Background
The Promise of Telemedicine
Mashavu: Networked Health Solutions for the Developing World
A Multi-Million Smile Enterprise

Background
Like many developing countries, Tanzania and Kenya suffer from a severe lack of healthcare professionals. There is one doctor for every 50,000 people in East Africa compared to one doctor for every 390 people in the United States. Provider shortages are likely to persist, as many countries do not have the means to train adequate numbers of medical personnel. Access to care is further limited when large distances must be traveled for basic medical care, and often times the decision to seek professional help is made too late.

With the expanding youth population of Tanzania, children are often the victims of poor access to health care. There are 2.4 million orphans in Tanzania, many of whom live in orphanages with caregiver to child ratios as high as 1:30. Children at Good Hope do not see a doctor on a regular basis because taking a child to the doctor costs a significant amount of time and money. We have witnessed first-hand a number of cases where a child's health was significantly compromised because the decision to see a doctor was made too late.

The Promise of Telemedicine
Communications technologies and telemedicine have the potential to help overcome some of the healthcare challenges in remote regions. Cell phones are rapidly transforming the African continent. It is estimated that 97% of the people in Tanzania have access to a cell phone. Computers are slowly making their way into rural Africa. Computers and cell phones can connect patients in developing communities with doctors around the world. Many health practitioners are interested in performing outreach in developing communities but cannot make commitments to long-term international assignments. Short-term mission trips are very expensive and not sustainable solutions.

Mashavu: Networked Health Solutions for the Developing World
Mashavu enables medical professionals around the world to connect with patients in the developing world using modern technology and communications infrastructure. Trained operators at Mashavu stations in developing communities collect essential medical information including weight, body temperature, lung capacity, blood pressure, photographs, stethoscope rhythms, and basic hygiene and nutritional information for each patient on a regular basis. The station operator serves as a facilitator during check-ups and the patient is encouraged to interact with the user-friendly software. At each individual check-up, the patient is asked questions, photographed, and given standard tests to monitor their health and nutrition.

Web servers aggregate this information from various Mashavu stations over a cell-phone GPRS link and provide it on a web-based portal. Medical professionals can view the patient's information and respond to the patient and the nearest doctor with their recommendations. The patients follow up directly with the local doctor, if necessary. In some cases, the system serves as a link between the patients and local doctors. The medical professionals can review community health statistics in order to evaluate any general health trends or possible epidemics in the area. This anonymous information can then be shared with local community leaders so that health priorities are addressed effectively.

A Multi-Million Smile Enterprise
The approximate cost of each Mashavu system will be $200, excluding an appropriate cell phone and computer. Customers--orphanages, community centers, churches, clinics, entrepreneurs--will purchase the system with help from micro-finance organizations. They will charge community members a small fee to use the service. This past summer, our team conducted extensive surveys in Tanzania to determine the feasibility of this business model. The people overwhelmingly supported the venture, with most willing to pay about 80 cents per visit. With these numbers, the ROI (Return On Investment) will be under 6 months.

We are also considering other models, such as having doctors around the world e-adopt children on Mashavu - making them responsible for looking over the child's health statistics regularly. The system without the networking is also valuable as an inexpensive basic diagnostic system or to encourage people to "know their numbers" and take an active interest in their health. We intend to set up a for-profit or non-profit entity to support the venture in the longer term. The UN Industrial Development Office (UNIDO) has taken an active interest in this venture, opening up the possibility of the venture being adopted by other UN agencies and large development organizations.