Remind Me: A tech solution to improve immunisation coverage in Nigeria
If you make your way along the busy Herbert Macaulay road in densely populated Yaba, Lagos State, you may hardly notice the building housing the Co-Creation Hub (CCHub). The building looks like any other you may find in this high density part of Lagos, however the building houses the hub that has raised the profile of Yaba, likening it to Silicon Valley in the United States. A step inside however, and the hub doesn’t disappoint both in the visual layout and the quality of work being done. Beyond being a co-working space for a good number of start-ups, CCHub incubates start-ups that are addressing social problems in Nigeria through the innovative use of technology.
One social innovation birthed at the Hub is Remind Me, a social impact platform co-founded by two entrepreneurs with no prior background in health. Tochukwu Egesi has a background in accounting and started off as a banker before focusing on product development, while Kelechi Ezenwaka has 12 years of experience as a computer engineer. Remind Me is an automated immunisation reminder system for mothers powered by USSD and voice technology.
The World Health Organization lists 25 disease conditions that can be prevented using vaccines. Despite the existence of these vaccines, a significant number of children under the age of five die from diseases that can be prevented if they were vaccinated. Nigeria’s 2017 Multiple Indicator Cluster Survey (MICS) puts the number of children aged 12–23 months vaccinated against vaccine preventable childhood diseases at a meagre 21%. There certainly is a need for improvement. For Tochukwu and Kelechi then, the question became, why not immunisation?
A different kind of Tech
After the successful launch of Identity, a for profit cloud-based web platform that helps businesses electronically manage visitors, Egesi and his Identity team were accepted into an incubator program supported by CCHub. Being part of the tech community at CCHub gave him access to unlimited talent in the tech space. This was where he met Ezenwaka, who would later become his Chief Technology Officer (CTO) and co-founder of Remind Me. The Remind Me journey started during one of their brainstorming sessions when they asked the question, “What health problem can we solve to help Nigeria and Africa?” Immunisation topped the list. When their research revealed that most of the existing tech solutions for immunisation focused on the use of mobile and web applications, they decided to try something different, a USSD feature where users only need to dial a USSD code (*347*01#) to start receiving reminders for immunising their children.
Once the team decided on their solution, they set a timeline of four months to develop a minimum viable product (MVP) and commenced work. The solution they had in mind was simple, says Egesi; to create something that would “remind mothers and caregivers about vaccination even if they don’t have internet enabled phones”. While his CTO started on the product development, he started doing research to better understand the challenges around immunisation, vaccine preventable diseases and all the stakeholders involved in the space.
Collaboration for Scale Up
The 17th Sustainable Development Goal (SDG) is focused on partnerships to achieve the other goals. While this may appear to be on a larger multilateral scale involving countries, international alliances and donor agencies, the impact of local partnerships and collaborations is very significant, especially for start-ups.
Once the MVP was developed, the team needed to conduct a proof of concept to demonstrate the feasibility of the product. The Each One Aid One Foundation provided the team with the first grant of N1.5 million to run the proof of concept in Abia State. The grant allowed the team to hire a state project manager, run logistics during the proof of concept, and settle bills accrued from the product development. The project was successfully flagged off in Umuahia, the Abia State capital, in 2018 by the Wife of the state Governor, Mrs Nkechi Ikpeazu, and the state Commissioner for Health, Dr. Chigozie John Ahukannah. Egesi says they have signed up 2417 users and are seeing a reduction in the immunisation dropout rates.
The Executive Secretary of the Abia State Primary Healthcare Development Agency (ASPHCDA), Dr Chinagozi Adindu, mentioned that the innovation, while good, would require the cooperation of telecom companies for effective scale up. He added that his agency is currently compiling more contacts of caregivers in the state. Armed with their contact details, dates of birth of babies and the national immunisation schedule, they plan to send out immunisation reminders for 2019 using the Remind Me platform.
The testing in Abia State gave the team an opportunity to understand the user experience and to tweak the product to address some of their findings. The team observed that some users were unable to read the messages in English. To address this, they made the messaging available in the three major Nigerian languages and introduced a voice feature where users receive an automated voice message instead of text. With plans to scale nationally, these features will be useful in the parts of the country where English literacy levels are low.
Once the proof of concept was set in motion, the team was nominated for a social entrepreneurship award which got them into the Leadership Effectiveness, Accountability and Professionalism (LEAP) Africa Social Innovators Program. A significant landmark came after they were nominated for another social innovation in health award by the Future Assured Initiative of the Aisha Buhari Foundation. Pitching Remind Me at the award ceremony which was attended by the majority of the stakeholders in the health sector was another opportunity to connect with relevant partners especially the National Primary Health Care Development Agency (NPHCDA). Access to the NPHCDA provided real world insight from experts working in the field to coordinate immunisation activities in Nigeria. The feedback helped the team to get to the final six solutions pitched at the 2018 World Bank Youth Summit in Washington DC out of a total 500 submissions.
Bigger Plans and Opportunities for Improvement
The NPHCDA is currently working with the team for a pilot of the platform in three states and Remind Me’s CTO, Ezenwaka is excited about the new prospects as their solution would help inform more caregivers about immunisation. From their initial surveys before developing the platform, he noted there was a communication gap because most of the people they interviewed were ignorant of immunisation schedules. He surmised that improving immunisation will have a huge impact on Nigeria’s health sector, especially in reducing disease outbreaks and vaccine preventable illnesses among children under five years old.
But the team is not stopping at reminding caregivers about immunisation dates for their babies. There are other value-added services they hope to incorporate into the platform, some of which were inspired by feedback from the NPHCDA team. While working on increasing demand for vaccination, the platform will also strengthen the overall immunisation infrastructure through inventory and supply chain management.
About 70% of the 5 million children born every year in Nigeria are not registered at birth according to the United Nation’s Children Fund (UNICEF) and out of the ten African countries assessed by the agency, Nigeria had the highest number of children without birth records. This is an area the team intends to improve with their birth registration feature.
In addition, a simple business model where users would pay N400 every five years is part of the sustainability plan of the platform. This is not only feasible, says Egesi, but will also enable them to list three mobile phone numbers for caregivers of every child. “Imagine a situation where for every immunisation schedule, the child’s father, mother and a community member receives message to immunise the child. There will not be any reason to forget”, he said.
The challenge of low literacy levels of some caregivers led the team to introduce indigenous languages and the voice call feature. For universal access, the indigenous language options of the platform need to extend beyond the three official Nigerian languages. Situations where changes in political leadership affect programs is also a potential source of concern for the team, especially as they are planning a pilot with the NPHCDA.
It is sometimes difficult to sift through the numerous tech solutions working to solve problems in the Nigerian healthcare space, because they seem to lack an understanding of the problems they are trying to solve or embed sustainability plans in their solutions. However, it is important to support valid tech solutions because technology has the potential to leapfrog healthcare in Nigeria as it has done in the financial sector. EpiAFRIC’s Health Meets Tech Hackathons which have taken place in three African countries (Nigeria, Kenya and South Africa) in 2018 provided that opportunity for tech start-ups and solutions to ride- on the shoulders of established structures to look for tech solutions to many of our healthcare challenges. Deliberate efforts should be made to find and support tech initiatives like the health tech innovators behind the Remind Me platform, who are working hard to nudge Nigeria towards universal health coverage, using innovative ideas to scale up access to healthcare for all Nigerians.