The personalisation of healthcare and its delivery mechanisms is critical to address the systemic gender and racial biases that exist in healthcare today. As it stands, consumers from emerging markets – the Middle East, Africa, and South Asia – continue to be under-represented in clinical research and trials, 92 per cent of which occur in the U.S. and Europe. As a result, these consumers endure significantly worse health outcomes than their white Caucasian counterparts. For example, women of African origin in the UK are four times more likely to die during pregnancy and childbirth than white British women, highlighted Sophie Smith, Founder and CEO, Nabta Health.
In an interview with Omnia Health, she discussed the necessity of growing women’s health technology. She said: “Only by building healthcare solutions that are tailored for women from emerging markets will we address some of these inherent biases and facilitate more equitable health outcomes.” Excerpts:
How is Nabta Health fulfilling the demands of the market and users by leveraging personalised care pathways?
Nabta Health’s broad target market is women between the ages of 18 and 58 who have specific health goals or aspects of their health they are struggling with, for example, “I’m unable to lose weight”, “I’m struggling to fall pregnant”, “I recently suffered a miscarriage and I need support” etc. For our initial clinical pathways, which focus on Polycystic Ovary Syndrome (PCOS) and related metabolic disorders, our users fall into two buckets, either women who have recently been diagnosed with PCOS and want to learn more about the condition, or women who are struggling to conceive naturally. Our personalised clinical pathways, which integrate smart medical devices and tests and are supported by value-based local healthcare providers, allow women to detect, diagnose and manage conditions such as PCOS wherever and whenever is most convenient for them.
Can you tell us about certain app features and AI integrations that make Nabta successful?
The central feature of the Nabta app is Aya, an artificially intelligent health assistant whose job it is to act as a personal health coach for women, from defining health goals, to understanding which activities should be tracked, to navigating personalised clinical pathways, from symptoms to diagnosis and beyond. While most of Aya’s decision making abilities were developed in-house, her symptom triaging, which supports Nabta app users with pre-consultation support for over 660 conditions, is powered by Infermedica, a leading AI-powered symptom checker.
How are machine learning and augmented intelligence integrated?
Hybrid healthcare is defined as combining the best of digital and traditional healthcare along clinical pathways to improve health outcomes. At Nabta Health, this means using our artificially intelligent health assistant, Aya, to move women swiftly along clinical pathways from symptom detection to diagnosis, and then working with trusted local healthcare providers to provide a formal diagnosis along with onward medical advice and treatment. Aya is the machine learning or “artificially intelligent” component; the clinicians and providers that we interface with are the “humanly intelligent” component.
How was the gap recognised for Nabta?
After we founded Nabta Health in 2017 with the intention of empowering women in emerging markets to effectively manage their health, we spent 15 months in R&D, analysing the existing women’s health technology (or FemTech) ecosystem to understand where the gaps and opportunities were. We quickly realised that while many FemTech companies provided useful insights to women in isolation – cycle length, ovulation status, etc – very few interfaced with the established healthcare ecosystem, meaning women were unable to move beyond detection to diagnosis and treatment.
Then, in the summer of 2018, I was diagnosed with insulin-resistant Polycystic Ovary Syndrome. I had always suffered with irregular cycles and had been using the OvuSense realtime fertility monitor (which detects ovulation with 99 per cent accuracy in cycle and is now integrated with the Nabta app) to help me fall pregnant a second time. When I failed to ovulate during a long, 60-day cycle, I went and saw a local OB/GYN, who ran a bunch of tests and gave me my diagnosis - PCOS. One trigger shot and 17 days later and I was confirmed pregnant. The experience was a eureka moment for me. Globally, it takes an average of 2.5 years and 3 doctors for women to be diagnosed with PCOS and even longer to fall pregnant. By incorporating digital technologies into the clinical pathway for PCOS, it took me just 90 days to get from the start of my first anovulatory cycle to a positive pregnancy test.
It was off the back of this – my own, personal encounter with infertility (mercifully brief) – that we crystallised our hybrid healthcare model, coined the term “Hybrid Healthcare”, and raised a Seed round to build our first clinical pathway for PCOS.
What has been the digital journey of Nabta’s development?
We launched our digital presence (website and social media) in the summer of 2017, while still in R&D. Our evidence-based, bilingual (Arabic and English) content and health awareness campaigns allowed us to engage women on different aspects of their health from very early on. We used the insights from these engagements to inform our product development. To date, we have reached over 25 million women across the Middle East, Africa, and South Asia. A BETA version of the Nabta app was released in June 2020, with a very embryonic Aya, to get some initial feedback from users. Now that we have completed the device and test integrations required to support our first clinical pathway(s), we are starting to actively market the Nabta app to women in the UAE for the first time.
How does Nabta use data to offer services/products for non-app users?
We identify women as potential users of Nabta Health’s products and services based on publicly available data, for example, the forums and groups they join, the questions they ask, and the interests they list. We believe that women should be the owners of their data, with the freedom to choose how, when and with whom it is shared – this applies not only to users of the Nabta app, but to women in general, all of whom could at some point be our customers, and whose data rights it is, therefore, our duty to protect.
How does Nabta offer telehealth services to users? Can you discuss the diversity of the app and how it caters to the user in many ways such as chat messenger and appointment booking?
As much as possible, we try to work with local healthcare providers to provide telehealth services to users of the Nabta app, and to do this using their existing technology stacks. Since the COVID-19 pandemic, healthcare providers around the world have invested billions in their own consultation and appointment-booking platforms. As long as we can interface with those platforms, allowing women to share their health and medical data in a systematic way with their provider(s) of choice, we don’t believe it is necessary for us to add to the byte bank. For countries where providers do not offer virtual consultations as standard, we will from 2022 be able to offer Nabta-hosted chat, video, and audio consultations as well as appointment booking for in-person consultations. We have some interesting projects in the pipeline to facilitate the move from provider-led to patient-led, patient-centric care – one involving a decentralised, ledger-based system for the “stamping” of data transactions and sharing requests, but more on that another time.
What does the future hold for Nabta as a product for women in the world of hybrid healthcare?
Nabta Health is one of only a handful of FemTech companies focused on improving health outcomes for women in emerging markets. Indeed, we are on track to become the leader in the detection, diagnosis, and management of non-communicable diseases in women from the Middle East, Africa, and South Asia by 2025. In terms of hybrid healthcare, we are excited to witness the continued adoption of our model – in emerging markets and beyond – and to work on building new, hybrid clinical pathways, with better, more equitable health outcomes for women and a healthier population overall.
