When Dare Ladejobi was a medical student in a hospital in Lagos, Nigeria, he routinely encountered situations that could only be called extremely dire. “There are almost 30 million people in Lagos,” he said. “There were many talented physicians but resources were stretched to meet the needs of too many very ill patients. Sometimes we didn’t have running water and had power cuts. You could be in the middle of a delivery or surgery, and suddenly the lights go out.”
Surgeries that had to be concluded using phone flashlights convinced him that he needed to bend his mind to systemic change. As a young doctor, he wasn’t yet equipped to help solve these problems, which he understood to be caused by a lack of infrastructure.
“When I see problems, I like to solve them. I want to help people,” he said. While still volunteering as a doctor, he broadened his knowledge by taking jobs at a health care insurer, at an investment bank, and at a company that was creating new satellite cities in Africa. In each case, he was focused on solving a basic problem, such as lack of health care, housing, or jobs. Aiming to develop the business skills he needed to launch a venture in the medical field, he went to Stanford Graduate School of Business. There, he came up with an idea for Healthcorp, a health care venture to bring frontline affordable care to people in Nigeria and other emerging markets. He received support from the Center for Social Innovation and won the fellowship to bring this idea to reality.
Only about 5% of the population in Nigeria has health insurance. The difficulty of accessing and paying for quality health care means many people first visit “chemists” — local shops that provide over-the-counter medications — or nurses. In some cases, the local experts have little more than a high school education. Rather than missing work and the related income, people ignore conditions or receive ineffective treatment until whatever ails them becomes full-blown and difficult to treat, overloading the hospitals even more.
At Stanford, Ladejobi met his classmate Madhu Sivaramakrishnan. In the Startup Garage course, they realized that India and Nigeria shared many of the same problems and attempts at imperfect solutions. Previous efforts to address the vicious cycle created by the lack of affordable primary health care focused on trying to expand in-person care, a difficult and expensive solution, or incentivizing doctors to treat people for free, which is unsustainable. So far, tech-based approaches have largely not focused on people at the bottom of the pyramid, the largest socioeconomic group in these populous nations.
The COVID-19 pandemic has inflicted unique strains on health systems everywhere, as well as creating an opportunity for needed change in health care systems. The infectious nature of the disease and the pattern of symptoms means disease detection and contact tracing are critical: If too many people are infected, there is an even greater potential for the system to be overwhelmed. However, broad awareness of the pandemic also means that people in Nigeria are motivated to change their behavior and to help their community and country.
The Novel Approach
In fall of 2019 at Stanford GSB, Ladejobi and Sivaramakrishnan developed the idea for app-based diagnosis, first-line prescriptions, and affordable telemedicine starting in Nigeria. The duo wondered what would happen if they could replace the first stop at a local, possibly unqualified, health care provider with an app that would dole out accurate diagnoses and follow-up.
They were working on launch plans when, in March 2020, COVID-19 was declared a pandemic and Ladejobi learned that the United Kingdom had asked retired doctors to come back to work. “If I have a medical license, I want to be back in Nigeria,” he thought. “I bought my return flight ticket that day,” he said.
Once in Nigeria, Ladejobi and his team began reaching out to other doctors in the country. “We asked, what were key parts of the problem and what were we best placed to address?”
In order to respond swiftly to the need, they established The 258 Initiative, a text-based system that enables people to send a code — 258258# — from any cell phone. The user then receives a USSD request to press 1 for a fever, 2 for a cough, and to report other details by USSD and text. Through a partnership with the Nigeria Centre for Disease Control, patients are identified and classified by risk tier. Data is shared every 30 minutes with the NCDC’s team of doctors to follow up and provide care.
After Ladejobi and team located a telecom company that would donate a toll-free number, the app launched on Jun. 13, 2020. The cofounders thought they’d have 200–300 users a day. “On our slow days, we have 10,000,” Ladejobi said. “On our biggest day, we had 70,000 people dial the code.”
As of September, The 258 Initiative has escalated about 300,000 cases to the NCDC. The app is not the NCDC’s only channel: People also report symptoms through websites, a chatbot, and other channels.
The ingenuity and networking required to accomplish each step in the process was monumental, Ladejobi said. He and the team were aided by the connections he had built up over his years working in different sectors in Nigeria. “For every single thing we did,” he said, “maybe each one of those has taken 1,000 phone calls.”
Building on this start, the team is implementing a mechanism for reporting the severity of symptoms and an automated way to follow up with patients.
Despite the urgency of the pandemic and the qualifications of the leadership team, hurdles abound. For example, Ladejobi initially found it difficult to set up a WhatsApp version of the app; the Facebook-owned company kept sending him an automated rejection, with no explanation, when he entered the company’s business address.
The COVID-19 response suggests that the underlying concept of text-based medical response could be widely used. The next step for Ladejobi and his team is to raise about $700,000 to expand their COVID-response platform to diagnose and triage other preventable illnesses, and to hone a business model. The app could make it possible for thousands, if not millions, of Nigerians to easily access first-level advice and screening, saving money for people, governments, and health care providers, whose costs rise as sicker people arrive in the system. And the technology could be adapted to other emerging markets, Ladejobi said.
Ladejobi was born in Lagos, the son of a teacher who later served as a school principal. He learned at a young age to find solutions to problems, and to separate short-term from long-term solutions — a pattern that has helped him throughout his life.
He took the same approach after he understood, as a young medical student, how much change was required to provide good health care. He looked for long-term, systemic solutions as he studied to get a finance certification and an accounting degree, then worked in health insurance and investment banking, all the while volunteering as a physician. “Then an unexpected opportunity to build something new arose,” he said. He was invited to join, at its inception, a company called Rendeavour, which designs and builds satellite cities throughout Africa: The company builds the infrastructure and then invites private companies, like hospitals and factories, to relocate. He stayed for seven years, becoming COO for the Nigerian business.
Having learned much more about how to execute complex solutions to basic problems, Ladejobi wanted to use those skills to provide health care solutions. He applied to the Stanford MSx Program in 2018 with one question on his mind: “How do we bring affordable, trusted health care to people in emerging economies? I wanted to learn more about the technology that was out there, lift my head above the water, and take some time to reflect.”
He hesitated a little before describing his dual identity as an entrepreneur and a doctor. One morning soon after his return to Nigeria in March 2020, he said, he got a call from a friend, who had noticed a man dumped by the roadside because he had COVID-19, and there was no room at the hospital.
Ladejobi got the call because his friend knew he was a doctor. He reached out to his contacts at the government’s response team to help get the patient into isolation, which they did. And then he started trying to trace the people the man had been in contact with — which was difficult. But speaking to the man’s brother was a start. And then they got the man into a hospital, where he recovered.
“This story might not seem directly related, but it really touches me,” he said. “I thought, ‘I have to get involved.’ ”
— Elizabeth MacBride