How Google-backed HealthDart is bringing tech-enabled efficiency to SA’s ailing healthcare system – Njabulo Skhosana

The pandemic has accelerated the shift towards digital healthcare. However, digital healthcare is still in its infancy in South Africa, with fewer than 100,000 patients using digital services. There is huge potential for expansion, and one of the companies aspiring to revolutionise healthcare in South Africa through technology-driven solutions is HealthDart. HealthDart has been selected to be part of the Google for Start-ups Black Founders Fund 2023 cohort. In an interview with BizNews, HealthDart CEO Njabulo Skhosana said that the company wants to use technology to streamline the patient journey to primary healthcare. He said that they would be working with Google to improve their products and were interested in establishing partnerships with medical aid organisations within the country to make healthcare cheaper and more accessible. – Linda van Tilburg

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Excerpts from the interview

Patient healthcare journey in SA is an inefficient process

So, in our view, the problem itself is actually centred around how effectively patients navigate these healthcare journeys. Currently, it’s an extremely inefficient process that all of us globally typically have to undergo. In summary, if I describe a typical primary healthcare journey, an out-of-hospital healthcare journey, here’s what happens: you fall sick, and in today’s era, the first thing people do once they’re unwell is visit a search engine, usually Google. They type in their symptoms, and you know how that usually goes. The search engine optimisation will make you think that you have the worst ailment in the world, causing panic. You visit a doctor, but you’re unsure if you truly need one. After visiting the doctor, you  have another step in the journey. In the South African context, if they’re not a dispensing doctor—meaning a doctor with medication on-site—you then need to travel to a pharmacy. However, upon reaching the pharmacy, you might discover that the medication isn’t available, which is a big, big problem. Finally, after possibly making two or three trips to different pharmacies, you eventually obtain the medication and are left on your own.

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How HealthDart wants to revolutionise primary healthcare

So, the way we look at it is that the patient’s problem isn’t actually limited to each of those steps. It’s about navigating the entire journey to solve your problem, which is getting better. So that’s truly the issue we’re addressing — there’s a significant inefficiency in navigating that journey. The high costs stem from visiting the wrong health professional when unnecessary, along with numerous interim costs and the process of moving from step to step. Our technological solution focuses on streamlining the patient journey. We accomplish this with the pharmacy at the core. While we offer various other healthcare services, such as virtual triage and access to consultations through our platform, we consider pharmacy-based services as the foundation. The rationale behind this is that pharmacies are evolving into integrated centres for primary healthcare. Their purpose extends beyond medication dispensing to encompass basic consultations and health advice. Regulatory and technological changes reinforce this patient behaviour. So in a nutshell, our goal and current efforts revolve around streamlining how patients access healthcare, particularly primary healthcare, anchored around the pharmacy as the future of integrated primary healthcare. In practical terms, you can visit one place, determine the specific health professional you need. We use AI to do that, book in a consultation with that health professional, either virtually or in person. We also provide house calls with nurses who go to your home. Following this, you can have your medication delivered to your door or your workplace, depending on where you are. You can choose to engage in the full end-to-end journey or specific components, depending on your healthcare needs.

Free triage, nurse consultations at R120, R300 doctor’s consultations 

What we envision as the ideal journey is starting with our virtual triage—a chatbot that reviews your patient history. So, you’re able to share past illnesses and the current concern you’re seeking assistance for. For instance, let’s say hypothetically you’re a 40-year-old male experiencing a headache. You’re also diabetic and the headache has persisted for two to three weeks. You’ve tried ABC, you’ve googled things, you’ve tried some home remedies and it just didn’t work. We collect key information about your demographic and healthcare information, along with your medical history and current issue. This is where AI comes into play—a rule-based system that guides you toward the appropriate level and method of care to fix  things. This quick chatbot poses basic questions, helping us understand the nature of your problem. Based on this, it suggests a suitable level and approach to address the issue. For instance, is a pharmacist required for a simple concern, a nurse for a somewhat more intricate issue that can still be managed by a cost-effective healthcare professional, or a doctor for a more complex situation demanding specialised attention? This information clarifies the required level and method of care, which could be virtual or in-person.

Commencing with this process provides a recommendation, offering an initial insight. This leads to booking a consultation, which might be a house call or virtual session if it’s conducted online. Virtual nurse consultations are priced at around R120—a standard starting rate. If a doctor’s consultation is needed, the cost rises to R300. Nevertheless, we offer unique direct consultations as well. For instance, if you’re dealing with a previously diagnosed chronic illness that’s proving challenging to manage, you can schedule a consultation with one of our healthcare professionals. You’ll share your results, they’ll delve into your history, and offer advice. We provide specialised services like at-home pap smears or PSA tests—a prostate-specific antigen test. Patients can request a healthcare professional to conduct these services. It’s a combination of these offerings on the forefront. As is customary in healthcare, the pharmacy often becomes the final destination. We also offer access to dispensing capabilities, ensuring people receive their medication to complete the care loop.

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Plans for expansion from Johannesburg, looking for partnerships 

We’re still in the early stages. In the last couple of years, our primary focus has been on acquiring our first 2000-plus customers or patients, ensuring we build technology that serves the bigger purpose that we are trying to achieve. We are just in Johannesburg right now although we do serve a small subset of patients, particularly in the south of Pretoria around Centurion. Our key objective over the next few months is to expand the model we’ve established to other key cities in South Africa. Initially, we aim to extend our presence to Pretoria, Durban, and Cape Town. Those would be our immediate priorities. Nonetheless, we see this as a universally beneficial initiative across South Africa. We are also looking for key  partnerships, especially with medical aid organisations over the coming months. As we continue to roll out our services, we recognise the value proposition this holds for them, particularly the potential cost savings throughout the entire healthcare journey. I believe achieving greater sustainability in healthcare across South Africa is a key goal that we aspire to contribute to as a company.

Working with Google to improve HealthDart solutions

A lot of the technology that we’ve been building and focussed on in the last two years has centred around A.I. It has been a central component of our efforts. We want to establish a world-class centre of excellence that was started here in South Africa and for that you need big global partnerships. It’s great to have the likes of Google on board because you can’t get much bigger than that. So, over the coming months, we’ll be working closely with them to take things from the foundation that we’ve laid and take things to the next level on both the clinical and non-technical aspects. Several key projects will be underway, which, I believe, will contribute to the betterment of patients, the industry, and the country as a whole.

Satisfied customers: Many lack better alternatives for medication access

We recently conducted a survey with 60 Decibel, a company specialising in comprehensive impact assessments for businesses. One aspect they analysed was our Net Promoter score. Our Net Promoter score reached around two times higher than the average score for companies in a similar category. We achieved a score of 72, whereas the commonly considered positive benchmark is 35. Based on both this assessment and interviews with our service users, we received great reviews. Over 85% of the individuals surveyed on medication access noted that they have found no better alternative for efficiently obtaining medication. We’ve got a lot of key data points from the survey indicating that people love the way we approach it. The key thing now is to expand access and awareness of the service.

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