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  • Healthcare Innovation in East AfricaNavigating the Ecosystem

    12 - 2016

    PATRICIA ODERO, SYLVIA SABLE, JENNIFER COOK, KRISHNA UDAYAKUMAR

    HEALTHCAREINNOVATIONS IN

  • Contents Acknowledgements I. Executive Summary II. Introduction III. Methodology IV. Findings: Regional and Country TrendsV. Findings: Innovation Trends A. Creating Patient and Provider Networks B. Improving Quality of Care C. Developing Technologies that Improve Efficiency and Financial SustainabilityVI. Findings: Healthcare Market Opportunities A. Financing Solutions for the Mass Market B. Prioritizing Patient Engagement and Experience C. Non-communicable Disease (NCD) Management Models D. Contextually-appropriate and Affordable Diagnostics VII. Mechanisms for Supporting Healthcare Innovators in East Africa A. Aligning Resources with the Growth Stage of Healthcare Innovators B. Making growth capital more innovator-friendly C. Understanding how to engage with the public sector D. Strengthening Partnerships within the Private Sector E. Leveraging connections between the technology and healthcare sectors F. Increasing Knowledge-Sharing VIII. Summary and Implications of the Findings IX. Conclusion

    AcknowledgementsThis paper was supported by the Social Entrepreneurship Accelerator at Duke (SEAD), which brings together interdisciplinary partners through a coordinated effort across Duke University. Innovations in Healthcare and the Center for the Advancement of Social Entrepreneurship are partners in SEAD. Leveraging institutional relationships and networks across the globe, SEAD helps to create an integrated global health social entrepreneurship hub for diverse stakeholders. SEAD is funded by the United States Agency for International Development (USAID) under cooperative agreement number AID-OAA-A-13-00004.

    Innovations in Healthcare is a leading global network supporting the scaling and adaptation of promising healthcare innovations worldwide. The organization helps to improve healthcare and advance health by sourcing, strengthening, scaling, and studying the best healthcare innovations globally. Co-founded by the World Economic Forum, McKinsey & Company, and Duke Health in 2011, it operates as a nonprofit organization hosted by Duke in North Carolina, USA. Between 2011 and 2016, it has developed a network of 67 leading healthcare innovators working in 49 countries, serving over 10 million people annually, and continues to grow its networks and offerings.

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    More information is available at: innovationsinhealthcare.org

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  • Photo credits

    The Center for the Advancement of Social Entrepreneurship (CASE) is an award-winning research and education center based at Duke Universitys Fuqua School of Business. CASEs mission is to prepare leaders and organizations with the business skills needed to achieve lasting social change. For over 15 years, CASE has been recognized as a leader in the field of social entrepreneurship and impact investing education, and has a global reach with MBA student and practitioner programming, research, and thought leadership.

    The authors wish to acknowledge the contributions of the many innovation ecosystem stakeholders whose insights and interview responses helped shape the research and content of this paper. Research findings were developed over the course of two years, building upon the ongoing insights of the SEAD team. Duke faculty member Cathy Clark of CASE served as advisor to this work and her leadership is gratefully noted. The design of this study built upon a similar ecosystem analysis conducted in three countries in Latin America, and the authors acknowledge that preceding work done by Innovations in Healthcare staff Erin Escobar, Logan Couce, Sylvia Sable and Andrea Taylor.

    A number of external reviewers provided valuable insights and feedback during the course of the project and we are thankful for their many helpful comments. Alden Zecha is a co-founder, former CFO and strategist at Sproxil. He is now an Executive-in-Residence at CASE and founding partner of We Scale Impact. Zecha, along with Sam Gwer and Moses Ndiritu of Afya Research Africa, provided innovator perspectives in their full review of the report. Njeri Mwaura of the IFC/ World Bank Group and Caroline Simumba of the Africa Capacity Alliance focused their comments on the public-private partnership sections of the work. Peter Gross of MicroEnsure and Luke Disney, formerly of North Star Alliance, provided insights on private-private partnership sections of the report. We also thank Bernard Olayo of IFC/World Bank Group, Sarah Gelfand, formerly at Innovations in Healthcare and now at Fidelity Charitable, and Edward Mungai of the Strathmore Business School in Nairobi for their valued review of the work.

    Within Innovations in Healthcare and SEAD, Anne Katharine Wales and Kellie Auman reviewed early versions of the document, leading to the development of a primer summarizing key highlights from this paper. Lauren Westervelt focused on entrepreneur-friendly growth capital in her comments. Jennifer Potts provided conceptual guidance to shape this report, editing it in its near-final stages. Simon Pitre reviewed the citations. Kyle Munn, of CASE and SEAD, is credited with leading the final design and presentation of the paper as well as copy editing.

    This work was led by the Innovations in Healthcare team, with guidance and contributions incorporated from the SEAD partnership with CASE.

    Africanmodern Page 19Duke Global Health Institute Page 29Dmitry Ratushny Page 24Jacaranda Health Page 18Kyle Munn Page 13, Page 17LifeNet International Page 20Penda Health Page 33Swathi Sridharan (ICRISAT) Page 38The Indie Image Page 7, Page 9, Pages 10-11, Page 15, Page 21, Page 22, Page 31ZanaAfrica Foundation Front cover

    More information is available at: www.caseatduke.org.

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  • Being effective at what were doing - which is setting up a social enterprise - has got to do with being ready to persist and being ready to wait for returns later.

    I. Executive Summary

    WE BEGAN THIS EFFORT IN 2014, IDENTIFYING OVER SIXTY KEY INFORMANTS FROM THE FOLLOWING STAKEHOLDER GROUPS:

    Healthcare innovators (care delivery, financing, training, technology and systems support) Funders (investors, grant-makers, donors) Academic institutions Public sector (local and national) Private sector (health and technology) Business development network organizations Technical assistance providers

    Innovations in Healthcare and the Center for the Advancement of Social Entrepreneurship are partners on the USAID-funded Social Entrepreneurship Accelerator at Duke (SEAD), which brings together interdisciplinary partners through a coordinated effort across Duke University. Across East Africa, investors, health system leaders, innovation accelerators, governments, and multinational corporations seek to identify and evaluate novel approaches to affordable, quality healthcare. Leveraging institutional relationships and networks across the globe, SEAD helps to create an integrated global health social entrepreneurship hub for diverse stakeholders.

    The SEAD project team started this work to identify clusters of innovations emerging in the East Africa region. Noting the growing interest from multiple stakeholders, the team decided to study and analyze those clusters to understand better trends in the region along with specific ecosystem characteristics that promote or hinder the development and scale of healthcare innovation. This ecosystem analysis includes interviews with key stakeholders from Kenya, Uganda, and Rwanda. While interviewees often represent country-specific viewpoints, a number of perspectives also represent the wider five-country region, including Tanzania and Burundi, and can be applied more broadly across the region.

    This ecosystem analysis includes interviews with key stakeholders from Kenya, Uganda, and Rwanda. While interviewees often represent country-specific viewpoints, a number of perspectives also represent the wider five-country region, including Tanzania and Burundi, and can be applied more broadly across the region.

    Sam Gwer | CEO, Afya Research Africa4

  • I. Executive Summary

    A NUMBER OF COUNTRY- AND REGIONAL-LEVEL THEMES ARE EXPLORED IN DETAIL IN THE FOLLOWING PAGES, INCLUDING:

    THE ROLE OF THE PUBLIC AND PRIVATE SECTORS: Kenya and Ugandas strong private sectors are spurring innovation. Rwandas strong public sector is resulting in increased investments in health, technology and the regulatory environment.

    HEALTH FINANCING: In Kenya and Uganda, public and private sector financing solutions have yet to reach the mass market. In Rwanda, financing is almost entirely through the public sector.

    INNOVATION ENVIRONMENT AND SUPPORT SYSTEMS: Kenya has a vibrant ecosystem for healthcare innovation while Ugandas is at an earlier stage. Innovations in Rwanda are focused on improving the existing public sector infrastructure.

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  • WE ALSO INVESTIGATE THREE MAIN INNOVATION TRENDS IN THE REGION:

    FINALLY, WE OFFER A NUMBER OF IMPLICATIONS OF OUR FINDINGS, INCLUDING:

    CREATING PATIENT AND PROVIDER NETWORKS: Healthcare innovators in East Africa are aggregating patients and providers into networks to create economies of scale that allow them to lower costs and increase access to care for patient populations.

    IMPROVING QUALITY OF CARE: In addition to quality improvement measures being implemented through wholly-owned and aggregated provider networks, there are a number of standalone innovators providing quality improvement models and systems to providers.

    DEVELOPING TECHNOLOGIES THAT IMPROVE EFFICIENCY AND FINANCIAL SUSTAINABILITY: Healthcare technologies are em