Patient-centric, data-driven health systems
In a data-driven healthcare system, patients need to trust that the data they share is used for their benefit to get better access to care. We can achieve this by demonstrating that care is more accessible and affordable for individuals and society when there is a better connection between patient and providers, including at home and via pharmacies or Patent and Proprietary Medicine Vendors (PPMVs). And by demonstrating that we can build data infrastructure and governance systems that ensure health data is only used for the purposes that the data owners – the citizens – have consented to.
If the reuse of collective data is institutionalized so that patients can trust it will not be used against them, the information can be used for better resource allocation and investments by stakeholders. And if the immense value of this data can be reinvested into the health system, a virtuous cycle is created where data is used to create trust in the healthcare system.
We believe that the best way to achieve this is by building data cooperatives: institutions that set the rules for fair and trusted data exchange, so all players can access the information needed for their purposes - but that information only. And that patients have the agency over this data exchange, by giving consent for the amount and type of information that they are willing to share. This has to be done by localizing (and not centralizing) data storage, building the health data system around the citizen.
In 2024, PharmAccess and partners were building the groundwork for these data cooperatives, using a two-tiered approach:
1. We focus on two high-need, high-cost, well-defined care journeys that allow us to demonstrate better health outcomes and efficient and predictable healthcare costs. These are maternal and childcare (MomCare) and non-communicable diseases (NCDs), specifically diabetes and hypertension.
In both cases, patients require long-term treatment, and both require a high frequency of appointments and systematic follow-ups. This makes it possible to collect data and identify areas of greatest impact for improvement. There are also high costs associated with maternal and NCD care. With systematic tracking, data can guide the best, most cost-efficient options, saving money and improving outcomes.
2. We demonstrated the proof of principle of a shared health record, showing it is possible to create safe and trusted data sharing between patients and primary and secondary care providers, enabling better care coordination and innovative financing approaches. NCD care and MomCare were also use cases for shared health records.
Patient journeys for maternal and child care (MomCare) and NCDs
Approximately 830 women die every day due to preventable causes related to pregnancy and childbirth, and 99% of these deaths occur in developing countries, including those in Sub-Saharan Africa (World Health Organization)
These poor outcomes are symptoms of a profound lack of trust in the healthcare system. Many women feel that the benefits of going to a clinic don’t outweigh the (opportunity) cost and time investment. They know that they probably won’t receive all the services they need, let alone in a timely or respectful manner, and that critical medications may be out of stock.
On the other side, clinics are reluctant to invest in higher standards of care because they don't trust that women will continue along the full continuum of care—from antenatal visits to postnatal checkups. This means that mothers often start their antenatal care visits late in the pregnancy, when it may be too late to manage risky comobidities and build a trusted patient-provider relationship, leading to preventable complications and unecessary costs. This vicious cycle of mutual distrust undermines the delivery of quality maternal, newborn, and child health services and perpetuates poor outcomes across the region.
MomCare is a value-based care program that uses data to improve quality of care and create transparency for patients, providers, and payers. It encompasses three pillars: financial cover for the cost of care linked to the quality of care, digital support tools for providers and patients, and quality improvement tools.
The objective is to deliver a model for high quality care delivery that is attractive to both mothers and providers, financed in such a way that it is predictable and affordable for insurers.
The MomCare backbone has been firmly established, and we’re successfully advocating for adoption at sub-country levels. At the same time, we continue to innovate to leverage the latest technologies to bring even more affordable, quality maternal care to Sub-Saharan Africa, and use AI and predictive analysis to better understand patient health seeking behaviour.
Connected pregnancy journeys
We have built a network of providers in the Nairobi private sector, catering to women in the informal sector who pay out of pocket, tracking over 10,000 journeys. It’s a market segment with a great deal of low-value care: for example, wrongly timed care or lack of care provision, double costs due to provider switching, high C-section rates, no mental health services, and no strong patient-provider relationship.
In 2024, we launched a hybrid care model for this target group, which combines traditional care delivery at the facility (‘brick’) with telecare consultations by HealthX in the form of planned telehealth (‘click’). This approach not only enhances patient engagement and adherence but also allows for earlier intervention, reducing the need for costly complication management. It supports more efficient allocation of resources while ensuring that patients get the right level of care at the right time. Teleconsultations will help reach the eight contact moments recommended by the WHO, without the expense and time investment needed for eight physical visits.
The introduction of this form of remote care requires trust. Patients are hesitant to reach out to an unknown care provider, while the click and brick providers also need to trust that they each deliver high-quality care, and that collaboration leads to a sustainable business model for both.
PharmAccess served as a trusted party to get this partnership off the ground, and we also deployed the Shared Health Record, which allows enables the providers to exchange medical records of the women in the program. The initial results are promising.
Maternity Rating
One of the key components of MomCare has always been to measure the quality of pregnancy journeys based on patient data, bringing actionable transparency to providers and governments. Going forward, this component will be embedded in SafeCare as the Maternity Rating: a scale of 1-5 stars based on patient data.
YOUR CARE JOURNEY
Scaling MomCare
We advocated for the adoption of the MomCare approach in 2024, gaining commitment from three local governments: Kisumu, Lagos State, and Zanzibar.
Kisumu County Government has adopted the principles of MomCare (branded by the county as Safe Mama Tech), to drastically improve quality of care and serve as a blueprint for the country. Through Safe Mama Tech, facilities can share data, following the journeys of all pregnant women involved.
In Nigeria, we reinitiated discussions with the Lagos State Health Management Agency (LASHMA) to implement the MomCare model.
Digitally enabled NCD care
Non-communicable diseases (NCDs) are chronic conditions that are not infectious but rather lifestyle-related or due to genetic predisposition. Accoring to the World Health Organization (WHO) Africa, NCDs are becoming a leading cause of death: in 2019, NCDs were responsible for 37% of deaths in the region, up from 24% in 2000. The prevalence of the NCDs we focus on – diabetes and hypertension – is increasing rapidly, with hypertension affecting 37% and diabetes 10.5% of people in the region.
NCDs are a major economic burden: the lifelong nature of their care leads to high costs, exacerbated by fragmented healthcare funding. Many healthcare systems in Africa are struggling with the financing of chronic NCD care.
By blending patient-centered care delivery and innovative financing models, we can support more sustainable NCD care. We do this by innovating around patient care journeys: we track patients’ care, providing personalized feedback and linking patients to care, whether that’s in the clinic, the community or at home, where they can self-monitor their disease and take control of their health.
Working with Dutch company Luscii, we are developing a scalable business model for NCD care in Ghana to bridge digital and geographic divides while proving the financial viability of remote monitoring. We piloted innovative payment models in six of the 11 facilities, aligning revenue with care quality and encouraging the use of remote monitoring. We provided video and audio explainers in local languages – Twi, Ga, and English – as well as WhatsApp and SMS tools, which improved patient engagement and therapy adherence.
The digital care platform has onboarded 1,453 patients across 11 facilities, supported by 199 clinicians. Remote monitoring has led to a 60% increase in therapy compliance, with 50% of patients – almost twice the national average – achieving blood pressure control within six weeks. The data also shows that patients are willing to pay, with cost savings of 15% over traditional care.
In Ghana, we also implemented a value-based care (VBC) initiative for hypertension management across 22 health facilities, through a collaboration with the National Health Insurance Authority (NHIA), the Christian Health Association of Ghana (CHAG), and Leapfrog to Value (L2V).
Training of patient group leaders on how to measure blood pressure - Ghana
Our digital and mobile-phone-based, patient-centered NCD care model improved access to and quality of NCD care for 1,626 patients in Kenya. We engaged 75% of the patients in self-monitoring, 50% in peer support groups, and 65% in M-TIBA – CarePay’s platform that acts as a digital connector between insurers, donors, healthcare providers, and individuals. Disease control increased from 35% to 50% for blood pressure and from 30% to 74% for diabetes. However, 50% still reported an unmet need to obtain primary care. Lessons are being incorporated into new 2025 NCD patient journeys. Read the full study: Oxford Open Digital Health
Shared Health Records
To demonstrate how digital connectivity and data interoperability could enhance healthcare, we implemented a shared health record (SHR) across 26 maternal care providers in Nairobi. The SHR uses internationally recognized open standards (FHIR) and connects multiple healthcare providers with mobile claims management partners (such as M-TIBA/CarePay) and patient engagement tools.
We demonstrated this open data exchange and are now starting to scale this in Kisumu County, Kenya, to a network of public and private primary care providers in collaboration with Kisumu County Government.
Patient journey tracking also makes it possible to expand datasets from hundreds to thousands of patients and support the visualization of anonymized health data in dashboards. With these insights, it’s possible to identify where improvements can make the biggest impact on health outcomes and cost. In Tanzania, over 9,000 pregnancy care journeys were tracked with a digital wallet linking care completion to provider incentives. The approach contributed to measurable improvements in care delivery, including an increase in facility-based deliveries from 17% to 52%.
Health Data Cooperative
Healthcare data is a public good and should not be owned by big tech companies; protecting patients' interests requires a robust legal framework, and a data cooperative can ensure proper governance, consent, and legislation.
The health data cooperative is part of a governance structure in which patients have agency over their health data. In this structure, patients are recognized as the rightful owners of their health data, giving them the ability to give consent on how it is accessed, shared, and reused—empowering them to benefit from the value their data creates.
2024: Proof of principle
We are developing a proof of principle for a data cooperative to institutionalize data governance and data value sharing. This involves partnering with payers, provider networks, and patient groups to form a coalition of trust. We have set out the basic design principles and in 2025, we will start a partnership with PharmAccess, CarePay, AARinsurance, AARclinics and IFHA. Based on the experience of the Care Journeys in 2024, we will start with a data cooperative around diabetes and hypertension, using the building blocks of the shared health record work for safe data exchange. We expect to add maternal care and other care journeys soon after that, moving towards a full insurance coverage package.
We are creating a legal environment through a cooperative for health data exchange, protecting and serving the patient’s interest.
We are also embedding governance, legal, and consent frameworks so patients can decide how their data is accessed and reused. User-friendly interfaces, such as WhatsApp, are important to enable patients to view and control their shared health records, and we are testing these in our programs.
A strategic partnership has evolved with Amsterdam Health and Technology Institute (AHTI) and the Amsterdam Municipality, who aim to develop a similar approach for the City of Amsterdam. We work together on technology and legal workstreams, and advocate for global adoption, laying the foundation of a Global Health approach for patient centric, trusted data exchange.
Epidemic Preparedness
We are increasingly at risk of epidemics and pandemics, with recent examples including bird flu, Ebola, Marburg, and Mpox. Fever is an indicator of infectious diseases like these, but fever is prevalent, and it is impossible to test every person who visits a primary care facility or pharmacy with a fever. With an AI-enabled early warning system in place, it is possible to track fevers in communities and identify high-risk individuals for testing.
By integrating diagnostics of epidemic diseases with digital health systems, we can improve patient care and support fast and effective responses to future outbreaks. This leads to the creation of real-time epidemic intelligence, higher-quality care, and more effective healthcare financing.
Our malaria ConnDx approach was rolled out in five private healthcare facilities in Kenya and detected 2,199 malaria cases among 11,689 patients with fever (18%). Our model predicts 25% reduction in costs if implemented more generally. Read the full study: Journal of Public Health in Africa (JPHIA)
In 2024, we established a data-driven infectious disease management system using rapid diagnostic tests and based on community-level data.
In a project co-implemented with the Kisumu County Government Department of Health, we aimed to support better diagnostics among Kenyan private sector providers in a hub (private health care providers) and spokes (chemists and community health promoter) model. The goal was to improve malaria testing prior to treatment, refer patients when needed, and prescribe correct and quality treatment.
Patients with fever were tested, treated, and tracked for malaria at five private health facilities, 25 chemists, or by 50 community health promoters. They used an AI-supported digital tool to collect data and upload malaria rapid diagnostic tests. The tool was connected to an automated digital payment platform, whereby monetary incentives were provided for every correctly uploaded test. By the end of 2024, they had collectively submitted 16,580 malaria tests.
This data was fed into a dashboard for (semi) real-time data visualization to improve policy guidance. Adolescents were found to have the highest rates of malaria positivity, and the county adjusted the policy to sensitize this target group.
Geo mapped semi real time dashboard