Shezlong: Anonymous mental health services from Africa to the world

FULL TRANSCRIPT

Narrator: Mental health in Africa is often misperceived, leading to the stigmatisation of people with mental health issues. Because of this, those in need of treatment usually put it off. The cost of therapy doesn’t help either.

On this episode of Built in Africa, we put the spotlight on Shezlong, the first mental health-tech solution in the Middle East and North Africa (MENA).

According to a survey carried out by Egypt’s Ministry of Health in 2018, about 25 million people in Egypt — a quarter of the population — are suffering from a range of mental illnesses. 

SFX: Ambulance siren. 

In 2014, Ahmed Abu ElHaz, an Egyptian software engineer, was in an accident that almost cost him his limbs. 

Ahmed Abu ElHaz: I had a severe depression after the accident and I wanted to go to a therapist to recover. But unfortunately, in Egypt, and similarly around Africa, it’s very difficult to find a good therapist. 

Narrator: Given his previous background as a consultant with the World Health Organisation on mental health, Ahmed decided to build a platform to tackle the problem he faced.

Ahmed Abu ElHaz: I thought about how we can connect licensed therapists with anybody having mental disorders in a convenient, private, and anonymous way. 

Narrator: Ruminating on how to tackle the problem, he considered stigmatisation, misconception, contradictions, and religious stance on mental health disorders, and concluded that online was the way to go.

Ahmed Abu ElHaz: The online therapy, definitely, it’s more convenient than clinics in different ways. The first thing is the people. It’s easier to share their emotions and share their thoughts in their houses, rather than going to the clinics.

Narrator: And so, in 2015, Shezlong was born as a video conferencing platform with a focus on mental health. With only three therapists initially, the platform was limited to Egypt and other Arabic-speaking nations.

Ahmed realised very quickly that the problem was two-pronged. To build a client base, he needed online awareness campaigns to destigmatise mental illness. On the other hand, he also needed to hire qualified therapists to provide service to said clients.

Ahmed Abu ElHaz: The main issue of mental health, it’s an untapped industry especially for people and government. The governments, especially in emerging markets, don’t put suitable budget for mental health and they don’t invest a lot to provide loans to protect the patients and the therapists. On the other hand, the people don’t have the awareness and the culture to go to the therapist, if we have depression, for example, and personality disorders.

Narrator: But he eventually surmounted the initial challenge. Today, Shezlong now engages over 300 licensed therapists who specialise in depression, anxiety disorder, psychotic disorder, addiction, among other fields. It has grown into a global product, used across 60 countries, and is available in English, Italian, Hindi, Swedish, Turkish, Greek, Urdu, Deutsch, and French.

Shezlong has managed to create a sub-niche in the area of European and American expatriates who require the services of culturally familiar therapists. These expatriates, Ahmed says, make up 30% of Shezlong’s clientbase. 

Along the journey, Ahmed enlisted the help of other professionals like Mohamed ElShami, who served as the Medical Director, now Medical Advisor, and Shaheer Shaheen, who serves as the CTO. Ahmed is the CEO of the company.

Shezlong works sort of like a marketplace for mental health services. Both clients and therapists can access the platform via specialised apps available on the Google Play Store and App Store. An internal team of medical personnel ensures that only qualified therapists can sign up; they also check their excesses and call them to order when required.

For the sake of anonymity, clients are encouraged to sign up using pseudonyms.

Ahmed Abu ElHaz: We are using the latest technology in video conferencing in a secure way. We secured collaborations with the highest secure video platform. And we are using Amazon Web Service to secure our servers.

Narrator: In the coming months, a chat interface will be integrated into the platform to speed up client-therapist conversations. 

Clients can choose their therapists in most cases. In some cases, however, recommendations are made after they fill an 18-question questionnaire to determine their state of mental health. 

Therapists on the platform offer services ranging from consultation, to diagnosis, to referral to a health facility or treatment and follow-up. They can bill per hour or for every 30 minutes spent with a client. In Egypt, a session costs $20 on average. It however varies across other markets.

Of course, there’s the risk of therapists charging and serving clients outside the platform but Ahmed says they have this covered.

Ahmed Abu ElHaz: We have a rigid contract with our therapists to address that. And on the other hand, we provide for the therapists a lot of tools. Not only payments, the administration work, the patient filing system and all the secretary administration and like that. So it’s easy and it’s convenient for them to take sessions inside the platform rather than talking to clients outside the platform.

Narrator: For quality assurance purposes on therapist-client conversations, which by the way are not recorded, clients are encouraged to give honest feedback.

Ahmed Abu ElHaz: Our customer success team ensures that after each session they take the review of the customer to know whether the therapist provided good quality or not.

Narrator: And if there’s a problem that requires the intervention of the medical team, they are contacted to take relevant action, which can include calling defaulting therapists to order. And of course, clients can rate the services of the therapist via the app.

You are probably already thinking, “but how does Shezlong make money?” 

Shezlong currently has 83,000 unique subscribers who either use it on a pay-as-you-go basis or subscribe to bundles of 5, 10, 15, or 20 hourly sessions that are subsidised at 5%, 10%, 15%, and 20% discount respectively. Normally, the first session on each bundle is free.

On the therapist side of things, Shezlong charges a commission.

Ahmed Abu ElHaz: We take like 30% from each psychotherapy session.

Narrator: Shezlong also employs a B2B business model through which it charges corporates bulk amounts to provide mental awareness programmes for their employees.

In 2020, at the peak of the pandemic, most healthtech platforms attracted more users by incorporating telemedicine into their services to avoid hospital visits. Interestingly, it was also a good period for Shezlong, as it increased its user base by 3.5x. 

Because of a peculiar circumstance in Egypt, Ahmed says Shezlong is exploring the addition of health insurance services.

Ahmed Abu ElHaz: In Egypt unfortunately, health insurance doesn’t cover mental health. But in the MENA region, in some other countries, we are now contracting with these insurance companies to provide our service to them.

Narrator: One major challenge that the Shezlong team faces is the hiring of technical talent to manage the platform.

Ahmed Abu ElHaz: It’s not easy to do that because all our talents are travelling abroad. We are promoting stock option plans to provide stocks for talented people, hiring talents from India for example.

Narrator: Ahmed adds that they will soon include a new hiring-stock model with a particular focus on bringing in talent from abroad.

Attracting investor interest is another challenge that hasn’t been easy to overcome either.

Ahmed Abu ElHaz: In Africa especially, we don’t have specific investments for health-tech; majority of investments come to car-hailing and logistics. So it’s hard to find a passionate investor in the health-tech domain, especially the mental health domain.

Narrator: Nevertheless, Shezlong’s first-mover advantage in East Africa and other parts of the continent has seen it attract several investments from Africa and the MENA region. In 2016, it got $15,000 to push the first MVP from an accelerator programme sponsored by the Egyptian Ministry of Telecommunications. 

In 2017, it raised $150,000 in a seed round from Endure Capital, A15, and Karim Hussein. And in 2018, it got into the 500 Startups accelerator where it raised another $350,000 in a bridge round from the accelerator and four other investors.

Shezlong also bagged some awards from Forbes as the most innovative platform in the Middle East and North Africa (MENA) region and also from the Ministry of Communication in Egypt.

To power its operations during the pandemic in 2020, Shezlong got $450,000 from Asia Africa Investment & Consulting (AAIC), a Singapore-based investor focused on healthcare startups in Africa. Also in the same year, it got a $100,000 grant at Expo 2020 Dubai.

Going forward, Ahmed wants to focus outside the continent to draw more funds.

As for future plans, Ahmed highlights two.

Ahmed Abu ElHaz: Our plan is two things. Horizontally to expand Shezlong in sub-Saharan Africa and the MENA region. Vertically, provide different services. Already in mental health we provide video conferencing. This year, we will launch a texting therapy model; like a WhatsApp or chat model to talk to therapists via texting. Also, we will provide group therapy for customers who need it.

Narrator: Currently, Shezlong is in the process of raising a Series A round, expected to close in Q2 2021, towards expansion to Saudi Arabia. 

Thank you for listening to  Built In Africa.

This script was adapted by Oluwanifemi Kolawole and edited by Muyiwa Matuluko

Research and interview by Oluwanifemi Kolawole

Sound design by Oghenekaro Obrutu

This is a production of Techpoint Africa

I am Emmanuel Paul

Please subscribe, share and drop a review of this podcast, by searching for ‘Built in Africa’ on Apple Podcasts, Google Podcasts, Spotify, iHeartRadio or wherever you get your podcasts. You can also email us feedback at [email protected]

For more stories on startups and innovation in Africa, please visit techpoint.africa