African healthcare poses challenges to startups filling the gaps

Startups trying to help African public health systems cater to the needs of everyday people, say they face barriers too.

Lagos, Nigeria — Three months after she was born, Ayotunde Omitogun was diagnosed with an atrial septal defect (ASD), a birth defect that causes a hole in the heart. In 2013, 26 years later, she was diagnosed with pulmonary hypertension (PH) caused by the untreated defect.

In India where she went for surgery, doctors prescribed drugs to help manage her condition but because they were not available in Lagos where Omitogun lived, she had to rely on Nigerian patients travelling from India. Then COVID-19 happened. No one could travel.

“So I was on and off my drugs which made me fall sick,” Omitogun, now 36, told Al Jazeera. In search of an alternative, Ayotunde reached out to a brand she had come across on Twitter earlier this year, Famasi Africa.

Founded in 2020, it is a Nigeria-based health tech startup in Nigeria built to digitise doorstep delivery of medications and routine checkups. It is one of a new generation of startups seeking to help Africans overcome hurdles in healthcare on a continent where half of the 1.2 billion people cannot access quality healthcare.

The lag is mostly due to an underfunding of the sector.

This year, Nigeria allocated 1.58 trillion naira ($2 billion) to the sector, less than 10 percent of the overall budget. Like some of its neighbours, it falls short of a commitment by African leaders at the 2001 Abuja Declaration to allocate 15 percent of its budget to the health sector.

Consequently, government hospitals usually lack the necessary infrastructure to carry out critical surgeries. Patients are often left unattended due to frequent strikes by doctors and other medical personnel; nurses in Zimbabwe still earn only around $50 a month and Lome hospital administrators say there are now more Togolese doctors in France than there are in Togo.

No wonder then that a June 2022 survey by the World Health Organization found that Africa has a ratio of 1.55 health workers (physicians, nurses, and midwives) per 1000 people.

Drugs are often off the shelf more than they are on it, in public dispensaries across Sub-Saharan Africa. And in some cases, the available drugs have turned out to be fake or expired.

“Africa has faced a long history of local health supply chains being susceptible to the influx of substandard products,” Juddy Gitahi, a senior consultant at Canada-based Salient Advisory, told Al Jazeera. “Specifically, [The] Gambia announced that substandard cough syrup was responsible for the deaths of at least 70 children in 2022.”

But Adeyinka Shittu, a researcher at Health Law Nigeria, a health ethics and law consulting firm, says Africa’s booming population is also a contributory factor to the dearth of resources. UN projections are that it will increase from 1.2 billion today to two billion by 2050.

“[So] existing services are not adequate and thus is driving the need for the tech market,” Shittu said. “Across the world, tech is gaining more attention for its potential to spark innovation.”

Filling the gaps

Indeed, a number of startups have emerged in recent years with technological solutions, to fill in these gaps. Online pharmacies have introduced virtual consultation services and counterfeit drug detection measures. In countries like Rwanda, drone delivery services are taking emergency health products to remote communities.

According to a July 2023 market intelligence report by Salient Advisory, a pan-African healthcare research advisory, there are about 350 startups helping bypass long-running challenges around efficient distribution of quality health products in Africa. Many of these startups experienced a boom during the Covid-19 pandemic, as public systems ground to a halt.

The report added that “data-driven approaches can reverse long-standing norms” in public supply chains “historically hobbled by inefficiencies”. Some are now partnering with governments too.

Kenya-based Maisha Meds, for instance, is a digital network of private pharmacies and clinics that has raised over $25m in funding since it was founded in 2017.  It is now working on a health insurance plan to help low-income households tackle cases of malaria and entrench family planning.

“The government has started to inquire about the software used and so we work with some government clinics and dispensaries in Kenya,” its founder Jessica Vernon told Al Jazeera.

After getting in touch with Famasi which built an inventory management software to track drug stock across partner pharmacies, Omitogun has been getting supplies consistently. They come with regular reminders and a bespoke delivery plan aligned with her prescriptions.

Gaps too big to fill

However, some of these startups are also encountering difficulties in going mainstream.

Analysts like Gitahi predict reduced funding in 2023 amid a global economic slowdown. Already, some startups have undergone rounds of layoffs to cut down costs. This August, London-based Babylon Health, whose platform integrated artificial intelligence, filed for bankruptcy despite being once valued at nearly $2bn. It had a partnership with Rwanda to deliver virtual primary healthcare there and had over 2.8 million users. Last October, Nigerian genomics research firm 54gene laid off 100 employees; this September, it began winding down operations.

But funding is not the only obstacle these startups are facing. A lack of proper internet infrastructure and fragmented healthcare systems means that the efforts of some of the startups are still ineffective beyond big, urban areas, experts say.

“Across countries, infrastructure is [still] lacking,” Shittu said. “Nairobi, Johannesburg, Lagos are all developing in isolation and the rest of Africa is not at par.”

Beyond that, there is also a delay in the adoption of progressive policies because of government bureaucracies but also due to the attitude of people toward medications.

And while Omitogun says Famasi has helped ease the stress on her such that she now feels better, not everyone has embraced new technologies. Industry insiders say many prefer to still think of God as the ultimate – or only – physician, or to apportion their finances to catering to other needs first.

“Africans don’t like to take care of their health until it is an emergency, then they start to look for which pharmacy has the drug, and which doctor to talk to and so we’d have to work extra fast to meet up in such situations,” Ayoola, Famasi’s co-founder said.

PHOTO: Flight operators perform pre-flight checks on a drone, amid the COVID-19 outbreak in Accra, Ghana, April 16, 2020 [Handout/Zipline via Reuters]