Exclusive: How Keheala Delivers Non-medical Healthcare Across Africa Via Feature Phones

Keheala is a digital health platform which delivers non-medical healthcare solutions through simple feature phones and smartphones to patients in remote areas across Africa. 

Founded in 2014, Keheala developed a low-tech approach to help promote adherence to healthcare and get patients to take their medication on time, using simple phone features such as text or SMS. Patients can also access information about illness and receive support without the stigma that is associated with it.

Business Elites Africa spoke to the CEO and Co-founder, Jon Rathauser on Keheala journey so far and the future of Africa’s health tech industry

Q: What does Keheala do? 

Keheala is a digital health platform that addresses the non-medical drivers of disease (access to care, community stigmas, a lack of information, motivation and support) in order to improve healthcare access and treatment outcomes.

We extend the reach of healthcare systems to directly empower patients away from facilities. Behavioural science guides the design of our interventions so that individuals are maximally motivated to adhere to their treatment regimen. Our Unstructured Supplementary Service Data (USSD) technology platform is accessible to any individual with ‘feature’ or smartphone access and offers a more functional user experience compared to SMS platforms.

Keheala is complementary to existing health systems with options for full or no integration, as desired. Self-verification inexpensively but effectively motivates adherence for the vast majority of patients. Automation facilitates rapid identification of non-adherent patients, enabling targeted-engagement by support sponsors. 

Additionally, patients can always access disease information and non-stigmatizing support at the touch of a button. This is an effective and cost-conscious substitute for SMS reminders and medication monitors, whose cost-effectiveness is inconclusive. Keheala is specifically designed for hard-to-reach geographies, is adaptable to the local context and easily scalable because it doesn’t require new hardware or maintenance networks.

Q: What path led to where Keheala is right now?

Keheala was born out of the realization that many of society’s greatest healthcare challenges are not medical; they’re behavioural! Over $2.8 trillion is spent each year on healthcare in the developing world The facilities, doctors, nurses, diagnostics and medication are all where they need to be. However, this investment means little if the infrastructure is not accessed or utilized properly. Healthcare is heavily dependent on individual behaviours: individuals need to show up to be screened for disease, diagnosed, return to start treatment and complete treatment. Improper use of healthcare resources leads to poor treatment outcomes, wasted investment and losses to societal productivity. Keheala was set up to be the behavioural ‘glue’ of healthcare systems.

Keheala was born out of the realization that many of society’s greatest healthcare challenges are not medical; they’re behavioural!

Q: What would you say is the greatest strength of Keheala?

In the last twenty years, an explosion of research in the social sciences has demonstrated that seemingly small changes in the decision environment, such as a change in the way information is framed, or a change in the default can result in large changes in behaviour. Our team specializes in the use and development of such “nudges”, as they’re often called, particularly for more effectively promoting prosocial behaviour.

Alternative interventions offer monitoring solutions that provide insights to healthcare systems about who may or may not be taking their medication…. then what? These alternatives are dependent on the underlying healthcare system to do something with this information. That’s often the challenge. Healthcare systems often lack the resources or expertise to address the non-medical drivers of disease, which exist outside of health facilities.

Keheala not only identifies undesirable behaviours but automatically and independently is working to address the drivers of non-adherence with powerful behaviour change interventions from the social sciences. This approach really works:

In partnership with the U.S. Agency for International Development (USAID), the Kenyan Ministry of Health and academic partners at MIT, Keheala implemented a 1200 tuberculosis patient randomized controlled trial in Kenya. Patients using the Keheala intervention demonstrated a 68% reduction in the unsuccessful treatment outcomes – death, failed treatment and loss to follow up – compared to the standard of care control groups. These results were recently published by the New England Journal of Medicine.

Q: Tell us about Keheala’s services?

Keheala’s feature phone accessible platform supports individuals from start to finish in their patient journey. Individuals can access Keheala by dialing into one of our USSD shortcodes. By answering a few simple questions, individuals at-risk for specific diseases are identified and ‘nudged’ to a local facility for diagnosis. Positive results are communicated in real-time while individuals who test positive are motivated to return to start treatment. Healthcare workers access Keheala’s Decision-Support Tool, leveraging Keheala’s predictive analytics to differentiate care: individuals who are likely to succeed on their treatment can visit the facility less frequently with remote monitoring and support by Keheala; conversely, those who would benefit from additional attention can access the healthcare system resources they deserve. Once on treatment, Keheala joins patients on their journey through the healthcare system, providing information, motivation and dedicated-support all at the push of a button.

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Q: Where is Africa with health technology? 

It is hard to summarize the status of Africa’s health technology as there is significant variation between and within countries. Many of the challenges are quite basic. There is no replacing an x-ray machine, diagnostic test or the expertise of a doctor or a nurse. Would Africa benefit from greater resources to address its health challenges? Absolutely. But focusing on this is unproductive.

Significant funding is spent on African healthcare, and yet, much of it does not get accessed or utilized as intended. If patients do not attend facilities, return for treatment or take their medication then society shoulders the burden of disease and losses to productivity. We can better utilize the resources that are already there. Keheala can help with such behavioural challenges.

Africa’s health entrepreneurs should look to Africa’s financial technologies for examples of how the old way of doing things can be leapfrogged to best serve the needs of Africans given the local resources and constraints. Thinking in these ways will lead to breakthroughs with local and international impact.

Finally, I suggest a rethinking of incentives may be the most beneficial approach to improving African healthcare. Currently, healthcare is delivered according to outputs (how many people were screened or treated) instead of outcomes (of those screened, how many started treatment; of those started on treatment, how many succeeded?). Focusing on quality over quantity will optimize the use of scarce resources. If these incentives flow from top to bottom properly, solutions demonstrated to be cost-effective will be implemented and achieve the greatest impact on healthcare outcomes.

Q: What are some of the most effective ways in which your company is currently taking healthcare services to the underserved remote areas of Africa?

Many health technologies focus on developing applications or introducing new hardware. The benefits may be significant, but if someone doesn’t have a smartphone, can those benefits be realized? If the hardware you brought into the country breaks, can it be fixed locally, quickly or affordably? We need to deliver healthcare services according to the existing resources and limitations.

To ensure accessibility to Keheala’s behaviour change technologies, we are committed to always maintain feature phone accessibility. At least eight out of ten individuals in Africa own a phone, but it’s not always a smartphone. Leveraging unstructured supplementary service data (USSD), which is accessible by 99% of all phones, Keheala is able to reach many of society’s most marginalized individuals, today! We also understand literacy to be a challenge. Offering a hybrid product-service model means that dedicated support is as close as a push of a button. We always ensure our interventions are designed as simply as possible so that even less literate clients can learn to use our interventions. In the future, we will further expand our access to less-literate clients by offering a fully voice-enabled option.

Other solutions will build smartphone apps to support healthcare workers in their duties. Keheala’s view is, “if patients have cell phones, too, why do we stop with the healthcare worker?” This is not a dismissal of healthcare workers, but the recognition that no one is better incentivized or positioned to improve one’s state of health than the individual themselves. Our healthcare workers love this approach as well as it saves them time, makes their job easier, more enjoyable and is improving treatment outcomes!

Q: In the efforts to deliver health services across Africa, does your company form strategic partnerships with tech companies, startups, SMEs, or any other relevant bodies?

We always work hand-in-hand in support of our clients and stakeholders as there is much we learn from them! As we think about greater growth into new markets across Africa there are organisations we believe we can collaborate with to create shared impact and value with. We are open-minded and opportunistic when it comes to addressing Africa’s greatest health challenges with a focus on pragmatic partnerships and solutions over-idealised public health interventions.

Q: Do you see a future where health tech companies in Africa collaborate more with each other?

Collaboration is the only way forward. The setup costs and barriers to entry in new markets are too significant. Local networks and expertise are also essential for success. Partnerships can lay the foundation for new programming much more quickly than going at it alone.

Q: How do you see Africa’s health tech industry evolving over the medium to long-term?

COVID-19 has accelerated a number of trends and will continue to demand traditional means of healthcare delivery be re-evaluated. Solutions that increase healthcare system resiliency, avoiding the need to interrupt long term investments or programming when responding to medical emergencies, will be prioritized. Single solutions to single problems will be deprioritized in favor of multi-problem solutions. Similarly, solutions that are horizontal in value across disease use-cases will be better positioned to offer affordable pricing.