Tibu voice over
[00:00:00] Peter Gicharu: We call it a clinic in form of a backpack, because everything they would need to run and operate on clinic, they have it in the kit.
[00:00:16] Emmanuel Paul: Okay, I'm going to say it if no one will, no one likes visiting hospitals. That's unless you have a passion for medicine and healthcare. Hospital visits are almost always unpleasant. And should you need medical attention, this unpleasantness gets magnified by tenfold. The lack of medical facilities and the long queues you'd find in most African hospitals will most likely discourage anyone. And I mean, anyone, from going there unless they have no choice.
To mark the return of Built in Africa, we spotlight Tibu Health, a startup looking to take away the long queues and inefficiencies that plague Kenya's healthcare sector by coming to your doorstep.
Now that's a dumbed down version of the solution, but more on that later. The question you could be asking is why will anyone take on such a challenge?
Before coming to Kenya in 2013, the Canadian-born Jason Carmichael, worked with an NGO to tackle a cholera outbreak in Northern Sierra Leone.
He arrived in Kenya to work with AMREF as a public health grad student, but he began to notice the painful gaps in healthcare delivery. Carmichael observed that most doctors did not work full time and those who did couldn't work to their full capacity. So they were barely enough to cater to thousands of people.
[00:01:35] Jason Carmichael: We saw some supply and demand-side problems early on that we wanted to further investigate and test and see if we could put a model around it and monetize it while at the same time solving an important public health problem.
[00:01:49] Emmanuel Paul: That's Jason Carmichael, co-founder and CEO of Tibu Health. When you dig into the public health problem he's referring to, you'd not only find an unpleasant story, you'd also be wondering if any solution can address them. First we'll need to understand Kenya's healthcare system.
Now Kenya divides hospitals into six levels. Levels one and two are facilities like community dispensaries or clinics for primary healthcare. And it progresses all the way up to level six, which features highly specialized referral hospitals. Hosi, a collaborative hospital listing and review platform placed the number of Kenyan hospitals at 243, which is public, private, NGO, and faith-based among others.
Now note that Hosi does not record community facilities and dispensaries which are levels one and two in their report. And it begins its record from small hospitals with just minimal healthcare facilities. Now let's move on. From these figures, we can surmise that there's one hospital serving 221,000 people in Kenya, but that doesn't paint the full picture of the country's healthcare system.
The UK, for instance, lauded as having one of the world's best healthcare systems has just one hospital serving 54,000 people. In contrast, Nigeria has one hospital for 5,000 people, but still rank, slightly lower than Kenya and way lower than the UK in global healthcare indexes. How can this be? You ask. Well, delivering quality healthcare requires more than just establishing hospital units and filling them up with beds. We need to consider medical infrastructure, healthcare professionals, costs, medicine availability, and most importantly, preventive measures. The figures that stand out show a clear gap in regulatory focus between Kenya and a first world country like the UK.
Let's take hospital beds, for example. We keep talking about them because they improve a doctor or a nurse's ability to treat a patient when used to their full capacity. A bed, in this context, ideally refers to one that is fully staffed, funded, and available for use by the patient. Following the COVID 19 crisis, most African hospitals, Kenya included, faced a huge dearth of hospital bed.
We should point out that Kenya was one of the better prepared African countries to face the pandemic. So far, Kenya has 1.4 beds for 1000 people, less than a global average of 2.3 beds for 1000 people. By comparison, the UK has 2.4 beds for 1000 people, which is slightly higher than the worldwide average. But the scenarios in both countries are different.
The UK is seemingly following the mantra, "why build more hospitals or more beds when you can put measures in place to prevent people from going to the hospital in the first place?" In recent years, the UK's policies have actively reduced the number of hospital beds in favor of providing healthcare that reduces the demand for hospital facilities and faster discharge. This initiative is not without its problems, but the country has been able to double down on other facets of healthcare. While Kenya has just 26 doctors serving 100,000 people, the UK by comparison has 443 doctors serving the same number of people. While one country has actively recruited doctors to boost its healthcare, the other has made some confusing moves.
With a less than ideal health situation. It has fallen to entrepreneurs to make the healthcare space in Kenya way more exciting -- a recurring trend across the entire African continent.
But, the problem on Carmichael's hands here, were as big and as lofty as they come. The technology to execute this at scale was no mean fit. But luckily he met the illustrious Peter Gicharu. Born and bred in Kenya, Gicharu met Carmichael in 2017. At the time. He was neck-deep in building solutions that include livestock management systems and tracking systems for different companies and individuals.
[00:06:11] Peter Gicharu: Part that attracted me most about the solution was the challenging bit that went along with it. So the tech implementation of it at the time, I thought the idea was a bit crazy since no one had actually tried to embark on such a journey at the time. Having a practitioner come to your place, was unimaginable, no one has tried it. So to me it was very interesting and challenging idea to pursue, and certainly has grown over the years to become something even more.
[00:06:47] Emmanuel Paul: Tibu's first iteration worked more like an on-demand healthcare delivery system. Just the way you would place an order and get matched to a driver on Uber. Before launching, all their dutiful surveys and data gathered, showed that people wanted an on-demand service. So they went all in. But Carmichael and Gicharu were in for a surprise.
[00:07:07] Jason Carmichael: And that assumption was pretty quickly vanquished.
[00:07:12] Peter Gicharu: We found whether what the market was in need of was more schedule approach. Where I don't need the doctor right now, but I'd like for them to come to my place, let's say, next week or the weekend, so that I can free up my schedule to accommodate for that.
[00:07:29] Emmanuel Paul: But how does it fare in the Kenyan space?
Since that initial phase, Tibu health has evolved into a more dynamic startup through its website, mobile app, SMS, or email, prospective customers can book various services like home consultations, lab work at home, COVID-19 tests and special services.
[00:07:55] Peter Gicharu: Once that gets to our side, we have customer support representatives who are able to engage the client. There's a triage process between dispatch and immediately after they call, where we're able to see whether this is a case we're able to send our practitioners over to. One thing to note is we do not dispatch for emergencies. In cases of emergencies, we do recommend our patients actually seek medical assistance from the nearest facilities. So you don't want someone who's bleeding out to wait for your services, they actually need medical attention there and then.
[00:08:30] Emmanuel Paul: Once the team determines it can attend to the patient, they deploy the required medical practitioners armed with the appropriate kit. Did I say kit? Oh, yes. Apart from its telehealth platforms, Tibu Health medical practitioners armed with a backpack containing items you typically find in clinics.
[00:08:51] Peter Gicharu: We call it a clinic in form of a backpack, because everything they would need, to run and operate on clinic, they have it, in the kit. It's a small backpack where they're able to do labs, take vitals, diagnose as well. For other services, such a sample collection, they might not need a backpack, they have a handheld kit where inside they have everything they would need to collect samples and send that to the lab.
[00:09:14] Emmanuel Paul: Tibu's doctors can write prescriptions and its partnership with some pharmacy chains allow speedy prescription delivery. Patients can pick up their prescriptions elsewhere if these partner pharmacies are unavailable. In the case of surgeries, patients are referred to the nearest hospital.
Running around Nairobi typically takes 30 to 60 minutes. So Tibu's drivers get around in a car or a bike depending on the type of kit in use.
Interestingly, Gicharu claims that no other company is currently offering what Tibu health offers. And the few that have tried this have had to pack up given how difficult this space is.
[00:09:52] Peter Gicharu: Apart from that I'd say maybe telehealth. But we find telehealth constrained in that your interaction with the practitioner isn't that detailed. We offer the opportunity of having a practitioner with you. So with that, they're able to take your vital. They're actually able to examine you and be able to treat you accurately, as opposed to you explaining your symptoms and explaining how you're feeling over video. And that has been a blocker at least for the telehealth space locally.
[00:10:23] Emmanuel Paul: He also adds that telehealth is just one feature out of several that will act as a support for its core business. With so many moving parts, Gicharu is not shy to talk about the difficulties of hiring the right people for the right roles.
[00:10:39] Peter Gicharu: at least for some few key roles that we found really good individuals to fill, others have been bit more painful and time consuming to fill. And when you actually do, it's not the right fit. So, we've been going through a few restructuring and a few hiring stages, especially for tech as well and admin roles, but it has been certainly not an easy time when it comes to recruitment.
[00:11:08] Emmanuel Paul: While companies face recruitment issues, getting staff to stay productive after hiring them is also a real pain. It's perhaps noteworthy that we came across Magic Mind while researching some part of this story. You see, in the era of remote work, 86% of employees are reportedly burnt out and some others have difficulties focusing at work.
The founders at Tibu health have had to come up with creative and painstaking ways to boost productivity, but magic mind, a proud sponsor of this episode is giving a magical elixir that makes you focus better on your work and your workouts, be more creative and reduce your reliance on Caffeine. Yes, that's coffee, the Magic Mind drink is made up of all-natural ingredients, including Adaptogens, which help reduce stress, Nootropics which improves blood flow and cognition, Ceremonial Grade Matcha that boosts energy. The narrative was so compelling that we decided to try one. And I'd say, it's worth your time. Head over to www.magicmind.co/bia and use our discount code BIA to get a limited 20% off your first order. If it doesn't meet your expectation after five days of consistent use, Magic Mind is offering you a money-back guarantee.
While we grapple with Africa's health issues a productivity drink to take your morning coffee or get into that heated workout is quite essential.
In addition to the healthcare difficulties we listed above, it estimated that 450,000 Kenyans are pushed into extreme poverty every year due to health related expenses. Seeing a general practitioner would typically cost 1,800 Kenya Shillings to 3000 Kenyan Shillings, that is $15 to $25. While visiting especially starts from a minimum of 3,600 Kenyan Shillings or $30.
This amount might seem small for some, but this is quite significant for a country with 16% of its population living on less than $1.90 a day.
Tibu Health's home consultation cost 1,850 Kenyan Shillings or $15, an amount Carmichael claims is too cheap for the quality of healthcare on offer.
[00:13:25] Jason Carmichael: That's the doctor at home doing a head-to-toe consult. That's high-end concierge medicine for less than $20. Unheard of. We're about 20% cheaper than anybody else in the market.
[00:13:36] Emmanuel Paul: Carmichael maintains that the company can beat down costs because it has fewer operational expenses than a standard brick and mortar hospital. In In his words, the medical kids can do 80% of what is done in a clinic. Employing this method has helped the company break even three times since its 2020 launch and increased revenue by over 236%.
But it's still a huge part of the market up for grabs. Insurance would make Tibu's preposition a no-brainer for most customers, but it remains out of the reach for most Kenyans.
At 11%, insurance penetration in Kenya is still very low. Carmichael seems to think that there's an apparent lack of accountability in the insurance sector, and most are not willing to take a chance on a healthcare model they are unfamiliar with.
[00:14:23] Jason Carmichael: The reality is our model can virtually eliminate the fraud question. Our model can save a ton of money for insurance companies, because we don't have this big health infrastructure. And because we increase the access points to healthcare services.
[00:14:39] Emmanuel Paul: Tibu currently partners with nine insurance companies, most of which are global, but two are in Kenya. While countries like Nigeria have a cultural issue with insurance, Carmichael insists that Kenya's insurance gap is mainly institutional.
[00:14:55] Jason Carmichael: The mindset needs to change to one that's a little bit more proactive and progressive. How do we leverage these new models and make them better and work with these companies to make them better, to make the insurance sector and the health system as a whole more efficient, more transparent, less corrupt, less wasteful, et cetera
[00:15:14] Emmanuel Paul: Kenya has a massive doctor deficit, but Tibu is hiring for many roles, including tech and design. The company shores up against inevitable losses to big tech by creating a talent pipeline where junior developers are hired and paired with senior developers to gain experience.
So far, the model has worked. The startup has gained up to 20,000 patients since the 2020 launch. Though there's some investor push for table to launch in West Africa, Carmichael, insists that they would rather close in on East Africa and understand it.
[00:15:46] Jason Carmichael: Our first objective is to expand our footprint and expand the service offering within Nairobi. So we can capture more of the market. After that we're looking at different strategic towns within Nairobi. And we'd like to plant a flag in both Rwanda and South Africa within the next year and a half or so.
[00:16:04] Emmanuel Paul: Interestingly, Tibu's founders are not so keen about raising money having chosen to focus on bootstrapping rather than taking the popular route, which he describes as a PR play. In November 2019, it raised $100,000 and a little more a few months later, but all under a million dollars. However, for Tibu to make a dent in Kenya's health sector, its services would need to be more widespread and available to counties outside of Nairobi.
In summary, we're saying Kenya needs more of Tibu or more startups like it.
Thank you for listening to Built in Africa, this script was adapted by Emmanuel Paul. Research and interview by Emmanuel Paul. Sound designed by Oluwanifemi Kolawole and Emmanuel Paul. This is a production of Techpoint Africa. I am Emmanuel Paul.
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