Doctors are a scarce resource in Nigeria. Numbers for physician ratios in Nigeria from the WHO ( dated 2009, nobody seems to have reported any since) reveal a dismal physician ratio of 0.41 per 1000. The WHO recommends a ratio that is greater than one. Places like Britain have a ratio 2.8 per 1000 and the U.S 2.5 per 1000.
Western countries with excellent physician ratios often struggle internally themselves in certain locations. They try to plug this gap by luring over African and Nigerian doctors, in turn exacerbating the Nigerian shortage even more. See this Nigeria Health Watch/ NOI polls survey (PDF) of how severe the problem is.
Looking around the big cities of Lagos and Abuja however, doesn’t make this shortage apparent. In these cities, plenty of doctors, pharmacies, clinics, and hospitals litter the place, almost battling with each other for clients ( their affordability, of course, being a different discussion).
To really see the shortage, you need to take a jaunt into the hinterland where physicians simply don’t exist*. The people that run the show are quacks, traditional practitioners and if lucky, community health workers and questionably trained chemists. Proper health care facilities are miles away.
Startups like Maza health in Ghana have sprung up to help ease health care access through affordable transportation from rural areas to local clinics. Hats off to them for an amazing service. Please donate to help their work via their website if you’ve some change to spare.
Without transportation services such as Maza health to ferry people to receive care, many rural dwellers would nurse serious illness and injuries for years. Enduring suffering and awaiting either death or the temporary savior of a medical mission.
Tech to the rescue?
Startups have begun to emerge to solve the physician access problem. I’ve come across a number of Nigerian startups that seem to be going down the route of a chat based interface for question and answers with doctors. I’ve listed 4 below of such below. 2 have featured in a previous article on 20 Nigerian health tech startups to know.
All seem really good commendable. The chat based approach is an interesting route and will certainly provide value. Does it however really solve the manpower issue or exacerbate it? Here’s why I think the latter is the case:
There is an absolute and relative shortage of doctors going by the physician ratio graphs above. Most of these doctors are immensely busy and in high demand. Hence it would be safe to assume that there’ll only ever be a limited pool of doctors that would be available to provide answers on any of these platforms. This limits the ability to scale to meet high demand
Next issue is how do you vet the quality of interactions and answers. I dare say that the worse the skills of a doctor, the less busy he is likely to be and the more time he is likely to have to spend on a chat app answering random questions from the public. Engaging top quality and experienced doctors would be a real challenge. Hence the quality of answers is a real concern.
Ok, shelve the pessimism, what if it all goes well and the platform gets busy, how would you scale past this limited pool of doctors? hire dedicated doctors? This would be exorbitant and even less scalable
Artificial intelligence will save the day
This is where artificial intelligence comes in. I’ve been privileged to contribute to the fantastic work being done by London based your.md.
From their website:
Your.MD has built the world’s first Personal Health Assistant to use artificial intelligence (AI) to help users via chat throughout the entire user journey.
Your.MD is an artificial medical brain that is capable of finding the most likely cause of an indisposition. Through a set of intelligent algorithms, based on a doctors’ thought process, the Your.MD chatbot is capable of reaching a comparable result to a doctor when given the same information – totally personalised to fit an individual’s history, profile and current situation.
Your.MD is democratising healthcare by enabling everyone around the world with a mobile phone to access free, trusted and accurate pre-primary care that is unique to every individual’s circumstance. When you can’t get to your doctor, or simply do not have access to a primary healthcare professional,Your.MD provides immediate clinically assured healthcare advice from the UK’s National Health Service (NHS) to help you get better.
Available to download on Android or iOS as an app, or via your favorite messenger platforms, Your.MD has already helped almost 1 million people worldwide, becoming the number 1 health app in over 70 countries. You can be part of the healthcare revolution by using Your.MD; each interaction improves the service, not only helping you but also helping others.
Using the most advanced Artificial Intelligence, Your.MD is helping you take control of your own healthcare.
They’ve successfully created intelligent doctor chat bots. I’ve it installed on my slack and often challenge it with tough clinical questions to my amusement.
For a while now, your.md has been trying to distill as much of a doctors’ knowledge into algorithms so you can chat with the bot and receive responses and direction as you would when chatting to a real doctor. This hasn’t been easy and has come at a premium. $17.3 million to be exact. This cash has enabled them to improve their tech, making the bot better and better over time with the help of doctors like myself who painstakingly feed it with useful evidence based information.
Thus the only way I see Nigerian chat based apps being successful ultimately and solving the manpower shortage problem is going the way of your MD:
A.I and super intelligent bots ‘trained’ by skillful health professionals.
This will not be easy or cheap to do. Especially as I think it needs to go a step further in Africa where we’re more oral and less literate than our western counterparts.
How much further?
We need to be considering voice based A.I, in various languages no less.
The ultimate goal:
Anyone can call up a number or an online service and have a chat with a bot that would be able to direct him/her on what to do with a specific health complaint. Again this would be hard and expensive to do, where would we even find the techies to do it, Andela perhaps?
If I were to suggest a way to begin, I’d start with a particular condition or demographic: Mothers or pregnant women (their health issues are often more defined and predictable). As such I see startups like Safermom or Omomi in a better position to enter the voice based A.I space sooner than the generic chat based health apps who may take a more generalist approach. Better yet, perhaps some of these startups can collaborate on bringing something exciting to the market.
I see only a maximum of 2–3 worthwhile players in this generic health chat market ultimately so if you don’t turn out to be one of them, your pivot may be to partner with other startups in the manner suggested above.
Other potential applications I see for this Voice based A.I for anyone looking to start out or pivot include:
- Medical Triage
- Health education for patients
- Finding services
- Symptom resolver/ finder
- Managing home injuries/ common ailments
These can be deployed in concert with a local service provider or directly to the mass market. I favor the former to help soften the market entry.
The future in this area is certainly exciting, let’s hope we’re around to see it and perhaps even take part in building it. Comments and corrections below, please.
*A quick note about keeping doctors in rural areas: This paper from Nepal suggests ways to attract doctors to rural areas. One way that seems to work and should be done more often is admitting people into medical school who come from rural backgrounds. The paper is quite fascinating, read here