Hello: can primary care deliver profits in Africa?

call in to classHello, healthcare. We were lucky enough to talk to the inspiring York Zucchi, founder and CEO of Hello Healthcare, and his colleague Dr Fanie Hattingh, who called in to MIT today. Catch Zucchi on video here. Students had prepared a case study of the cooperative business that Zucchi and his colleagues operate in South Africa. The organization operates as a platform that brings together its member companies for specific projects that deliver low-cost private primary care in South Africa and dozens of other settings across the continent and in the Middle East. Here’s how they put it:

Hello Healthcare is a group that is trying to make a difference in people’s lives by tweaking how primary healthcare services are delivered in Africa. We provide healthcare institutions, other service providers, healthcare professionals, businesses and governments with access to integrated end-to-end primary healthcare services (a so-called “one-stop shop”). (source)

Hello Healthcare engagements focus on primary care, York told us, but the organization offers a wide range of services. Their site mentions mining sector services and solutions, training, medical equipment financing, paramedics, and nursing services, to name a few.

What needs, specifically, does the company address? I did a bit of sleuthing, and discovered this pitch:

The primary healthcare sector is one of the fastest growing health sectors in Africa and around the world. Typical clients are retirement homes (1,700 in South Africa alone), Primary Healthcare Clinics (12,000 in South Africa), Nursing agencies, Home based care, Medical insurance companies and Factory clinics.
The majority of this market is still processing health records, stock control, invoicing, HR, nurse/doctor scheduling, maintenance, medication control, management control and reporting – all done manually. To address this we have developed a fully functional integrated IT system solution which caters for all these areas and computerises the entire business operations. (source)

The resulting value proposition rests on efficiency and productivity:

Correct and efficient systems for patient record retrieval, invoicing, stock control, medication management, practitioner productivity control and reporting mean that significant cost savings and process improvements are possible through stock loss control whilst improving productivity in each Clinic. This means a bottom line financial improvement which justifies the actual cost of the system solutions. Additionally, there is substantial benefit in the mitigation of risk for executives/directors due to correct system record keeping. (source)

Management and software systems seem to be at the core of its offerings, but we were also intrigued by the prospect that the collaboration itself offered significant value for the firms that were members of the cooperative—via branding, shared infrastructure, and access to funders and collaborators. According to the case, Hello Healthcare members ranged from large infrastructure company Legrand to transport firm TFM  but also included small companies with little visibility in global markets.

The upshot of Hello Healthcare’s efforts.  Earlier this year, Zucchi said it was able to offer primary health consultation for R38 in Zambia (around US$3.50) to offer doctor consultations, excluding consumables, at R50 in other African markets (US$4.60; source).
He also offers guidance to would-be primary care entrepreneurs and often encourages others to start up their own businesses, freely sharing advice and generously giving his time to students everywhere—including at MIT!

Looking at the context. While Hello Healthcare aims to address the problem of fragmentation in primary care delivery across the Africa, in some ways it seems to us that it also benefits from the fragmentation which offers its business plentiful opportunities to step in and do things better. We wondered: are the opportunities to execute short-term collaborations a product of current market conditions, and will the business opportunities that Hello Healthcare currently addresses eventually diminish as health systems and economies develop?
Hello Healthcare is looking ahead, taking on an issue we had wondered about in class too, by documenting its new ideas about how to improve primary care. Ultimately, primary care requires the public sector; in fact, Zucchi’s vision includes “handing things over” to the public sector. His company’s journey to this transition will be fascinating to watch, we all agreed.
And despite the fact that many citizens across Africa and in other emerging markets currently get much of their healthcare from the private sector (see, for example, this investigation of the role of private-sector care in low-resource settings) even today the public sector is, contrary to many of my students’ expectations, not always the least preferable option. In fact, a 2012 systematic review of research in global health delivery found that no support for the claim that the private sector in low and middle-income countries is more efficient, accountable, or medically effective than the public sector, although it did note that public sector appears frequently to lack timeliness and hospitality towards patients. Nor may the future hold much promise for business approaches to address the needs in primary care, according to a recent study assessing the prospects for the private sector to reach the poor at scale.

To ground your own analysis of the needs and opportunities, start by learning more about the state of healthcare. Check out this 2012 report by the Economist Intelligence Unit on the future of healthcare in Africa. It’s interesting to contrast it with a US-based view developed in Primary Care 2025: A Scenario Exploration, which depicts several alternative visions of what American primary care might look like in the year 2025, taking into account potential economic challenges, political polarization, and opportunities afforded by disruptive technological advances and new delivery systems.

And to put developing-country primary care needs in context, take a look at this 2012 blog post—a useful review of primary health care implementation and this post by one of Hello Healthcare’s collaborators presenting primary care issues.

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