Our monthly online newsletter,"L'ESPACE".
L'ESPACE is a diverse French word that means place,area,cosmos,and gap.
- Delivering health and smiles to Africa through the Japanese OKIGUSURI model -
In Close Up this month we introduce AfriMedico, a non-profit organization dedicated to providing medical assistance in Africa. OKIGUSURI is a system whereby boxes of medical supplies are distributed to homes which are later revisited to re-supply and accept payment for the items consumed. Copying the OKIGUSURI model begun during the Edo period in Toyama, Japan, AfriMedico endeavors to promote "self-medication", that is, to take care of one's own health in areas lacking access to medical services due to the absence of hospitals and pharmacies. On this occasion we spoke with AfriMedico´s Director, Mr. Motohiro Aoki, about the OKIGUSURI Project currently operating in Tanzania.
Please tell us what led to the establishment of AfriMedico.
The CEO of our organization, Eri Machii, worked 6 years as a pharmacist for a pharmaceutical company and later participated in JICA's Japan Overseas Cooperation Volunteers program, dedicating herself to educational activities to prevent infectious diseases in Nigeria. After a 2-year term, feeling limited by the scope of help she could offer as a volunteer, she enrolled in a business school to find a way to elaborate a sustainable business model and apply it to Africa with the goal to fundamentally overcome the obstacles to medical care in Africa. Along with her business school colleagues, she founded AfriMedico in April 2014 which endeavors to recreate a sustainable medical service based on the OKIGUSURI system. Due to the worsening situation in Nigeria, AfriMedico began its base of operations in Tanzania where the organization had prior contacts with local pharmacists. In addition to rolling out the OKIGUSURI system, providing health care education to residents, and studying the local medical scene in Tanzania, the organization undertook activities in Japan to disseminate the current state of medicine in Africa through events and seminars with the mission of "Connecting Africa and Japan through medical services delivering health and smiles".
Why was it thought possible to apply the OKIGUSURI system in Africa?
Considering the state of Japan when the OKIGUSURI system was widespread, one sees much in common with rural areas of Africa today, for example, poor infrastructure, large families, absence of a publicly funded national medical system, etc.. Consequently, Machii believed the OKIGUSURI system would prove effective to enhance medical services in rural Africa. The introduction of OKIGUSURI in regions of a large country without access to medical services due to the absence of hospitals and pharmacies, would reduce the number of deaths due to easily treatable illnesses not requiring a visit to a hospital, such as diarrhea and the common cold. The biggest advantage of OKIGUSURI is self-medication, enabling the individual to be responsible for her/his own health and providing the person access to needed medicine.
How are you developing the OKIGUSURI project in Tanzania?
We are currently launching the OKIGUSURI project in three villages in eastern Tanzania. Two, Bwama and Mlegele, are more than 3 hours by car from Tanzania's largest city, Dar es Salaam, and located 30-40 minutes by car, or 2-4 hours by foot, to the closest medical facility. The other village, N'g Ombehela, is a further 20 minutes on motorbike beyond Mlegele. By 2018 AfriMedico had placed OKIGUSURI boxes in nearly 200 households in these three villages. In the boxes are medicines obtained in Tanzania: internal medications such as antipyretics, analgesics, antiallergics and cough medicine; external medications such as anti-inflammatory analgesic ointments; medications for skin ailments; and others such as oral rehydration and antiseptic solutions. The patient pays only for the cost of medications consumed, and residents are liberated from the long travel times to the hospital and possible long wait times once there. Furthermore, they can avoid going in vain to a pharmacy which sometimes does not have the medication the hospital prescribes.
In addition to distributing OKIGUSURI boxes, do you also provide health education to residents and investigate the medical situation?
Because the mission of AfriMedico is to deliver health and smiles to the African people, we feel that in addition to delivering medication, it is important to provide information on the proper use of medications and preventive medicine. For example, using simple tools like a picture card show, we emphasize the need to use a mosquito net to prevent the most common illness to residents, malaria. The distribution point and center of activities is the "OKIGUSURI Station", which also serves as a health center to promote health care to villagers and is responsible for replenishing medications, collecting payment, health education and the dissemination of information. Moreover, investigating the medical situation is one of AfriMedico's most important roles. Using our network, we determine which medications are needed by the average family in Africa, and what means of transport are available to deliver medicines to homes in remote locations, etc.
What are the duties of the local staff?
Tanzanian staff undertake inventory checks, replenish medications, collect payment, conduct interviews to assess the needs of the client, provide instructions on the proper use of medications, and facilitate telephone consultations. In fact, we don't have enough staff to assume these functions. As a result, though we can rapidly increase the number of households in which to place an OKIGUSURI box, we intentionally do not do so. It takes time to train quality staff having the required negotiation and communication abilities, as well as with medical knowledge to at least the level of nurse practitioner.
How have you been adapting the OKIGUSURI model of Japanese traditional medicine to medical assistance in Africa?
Needless to say, we are adjusting it to be an African version of OKIGUSURI with medicines, prices and a distribution system fitted to the situation on the ground in Africa. We are also taking on the challenge to update it to a modern version using IT and AI. Here in Africa where the percentage of the population with smartphones is very high, we have raised the efficiency of OKIGUSURI and reduced the cost of launching the system by implementing a mobile money payment method and developing and introducing an easy to operate app to manage the inventory of medications. We're hoping to create an automatic inventory management system by producing a data base linking client information with their respective medications. The OKIGUSURI business model is difficult to adapt to present-day Japan, but as OKIGUSURI evolves in Africa in a more modern form, perhaps it will be possible to re-introduce it in our country.
It is said that AfriMedico is a group of workers with parallel careers, is that so?
Yes, all members including directors participate pro-bono in the organization and contribute their skills and expertise to a social cause while maintaining a regular job. People working in companies involved in the areas of medicine, Africa, or social enterprise, have noticed the organization and joined AfriMedico, bringing fresh ideas and dedicating their time to its activities. It seems their pro-bono participation in OKIGUSURI activities has elevated their personal skills, which positively impacted their regular work.
What activities are planned in the future?
The challenge we would like to tackle is to further increase the effectiveness of the operation using IT and AI, and moreover, to introduce Japanese medications in Tanzania. We are currently supplying the villages with locally available non-Tanzanian medications, but in the future we'd like to supply Japanese products. To do this, it is necessary to first prove the effectiveness of OKIGUSURI, not only as a business, but also as a medical service model. Consequently, we are working on an initiative with a university to demonstrate the effectiveness of OKIGUSURI, for example, reduced medical costs or improved survival rates due its introduction. Presenting hard evidence will encourage Japanese pharmaceutical companies to extend their business to Africa, and it will give us much pleasure if this results in bringing good health and smiles to the people of Africa.