Combine local resources and mobile technologies to increase resort to care and reduce child mortality

Combine local resources and mobile technologies to increase resort to care and reduce child mortality

Bamako, MaliParis, France
Organization type: 
nonprofit/ngo/citizen sector
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.

With mobile health monitoring and cheap insurance cover, Pesinet brings prevention into households to sustainably reduce child mortality.

About Project

Problem: What problem is this project trying to address?

Pesinet’s mission is to sustainably reduce child mortality by facilitating access to existing healthcare systems. Many Sub-Saharan countries face dreadful levels of child and maternal mortality. Yet most of these deaths could be avoided: children and pregnant women die mostly from benign illnesses that could easily be cured with the medical resources available locally. People resort too little and too late to the doctor when sick, for cultural, financial and geographical reasons. As a result, untreated diseases get complicated and become lethal, while under-used local health structures encounter economic difficulties. In many countries suffering from mortality rates, lack of demand for health is at least as big an issue as the quality of available health structures.

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

Pesinet designs and deploys innovative proximity services targeting children and their mothers. These services include regular home-based health monitoring, health insurance, and education to prevention. Delivered in partnership with local health structures (CSComs), they leverage simple mobile technologies as well as the work of agents in the communities to enable remote monitoring by the local doctor, accelerate disease detection and facilitate early access to basic medical care. They are designed to be economically sustainable while remaining affordable to low-income populations. Our services are very local yet replicable in many countries: the main principles apply everywhere while the sanitary, economic and operational features are customized according to local contexts. 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.
Impact: How does it Work

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

We have developed a service for children under 5 that is deployed in Bamako, Mali. We work in the 3rd District of Bamako - in Bamako Coura, Dravela and Ouolofobougou - in partnership with the health centers of those 3 areas. 800 children are enrolled in the service, which works as follows: - Every week, Pesinet’s agents visit the children at home and collect simple health data (weight, fever, stools…). They also provide nutrition and prevention advice. - Data is transferred to the doctor of the partnering CSCom via mobile technologies. Every day, he reviews the data, identifies children at risk and indicates those that he would like to see. - When children are called in by the doctor, families are warned by the agent and prompted to go to the health centre. Pesinet covers the cost of doctor examination and half of the medication. - Agents also organize monthly gatherings of mothers to discuss program and health issues. Families subscribe on a voluntary basis. The monthly price for the whole package of services is 500FCFA (USD 1) per child, the equivalent of a kilo of onions, a price affordable to low-income families in Bamako. Activities are organized in small operational sites. In each area, Pesinet works with the referring local primary health structure, in line with the Malian health zoning. Each site is managed by a supervisor. The current service is designed for urban areas. It can be deployed in rural areas with some adaptations. We are also developing a service for pregnant women.
Sustainability

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

Our key partners are the health centers: the service relies on their medical resources and reinforces their capacity to reach populations. Our long term objective is to deploy the service in the CSComs, operate it at first, then transfer it to them once it is properly running and viable. There is no exact same service as Pesinet, but we may have competitors on some specific aspects of our offer: mutual insurance organizations for the health insurance part; NGOs and local associations on the prevention aspect. We do not consider them as rivals but are rather looking to work cooperatively with them so as to complement each other and create some synergies. We are currently building a project with a large NGO; and are developing partnerships with mutual insurance organizations.
Team

Founding Story

When Pesinet was created, the 3 founders were willing to design a system to detect children diseases via monitoring of simple health data to reduce child mortality. After experimenting the service with a private doctor, we realized that it created a huge incentive for families to seek medical care. That is when community healthcare centers started to see us as a solution for their endemic under-use issues and expressed their desire to host the Pesinet service. At that time, we realized that if the service was to be integrated in the network of primary health centers around the country, it could drive a systemic improvement, as population would resort to care earlier on and healthcare centers would secure their revenues and ability to supply qualitative health services. We then envisioned that our simple and very local solution had the potential to generate a long-standing virtuous circle that could change the healthcare situation of many populations of Mali and beyond.
About You
Organization:
Association Pesinet
About You
First Name

Lucie

Last Name

de Clerck

About Your Organization
Organization Name

Association Pesinet

Organization Country

, J75, Paris

Country where this project is creating social impact

, CD, Bamako

How long has your organization been operating?

1‐5 years

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Innovation
How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Quality.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

Our ultimate goal is to sustainably reduce child mortality. We are working towards that goal by driving a double impact that will create the necessary conditions for sustainable change in the healthcare situation of the countries where we work:

- Impact on populations: increased resort to care; reduced delay in resorting to healthcare when the child is sick; improved education on prevention and key health practices;

- Impact on health systems: increased activity at primary level, increased revenues for community health centers; improved capacity to deliver quality services.

What has been the impact of your solution to date?

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 much as non-subscribing children in case of sickness
- More than 50% of the medical examinations registered at the partnering health center are related to Pesinet subscribers
- 70% of the medication prescribes is bought at the partner health center, thus increasing its revenues

Though it is too early to provide reliable statistics at this point, there have been 2 deaths among the 1,000 children monitored by Pesinet when Mali child mortality rate is 191‰.

Surveys among beneficiaries have shown that satisfaction is very high. They demonstrated the success of our paying approach for prevention, among low-income people: 97% of families deem the service “very affordable” while 90% say they have unstable revenues.

What is your projected impact over the next five years?

We plan to replicate our services at a large scale in Mali, in partnership with CSComs, both in urban and in rural zones.
At current projections, in 5 years we will have 15 urban sites and 5 rural sites up and running. We should have about 15,000 children and 5,000 pregnant women enrolled.
Though our long term objective is to deploy Pesinet in other Sub-Saharan countries, our focus as a direct operator will be to scale-up in Mali, in the next 5 years. Indeed, we know from experience that deploying this type of innovation in Mali with the public healthcare system takes a lot of time. Nevertheless, we will be happy to transfer our know-how to others and assist organizations that wish to develop Pesinet in other countries. We have already been approached by several organizations.

What barriers might hinder the success of your project? How do you plan to overcome them?

Economic model: At current price we are able to achieve 50% local operational self-financing. We are investigating solutions to complete the other 50% in a sustainable manner (cross-subsidization, partnerships with mutual insurance, local subsidies).

HR: Competent staff is scarce in Mali; finding and retaining the right people to run and develop activities is a key issue. We have an efficient recruitment process, a strong training program; attractive personal development and job evolution prospects for our key employees.

Security: There is a growing instability in Mali with the presence of Al-Qaida and the conflict in the North. We have been working at transferring competences to senior local staff so that they could continue to develop activities, should the CEO leave Mali.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

We plan to have 1,400 children on 4 sites in Bamako District 3 + 80 pregnant women enrolled on a pilot site in Bamako District 1

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Design, prepare and launch the service for pregnant women in Banconi (District 1) – operational launch planned for June 2012.

Task 2

Extend the service for children in the district of Badialan (District 3) in Bamako – operational launch planned for July 2012.

Task 3

Promote the service and grow the number of subscribers through active communication and social mobilization plans.

Now think bigger! Identify your 12-month impact milestone

We plan to have 2,200 children and 200 women enrolled in Bamako, and be about to launch a pilot site in rural zone.

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Extend the service for children in the neighbourhood of N’Tomikorobougou (District 3) – launch planned for October 2012.

Task 2

Prepare the launch of a pilot in rural area (identify partner, choose area, lead negotiations, adapt the service).

Task 3

Promote the service and grow the number of subscribers through active communication & social mobilization plans.

Sustainability
Tell us about your partnerships

Our partnerships in Mali: 1. Operational partnerships with the health centers with which we work ; 2. Partnership with the Ministry of Health, to align the Pesinet project with the country’s health strategy; 3. Partnership with the FENASCOM (national federation of community health centers), to replicate Pesinet at a large scale.
We are also building operational partnerships with NGOs, and plan to do so with mutual insurance companies. We also have partnerships with several companies and private foundations that bring us financial, material or skills support, on a one-shot or recurrent basis.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

- We are launching a service for pregnancy monitoring, because 1. the issues of child & mother mortality are closely intertwined, thus it is key to take care of the mother to protect the child; 2. there are operational & commercial synergies between the 2 services.
- We plan to develop the service in rural areas, because 1. in the countries we target, most of the population lives in rural areas and 2. the need is particularly strong there as healthcare structures’ use rates are very low, and as avoiding complications of diseases is particularly critical given the distance of hospitals.

What type of operating environment and internal organizational factors make your innovation successful?

The factors that make our initiative successful are :
- Our integration into existing health centers, in total compliance with the organization of the local healthcare system
- Our community-based approach
- The deep understanding of the local context and culture of the communities that we serve, acquired through research, a participatory design process of our services, and continuous users’ feedback and dialogue with families
- The fact that we have adopted a very professional, business and result-oriented approach in the way we work, with objectives, management control, results monitoring…
- A good balance between « business » and « social work » profiles within our team

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

We would like to use the platform to access information about innovative health programs that could inspire us and contact organizations that we could partner with (for operations, evaluation, technology…). We are always happy to share what we have learnt while developing Pesinet if it can help others develop or improve their own solutions, or contribute to the global apprehension of health issues