How Can Nigerian Health Tech Startups Build Sustainable Businesses?

Health Meets Tech

Between the 30th of June and 2nd of July, medical doctors, software developers, graphic designers, business development guys and many others gathered at the Co-creation Hub in Yaba, Lagos for a hackathon called "Health Meets Tech" which was organized by a partnership of Digital Health Nigeria, EpiAfric and Facebook, and covered by the Nigeria Health Watch. Throughout the 3-day period 5 different teams, each comprising of medical doctors and other healthcare workers, software developers, graphic designers, business people and so on, worked on an idea that would leverage technology to improve an aspect of healthcare in Nigeria. I joined the program on the second and final day during which I went round to interact with each of the teams on what they were building. My interaction focused on the healthcare problem each team was trying to solve; whether this healthcare problem was a recurring pain point for the target market; the willingness of the target market to pay for the solution that was being built to address the healthcare problem; whether the business is for profit or a social enterprise; and the sustainability of the model on which the business will be built.

How Self-Driving Tractors, Drones and Virtual Reality will Transform Agriculture in Nigeria

Technology has enabled tremendous advances in every area of human life in every part of the world; but the rate of that advancement has been different and much slower in the emerging economies—Nigeria and most other African countries especially. That the technology community has been abuzz for the past one week because of Mark Zuckerberg’s first visit to Africa—Nigeria first and then Kenya—is something that a lot of young Nigerians have come to see as the beginning of a never-before-seen technology revolution that will sweep across the country and continent. Many young talented Nigerians are using technology to solve local problems, ranging from education through transportation to healthcare, and some of these were showcased to Zuckerberg during his visit at the Co-Creation Hub in Yaba, Lagos.

While these tech solutions to local problems were commended by Zuckerberg, he also stressed, during a Question & Answer session for entrepreneurs and developers, that Nigeria and Africa have the talent to solve relevant global challenges. There are so many global problems today craving ground-breaking solutions; but one of such problems whose solutions can come from Africa is food security through agriculture not only because of how technology can be applied to scale agricultural production but also due to the fact that more than half of the earth’s arable lands, that can be exploited for agriculture without harming the green ecosystem, is in Africa. This means that applying the right technology in agriculture could turn Africa into the food hub of the world, and there’s need to start work now not just for the sake of the world but also for the food safety of our country and the entire continent: Nigeria’s population is estimated to surpass that of the US by 2050, making the country the 3rd most populous in the world, and a strong food security will certainly prevent a lot of problems.

How We Can Avoid Social Media Distraction When In A Serious Business

Online distraction while studying.
Image credit to Connections Academy.

Often times while in a lecture (particularly if the lecture is boring) or when I'm about to work on something important (and which may require I stay online to get some resources) or I'm about to read, I have found myself drifting away from these serious businesses towards the coral reefs of social media networks such as Facebook, Twitter and Instagram to check my notifications, who re-tweeted or favorited my tweets, or who liked my pictures. Before I realize what is happening, I'm spending hours on these social reefs, drowning into the colorful distractions and forgetting what I had planned to work on.

I know a lot of people experience this too; and I have read so many pieces of advice and strategies by different people on how to stay focused and keep away from online distraction when working: strategies such as switch off your phone or its internet access; turn off your email notifications; go to the library without your phone; and so on. But the world has changed in such a way that we now have a digital duplicate of our daily life: the Internet is an inevitable part of our lives. However, we should not allow this technology ruin us in the form of preventing us from concentrating on daily activities that are key to our growth and development and that of the society in which we live. This resolve requires we look for smart ways to stay focused on our work while online.

The Kudoso router. Image credit to
Kudoso

And one of the smart ways I came across is the strategy designed by Rob Irizarry, a technology expert. Seeing how technology--too much time on TV and on the internet--has taken over his children's lives, with a potential of health problems in the future from sedentary life before screens to the internet, he decided to design a system, he called  Kudoso, (software and hardware) that limits their access to internet TV and other sites, including Facebook and Twitter, and awards them time to these sites based on points they accumulate by completing other engaging activities such as home chores, school work, lessons on educational sites like Khan Academy and physical exercise such as running. Hence, kids will not be able to access online TV sites such as Netflix; social media sites like Facebook, Twitter, Instagram and so on; and other entertainment based sites-without having worked for the access points. And these access points have time limits on each of these sites, so that these kids don't spend forever on them. The Kudoso system works as an app that can be installed on home internet routers and also comes as a router preinstalled with the software.

Rob Irizarry, inventor of Kudoso

While this is ingenious, it is aimed at kids mainly. What about the teenagers and adults who spent most of their time outside the house-in school, at the office and alone in their own apartment-with their smartphones always around them. This age bracket is the most productive in the population, faced with so many tasks to accomplish; but could be under-performing because of distraction from social media when at work: in fact, a survey carried out by Salary.com last year showed that 69% of employees in the US spent time on non-work related websites each day in office, with social media sites like Facebook, Twitter, Tumblr and Instagram taking the largest chunks of the total time wasted, and costing these employees' companies hundreds of millions of dollars. Little wonder some business organisations in Nigeria block access to these social media sites because of their impact on workers' productivity at work. But we need other options too--to augment the effort inside and outside the office. And one thing we must note is that whatever options that will emerge must involve our own conscious voluntary effort to help them help us stay focused and undistracted from online distractions while working.

One more option is to develop a mobile application. But hey wait; this is an idea (others might have thought about it too) I'm throwing to app developers and the likes out there (I'm yet to learn how to code; but learning how to code I have promised myself: it may not be now, but I must surely learn how to code). So let's go back to the application. What if there is a mobile application that can block access to all social media sites and apps and uses an algorithm to block access to other entertainment based sites (unless you are working on something entertainment-related). The app will have a Work Mode and a Leisure Mode. For instance, if you are about to work on a project, you open the app on your smartphone, or computer (a desktop version could be made too) and put it in the Work Mode. Once in this Mode, you can choose the minimum period you intend to work, or you can leave it on unlimited period (it will give you the option of easily switching to the Leisure Mode after a minimum period of time). If you're going for a lecture or to work, the app will use your phone's GPS navigation to pop up reminder that you're heading for the location of your work (it will have a feature that enables input of workplace, lecture venues and so on via map and GPS) and should switch to the Work Mode to avoid distraction, such that once the lecturer comes into the lecture theatre or you hit the office and start work, you can choose to switch to the Work Mode. You can also choose to synchronize the app with your phone's reminder or to-do-list of activities so that it gives you the option of staying undistracted from online nuisances while accomplishing your tasks.

Someone out there is already asking whether I can't switch back to Leisure Mode and float on the stream of social media networks and the likes midway into my work. Like I said earlier, its functionality depends, to a large extent, on our conscious effort to stay away from online nuisances during our work periods. However, the app, which I call UnDistract if I were to develop it, would be designed such that reverting to the Leisure Mode before the minimum period of time set by default, depending on the activity, is spent , will be very tedious, involving answering series of questions, covering science, technology, music, arts and so on, drawn from the internet such that the user may stop midway: and the time spent trying to revert will count as that spent on the actual work because the user has got involved in some form of mental work. The activity-based minimum time frame feature will start working after the user has accomplished so many tasks spending the minimum time which can be manually set on the app, and the application's algorithm has gathered enough data to allocate a minimum time frame for any input activity.

I will keep on saying it--such an application will only be effective if we consciously want to stay undistracted while working: I can as well uninstall it after a few days if it seems to impose restrictions to my undisciplined freedom of deviation when I'm working. But would doing so be for my own good?

Warning: if anyone out there finally develops this app, be sure to give me 5 % of the revenue when it explodes with success, else I will sue you the same way the Winklevoss brothers sued Mark Zuckerberg when Facebook became a household name.

Bypassing Needle-Dependent Insulin Therapy in Diabetic Patients.

Modern Digitized Insulin Pump
Image credit to Tandem Diabetes Care.

Two weeks ago, we had a counselling session in the clinic for children with Type 1 diabetes mellitus (a type of diabetes that totally depends on taking an artificial form of the normal insulin produced in the body to be able to stay healthy and alive) when I rotated through the Endocrinology Unit of our Paediatrics department; these patients came along with their family members, and a pharmaceutical company that manufactures artificial insulin was also invited. Our consultant endocrinologist headed the counselling session, educating and re-educating these paediatric patients and their families on the management of their medical condition--diabetes--through lifestyle modification (taking the appropriate food, drinks and so on) and appropriate use of the injectable insulin: how many times to inject themselves with insulin in a day; on ensuring they take some insulin shots before meals; and so on.

Digitized Insulin Pump linked to
a Health Management Software on
a PC for patients and Physicians.
Image credit to Tandem Diabetes Care

These children, I must say, were learning from these periodic sessions evidenced by how they gave very detailed accounts of what they have learnt and the risks of not adhering to the guidelines given to them. But worried me as I sat among my fellow medical students that day was the constant pricking these children would have to endure every day to take their insulin because the only insulin therapy still available in Nigeria currently is the injectable insulin (variations exist such as the insulin syringes and the insulin pen which the invited pharmaceutical company displayed and educated the patients on how to make use of). Aside this, even the insulin pumps (with all the newest modifications they have undergone) that are common in developed parts of the world still require the patient to insert the infusion set under the skin and carry it around (hence, the patient has to always be cautious about some activities in order not to disrupt the inserted infusion set of the pump which would dislodge the pump from the body and pose health risk to the patient).

Afrezza Technosphere Inhalable
Insulin. Image credit to Mannkind Corp.

The highlighted worry above is not just the problem faced by diabetic patients in Nigeria alone, but the world over. Though, research (such as artificial pancreas, pancreas transplant and so on) is intense to address this major problem of invasive insulin self administration, something immediate need to be done to reduce the need for needle pricking several times a day by people with diabetes, especially Type 1 (people with this type of diabetes may die if the level of sugar in their blood goes far above or below a certain level, and hence a standby insulin at all times is very essential). And it seems that there is hope (though for now not for Nigerians with diabetes) as the US Food and Drug Administration, FDA (the US version of Nigeria's NAFDAC), on the 27th of June this year approved an inhalable form of insulin called Afrezza designed by the US pharmaceutical company Mannkind Corporation, after the FDA advisory panel met in April this year and over 90% of the members voted in favour of the inhalable insulin, following data gathered from the clinical trials confirming its efficacy was carried out in over 3000 patients with both Type 1 and 2 diabetes (Afrezza is not the first attempt at making inhalable insulin: the pharmaceutical company Pfizer did come up with its own inhalable insulin called Exubera developed by a company Nektar Therapeutics far back in 2005 but the product was pulled out of the market in 2007 because of the lung problems that ensued in some users, the high cost and lack of benefit over the injected insulin). The FDA has mandated that Afrezza be subjected to post-market study to monitor possible long-term outcomes, one of which is the possibility of some patients having lung cancer from the use of the product.

The Afrezza inhalable insulin uses what its manufacturer calls the Technosphere technology (particles in
 powder form made up of biologically non reactive chemicals that carry the artificial insulin to the lungs once inhaled, and they completely separate from the insulin in the lungs to allow rapid absorption into the blood) to deliver inhaled insulin to the lungs where the insulin is absorbed rapidly into the blood, reaching maximum level between 15 and 20 minutes, hence preventing any imminent sugar overload of the blood, especially after meals. Afrezza inhalable insulin is contraindicated in patients who smoke or have asthma, or chronic obstructive lung diseases such as bronchiectasis.

The major setback though is that the inhalable insulin cannot replace the long-acting insulin needed by Type 1 diabetic patients, meaning that these patients still need to inject insulin, but probably once a day, while using the inhalable insulin before or a few minutes into their meals. Now, this is where something can also be done, maybe not immediate.

Women have the option of using the implantable contraceptives (which are inserted surgically, under local anaesthesia so that no pain is felt, deep into the skin of the inner part of the upper arm or thigh) which deliver artificial oestrogen and progesterone at rates required to prevent pregnancy for at least 3 years. Something similar, I think, can be done in the case of insulin: we can have insulin implants designed to release insulin at rates required for the basal level in these diabetic patients. This will replace the long-acting insulin injection and last for probably up to 3 years before it could be replaced; there is still pricking, but this time it is probably once in 3 years and then it is done under local anaesthesia, so the patient would not feel any pain. I believe work is ongoing on something like this.

A Software Program to Bill our Calls based on the Quality of Connected Call.

Poor network reception and poor call quality. Image credit to Today's Telegraph

There is no doubt that mobile telecommunication has in numerous ways expanded the growth and development of our society and made our world a global village. In fact, the great impact is very well felt in the developing parts of the world like Africa and Nigeria where I live.

But in the developing world, here in Nigeria, while mobile telecom has expanded our economy, some elements are emerging that are insidiously denigrating the good impact of mobile telecom emergence: an occasional decline in the quality of call and mobile internet service offered by the mobile telecom companies operational in the country. Peripheral to the core of this occasional poor service delivery is the interruption in call by the "one minute remaining" voice that for some seconds (and which is money you've already paid and can't be refunded) actually prevent you from hearing the person you're conversing with-you have to ask him or her to repeat what was said during the lost seconds (money).

The people of Nigeria have been complaining, but on a very weak scale, concerning the 'peripheral problem' I talked about. But the bigger problem we have with these mobile telecom companies is the frequent abysmal quality of voice calls which I can estimate virtually every Nigerian on prepaid plan has and will keep on experiencing if nothing is done about it (this issue does not look like a litigable one in Nigeria for now). It is so annoying to call a number, get connected but for almost a minute of this call you and your caller can't hear each other-- instead you hear this sea roaring noise, all because of bad network reception. Technically speaking, it may not be the fault of these mobile telecom companies all the time and hence they may not be blamed at all times. However, the rule is that one must get the high quality value for money one paid for any service, and hence the customers subscribed to these telecom companies should not be the one suffering from this occasional decline in quality of calls by spending money and not getting the quality service. That is an economic waste both to the customer and the country as a whole: there about 120 million mobile phone subscribers in Nigeria as at June last year according to the Nigerian Communications Commission; estimating that 1% of this number experiences this problem for one second everyday, thats 1.2 million subscribers multiplied by the call rate for one second (which 0.15 naira for intra-network calls) and we have N180,000;  and for 30 days it is N5.4 million; this is the lowest threshold I set but I know it could be higher than this. This estimated threshold statistics shows that annually, Nigerian mobile phone subscribers practically throw about N64.8 million into the fire.

Normally, calls are billed at a per unit time rate in most places. This billing method is okay by me if the quality of the call is at its best and which should be because customers paid for it. But because of the occasional problems in quality that callers may experience, and which is never their fault at all times, and the fact that they must get quality for the money they paid, I'm proposing that a new factor be brought into the phone call billing equation. A new software can be developed that will use a special algorithm to calibrate levels of quality in voice call which will be integrated into the per unit time billing algorithm. Technically, the two factors-time and quality of the call (based on network reception at both users' ends)-will be mathematically represented by two waves on a graph. When network reception is good, the call-quality wave fizzles out and the caller is normally billed per unit time; if the network reception and consequently call quality is bad, two things can happen---either there is a freeze in the timing of the call (in the case where the two connected callers are not hearing each other) and no money will be charged the caller during this period until the reception returns to normal when the timing will be unfrozen; or in the case where the call quality is mildly to moderately poor, the time wave aligns with the call-quality wave and the caller is billed based on the call quality alone. The Nigerian Communications Commission can supervise the development of this program and constitutionally mandate telecom operators to adopt it into their call billing operations.

This new, innovative proposal, if taken up and developed, will further guarantee that customers get the full and high quality value for the services they pay for. Last year, the Nigerian Communications Commission fined the three major mobile telecom companies in Nigeria for abysmal service delivery, one of which is what I have just talked about. But the money fined these companies will not come back to the subscribers who did not get the value for it in the first place, and hence did not record a corresponding socioeconomic growth and development. Technology is here to enable us devise innovative ways of solving any problems that arise in our everyday lives. In Nigeria, mobile phone subscribers often do not get the full value for the services they paid for; this is a socioeconomic problem--and my proposal is one of the novel ways in which it can be solved.