Babyl recently unveiled an artificially intelligent chatbot that uses machine learning to interact with patients using voice or free text, which is a powered computer programme specialised in medical triage that can provide medical diagnosis. A chatbot is computer programme designed to have a conversation with a human being, especially over the internet.The new feature will be integrated under babyl’s digital healthcare platform. So far, more than 750,000 people have consulted babyl doctors through a mobile phone. This is the first digital healthcare system in Rwanda. The New Times’ Julius Bizimungu sat down with Babyl Rwanda’s deputy chief executive officer, Shivon Byamukama, to understand how the system operates and how it is set to revolutionalise the health sector in Rwanda.

Below are excerpts;

What is your vision, and what are you trying to do here in Rwanda?

Our vision is to provide affordable healthcare access for everyone on earth. This is our global vision. We think that it [healthcare] should be democratised in a sense that everyone has access to healthcare.

In the last ten years, mobile phones have become smarter. What they [phones] used to do ten years ago is not what they do currently. What we are trying to do is to use mobile phones to be able to provide access to healthcare.

In Rwanda, we do it differently from how we do it in the United Kingdom where we began.

Just break down for us how this works exactly?

Basically, in the UK, our focus is on smartphones. What you do is to download an app which does one’s triage. Let’s say you are feeling a headache or stomachache, the app enables you to have a conversation with a chatbot, it takes you through the conditions until it tells you what your diagnosis is and then you can go to the pharmacy and get the medication.

We find that, in Rwanda, it is a little bit different. Even if we have over 70 per cent penetration of mobile phones, only 10 per cent have smartphones. When we came to Rwanda, we asked ourselves what we can do to ensure that everyone can access the service. What we did is that we developed an Unstructured Supplementary Service Data (USSD) version of the platform.

This works exclusively for all feature phone holders who are the majority we are trying to serve. The process is simple; anyone may dial *811#, and register for the platform using their National ID, which is attached to their sim card. Your ID is verified with NIDA in a second and feedback provided.

At the moment, we are focusing on enabling people with feature phones to easily access healthcare. But we believe that even smartphone holders can access our service although we haven’t established an application.

But I want to say that in the near future, all options will be available. In fact, we have arrangements with Samsung that the new version that will come will come with a pre-loaded Chabot of Babylon health. That means that if you have that smartphone you can automatically use the app.

Is there anywhere this has been tried before?

We have already been operating quite a similar service in the UK. In the UK, it may take you two weeks to set an appointment with a doctor, but with our digital service, a patient can make an appointment in one day. We are finding that many people are converting from traditional ways to Babylon health.

But this is the first time we are trying a USSD version anywhere. Rwanda is our first place, and we are trying to get the service work and we believe this is perhaps what is necessary in a developing world.

How did the idea come about and why did you choose Rwanda?

When we launched our service back in 2014 in the UK, the Rwandan ambassador to the UK was there and he said that this is absolutely the right thing to do in Rwanda. We said let us go and try this out in Rwanda.

When we came here we found it so fascinating that the country was so visionary and its vision aligned to the company’s goals. It was just a natural place to go.

Indeed, when we started operating here we found out that it was the right environment to do business. It is a place with zero corruption, clear environment for business, and a well-defined healthcare system.

It was almost that the bed is very well laid for us to start doing business in Rwanda.

What healthcare challenges does this really address?

Obviously this is a completely different way of accessing healthcare services, and so we had to do more education for people to understand our vision and how the entire system works. People will always ask you if you don’t really need a doctor, but 60 per cent you don’t need to see a doctor physically.

Again it takes a bit of time to talk to different stakeholders. Education is what needs to be done and we are ready for the challenge. However, it is important to state that it is so surprising that the update has been amazing.

How has been the uptake, what has been the reception of the service, and what are some of the lessons learnt?

Since September 2016 when we started operations in Rwanda, we have seen about 750,000 people register on our platform, and we have over 135,000 people that have called seeking appointments to speak to our doctors.

For us, this is an amazing statistic and this indicates that the uptake has been good. Rwandans are ready for the service we are bringing to them. We really feel that the people of Rwanda are aligned to the digital vision of their country.

We want babyl to really be a way of life where we can reach a point where people can say ‘why don’t you babyl it’, which means why don’t you check it out on your mobile phone? We want babyl to become a verb.

Why and how is babyl such a big deal?

Globally, one of the biggest challenges we have is that the ratio of doctors to patients is very high. In Rwanda, for instance, the ratio of doctors is 1 doctor to about 15,428 patients. This means it is hard for a patient to consult with a doctor.

Over the phone, a doctor can speak to six people in an hour. But this wouldn’t be the case if you go to the health centre or health post. Additionally, there are always long queues of people waiting for the services at health centres. This is another big issue.

But if we can deal with some of the primary issues on the phone, it means that we are reducing burdens to the doctors but also patients at the same time. Of course, we don’t deal with chronic issues, people who got involved in accidents or women with labour. It is only these few cases that require someone to physically see a doctor.

This is really a big deal because we are bringing efficiency and convenience.

You have announced that you had plans to expand to other parts of Africa Africa. What is the status on this?

We already have a clear rollout plan of how we are extending our service to other parts of the country. We have funding from Melinda and Gates Foundation and recently signed an agreement with Rwanda Social Security Board (RSSB) and the Government of Rwanda.

We are starting with Rwamagana and later to other parts. We will soon start to install our chatbot in different health posts.

But I have to say that since this is a digital solution, everyone with a mobile phone can access it even those in deep villages. This is the advantage of technology, because one doesn’t have to travel miles to look for the service.

Rwanda is our testing field but we have plans to go to other countries like Kenya, Uganda, and Nigeria, among others.

How is the partnership with RSSB and government important?

The partnership we entered will see Mutuelle and RAMA [health insurance] schemes integrated to our system. This means that a patient will Mutuelle or RAMA will be able to consult with our doctors without incurring extra costs, which was a different case before. Holders of both Mutuelle and RAMA cards will also be able to get medications at our partner pharmacies.

Previously, people on these two schemes would pay to consult with our doctors, but now we are really adding RAMA and Mutuelle an additional service. We also see our service benefitting more people with all the partnerships we are creating.

We are entering discussions with other insurance companies so that their customers can as well start to access our digital service without paying extra costs.

Like every solution, there will be challenges and one of them is misdiagnosis. What is in place to minimise this?

One thing for sure is that we are using practicing professional doctors, but beyond this, we take them through thorough additional training, especially using the digital platform. We also have interlinkages between our doctors in Rwanda and those in the UK.

We also have audits done on a regular basis. Every phone call that comes through is recorded, this means that a doctor himself can go back and listen to the conversation he had with a patient to find out whether all they said was right. But we audit all the doctors.

We also have a follow up mechanism where doctors have to follow up on patients who consulted them to know whether there was an improvement and whether something else needs to be done.

All this helps us to minimise chances os any new issues arising.

Talking about artificial intelligence, take us through how this is revolutionalising the health sector?

The most important thing about artificial intelligence (AI) is democratising healthcare. Can you imagine a situation where you feel a headache and you can have a quick conversation with an AI enabled chatbot which can tell you why you are suffering from headache!

We need to move away from a situation where a doctor knows it all. We need to be able to use intelligent systems like a Chabot to be in charge of our own healthcare. If everyone can be able to use AI to manage their health, it means that you deal with a condition as it comes.

AI is revolutionalising the health sector in a sense that people are taking care of their healthcare and wellness, and it is bringing down costs of accessing healthcare services as well as bringing convenience.

Explain to us the process of payment, and as a firm that is looking to generate revenues, how are you making money? What strategy are you using, and how is the service compared to the traditional services we know?

Our system enables patients to pay with mobile money. Before you book an appointment, the system takes you to the payment option and you pay to be allowed to access a doctor. We have been running a promotional code where people would pay only Rwf500, but at the moment we charge a small fee.

The fund we received from Melinda and Gates Foundation will help us conduct over 350,000 consultations this year, and the biggest beneficiaries will be Mutuelle de Sante card holders. But a fee of Rwf200 will be charged and this will be sent to our partner pharmacies.

At the moment, we are not charging money for the consultations. In the long-run, we will be charging but I can definitely tell you that it will be significantly cheaper than you would physically consult a doctor.

This is revolutionary that even big funders want to put in their money to see the sustainability of the innovation.

In terms of information protection (privacy) and security of people’s identities, how do you protect them?

First of all, all sensitive patients’ data is kept in Rwanda, all patient information is encrypted, and access to the patients’ data is on a must-have basis. If a doctor wants to have access to the patient’s profile, it is on a need-to-know basis. Any access to patient information is restricted.

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