One of the biggest challenges for healthcare startups in Nigeria is access to market.

“In Nigeria, healthcare is fragmented, making it difficult to find distribution channels. We have to be creative and may need to look outside healthcare for distribution channels,” says Jennie Nwokoye is the founder and CEO of Clafiya - digital primary healthcare service that connects individuals and businesses to health practitioners to provide convenient, quality, and affordable, on-demand primary care from their mobile phones.

In this discussion, Jennie explains: 

• What are the healthcare challenges in Nigeria,

• How do startups do business in Nigeria and why is it difficult to scale,

• How do startups work with local and international investors and more 

This is the full transcript of the discussion:

You are split between the U.S. and Nigeria. Can you tell me a little bit more about that?

I was born and raised in the United States. I then moved to Nigeria when I was younger with my family and lived there for six years before moving back. I've spent the majority of my life in the United States. However, as I started Clafiya, I realized the importance of being on the ground in Nigeria to be closer to our customers and my team, to understand the market better, and to establish stronger partnerships. I'm not permanently in Nigeria because I still have family in the United States, and I want to be close to them. Most of my friends are also there, so it helps me maintain a balanced lifestyle.

Tell us a little bit more about Clafiya. If you look at the website, it has a very Western feel. You can observe a similar impression with other startups. Oftentimes, these companies are founded by people from abroad. How did you create a company in Nigeria, and how would you say that you differentiate from other healthcare providers in Nigeria?

As I mentioned earlier, I was born and raised in the United States and moved to Nigeria in 2000. During my six-year stay, I experienced the challenges of accessing healthcare firsthand. For my family, the issue wasn't affordability but finding the best hospital and ensuring quality care in a fragmented healthcare system. I have two younger siblings with chronic conditions, and my parents decided to move us back to the United States for better healthcare access. This experience stayed with me, and I knew I wanted to contribute to Nigeria's healthcare sector, but not as a medical doctor or practitioner.

In 2016, I began visiting Nigeria more frequently. I spoke to people to understand their healthcare experiences. I realized that the challenges I faced a decade ago were still prevalent or had worsened. During my master's program at Georgetown University in systems engineering, I focused on improving Nigeria's healthcare system. This led to the inception of Clafiya. We launched in June 2021 in Enugu, Nigeria. We chose Enugu to ensure we weren't just catering to the Lagos market. Lagos is Nigeria's economic center, but expanding outside of it presents challenges, especially in infrastructure.

What differentiates Clafiya is that we are a virtual primary healthcare and wellness center. We prioritize the patient experience to make it personalized and bring healthcare closer. We offer initial consultations, care navigation, drug delivery post-consultation, diagnostics, mental health services, and specialist referrals. Our approach is personal, safe, convenient, and affordable. We also employ nurses and community health officers, tapping into their potential as they are often underutilized. Our tech stack is another differentiator. We began with a USSD-based platform, ensuring those without smartphones or internet could access our services. We're now developing a mobile app. Additionally, our health savings accounts set us apart. They allow businesses and individuals to save money, which accrues interest and can be used for healthcare services.

Who would you say that your targeted customers are? I want to tie that to the broader picture in Nigeria. How would you assess access to healthcare for different groups in the population? Nigeria is a large country population-wise. It has 200 million people, essentially two-thirds of the US or the population of Brazil.

Currently, Clafiya targets the lower middle class to the upper middle class. Initially, we aimed to serve the lower class, which constitutes most of Nigeria's population. However, due to the nature of our funding, we shifted our focus to those who are health-conscious and can afford our services. We target business owners, especially SMEs and startups, offering flexible healthcare solutions for their employees. Our B2C approach targets younger individuals, such as students and young professionals, who are health-conscious and seeking affordable healthcare solutions for themselves and their families. As we grow, we hope to collaborate with larger organizations, NGOs, and the government to serve the lower class.

How would you assess the quality of healthcare in Nigeria and access to care? Nigeria has 0.2 doctors per 1,000 people. Where do you get the workforce that works for you?

That's why we've tapped into nurses and community health officers. They are the first point of contact and are embedded in the community. We recruited them from schools, online groups, and other platforms. We have over 300 health practitioners in our community, ready to meet demand. We rely on our partners for advanced care, ensuring our customers receive a seamless experience.

That basically means if care needs to be advanced, patients are not left on their own.

Exactly.

If I try to understand the broader picture in Nigeria, how would you describe the state of healthcare in terms of its weaknesses and strengths and in terms of private providers such as yourself that are present on the market? Are they usually specialized for the Nigerian healthcare market? Do you see that they're present more broadly in African countries? What are some of the observations that you have in terms of the market?

Nigeria's healthcare infrastructure requires significant improvement. More private entities, including startups and larger organizations, are stepping in to address these gaps. While the rise of healthcare startups is promising, we need better infrastructure to enhance the tech experience. Additionally, we need more healthcare providers, especially specialists. Many are leaving Nigeria for better opportunities abroad. If this trend continues without adequate training of new professionals, our healthcare system will be strained. Private entities like Clafiya are doing their best, but government support and friendly policies are crucial for sustainability. We also see non-healthcare private entities, like banks, investing in healthcare. The private sector is stepping in where the government is lacking.

I mentioned earlier that I've noticed that foreigners run many startups and initiatives in Africa. These could be large international organizations or just foreigners who had an idea and came to Africa to build their solution. What do you observe regarding local innovation and the funding available to local innovators?

Yes, to your point, there seems to be a significant Western influence. People from other countries, either from the West or the East, come to Africa and can start companies, sometimes overshadowing the local populace. In certain regions, like East Africa, you see more foreigners leading major healthcare or health tech companies. In contrast, in West Africa, while there might not be as many foreigners, some individuals have lived abroad and are returning to start businesses. And to your point, is it an advantage for someone like you, who has spent most of their life in the U.S., to have access to resources in the U.S. or Europe?

For local entrepreneurs, the situation might not be as favorable. That's where local investors can play a significant role. There has been a noticeable increase in local investors in places like Nigeria since around 2015. These investors have backed various companies. In fact, Clafiya's first institutional check came from a local investor. This was powerful for us because when we pitched to foreign investors, they saw that we had local backing, indicating market understanding and trust in our capabilities. So, is local backing a strong signal for foreign investors? However, many local investors don't have substantial funds. So, while there are many of them, their fund sizes are often smaller compared to their international counterparts. This limits their investment capabilities.

Clafiya's first institutional check came from a local investor, but how does the capital from local investors compare to that from foreign investors on your cap table? I'd love to see more local investors with larger funds on the continent to support local innovators. Not everyone can access capital from the U.S., Asia, or Europe. So, how do we ensure that local funds offer favorable terms for founders to build sustainable companies?

How do these investors collaborate, and how do you view them as partners?

For Clafiya, foreign investors provided more than just capital. They connected us to other investors and offered various skill sets, from marketing to scaling. How do they assist in market entry, especially in legal aspects? On the other hand, local investors help us grow locally and better understand African founders' needs.

What has been the biggest challenge for you in developing the company?

The challenge varies. For instance, while the U.S. has established healthcare distribution channels, Nigeria's healthcare system is fragmented, challenging market access.

Given your partnerships, investors, and clients, how do startups or founders collaborate in Nigeria? Is there a strong ecosystem of support and collaboration?

When I started Clafiya, I felt there was a lack of emphasis on collaboration in Nigeria. However, collaborations are becoming more common. We must rely on partnerships and collaborations for Clafiya to provide the experience we envision for our customers.

Also listen:

Nigeria has 220 million people which is roughly ⅔ of the population of the US.

While many healthcare-related resources are scarce, the Internet is available and so is the fierce ambition of local entrepreneurs. These use digital tools to bring healthcare information and care closer to patients or to upskill the workforce. So what does care in Nigeria look like? What challenges do startups face? Where do they get investments? 

Hear from:

• Charles Umeh, Chief Medical Officer of CribMD,

• Ossai Ifeanyi CEO of CribMD,

• Jennie Nwokoye, CEO of Clafiya and

• Christian Chidoziem, Pharmacy Student and Entrepreneur.