"As a HMO, all our data sit in the cloud"— Simbo Ukiri

The Chief Executive Officer, Avon Health Maintenance Organisation, Mrs. Adesimbo Ukiri, speaks to OZIOMA UBABUKOH on how cloud, the Internet of Things and other technologies are helping to improve health insurance policies.

CEO of our investee company, Avon HMO, Simbo Ukiri Ukiri,

Most global companies are going the cloud technology route to grow their business but the reverse is the case in Nigeria. To what extent are health maintenance organisations like yours adopting cloud technology?

Obviously, I can speak for Avon HMO in this area. We have an operating software that enhances our capacity to utilise and fully exploit the potential of cloud technology. So, when we say that we are at the intersection between health and technology, it is a claim we make with modesty, but also with confidence. Since we started in 2013, our core operating software has been in the cloud because when you host such things on onsite local servers, there is

room for all kinds of risks and the continuity of your business is under threat. As a HMO, all our data sit in the cloud, whether it is utilisation data or the data of the experience our enrolled members have at the hospitals. Even our accounting and finance software sit in the cloud. So we are a fully a cloud-based organisation. We only use our physical servers as backups in case something happens with the cloud connection, so that our business does not experience any disruption. But as soon as the connection is up and running again, we are automatically hooked up.

Aside from cloud, technologies like the Internet of Things, social media and big data have become critical in the business space. For big data especially, why are companies in Nigeria not thinking along that line to grow their business?

I think, with respect to big data, the challenge for us in Nigeria is that we don’t even have the data in the first place. If we had it, I for one, would be very happy to mine it and get insights about the market, so that I would be able to do what you can call predictive technology. When you have big data, you know that you have predictive technology, which is going to be huge in the health sector.

Because by the time you mine big data, you would be able to predict who would fall ill to certain medical conditions, when they will and in what numbers. There are exciting things that big data can do for us, but as a country, that is not an area which we have much access to. There is a huge gap on the medical data side. There are other types of data that are available that you can mine. In our usage of telecommunications capabilities, for example, there is data on that. The Nigerian Communications Commission keeps very good data on that. We probably also have data on our use of the Internet, what sites we visit and what we use it for, because those things are not collected for use locally. But for the services that we utilise locally, healthcare services for instance, we don’t have data on that. It’s a shame really. I look forward to us, as a country, being able to have data on healthcare spend and utilisation that will enable us to look into the future and also help us plan adequately for the kind of medical infrastructure and access to medical finance that the country needs. As a company, we have always spoken about data from inception. As I mentioned, we started by putting our operating software in the cloud. So, from the get go, we were passionate that even if nobody else was keeping medical data at the granular level, we would. From the years that we have been in operation, we have data. But wouldn’t it be wonderful if all the HMOs and hospitals had the same level of granular data? I think that as a country, we need to begin to lay more emphasis on this, because the gains for us will be really tremendous.

To what extent can the unpopularity of health insurance be turned around using a social media that is devoid of hate messages?

Social media, by its very nature, leaves itself open to all kinds of abuses and Nigeria is not exempted. Other countries have also had incidences of hate messages and fake news, among others. This is the negative side of the social media. However, social media has its positive aspects as well, because it just gives you the ability to engage with such a large number of people simultaneously, while also allowing two-way communication. We started initially on just Facebook and it’s been phenomenal. Right now, we have about 37,000 followers on Facebook and the level of engagement increases every day. We are the only HMO in the country that has that many followers.

Beyond Facebook, we are also on Twitter and Instagram where we are growing. I dare say that there is a wide gap between us and our peers in the industry. We’ve found it very useful because it lets us know what Nigerians are concerned about. We sponsor a radio show where we talk about health issues. So anytime the radio show is about to go on and we post health topics, people engage with us on all the social media handles; to let us know what they would like to ask when the doctor comes on. You know, there is nothing like giving people an avenue to talk back to you about what concerns them. I will have to let you know that a key part of our growth can be attributed to social media. Interestingly enough as well, when we launched Avon online, which is a platform that enables people subscribe to our health plans online using their mobile phones and tablets, the first buyer we had found us on Instagram.

Now, I know that Nigerians have an aversion to the term, health insurance; and many Nigerians don’t trust it. But the truth of the matter is that we are not really a health insurance company. We are a Health Management Organisation. What we do is manage people’s healthcare based on their subscription to a health plan. So, unlike your typical health insurance which will underwrite each person individually – they will look at you and ask you questions like: Do you smoke? Do you drink? How many hours of exercise do you do in a week? What are the health issues you have in your family? etc. Now, another person exactly your age, but having a different health profile, will pay a radically different premium. That is health insurance. But what we do is that we get a pool of people together and we make some assumptions about proportions of how many will be ill at any point in time, and what kind of illness they will have, so that everybody pays exactly the same and belong to the same health plan. It doesn’t discriminate. That is why it is called “managed care,” because we also have relationships with hospitals. We contract with them and the hospitals have to adhere to certain minimum quality standards. Therefore, there is no discrimination on the basis of one’s peculiar status; depending on the health plans you choose.

How are Google maps and other apps helping people to access quality healthcare in Nigeria, amid financial challenges and other economic factors?

People like us in the industry are excited because the Minister of Health has stated that he will be focusing on primary healthcare delivery. He has said that he is going to ensure that we have 20,000 primary healthcare facilities, because that is the point at which you can begin to say that you want to achieve Universal Health Coverage. There can be no UHC if there are no hospitals within easy proximity for every Nigerian. That is the bedrock. Financial access is why we are here. It is because we know that everybody cannot fall ill at the same time; that’s why we do what we called a ‘Health Plan’ and not really a ‘Health Insurance Plan’. So, you join a scheme that gives certain benefits and whatever each person is paying is far less than what they would have paid had they gone to get an insurance plan on their own. That helps financial access to quality healthcare. So, at the point of needing to go to a hospital, you wouldn’t need to have money in your pocket because you belong to this pool of people from whom small amounts have been gathered overtime and the “gatherer” of this pool, so to say, will pay for you when you get to the hospital. That’s the financial access part.

Now, geographical access and being able to even know where the hospitals are is also something that technology has helped us in resolving. Yes, we know that Google maps can be unreliable sometimes, but it has proven to be very good in recent times. You can log into our website if you want to find any of our network of hospitals. You can do so on your mobile phone. The idea is to ensure that no matter where you are, you can find a hospital that you can use within your vicinity if you are on the Avon HMO plan.

Huge funds have been allocated to this sector to push the drive to achieve UHC in Nigeria, yet we have not seen much traction. What appears to be the problem? Is it that government is too lackadaisical, or that the private sector has not done its bit?

You are right. I think that the government certainly could have done more in the past couple of years. I feel that in successive years, we have failed to have the right level of investment in healthcare infrastructure, in particular. We have also failed to have the right level of monitoring and accreditation when it comes to the healthcare facilities in the country. We have paid the price for it. We know how much is being spent on medical tourism. We also know how much of our population die needlessly, year-in-year-out. There’s a failing on government’s part because of poor levels of investments over the years; not just this year or last year.

The private sector has not done all that it needs to have done over the years. In other countries, the health sector is big business and it brings good returns. But to invest properly in the health sector, you need serious business-minded people. As a country, I think most of the hospitals we have are self-owned and self-managed, fragmented and small, and one-man operations. You either have a man and his wife or a man and his friend. We don’t have institutions as such investing in hospitals. But I see the trend turning. I see all of that changing in recent times, though we see the new trends limited to Abuja and Lagos. We also have seen foreign investments coming in, not only in hospitals but also in diagnostics. We have seen foreign investments partnering local investment and expertise in these hospitals. I think we have turned a corner as a country. But the question now is, how fast do we accelerate?

This article was first published in the Punch Newspaper.