Based on a simple insight and a powerful technological platform, Adama is revolutionizing and democratizing access to medicine through a system of exchange that allows everyone to contribute and improve community health.
The New Idea
With the realization that a large volume of safe unused drugs stored in family medicine cabinets when others could use them, Adama launched JokkoSanté, a virtual community pharmacy to optimize drug use and access. Using a secure virtual platform and a user-friendly application adapted to all types of phones, Adama allows everyone to be a member free-of-charge who can make medicine deposits, withdrawals, loans and purchase. The platform also includes a database of all approved drugs by the Ministry of Health with official prices, contributing to greater overall transparency when it comes to drugs in a country where unofficial medicines are often used by the poor.
While offering a parallel platform for drugs to individuals, Adama’s model is supported by the Ministry of Health and fully integrated to local health facilities knowing that drug purchase and use is closely monitored. Through this approach, health facilities can not only benefit from better attendance rates (when it’s clear that they have a greater availability of medicines) but also from an alternative system in case they are out of stock for a specific medicine, since drug supply management is still a challenge in Senegal.
Leveraging smart technology and data, Adama elevates drug donations and contributes to developing a culture of giving by enabling full traceability, be it for the diaspora supporting family members in Africa or for companies willing to support specific population groups as part of their CSR (Corporate Social Responsibility) programs. Adama piloted his project in a rural community in Senegal in 2015 and within a year, the platform registered 750 members covering 600 households, securing the strong support of several key companies, including the country's largest communication company and of the Ministry of Health. The latter endorsed the platform for deployment in all hospitals and health centers in Senegal. This is a critical factor for fast roll-out throughout the country in 2017 in six other countries in West Africa.
Each year, according to WHO, about 44 million households worldwide or more than 150 million people face cripplingly high medical care expenses relative to their income. Thus, some 20 million households - more than 100 million people – fall into poverty due to the cost of health services and drugs. These are so high they have to reduce their expenses on primary necessities such as food and school fees for their children or cannot get access to treatment.
In Senegal, as in many other developing countries, access to drugs is especially difficult and unequal. Indeed, drugs expenses represent 52% to 72% of health spending and yet only 20% of the population, made up of employees of the public, parapublic and private sector, has a medical coverage. So, a large proportion of the population finds itself excluded from the health care system as a result in the informal sector and in rural areas.
To address these issues, Senegal has adopted several strategies to improve access to health care including the construction and equipment of several types of decentralized health facilities. Health posts and centers equipped with basic hospital equipment, electricity, computers and internet have been set up in remote rural areas. Several strategies have been developed to support these policies such as the Bamako Initiative, the compulsory health insurance for private sector workers, the authorization of private insurances, mutual insurances, flat-rate pricing and UHC (Universal Health Coverage). Reforms have been initiated to organize and strengthen public participation in solving health problems.
The implementation of these health policies has certainly led to significant advances, but has not fully solved the problem. For example, drugs such as those offered by these health insurance schemes are mostly basic medicines such as painkillers or first aid tools. In such a context, access to medicines remains a challenge that tends to worsen. NGOs and companies, as part of their CSR activities make donations but have no visibility or guarantee of their destination.
The first idea Adama had when realizing that his home medicine cabinet was full with expired medicine was to create a platform for a direct exchange of drugs between members. He soon realized, however, that it does not comply with regulations on UD (Unused Drugs) and pharmacies in Senegal. Thus, Adama made a point to engage in negotiations with the services of the Ministry of Health in Senegal and WHO and get their permission for the health structures to collect and distribute the drugs gathered through the platform at their local pharmacy. He soon started to develop the application JokkoSante whose name means “giving and receiving” in Wolof to illustrate this new approach in which anyone can share and benefit mutually.
In February 2015, he started in the poor rural community of Passy (a few hours away from Dakar) to test the application in reality. Adama worked closely with the pharmacy in the health center, selected and trained two women members of the local staff to manage parallel withdrawals/deposits and registrations of the population. As members of the community, these representatives of JokkoSante run awareness campaigns at the health center, at social gatherings, with women, religious and community leaders.
In parallel, Adama launched an unused drug collection campaign locally in Passy, Dakar and in France. With a team of volunteers made up of doctors, pharmacists and an agent of the Ministry of Health, a weekly screening of drugs received is made, based on medical prescription or proof of purchase required for any deposit. Each member has a personal account linked to his mobile phone number that is credited points whenever the member brings drugs or is given points by another party and debited when he/she makes a withdrawal on presentation of a prescription. These points are equivalent to the financial value of the registered drugs (1 franc = 1 point). This new form of currency allows transactions such as exchanges between members, loans for those who are struggling to pay the price and purchase orders for those from the Diaspora want to support relatives with health expenses. However, Adama ensures that points are always less than the available stock of medicines. Transactions are conducted primarily via SMS allowing the application to be accessible from all types of phones and all mobile networks.
Closely working with the Direction of Pharmacy and Medicines, Adama has access to the full list of medicinal products authorized in the country and their approved price. This list is publicly available on JokkoSanté and publishes them with the posology and equivalence of each medicine. Consistently with his philosophy of giving and receiving, Adama allows the Ministry of Health access to all real-time statistics on the members’ drug consumption. In case of shortage of some medicines like those for metabolic, chronic and incurable diseases, the platform becomes an alternative to retail chains that the members can use to research availability with other members or pharmacies.
Understanding the limits of the UDs in areas where the poor live, he has included an approach allowing the rich to contribute to the health expenses the less privileged. Thus some companies, as part of their CSR activities, or some individuals can provide funds to JokkoSante that can be offered as credit points to target populations according to the interest of the company in terms of geography or specific target population. In such a case, the account of the befitting member is credited and he/she receives an SMS indicating the name of the company offering the credit points. Companies have their own special accounts allowing traceability of their funds, the number and identity of the benefiting people and key indicators for their giving.
In March 2016, Adama concluded the pilot phase with outstanding results. After a year of functioning, the project has registered 750 members and touched more than 6,000 people on the 12,000 inhabitants of the commune. As of today, JokkoSante has never received any complaint on the quality of the medicines exchanged. The health structure has noted a better attendance and coverage of health expenses. For the medicine shortages, JokkoSante has positioned itself as a body that supports the various programs reducing the health expenses of the populations. In fact, the offer of medicine is more diverse and when the stock does not include the needed medicine, member pharmacies can provide it and be paid out of JokkoSante’s capital (more than one million credit points) from the CSR funds. The city council of Passy has estimated to around $3,500 of funds saved from its social cases provision.
In the execution of the pilot phase, Adama has been supported by the city council and the health committee of Passy, from the NGO RAES for deployment on the field and from the private sector side, by his former employer Orange (the biggest communication company of the country), as well as Bollore Africa Logistics and Sodipharm. He was able to secure the very significant support of the biggest cancer specialist in Senegal, Dr Abdoul Aziz Kasse who is accompanying him in his information and awareness campaigns. Very satisfied with these results, the director of Orange has recommended JokkoSanté to five big state institutions among which the Ministries of Health and Social Affairs, of Post and Telecommunication and of Investments.
Adama already has the approval of the Ministry of Health for the formal integration of JokkoSante in the health structures. He received funding from the BMC bank for coverage by the end of December 2016 of the 15 hospitals and 50 health centers of Senegal. In order for the national expansion to be done more quickly, Adama has planned for the managers of the health structures a sharing and training workshop to be organized by the two agents of Passy who have participated in the pilot phase and agents from pharmaceutics industries such as Pierre Fabre and Sodipharma. He already has six big companies who will accompany the initiative, among which BICIS Bank, Sodefitex Textile Company, and the gold extraction company IAM Gold. To achieve his objective of 500,000 members, he has approached national and local authorities for support, associations & NGOs like Youth for Relay. A new partnership with the Ministry of Health and WHO ‘Be Healthy’ is being designed to build awareness around some illnesses for JokkoSante members who will benefit at the same time from bonus credit points. Adama also hopes to extend his actions to health care and hospitalization. Thanks to the field offices of Orange and BNP bank in Africa, Adama plans in 2017 to cover 7 other countries in the sub-region.
JokkoSante is registered as a company and operated as a Social Enterprise. A small percentage of transactions is used to cover the cost of operations. In addition, Adama is in the process of creating an association that facilitates giving campaigns and contribute in the sustainability of his initiative.
From a very young age, Adama has distinguished himself with his resourcefulness commonly called ‘R System’ in Senegal. Growing up in a very large family, he understood he needed to be productive very early to sustain his studies and his mother. At the age of 12 years old, he started selling water and ice cream, and was a fish merchant at 13 years old. He later became a tailor and then started a business to raise chickens.
In 1997, he won a scholarship offered by Sonatel, Senegal Telecommunication Company to study engineering at university. Upon graduation, he joined the company as a telecom engineer and occupied 5 different managerial positions in 16 years of career, each time finding creative ways to improve how things were working. Among other things, he launched from scratch the first call center in Dakar, participated in the elaboration of important programs such as the Document of Strategy for Poverty Reduction (DSRP) and redaction of the codes of telecommunication. His experience in the sector of fishing in his young age also prompted him to develop the application ‘Ecos Peche’ with a friend in 2011 as a side project, to fight against illegal fishing. The application was later acquired by the Ministry of Fishing.
One month before the birth of his first child, Adama realized the extent of unused drugs. In his efforts to make more room for the baby with his wife, they noticed the volume of medicines accumulated for many years and which most of them were expired. He thought that for sure his neighbors, close relatives and some poor people could have used them before they were expired. He started the project as an employee of Orange that very quickly understood the potential of JokkoSanté and provided full institutional support with the Ministry of Health and by funding the first pilot. This was the first case of the Entrepreneur Support scheme initiated by the company in Senegal.
He started the initiative JokkoSante in 2012 and received a Certificate of "Recognition of Excellency" delivered by the International Union of Telecommunications. JokkoSante was chosen by the 2015 African Entrepreneurship Award as the best African project in an unexplored domain and in the preservation of the environment with a prize of 150,000 USD. In July 2015, at the international competition for e-health, JokkoSanté won unanimously for the first time in 10 years, the Grand Prix all categories. It is one of the nine best projects in Africa and Asia selected by the E-Health Observatory of the Southern countries in 2016.