Most of the hospitals in Africa rely on outdated paper-based information systems – a technological gap that has a dramatic impact on the quality of primary medical care. The World Health Organization (WHO) estimates that in Africa, there’s a 1 in 300 chance of getting a healthcare-induced injury as a result of bad practices and system inefficiencies. If a patient lost his paper card, for example, all of his or her previous medical health history is lost, too. In a country like Ethiopia, with a population of 96m, that’s a big deal.
Using a proprietary low-cost and low-code solution called ABAY-Andromeda, Lalibela Global-Networks is digitalizing hospitals’ paper-based outdated systems and patients’ medical records across hospitals and clinics in Ethiopia. Amid the Covid-19 pandemic, the company has also released its ABAY-CHR Covid solution for free, for use in emergency response in hospitals and clinics. There are over 100,000 hospitals and clinics in Africa, 4,500 of which are in Ethiopia.
The company’s CEO and founder, Wuleta Lemma, was born and raised in Ethiopia and studied tropical medicine in the US and UK. She has spent the past 28 years optimizing hospital management processes through technology. In 2016, she founded Lalibela Global-Networks.
The startup, which is seeking funding to expand its solutions across Africa, took nearly two years to build ABAY-Andromeda, an end-to-end electronic medical record SaaS, and the full suite of healthtech solutions such as e-pharmacy, radiology, imaging and lab information systems.
Earlier this month, Lalibela won the Web Summit pitch competition, one of the biggest events in the European startup ecosystem. CompassList interviewed Dr Lemma to learn more about her challenging journey and how the doctor intends to disrupt the African healthcare market, projected to be worth over $30bn by 2025.
What is your background and what motivated you to dedicate your life to improving the African healthcare system?
I grew up in Ethiopia. At six years old, I wanted to be an engineer but then I heard about a teacher who died of malaria because he got the wrong diagnosis and couldn't get the right drugs. That episode marked my life. I asked my mom if was possible to be both an engineer and a doctor and she said, “Why not!”
Fast forward a little and my sister used to get sick a lot. When she visited hospitals in Ethiopia, her medical records didn't move with her so she had to start all over again whenever she was being moved to a new facility. This, too, had a huge impact on my life. My sister was educated. She was an aspiring nurse so she could tell doctors what had previously been done to her, but this is impossible for millions of our patients.
I, therefore, made it my life's mission to truly change the African healthcare information system. That’s why we started Lalibela in Ethiopia around four years ago.
How have you overcome the initial barrier of moving from a paper-based system to a fully digitalized one? What have been the biggest struggles?
I was working to digitalize the Ethiopian healthcare system before founding the startup. The biggest problem was the flexibility that is needed because the workflow structure in hospitals varies from one hospital to another and changes very quickly. Also, most hospitals and clinics don't have IT people. If they want to move to digital solutions, they have to hire programmers.
We decided to facilitate this by making it simple. We developed a low-cost solution that doesn't require a lot of programming – just basic digital knowledge such as Microsoft Word and Excel, for example, is good enough. To date, we have already digitalized 1.2m records.
What happens if a patient moves to a hospital that doesn’t have the software to read and store patient information?
We are currently testing the beta version of our ABAY-CHR mobile app. The idea is that if the hospital is already working with our ABAY-CHR SaaS, the mobile automatically retrieves patients’ medical records. If the hospital is not using ABAY, it can at least access patient medical information through the ABAY mobile system. Users can even search local services to find nearby clinics, hospitals, labs and pharmacies.
How do you ensure patient data is safely stored?
The information stored on hospital servers is encrypted. We provide a role-based security system with user ID and encrypted passwords. We are also currently working to integrate our solution into the Microsoft marketplace. Once we do that, Microsoft will take care of all of the security matters.
Have you built any partnerships with African governments, universities or technology companies?
In Ethiopia, we are working with Wollo University, which has over 20,000 students, plus medical and engineering schools. There, we have established a training center for app development. We also collaborate with the university to hire new graduates. We have additionally collaborated with Microsoft, since most of our technology has been built using their systems.
The Ethiopian hospitals we are working with are government ones. One is among the largest hospitals in Amara. Then we have the St Peter Hospital, which is a federal government hospital under the Ministry of Health. There’s also the new Covid-19 Hospital, which is also under the Ministry of Health, where we integrated our modular Covid system.
How does the modular Covid system work?
The St Peter Hospital, which has around 220,000 patients, demanded a Covid solution. It would have been impossible before, as it takes six months to develop something like this. But since we use a low-code solution, we developed it in only 10 days using the WHO's guideline for Emergency Management.
The Covid module keeps track of patient care, telling doctors the emergency grade and whether a patient needs fast ventilation or not. The Covid module is like our Awash or Lucy systems: a standalone system that you can take and use anywhere. We offer this solution for free, by the way. We are a small company, but Covid is a big problem for the whole world.
What is Lalibela’s business model?
We are using a SaaS model that has a small fixed set-up fee and then a monthly fee per patient.
How many people are currently employed by Lalibela?
When we started, we were 10 full-time employees. At the moment, most of us don't get salaries, such as myself and my CTO. We have five employees. The rest are part-time people.
What has been your revenue growth to date?
We’ve just started, but so far we’ve gained $100,000 in revenue.
Are you looking to expand outside Ethiopia? If so, what are the biggest challenges you’re expecting to face during scale-up?
Yes, we are trying to make ABAY multilingual in French, Portuguese, Arabic, and Spanish for the African markets. Our biggest challenge is financing. We can expand slow or fast depending on funding. Ethiopia has a pool of IT professionals and Africa produces a lot of smart young people. If we have funds, we can expand rapidly. We’ll also use the new funding to put our system in the Microsoft marketplace. Once we do that, it will become available to virtually everyone. We are getting it ready for the African market, but anybody can use it.
According to the High Tech Health on African E-health Startup Ecosystem Report 2020, this has been a record year for local sector with over $90m invested and 180 active companies. Do you believe there’s an infrastructure in place to kick projects off?
I believe it's a very untouched market and it's an emerging one. The potential is great. Only in Ethiopia, there were 81m hospital and clinic visits last year. A World Bank study estimated that the African healthcare market will be worth $30bn by 2025. It's a big market and everybody needs data.
Helium Health, the Nigerian electronic medical records SaaS, recently announced a $10m Series A funding round to expand its footprint in other African countries. What’s your strategy to stay competitive?
I think one of our biggest advantages is that we know African healthcare. I've been working in it for many years now. It’s also our low-cost solution. Our competitors don't have many local solutions at the moment, while ours is very flexible. We didn't look at raising external funding because we first wanted to make sure our technology was on the ground, and that we had enough hospitals and patients using it. There are also some smaller players that have developed just a lab system or an e-pharmacy system. It's like in Europe – you have so many players, but the market is huge and there's a lot that needs to be done.
What has been your financial backing to date? Are you looking to raise more?
We haven’t started any funding rounds so far. We initially bootstrapped the capital needed for the development. We’re now starting to look for investment in order to expand faster and we’re aiming to get $2m. We’ve been talking to both European and US-based investors.
We don't yet have Asian-based ones but we'd love to. I studied systems in Thailand, Cambodia, China and Nepal, so I'm familiar with what exists out there. We'd be interested in getting investors from Japan and China. The Japanese tend to spend a lot of money on hospital infrastructure in Africa.
You have been selected among the top 20 African startups backed by the Jack Ma Foundation. What does this mean for Lalibela?
With the Jack Ma Foundation and now with Web Summit, we gain even more international exposure and we’re getting connected to investors. We need to show there are companies in Africa trying to build disruptive solutions. Africa is ready for this kind of thing.
Are you currently working on other solutions and technologies?
We are building a mobile payment solution into our system so that people can use our app to pay. Imagine you are based in Barcelona and you have family in Ghana. You could use your mobile to pay for their hospital care. We are aiming to launch it within the next six months, depending on funding.
What other milestones are you looking to achieve next year?
In 2021, we would like to expand to 100 hospital clinics. We are also looking to have our system in multiple languages and easy to access in the cloud.
