Doctor on call

A digital health service in Rwanda enables patients in remote areas to consult experienced doctors over phone

A morning buzz gathers momentum in a well-lit office on the sixth floor of a building in downtown Kigali. A mission statement, hanging at the entrance, explains the hum, “…To put an accessible and affordable health service in the hands of every person on earth.” This is the nerve centre of one of Rwanda’s newest digital healthcare revolutions. And it is being widely embraced by the people of the small east African nation, especially the poor living in the countryside. All they have to do is dial *811#  to patch through to a doctor.

Welcome to Babyl, a health service where digital technology meets primary healthcare.

Dr Peter Scott (name changed) wears his headphones and gets ready for his next call. A medical triage (sorting people based on their medical treatment requirement) has already been completed by a nurse over the phone. Joyeuse Nyirasafari, a 26-year-old woman from Musanze district, 115 km from capital Kigali, has had a dry cough for the past three years. Now, for the first time, she is seeking medical help on Babyl.

Scott dials in at the assigned time (usually within 15 minutes after the triage), introduces himself in Kinyarwanda — the official language — and asks her detailed questions about the cough and the medicines she has taken so far. After a 20-minute consultation, he concludes that she may have chronic bronchitis.

He feeds his diagnosis and prescription into the system. The prescription will go as a barcoded message to her phone, which she will show to the nearest pharmacy that her insurance covers, to get her medicines. In a week, Babyl will follow up to see how she feels. The next round of action, if needed, could either involve lab tests or a visit to a district healthcare facility for more advanced treatment. Nyirasafari has had to pay Babyl only a one-time registration fee of 200 Rwandan franc (₹15), the amount she would have paid at a government facility. It includes consultation, medicines and lab tests.

At the Babyl headquarters, a team of 75 doctors and 120 nurses receives 2,500 to 3,000 calls each day. “We’re not in the business of replacing doctors. We’re augmenting their efforts,” says Dr Patrick Singa, medical director at Babyl.

For Rwanda’s government and people, healthcare has been an issue of concern. After the 1994 genocide against Tutsis, the country’s medical system crumbled. “We started from zero,” Singa says. The government invested in health, building new facilities and improving access. By consistently allocating an astounding 15 per cent of the budget towards health (for comparison, India has never exceeded 2 per cent), Rwanda — still one of the poorest nations in the world — recently met the UN-proposed millennium development goals of reducing maternal and infant mortality. Singa believes that Babyl is one way of adding to the basket of initiatives that promise to give Rwandans universal healthcare coverage.

“We are reaching a threshold of what we can do within conventional settings. You cannot keep building hospitals indefinitely. At present, we have 1 general practitioner per 14,000, for a population which is growing by the day. Babyl, through its remote intervention, eases the pressure on government hospitals by treating the less-serious conditions so that they can focus on the critical ones. We save patients’ time and resources and ease the queues from public healthcare facilities,” he says.

Babyl is originally a UK-based digital healthcare company, registered as Babylon Health in 2013. The idea was to provide easy, affordable, artificial intelligence (AI)-enabled public primary healthcare. The name Babylon was meant to connote the healing medicinal gardens of Babylon. But when the company decided to enter Rwanda in 2016, it realised that Babylon also meant other things. In a deeply religious Christian country, people connected the name with a place of evil mentioned in the Bible. So, when they launched in Rwanda in 2017, the name was shortened to Babyl.

The company brought in other changes too. With Rwanda’s smartphone penetration known to be only 10 per cent, it introduced a platform which enabled people to access the service using an ordinary mobile phone. It put a human face in place of its UK model, where an AI-run system gauged people’s problems. Nurses were employed to make remote calls to patients before referring them to doctors.

Since 90 per cent of Rwandans are covered by insurance, Babyl also entered a tripartite agreement with Rwanda’s ministry of health and Mutuelle de Sante, a government-subsidised community insurance. This allowed public health facilities to be used for lab tests and advanced consultations. For Babyl patients, this meant minimising waiting time for consultations and getting insurance to pay Babyl for the service. Babyl, which has the doctors and nurses on its payroll, meets its costs through the insurance coverage and the registration fees. Sixteen per cent of the patients who belong to the poorest of the poor are exempted from paying the fees.

“The biggest challenge was how to get someone in the Rwanda countryside to trust someone on the phone rather than an important-looking doctor wearing a white coat and a stethoscope,” Singa recalls.

But there are advantages to having an anonymous attentive voice on the other end of a phone instead of a doctor too pressed for time. “We get a lot of calls pertaining to sexual health, reproductive issues and mental health. Patients feel they can share their concerns more freely when nobody’s watching,” says Singa, proud that already two million Rwandans are registered users.

In the future, Babyl hopes that with increased smart phone penetration and better internet network, processes will be more AI-supported. With its growing database of patient history, it hopes to be able to predict outbreaks, detect epidemics and even enable better diagnosis based on regional health trends. Babyl, which is already in the UK, the US, Canada and Rwanda, is now setting foot in Kenya and China. “We try to be as agile as we can,” says Singa.