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Improving Health Care Access in Rural Nigeria and Kenya

For the 85 percent of people living on less than $5.50 per day in Africa, an unexpected health expense can have a catastrophic impact on their precarious financial situation. This is particularly true for those in rural areas, who also face greater challenges in accessing affordable, quality care and have poorer health outcomes than their urban counterparts. 

“People in rural communities are geographically disadvantaged and financially do not have the purchasing power or health insurance which grants them access to a physician and care,” shares Opeoluwa Ashimi, founder and CEO of M’Care.

Ashimi and Iregi Mwenja, CEO of Pamoja Initiative, were among seven Solver teams chosen during the 2021 Global Challenges to address the Health Security & Pandemic Challenge and are working on technology that will provide more accessible care to people living in rural Africa. 

Ashimi developed a mobile application that provides community health workers in Nigeria with real-time diagnostic and treatment support. The application also creates a dashboard that is available to government health officials to help identify disease trends and deploy timely interventions. 

Mwenja focuses on making mental health support more accessible to rural Kenyan communities by upskilling members of the community to serve as lay counselors and by providing access to mental health specialists at the Pamoja clinic and mobile mental health units.

The inspiration behind the innovation

Ashimi spent years working in various aspects of the health system, including at a community pharmacy, for big pharma trying to improve access to medicine, in drug development, and as an advisor to guide community health messaging and analytics. However, she felt a void. 

“If I left those spaces, someone would be able to do what I was already doing. I was concerned about the space that nobody was doing something strong enough to make a lasting impact, and that was within rural health,” shares Ashimi.

Ashimi worked as a rural health worker during medical school. She had first-hand experience working with these populations as well as understanding the gaps rural communities face in receiving health care. However, losing her godfather due to the lack of accessible health care in his rural village is what solidified her mission to improve rural health. 

Mwenja similarly shares, “Personal experience and the need for mental health services in my community were key in inspiring me to take the lead and find a solution to address the systemic neglect in mental health through championing mental health equity in Kenya.”

After living 30 years with undiagnosed ADHD, Mwenja decided to take action to improve mental health literacy and service availability. 

“I did not want another person to have to live for 30 years or more with an undiagnosed mental condition like I had. I wanted to change the narrative to ensure that no one ever had to go through the suffering I went through, [or experience] a lack of access to mental health services, and a lack of awareness,” says Mwenja.

Barriers to community care

M’Care is effective because it was developed by Ashimi and a team that understands the nuances of health care in rural Nigeria. Whenever M’Care expands to a new region, Ashimi knows that she will need buy-in from various stakeholders in that community such as religious leaders, mothers, and other gatekeepers that may influence how medical care is viewed and prioritized. Ashimi explains, “Messaging that is socially and culturally appropriate is critical.”

Mwenja shares the hurdles citizens have to face in his country to access mental health care.

“Low budgetary allocation and failure to integrate mental health care into primary health care have led to more than 85 percent of the treatment gap in the country. Only 0.01 percent of the total annual budget goes to mental health in Kenya. At most, about 100 psychiatrists are serving 55 million Kenyans. Most are based within Nairobi, the capital city. Outside of Nairobi, there is one psychiatrist per million [people]. This translates to a lack of adequate facilities hence a mental health treatment gap. For poor and marginalized communities in Kenya, mental health services are practically inaccessible and unaffordable.”

(Mwenja training prison officers in mental health and lay counseling in Mombasa, Kenya)

The support innovators need

Innovators like Ashimi and Mwenja can impact many lives. M’Care has 700,000 subscribers and assisted with over two million cases (which includes repeat users).

“Through the community innovation model, over 12,000 Kenyans have received affordable mental health treatment with 90 percent from low-income settings,” Mwenja shares about the Pamoja Initiative. He adds, “It has been successful in training 500 community mental health workers and peer advocates as lay counselors and peer support specialists.”

However, without support from external entities, they cannot continue to grow their impact. Ashimi calls out, “Governments can open the doors to us— give us room to collaborate and work together. Private organizations should sponsor a community or adopt a community to take care of.” She teasingly adds, “Coca-Cola there is room for collaboration for you too.” 

Mwenja shares the three things he needs to scale Pamoja Initiative. 

“Mentorship and expertise for scaling mental health services in additional counties, partners to assist in training on refining “deep scaling strategies” to enhance the health and social value of the existing model, and expertise and experience in financing similar existing models.”

Although it may take time and patience to overcome the various hurdles for both innovators to expand their initiatives, their passion for their work and commitment to improving community health serves as a beacon of inspiration. Mwenja explains his vision for the future, “I intend to scale up the model and replicate it nationally soon. My long-term plan is to replicate the model in other low-middle-income-countries.”

Ashimi is looking to scale nationally, and shares, “The government can properly structure health care reforms to include digital solutions like ours. Over 83 million Nigerians do not have access to affordable care and solutions like M'Care bridge this gap at four times less the traditional cost of care.”

If you are interested in meeting the 2022 Class of Solvers tackling the Equitable Health Systems Challenge, register for Solve Challenge Finals here. This live pitch event will take place in New York City on September 18. 


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