From Physical To Digital: Creating An Effective User Journey

Jephthah Aletan at UXDX Community: Africa. Video: https://youtu.be/XV7TIhlzJV0

Readable transcript: edited from the recording's captions for readability (fillers and false starts removed, punctuation and section headings added). Wording is the speaker's own. Timestamps are positions in the video. Names marked [?] could not be verified against the audio.

Introduction and what WellaHealth does

[00:00:00] My name is Jephthah Aletan, I am the design lead at WellaHealth. I'm privileged to be giving this presentation at the UXDX Africa community meetup, and it's so amazing to be discussing something that's very important to my team. From the topic you can see that I'm going to be discussing "From physical to digital: creating an effective user journey." I'm going to be sharing the story of how our team at WellaHealth has developed this successful customer journey map that reduces a typical three-to-four-hour physical experience to a 15-minute digital experience. As we go along we're going to see how this happens.

[00:00:38] A brief on what we do at WellaHealth. WellaHealth is a health technology company. We work with insurers and pharmacies to make sure that healthcare is delivered very affordably and accessibly to Africans. We do two main things: we run a micro-insurance platform, and we also do pharmacy benefit management. The micro-insurance platform gives people access to comprehensive healthcare by paying a smaller amount of money every month. Pharmacy benefit management means we help insurers to have access to drugs from pharmacies all across the country.

The problem: three to four hours to access basic care

[00:01:26] The problem we noticed when we started WellaHealth was that last-mile quality care that gets delivered to the largely poor African population is really, really expensive, and also is not so accessible. For example, I live in Nigeria. One of the major problems we have in this part of the world is that it takes a very long time for people to be able to access quality healthcare. By quality healthcare I mean people that need to visit secondary and tertiary institutions to be able to access care. And these are not even for really serious illnesses. We are talking about common illnesses like malaria, like typhoid, like infection, cold and fever. People need to walk long distances to commute to hospitals, and to take some kind of means of transportation to get access to this care. And when you get to the hospital, they need to spend a lot of time waiting to be seen by a doctor.

[00:02:24] We were able to delineate certain reasons for why this was happening. One is that patients are crowding these secondary institutions, and also most of the people that were coming for treatment in these places, that were supposed to be meant for treating way more serious illnesses, were coming for cases such as malaria. Seventy percent of outpatient clinic cases were because of malaria. And also, the centers that are supposed to be taking care of these common illnesses, which are called primary care centers, are sparsely distributed in Nigeria. Primary care centers were designed to be localized to certain communities, so that people can easily just walk from their home and go there to get treatment, but one, they are not functioning, and they are not so evenly distributed around the country.

[00:03:12] Then there's a very high patient-to-doctor ratio. A doctor in Nigeria, I think one doctor is supposed to see about four thousand patients, and when you compare the number of doctors we have to the population that we have in the country, that makes the workload very, very high for doctors.

Running a three-day design sprint on the problem

[00:03:31] So we needed to think of a way to solve this problem. And recall that we get problems, because we realize that while we solved one, a new problem came from the solution, but that doesn't deter us from trying to make sure that we find the solution to this. At WellaHealth what we do is we use design sprint sessions to discuss problems we've noticed and find solutions to them. We have an internal philosophy that we need to experiment fast, push out a solution and iterate on the fly, so that we are learning as we progress, rather than spending a lot of time thinking and thinking about solutions. Rather, come up with a solution first, push it out and start seeing what the result is going to be.

[00:04:16] Like I said, we use design sprints, but a typical design sprint is supposed to last for five days. Unfortunately that doesn't happen. We recently became 34, but when this was happening we were just 10, and that means that we have a lot of work on our hands, and to be able to do this we definitely needed to modify what our design sprint sessions are going to look like. So we're shortening them to three days.

[00:04:41] Within those days we have to go through the entire process of what design sprint principles should look like. So we try and understand the problem that our users are having, our potential users, and we started ideating around it. We came up with a possible solution, we started designing those solutions, we prototyped and tested. We had a group of users that came in and tested a proposed solution, which I'm going to discuss as we go on. But the ultimate goal of that particular sprint session for us was, we wanted to design a service that will allow people to be able to go from spending three to four hours trying to access healthcare that is supposed to be very easy to access, to making sure that it doesn't last more than 15 minutes for them to be able to get it.

Mrs. Amaka's physical journey

[00:05:28] To give you an idea of how the current journey looks like, we'll be using Mrs. Amaka[?] as an example. Amaka is a typical young Nigerian woman. She owns a provision store[?], she's married with three children. Let's discuss what a typical journey for her to be able to access care would look like.

[00:05:48] Say Mrs. Amaka is feeling sick now and she wants to get quality treatment. The first thing she does is she needs to go to the hospital. But here's the problem: there's a lot of traffic in Lagos. She needs to brave that traffic, probably board buses, commute with people inside crowded buses to get to the hospital. So you know how Lagos traffic is. She spends hours on the road. Say she spends 45 minutes on the road. She gets to the hospital, and on getting to the hospital there are other people that have come looking to speak with the doctor, so she needs to sit and wait. Say another one hour before she can speak to the doctor.

[00:06:28] Finally she gets to speak with the doctor, and after the doctor has taken a history and examined her, he says, oh, I think you have malaria, but we need to confirm this, so let's do a test. Now what Mrs. Amaka needs to do is, the doctor writes a test order for her, she needs to go to the accounts department in the same place to pay for the test. There she has to wait on a queue again, because there are thousands of people in that secondary facility that need to access the accounts department also. So she joins another queue.

[00:07:03] After she has joined this queue and successfully paid, then she needs to go to the testing center to take the test. And if you have an idea of how Nigerian hospitals are built, they are not well structured, so we're talking about a distance of 10, 15 minutes sometimes to get to it, widely separated parts of the hospital. So she walks, she gets to the place, then she needs to join another queue to be tested for malaria. Then when the test is done she has to wait again to collect the test results, and she needs to take that test result by hand, by herself, to the doctor. She takes this and goes back to the doctor and joins another queue again, because some people are already waiting for the doctors to write their tests.

[00:07:46] Then finally she gets to see the doctor again. The doctor writes a prescription for her, now she has been confirmed. So what does she do? She needs to take that prescription, go to the hospital pharmacy, wait on a queue to pay. This is a very, very serious journey, and it is quite expensive also. Expensive in terms of the money she's going to spend, expensive in terms of the time she's going to spend. Usually this kind of journey takes three to four hours for people to be able to access care, for cases that are supposed to be managed at primary care.

Finding the friction and the user behavior to build on

[00:08:24] So we spoke with people that were going through this, and we knew that we needed to do something about it. The question we had in our minds was: how do we optimize the service design so that we can deliver quality care in the shortest possible time? Case in point, we noticed that the major problem that was causing this was that healthcare centers usually have a high number of patients, an overwhelming number of patients, and also the hospitals are poorly designed when it comes to infrastructure. So how do we make sure that people get qualitative care rather than spending such a number of hours trying to get care?

[00:09:07] We came to two conclusions. We needed to identify the friction in touch points and processes, and we needed to find a way to make sure that the payment is faster and it's affordable for this population of the country. And that was what our journey mapping goal was.

[00:09:23] So now, the touch points and processes. The first thing we noticed while we were doing our design sprints and speaking with our customers was that, including our existing subscribers[?] and the general population, everybody, because they do not want to go and spend so much time in the hospital to see a doctor, they first visit the local pharmacy store to get drugs. In Nigeria it is very common that where you start having people with even a cough, the first thing everybody says is, let me speak to my pharmacist. So they go to the pharmacy store and just tell them, I'm feeling this and this, and the pharmacist just prescribes drugs for them. They go and they take the drugs. Sometimes they feel better, sometimes they don't. So usually people tend to go to the hospital when they've tried this particular treatment behavior and they realize, okay, I'm not getting well. That's where they decide to go to the hospital.

[00:10:20] But there was a problem with this. Most people were just getting drugs, just using malaria drugs. And the reason why prescribing malaria drugs is so easy in Nigeria is because malaria is a very rampant illness. There are over 80,000 deaths yearly in Nigeria because of malaria, so the WHO[?] made it a policy that malaria drugs are easy for everybody to access. And because of this there's a lot of abuse. People tend to become resistant to malaria drugs, because people just use it immediately, and sometimes they will not complete their treatment and stop it.

[00:10:52] So we knew that okay, there's a major problem with the self-medication behavior. But rather than try to change that, why don't we use it? We realized that we needed to use local pharmacies as primary access points when it's for common illnesses like malaria. So now we found out the user behavior, then we needed to build on this. But yes, again, we needed to make sure that that treatment is actually comprehensive. That means there's a diagnostic test and a treatment that actually works, and that's the path where we now needed to onboard the pharmacies for this to happen.

[00:11:30] So we started reaching out to pharmacies, signing them up, training them on how to effectively manage malaria. We came up with a drug formulary that actually works for malaria, treatment options for malaria, and we trained them on how to use something called an RDT, a rapid diagnostic test, that actually brings the result out in 10 to 15, or five minutes. It is 99 percent accurate for the malaria test and they can easily do it. They need a prick blood sample and the pharmacist can easily just determine if that person has malaria or not. And that effectively reduced people taking the malaria drug immediately without knowing if they truly have malaria or any other infection.

Making payment faster and affordable

[00:12:12] The second thing we needed to do was to make sure that we created a faster, affordable payment system. Most people actually pay out of pocket for care in Nigeria. That means that we needed to work with insurance companies[?] to make sure that we provided for quality care in Nigeria. That was when we came up with something called the Malaria Care Plan. It's a micro-insurance plan that allows people to be able to pay as little as one dollar, that's 500 naira or something there, every month, for treatment for different kinds of common illnesses.

[00:12:46] That has allowed over 4,000 people to be able to have access to an insurance plan, and that number is growing every day. In fact, most of the people that use our micro-insurance are new people that are getting insurance for the first time in their life. So that does make things easier for a lot of people to be able to access care. But also, we discussed that it needed to be easy for them to be able to pay, so we decided to create a lot of channels for people to be able to access it and to make payments. You can easily go onto our website and make your payments, and we also started working with local agents, so for people that do not use smart mobile phones, they can easily walk up to the local agent and pay for their subscription[?].

The new 15-minute journey

[00:13:32] Now, solving the challenge. What happened after we came up with this solution is that now Mrs. Amaka can get treatment in 15 minutes. Let me walk you through what happens, in comparison with the physical journey. So Mrs. Amaka is now on our micro-insurance plan and she has fallen sick. What does she do? She picks up her phone and calls WellaHealth, or uses USSD, and requests for treatment, or she goes to our website and requests for treatment. The moment she has done that, we get notified at the company, then we send that to a local pharmacy for testing and treatment.

[00:14:08] So now, this is the amazing thing. Mrs. Amaka would have actually gone to the pharmacy in the first place, but this time around we are the one signing her up, so we send it out to the pharmacies we onboarded. The pharmacy knows the person that's coming, because we've notified them, and they know she likely has malaria already. So she gets there, the pharmacist takes a blood sample, tests it with the RDT, and that gives them the results. If it confirms that she has malaria, it gives her a medication. If she doesn't have malaria she still gets some form of medication for pain relief and other things. And even if she wants to speak with a doctor, she has access to a telemedicine line that she can easily call and speak with the doctor if she's not fully satisfied with what the pharmacy has done. But what usually happens is people do this, they get their drugs, they go home, they get treated and are usually happy. And this all happens within the space of 15 minutes.

[00:15:00] This really has solved a problem for a lot of people. Most of the feedback I've gotten from people that have been on our platform has been that they are so happy now. They're not spending so much, they're paying less than 500 naira every month, and also they are spending very little time commuting to access care, because they can easily walk 10 minutes and get treated.

Challenges and what's next

[00:15:25] There have been challenges. There's no way you don't have challenges in journey mapping and solving problems. Part of the problem we had initially was we didn't have enough pharmacy coverage at the beginning of the entire process, so we had a lot of disruptions for subscribers, because we sometimes had to send them to pharmacies that are far from them, or we needed to actually get someone onboarded on the fly right there for them to be able to use. But our pharmacy network has increased to over 5,000 now, and that makes a lot of sense for us because people now can easily access care.

[00:16:03] Some of the things we need to fix are how to form better partnerships with the pharmacies, and the rapid tests that are used also are sometimes not up to standard. Sometimes they are used past expiration, sometimes false negative results came from them. So we need to make sure that they actually treat people the way we explained, and that is still ongoing. That's no way that's going to happen overnight.

[00:16:34] Also, part of the challenge we had is that we didn't think about people depending on some other part of the country, and we had that challenge there because we expanded our services. We had people saying things like they have to go to a relative, drop a blood sample, take it to the city center for people to be tested for malaria. So we needed to start looking around that: how do we modify it for people that don't have access to pharmacies around them, that do not have access to testing centers around them?

[00:17:07] So we started building experience centers. We currently have one, and the opening was launched a few days ago, where people can walk in and actually speak with the pharmacists, if they do not have access to more pharmacy centers around the town. And also now people can actually have physical contact with WellaHealth.

[00:17:30] Initially, like I said, we were thinking around malaria alone. Now there are other conditions in the country that people actually need to find a way to treat, so now our treatment plans have started including all these things like typhoid, headache and other ailments that people usually have commonly in this part of the world, to make sure that those things are included in our plan. And we are steadily growing. So thank you so much for your time.