Week 2

Hello world, it is me again, here to update you on some GSIF developments. To recap, I am on the Ukweli Test Strips team working to combat one major problem: Maternal Mortality. This is a huge problem and can be addressed in many ways. Ukweli aims to address one specific aspect of health that can lead to premature deaths among women: Urinary Tract Infections. The core of this project resides in the concept of last mile distribution. Basically, how do we get the women in the furthest village in the most geographically remote area access to our test strips? You may be thinking what do test strips and UTIs have anything to do to with maternal mortality? – the short answer is this: UTIs can lead to a myriad of birth complications and we hope to empower women to make informed decisions about their healthcare and the well being of their newborns.

Moreover, let us talk about the last two weeks. We got some snow last week which means class was canceled. However this week we were jam-packed with GSIF events including a Retreat on Saturday, Sierra Leone Healthcare System presentation on Monday, and class on Tuesday. Needless to say, there are a lot of insights and takeaways that I gathered from these events.

From a top-down analysis, my team has been posed with two interesting questions: 1) How does the African context present different challenges than the American context? 2) How does the African context present different resources than the American context?

With regards to the first question, I have identified three challenges in particular: working with protected populations, sensitization, and supply chain management. In Sierra Leone, protected populations do not pay for healthcare treatment. These populations include women who are pregnant, lactating mothers, and children under 5. How will this venture succeed if at first glance there is no profit available? We addressed this challenge through the technology, and intent of the technology. Our test strip is a screening device and is not treatment which allows for our revenue model to work. In addition, our venture is heavily dependent on donor dollars to cover overhead and large capital investments that will allow Ukweli to grow with time. Next, in the United States, sensitization to UTIs and other illnesses affecting the urinary tract are generally not needed because they are pretty well known. In Sierra Leone, people typically go to get conditions checked by physicians only if there it is a life-threatening problem. So how might we explain the importance of screening early and the dangers of waiting? This semester, the Ukweli team is exploring different modes of communication i.e. radio, mother support groups, and the involvement of high ranking community stakeholders. Lastly, in the west, people value time more than most material goods, and this can drastically affect how the supply chain processes will work in Sierra Leone. With consistent unreliability in terms of time and the general uncertainty of how to organize the flow of test strips from its arrival in Freetown, we have much work to do on this front. I anticipate our biggest asset to addressing these challenges will be the cooperation of World Hope International, our partners on the ground.

Challenges Presented via the Sierra Leonean Context and Proposed Solutions
Challenges:  Protected Population & Profit Sensitization Supply Chain Management
Ukweli Solutions: Donor Dollars & Cost Recovery Model Communication & Leveraging Key Community Groups/Leaders Collaboration with World Hope International

While the African context may provide several challenges, it also provides us with several resources that are pivotal to the success of Ukweli. The first is in the Community Health Worker network. This group is a nexus of young, capable, and driven individuals that give up possible income opportunities to serve the needs of their respective communities. CHWs can be leveraged because our venture employs a cost recovery system in which the CHWs benefit by selling/administering the test strips. In addition, CHWs are generally young which means they would be more open to the cost recovery system idea and be easier to teach. Another resource that working in Sierra Leone has is its partnerships with the Chinese government. Our test strips are currently being manufactured by an Original Equipment Manufacturer (OEM) in China, and with these partnerships, the trade will be much easier than if this venture were to be based in the United States. The final resource that my team has identified is both a challenge and an untapped opportunity. As discussed previously sensitization can be a huge challenge, but in Sierra Leone, it can be overcome by the utilization of key community stakeholders. I am particularly interested in what effect mother support groups and involvement of the matriarchal head-of house will do in getting people to be screened.

To get a better understanding of Ukweli, a bottom up analysis (rather than a top down analysis) can be used to get a deeper understanding of how this venture affects various stakeholders. It is important that I explain what exactly a stakeholder is in this context.

Stakeholder : An independent party (individual or organization) that has a vested interest in the success of a venture. These key players at all levels have value propositions that one can leverage for the success of a venture. 

The Ukweli team through research and travel has identified several key stakeholders that are vital to the success of the venture and a corresponding value proposition for each:

Summary of Stakeholder Identification and Value Proposition
Stakeholder Value Proposition
Community Health Workers CHWs can benefit from Ukweli through empowerment. CHWs can improve their efficacy and effectiveness through this objective way to see if someone might have a UTI, and thus make a better informed decision on referrals while bolstering their livelihood through an income generation opportunity.
Community Health Officers CHOs can benefit from Ukweli by increased efficiency and patients, which will provide the needed data to receive more aid money from the government. The clinics can prove that people are using their service and that they need to expand.
Nurses In Charge NICs can benefit from Ukweli by increased accountability of the CHWs and by getting the right referrals. NICs do not want women coming to them too late when a UTI has progressed to something worse.
Peripheral Health Units Peripheral Health Units can benefit from Ukweli allowing the power of screening to be leveraged by under-served areas, building a national identity and supplying technologies that give an objective, actionable results.
Hospitals Hospitals can benefit from Ukweli by improving systemic health. Through an increase in regular visits from people who usually never make the trip to hospitals, their facilities will become more trusted if they can provide quality care.

I feel this might be an information overload, but this venture takes a lot of dedication and time if we want it to succeed. Perhaps a simpler way of looking at the Ukweli might be through identifying ways we validate and gain credibility during this semester so work on-the-ground goes smoothly.

  1. Obtaining a marketing license through the SL Pharmacy Control Board
  2. Creating a training and communications protocol for Community Health Workers
  3. Identification and development of a distribution pathway
  4. Review of core assumptions that affect the financial model

In summary, the context of working in Africa presents several challenges and resources. How we choose to approach them will determine the fate of our venture. The biggest challenge to the success of Ukweli right now is sensitization and supply chain management while the greatest resources we have are Community Health Workers and the collaboration with key players such as World Hope, chiefdom leaders, and mother support groups. Through deeper look into Ukweli one can identify the various stakeholders and a value proposition for each of them. This exercise has led to the realization and conceptualization of our progress in the venture creation process, and we were successfully able to identify threads that need to be explored this semester to conduct meaningful on-the-ground operations.

Catch you next time!

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