsidies from foundations and private donors. In the current model as it exists today in Bamako, the monthly fee paid by subscribers covers 50% of the operating costs of the program at optimal functioning. Optimal functioning is defined as all health monitoring agents working at maximum capacity, and maintenance of an 80% service fee recovery rate.

The remaining 50% of operating costs, as well as our structural costs (salaries of higher management, office in Paris, flights) are financed by private foundations with whom Pesinet has long-standing partnerships. While we are continually exploring ways to bring our operational self-financing rate closer to 100%, we will always depend on our financial partners for the structural costs of the organization as well as the funding needed for program growth and extension.

In Ouagadougou, the service is being remodeled and will be priced in order to cover 100% of operating costs as soon as the first pilot sites mature.

Part de la production de revenus dans le revenu total de l'organisation (en pourcentage)

13% of our total income comes from revenue generation

Les ventes directes aux patients ou aux autres bénéficiaires (en pourcentage)

11% of revenues come from direct sales

Parmi les sources possibles de ces ventes énumérées ci-dessous, cochez toutes les cases qui s'appliquent à votre stratégie actuelle

Particuliers.

Les frais de licence, par exemple pour la technologie / modèle de franchise (en pourcentage)

0% of revenues come from licensing

Parmi les sources possibles de ces opportunités de licences énumérées ci-dessous, cochez toutes les cases qui s'appliquent à votre stratégie actuelle

Contrat de service avec les organisations, par exemple, le gouvernement, les ONG (en pourcentage)

89% of our revenues come from contracts with other organizations

Parmi les sources possibles des marchés de services énumérées ci-dessous, cochez toutes les cases qui s'appliquent à votre stratégie actuelle

ONG, Les entreprises privées.

Expliquez votre stratégie de génération de revenus de manière plus détaillée

Pesinet’s revenue strategy is centered on the monthly contribution paid by subscribing families for the service. In Bamako today this is 500 FCFA/child/month (1 USD).
While Pesinet is committed to keeping its service affordable to low-income families, serving the poor sustainably often necessitates targeting a broader segment. We have designed a premium offer of the service that will allow us to cross-subsidize the cost of the basic service, which we plan to market directly to companies as an employee benefit, as well as middle-income families.
As a pioneer in the development of technological tools for health, we are approached by NGOs interested in benefitting from our expertise to implement their own development programs. This kind of service contract has generated substantial revenue.

Part de la production de revenus dans le revenu total de l'organisation (en pourcentage)

87% of our total income comes from philanthropic funding

Stratégies de philanthropie que vous utilisez

Stratégie diversifiée .

Expliquez votre démarche philanthropique plus en détail

Pesinet has developed strong relationships with private foundations. Our financial partners support the service with in-kind and monetary donations.

Orange Mali has provided mobile phone credit for transmission of the data between agents and health centers. TEFAL provides the scales for weighing the children. Alcatel TCT provides the mobile phones used by the agents.

Foundations Alcatel-Lucent, BNP Paribas, Sanofi Espoir and Medicaments Export have funded us for several consecutive years and can be counted on for continued support.

In parallel, we have begun to develop our individual donor base through targeted charity events, letter campaigns, and crowd-funding platforms.

Développer vos sélections; expliquer comment vous allez maintenir le financement au cours des 1 à 3 prochaines années.

Fondation Mérieux, Medicaments Export, Ashoka and Tefal have committed funding or in-kind donation for FY 2013. We have a 3-years partnership agreement with Fondation Sanofi which goes until 2014. We continue to solidify new partnerships and are preparing to approach bigger public funders in the coming years.
Over the next 3 years we expect operations in Ouagadougou to be financially self-sustaining. Subsidies will be used only to launch the service in new zones and to finance the salaries of international managers involved in program direction.
In Bamako, we expect to have launched the premium offer and enrolled enough families to raise the operational self-financing in Mali to 70%.
Finally, we continue to explore ways to hand over financial responsibility of the project to the government. As soon as the political situation stabilizes in Mali, we will reinitiate our pursuit of partnerships with health mutuals, which will give us access to government funds intended to develop the informal health insurance sector.

Années de fonctionnement

En activité depuis 1 à 5 ans

Votre organisation a-t-elle reçu des récompenses ou des prix ? Si oui, indiquez-nous lesquels.

Pesinet has won several awards:
- Winner of the European final and world finalist of the Global Social Venture Competition 2009
- Laureate of the Convergences 2015 Awards (International category) in May 2011
- Laureate of the Top 11 Innovators competition in December 2011
- Anne Roos-Weil, Pesinet CEO, is an Ashoka Fellow since October 2010

Fichiers joints: 
Office presentation icon figure4_pesinets_health_service_for_children_under_5.ppt