Acting Senior Manager and Senior Project Manager the University of Cape Town’s (UCT) Graduate School of Business’ (GSB) Bertha Centre for Social Innovation and Entrepreneurship, Katusha de Villiers, talks about the Social Innovation in Health Initiative (SIHI) and how it’s fostering peer-to-peer learning and collaboration among African mHealth pioneers.
Tell us about your background and the work that you do at the Bertha Centre.
My background is in health management consulting and at the Bertha Centre I support project work within the innovative finance, education and healthcare focus areas. I also lead and support various strategic initiatives occurring across the centre.
Tell us about the SIHI and the Bertha Centre’s role therein.
In 2014 the World Health Organisation’s (WHO) Special Programme for Research and Training in Tropical Diseases (TDR) initiated the SIHI as a project to find out what sort of existing social innovations there were in health within the global south (Africa, Asia and Latin America), that address healthcare delivery challenges – specifically for infectious diseases of poverty.
In early 2015 the SIHI put out a call for proposals for social innovators who had implemented such solutions to submit their work. The SIHI received 179 submissions from 48 different countries, and of those 25 innovations were selected as deserving further exploration and exposure. SIHI representatives carried out field visits to see how the different innovators worked and then compiled detailed case studies about what they are doing to enable greater equity, affordability and sustainability of healthcare services for their community. All of these case studies can be accessed on the SIHI website.
That was a really great project because it not only exposed us, the Bertha Centre, to these organisations across the global south, but it also brought them together as a cohort.
As of 2017, the SIHI’s implementing partners include UCT, the London School of Hygiene and Tropical Medicine, the University of the Philippines, the University of Malawi, Makerere University, Uganda and the Pan American Health Organisation. As a partner, we are contributing to a network whose combined skills and resources are supporting key activities to promote social innovation in health, with the ultimate goal of achieving the Sustainable Development Goals (SDGs) and improving the lives of communities. The SIHI has also sparked social innovation across its partners’ health facilities, for example the University of Malawi and the University of the Philippines have begun their own social innovation hubs within their health facilities – similar to the work we were involved in during the Groote Schuur Hospital Innovation Programme.
You recently returned from Uganda following the implementation of phase two of the Health Systems Entrepreneurship Project in partnership with Johnson & Johnson (J&J). Please tell us more about that project.
The project started from the SIHI back in 2016 when the Founding Director of the Bertha Centre, Francois Bonnici, J&J and a number of prominent healthcare delivery organisations were attending the Skoll World Forum and were all talking about how difficult it is for health service organisations that use mHealth technology to integrate their solutions with government. We thought it would be a great opportunity to use the platform that we’ve established through the SIHI and the networks that we formed through the initiative to further explore and tackle this issue.
We put in a proposal and in 2017 we got funding from J&J that allowed us to take SIHI’s initial work a step further to look at health systems integration of organisations with mHealth innovations. We used some of that funding to provide grants to some of those African organisations using mobile technology to deliver quality services at the frontlines of healthcare delivery and improve community health outcomes. The organisations are: Last Mile Health in Liberia, Living Goods in Kenya, Muso in Mali and the Ihangane Project in Rwanda. We also brought in two learning partners – VillageReach in Mozambique and mothers2mothers here in South Africa – to create a cohort of six organisations. We included mothers2mothers because they have successfully integrated with the South African government through MomConnect, the SMS-based messaging platform that supports mothers from pregnancy to their baby’s first birthday with information and advice on pregnancy.
Over the course of 2017 we held regular cohort calls with the six organisations and also funded peer-to-peer learning visits amongst themselves so that they could further explore what it looks like when an organisation wants to partner with government or to be more fully integrated with government.
This year we put in for another round of funding from J&J and we were lucky enough to receive it. The recent Uganda workshop I was involved in was about meeting up again with those six organisations that form that cohort. This year we’ll continue working with them and further drill down into the learnings that we established last year, specifically around the topic of mHealth technology and how to use it as the lever to ensure systems work.
Can you give us an example of how those above mentioned organisations are using mHealth?
Sure, for example Living Goods has a micro-entrepreneurship model where they recruit members of a community to become community health workers (CHWs). Through the platform they are not only giving the community members/CHWs an opportunity to go door to door selling goods like mosquito nets, safe cook stoves, solar lighting, nappies, etc.; but by providing them with a mobile phone they can also carry out health assessments of their neighbours, register births, give hospital referrals and sell medications like antimalarials, ibuprofen or contraceptives. Not only are CHWs making a business for themselves through the micro-entrepreneurship side of it, but they are also gathering important health data that links into the Living Goods system which speaks to the government health system.
During my recent trip to Uganda we went on some site visits with Living Goods – because they’re also based in Uganda – where we had the opportunity to see how their system differs from what they are doing in Kenya, because they are quite different geographies. In Nairobi they’re working in a transient community, so it’s hard for CHWs to get to know people on a more personal level. Whereas in Uganda it’s much more rural, so the CHW is actually living next door to the people that they are serving. It was amazing seeing first-hand how they work on the ground, for example I met a mother who had given birth the night before. She was accompanied to the hospital by the CHW who thereafter provided support and also registered the baby.
CHWs really do play an important role in the African healthcare setting. Do any of the other organisations in the cohort base their model around CHWs?
Yes, there’s also Last Mile Health. Because they’re based in Liberia they were at the epicentre of the 2014 Ebola epidemic , and it was through the work that the CHWs were doing within the community that the government realised what an amazing resource they had in those people. The CHWs are on the ground, really at the front lines of healthcare, and they know their neighbours and know when something isn’t right with them. The CHWs were able to report Ebola incidences up to the district health level, which then went up to national level; this meant that containment procedures could be taken. For example, the CHWs were educated about “no touch protocols” and what to do if someone died, like how to treat the corpse, and then they were able to give those learnings back to the community. Last Mile Health also trained hundreds of community members during the outbreak, not only educating them on the causes of Ebola, but also on how to prevent its spread or report a case.
Not only are CHWs really amazing in terms of those kinds of epidemics or outbreaks, but they also play an important role in connecting the community to the health system. If you’re in a very rural area, you might be a couple of hours walk from the nearest district health centre. Not only is it far but it’s also a big investment in terms of time and money. With CHWs you have someone who is next door to you who at the very least can prescribe you some low-level medication and who can record your vitals and symptoms on an app. The app then tells them whether there’s an issue and if they should refer you up to the district health level. CHWs serve a very valuable purpose in the community.
Do you think CHWs are being utilised in South Africa? Do you see them playing a bigger role in the collection of data, which can then be used to inform health decisions at the national level?
I think they can always be utilised more. It’s important to empower the CHWs to play a larger role in their community and to know that when they collect data it has an important, bigger purpose. There needs to be a communication loop so that CHWs understand that when they’re going door to door and collecting information, that information means something and it can be translated up to national policy. Being a CHW is not an empty exercise, they aren’t just giving patients immediate relief from their symptoms, but they’re also putting it into context with what their community, region, province and country’s health looks like as a whole.
You mentioned that this year you’ll be working more with the six cohort organisations. What exactly is the next step with them?
Our next step will be at the Skoll World Forum in April, which J&J is sponsoring this year. The forum will provide a platform for those organisations to speak on a panel together about the importance of technology in the global health system. And then in May I’ll be in Malawi for the SIHI partners meeting that will focus on developing a research guide for social change systems, which is quite exciting.
What I really want to highlight is that through this J&J sponsored project we were given an opportunity to bring together an amazing group of organisations who have invested a lot of time and effort into improving healthcare in their communities. It’s been a difficult journey in developing our platform and bringing together this cohort and helping it to grow, but these organisations have really stepped up. I think some of it has to do with the fact that they know each other and they know the type of work each other are doing. It’s an opportunity for them to be very open and frank and transparent, like “this is where we have problems and these are the issues that we are having.” It’s really important to have those kinds of conversations.
Also through the peer-to-peer learning visits they are able to spend good time, like two or three days, with one another to see what they actually do and how they actually work and integrate with government and with the healthcare system in their country.
So how have they been doing it in South Africa with regards to integrating with government systems?
It tends to be on a provincial level and then hopefully from there you can get traction to go national. I mean MomConnect is national. It is very difficult, because often you don’t know who you’re supposed to speak to and you don’t know what the processes are. While it looks very difficult to us, but on the flip side, if you’re government there’s a deluge of people saying they’ve got a solution that you need to implement.But they can’t test every system because they need to ensure a robust monitoring and evaluation process takes place for the ones they do.
MomConnect came out a couple of years ago and was THE solution. From your experience in the SIHI, what should social entrepreneurs focus on now in the health space?
The public healthcare system is enormously overburdened, therefore social entrepreneurs need to figure out ways to incentivise private doctors and the private healthcare system to help shift the burden from the public healthcare system. There are a number of ways in which people are tackling this, for example in Gauteng BroadReach Health has partnered with private doctors to take on stable HIV/AIDS patients to avoid them having to go to the public healthcare system every week or month to have a check-up and get their medication. It’s all about how you collaborate with those private GPs; it requires a partnership with government, with private sector, and with the social entrepreneurs.
How does the South African innovation space compare with other African countries you visited?
In Rwanda, for example, it’s very easy to get a small business licence, unlike here in South Africa. In Rwanda it can be done in just six hours. That situation therefore facilitates people in actually trying and to see what happens, since the process isn’t so onerous.
But South Africa has amazing innovation coming out of it. For example, the Groote Schuur Hospital Innovation Programme was immensely successful in demonstrating that innovation doesn’t have to come from young social entrepreneurs, it can come from the inside as well. There are people in these healthcare facilities that are innovators and creative problem solvers. It’s just a matter of trying to tap into that and creating a system that supports them. You need to figure out a way to celebrate them, acknowledge them, and then learn from them.