The mobile revolution in health delivery in Africa is moving beyond pilots to a world where its impact may set the standard for everyday service. Russell Southwood talks to Nivi co-founder and VP Business Development Ben Bellows about delivering contraception to Kenyan women.
I first met Ben Bellows four years ago when he was a Research Associate at the Population Council in Nairobi. We discussed the two topics he was researching: distributing health vouchers to women which they could use to pay for certain kinds of health treatment and the potential for using mobile phones to deliver these vouchers: https://www.youtube.com/watch?v=lhpi8qcsiWI
Both ideas seemed a refreshing and innovative way of putting donor funds for health directly in the hands of the women. The process also provided a built-in feedback loop because the women then were free to choose (in theory and often in practice) the health facility that best met their needs and the evidence of their choices might drive a discussion about shortcomings in particular types of healthcare and facilities.
Whilst still an associate at the Population Council, he is now co-founder of Nivi, a start-up that is using mobile technology and IVR to deliver contraception to women in Kenya. His co-founders are seasoned entrepreneur Sidd Goyal and academic Eric Green.
The idea for the start-up goes all the way back to 2011 when he got an Saving Lives award to pilot an IVR solution in Kenya for two years:" It performed as well as a nurse in Nairobi. The solution was then rolled out in Western Kenya where there were operational challenges. It was much harder to co-ordinate urgent care from the local health service".
"Two years on we are returning to an IVR solution. We pivoted the idea to family planning. It didn't have an urgent element and we wanted to try a new solution in Kenya".
Nivi also seems to be part of a broader movement in development research ecosystems to build what are known in the jargon as value-chains. People are setting out to collect and use data plus build feedback loops and do it in ways that create start-up businesses that are financially sustainable. The argument is that it can change how information, data and research will impact on areas as diverse as health and agriculture.
Coming down from these kinds of lofty ambitions, Nivi's goal is essentially very simple: every women should have access to accurate family planning information and the ability to choose the method that is right for them. It does this through offering women an IVR service (available on any mobile phone) where they respond to questions that help identify the right choice for them.
Having gone through 2-3 minutes of screening questions, the women caller gets a contraception recommendation; the service can arrange a free ride to a clinic at the caller's convenience where she can get the contraception method recommended; and last but not least she can rate her experience of the process by phone plus have on-going support to help them make family planning work in the circumstances of their life.
"It uses questions and prompts using the phone's key pad and criteria like age and contraceptive preferences. It offers 3 recommended methods and 3 providers. It offers clarity on providers in an opaque market".
The built-in incentives of a free ride to the provider and free delivery are another element of this new wave of delivery that seeks to use individual active motivation to get health care rather than simply passive provision. Nivi will build expertise in experimenting with the best ways of getting this kind of active involvement.
Currently the service is running in Bungoma and Nairobi and Nivi has signed agreements with Well Told Story, Marie Stopes and Zena to market and deliver the service.
The service is offered in English and Swahili and a flexible and dynamic algorithm:"
We're developing a chat bot so we can take the dynamic element a step further using natural language and conversation. We want to better understand when (the women callers) are likely to be fertile".
In the pilot last year, there were 8,700 callers and 500 referrals:" The intent was to prove the model could work. We did a series of tests offering credits for Boda Boda rides and partnered with Marie Stopes on free trial services. We're now taking a more automated approach to providers and there are currently 25 callers a day".
Launched in 2016 with US$1.4 million equity funding from Merck for Mothers, it is current looking for both VC investment and grants. It has started its roll-out in Kenya where it wants to go national in 2-3 years before expanding to Uganda and India.
So what's the business model?
"There's a sustainability issue about how to finance it". But it's looking at three different ways to square that circle. Firstly, it can get paid to deliver both advice and contraception more effectively for women ; secondly, private providers can benefit from getting increased patient volumes; and thirdly, there is anonymized data on contraception delivery performance which donors, NGOs and Government need to fine-tune provision.
"The referral code and satisfaction rating allows providers to identify problematic sites and procedures and give real time insights on: who they are, their age, fertility and what they select. We can also use different nudge techniques to explore whether there is unmet demand/need for contraception. Is there a desire to contracept but women are not able to find it? There is also some value in being able to forecast things for NGOs like use levels and other organizations are also keen to know where trends are headed. We want to be a bit like mSurvey but we want to go more deeply into things."
In terms of delivery, he also stresses the ability of a start-up like Nivi to respond quickly:"Coming from Population Council, it complements the work we do on research. It's a very difficult thing in many ways and I'm excited by where it's going. We can move more quickly in this space than NGOs".