Covid-19 has accelerated innovation in the Nigerian health tech sector, providing opportunities for growth in an industry that has typically lacked investment, government endorsement, and attention.
After his father had two strokes and his mother was diagnosed with high blood sugar, Ebi Ofrey had an epiphany: with vigilant healthcare, both events could have been avoided. But in Nigeria, there are very few health services dedicated to taking care of the elderly and health insurance coverage – both private and government-run – ends at age 65.
So Ofrey and his friend, fellow doctor Ajibola Meraiyebu, decided to start GeroCare, a subscription-based service that provides care-at-home for the elderly, using mobile technology to track health status, manage conditions, and dispense health advice, all in real time.
Until Covid-19 struck, Nigerian health tech companies like GeroCare were overlooked, rarely making the covers of magazines and remaining mostly unknown to the public. Companies struggled to attract investment or government partnerships that could help them improve public healthcare delivery. The health tech industry raised only USD 7.8 million (EUR 6.9 million) in investment from 2014 to 2018, according to a TechCabal report. In contrast, fintech companies raised USD 482 million (EUR 426 million) in the past two years alone.
In the wake of the pandemic, GeroCare has become the go-to service for elderly care, winning more clients and triggering a behavioral shift as people opt for attentive home care before going to hospitals. Along with other Nigerian health tech companies, GeroCare has proven essential. It has been leveraged across the country to preserve the health of those particularly vulnerable to a virus that has infected over 25,000 people in Nigeria and 10 million worldwide.
Covid-19 as catalyst
There are two reasons why the pandemic has spurred interest in a sector that had received little attention in Nigeria until now. First, most entrepreneurs see health tech as a form of charity or a social problem, so "it was hard to prove you could build a sustainable business around it," says Lanre oduMowo, lead analyst at TechCabal and a health tech researcher. The other big problem is that health tech is a relatively new sector and so regulators have not yet set the proper guidelines and best practices.
The Covid-19 pandemic has interrupted this state of affairs. Within weeks of the virus making landfall in Nigeria, Ventures Platform Foundation and CCHub, two Nigerian tech hubs that invest in early-stage start-ups, made a call-out to health tech companies, asking for collaboration with the Nigeria Centre for Disease Control (NCDC) in its pandemic response and management.
They challenged start-ups to develop solutions that could disseminate useful information, help the government monitor infection trends, produce essential medical supplies, and support contact tracing. "We believe in solutions that are trying to democratise or provide a lot more access to services, particularly for people at the bottom of the pyramid," says Mimshach Obioha, executive director of Ventures Platform.
Ventures Platform Foundation promised mentoring, infrastructural support, and USD 6,000 (EUR 5,303) in grant funding to winning start-ups. It also promised to facilitate partnerships with the government and other interested private organizations. Meanwhile, CCHub said it would provide design and research support through its product designers and engineers and award anywhere from USD 5000 to USD 100,000 (EUR 4,420 to EUR 88,396) in funding to selected solutions.
Furthermore, CCHub announced a separate call-out and partnership with the Lagos State Science and Research Innovation Council to provide solutions specific to the state, which currently has the largest share of Covid-19 cases in the country. In this instance, the state would provide USD 1,000 (EUR 884) in grant funding to six winning solutions, with the possibility of longer-term partnerships. "Covid-19 was the last push that the industry needed," says oduMowo. "It is an unfortunate but an unintended catalyst."
A renaissance in Nigeria
In the last few weeks, health tech inventions in Nigeria have sprung anew. In other cases, previously existing companies have adapted their work to fit current concerns. Collectively, they are enjoying momentum and reach that could guarantee the growth of the industry at large.
Take, for instance, the risk communication tool Infodemics, which was founded in 2018 and is a winner in Ventures Platform Foundation’s latest call-out. Infodemics uses geospatial technology to transmit important health information to thousands of people who otherwise cannot be easily reached. These people live in off-grid communities across the country and do not have phones or the benefit of the radio, newspapers, or updates on social media. They typically look to their traditional, social, and political leaders for information and deeply trust these leaders.
To take advantage of these social hierarchies, Infodemics transmits health information in local languages to these leaders, who in turn pass it on to their communities. It also collects feedback from the communities, tracking how widely false rumors may have spread so as to adapt its messaging accordingly.
In the past, Infodemics applied its tech to the Lassa Fever that broke out in several Nigerian states. Now, the NCDC is using its solution to provide important Covid-19 advice and fight rumours that range from the theory that 5G connectivity caused the virus to claims that the virus doesn’t exist at all. Infodemics is also in talks with MTN, the largest telecommunications company in Africa, to adapt its technology. "[The pandemic] has definitely emphasized the need for preparedness which we have been doing...but it now shows that we actually need to improve, we need to do better, we need ears all over the country," Infodemics founder Nestor Imeigha says.
And there’s Wellvis Health, a telemedicine solution that digitally connects doctors to Nigerians, who often lack hospital access because of geography or because they do not want to be caught in the overburdened hospital system. (A visit to an affordable public hospital could require a three-hour wait on the best of days, while a visit to a private hospital is prohibitively expensive.) The pandemic exacerbated this problem, causing many people to inundate the NCDC-provided hotline with calls.
So Wellvis Health created COVID Triage, a digital self-assessment tool with which users can gauge their exposure to the virus and then take next steps. The NCDC in turn collects this data and can see who might be at high risk in order to contact and isolate them. At last count, 500,000 people (70 percent of them in Nigeria) have used the tool.
GloEpid by Tech4Dev is another example of a Nigerian health innovation being used to combat Covid-19. GloEpid is a contact-tracing tool, uses telco data from smartphones, GPS, and Bluetooth connection to trace the movements of those who have been potentially exposed to the virus. Further, GloEpid is developing a management tool that shows public health agencies how many beds there are left in isolation centers and predicts the availability in five days to a week – to a ‘70 percent degree of accuracy’, according to Tech4Dev founder Joel Ogunsola. GloEpid's range of services is being deployed in four states in Nigeria, with plans to roll it out in 20 more.
Ultimately, GloEpid wants to get in front of the next public health emergency. With a team of 40 engineers, it is collecting data sets that can predict disease outbreaks based on their recurrence and is ensuring that its disease tolerance solutions can cover multiple diseases at any given time. Its technology is in high demand: Not only is GloEpid in talks with state governments across Nigeria, it will also potentially work with the African Centre for Disease Control and Prevention to see how the solutions can be adapted across the continent.
Opportunities and risks
As the doors of opportunity suddenly open a little wider for health tech in Nigeria, regulators have not yet created clear guidance for the sector, let alone a clear risk assessment. The Central Bank of Nigeria provides regular guidance on everything related to digital banking operations, from offering credit to insurance processing payments, but the health tech industry does not enjoy such guidance.
"From a health technology standpoint, the regulations are not rigorous compared to fintech, understandably, because the risk level is not as high," Ogunsola of Tech4Dev claims. Health tech is significantly less advanced than industries like fintech and still requires human checks and balances – so regulators believe it’s less susceptible to problems and therefore less in need of detailed rules, he says.
There have been some attempts by the government to put stronger regulatory structures in place, notably via the National Health ICT Strategic Framework launched in 2016. But by and large, health tech still operates under regulations intended for traditional health care delivery (doctors, pharmacies) which are opaque and not specific to their needs.
Questions of data privacy and digital rights are also waiting to be addressed. GloEpid and the NCDC have sought permission from the Office of the National Security Adviser (NSA) to collect the data, according to Ogunsola. GloEpid has been allowed to use Bluetooth and location functions to collect data because smartphone users are able to choose the permission to do so on their phones. People who don’t use smartphones cannot give permission and the NSA has declined requests for the organization to trace these citizens with data collected directly through telecommunication companies.
Investors are taking notice of the health tech boom in Africa’s most populous nation, but are likely to remain cautious until the business opportunity and regulatory environment become more predictable, making it too early to tell if foreign companies will dip into the market and compete with local innovators, as has been seen in other sectors like fintech.
"The numbers [of possible investors] have not changed significantly from before, but what happened was access was harder. Now … nobody wants to miss out if we are a thing that is genuine," says Wellvis Health CEO Wale Adeosun. "[Investors] are looking at a post-Covid scenario. So those conversations are happening faster than it [would] have happened in the past].
Yet oduMowo, the Lead Analyst at TechCabal, doubts that there will be major international investment. "I wish them luck," oduMowo says. "People will want to wait a bit...there are questions: will Nigeria go through a recession, will consumer spending drop? But if anyone were to do it, it would be the Asian companies who have a high-risk appetite and have similar markets, and understand our dynamic better than Western companies. The best that can happen with Western companies will be to partner with [the likes of]... 54Gene, Helium Health."
Ultimately, with the epiphany that birthed GeroCare, inspiration from local contexts that fuels Infodemics and Wellvis Health, and the ingenuity of GloEpid, aggressive innovation across the Nigerian health tech sector is on the rise. Apparently, because of a deadly virus, a change is going to come.