Evaluating Digital Health Startups in Africa: Metrics That Matter

Abstract

The digital health startup landscape in Africa is rapidly expanding, yet many solutions struggle to demonstrate long-term impact or scale. This white paper presents a framework for evaluating African digital health startups, tailored to the region’s infrastructure, market maturity, and healthcare needs. Drawing from investor, donor, and government perspectives, it outlines metrics in six domains: impact, scalability, adoption, financial sustainability, interoperability, and regulatory alignment.

Introduction

As Sub-Saharan Africa faces a growing burden of disease and critical shortages in health infrastructure, digital health startups are filling essential service gaps. From mobile diagnostics to telemedicine platforms and AI-powered triage tools, healthtech solutions are proliferating. However, investors and governments often lack standardized frameworks to assess their value, risk, and readiness (WHO, 2016; MobiHealthNews, 2023). This paper introduces key evaluation metrics aligned to Africa’s unique innovation and health ecosystems.

1. Health Impact Metrics

Health outcomes are the foundation of evaluating any healthtech solution. African startups must demonstrate real and measurable improvement in care access, delivery, or outcomes.

• Clinical Effectiveness: Reduction in morbidity/mortality (e.g., improved maternal survival via SMS reminders).

• Service Coverage Expansion: Number of new patients reached in rural or underserved areas.

• Continuity of Care: Enhanced patient follow-up rates or medication adherence.

• Health Equity: Impact on gender, disability, or income-related disparities.

Example: LifeBank in Nigeria has delivered over 50,000 pints of blood using mobile and drone technology, directly reducing maternal deaths due to hemorrhage.
Source: https://www.lifebank.ng

2. Scalability & Geographic Reach

Scalable healthtech can extend impact regionally or nationally with relatively low marginal cost.

• Users per Site or Region: Is the solution gaining traction across counties, provinces, or countries?

• System Load Tolerance: Can infrastructure handle growth (e.g., SMS volume, app downloads)?

• Localization Capacity: Language, cultural, and platform adaptability (Android, USSD, WhatsApp).

• Scalability Roadmap: Documented plan for reaching 10x more users within 24 months.

GSMA (2022) notes that only 25% of Sub-Saharan Africa’s digital health pilots scale beyond pilot phase.
https://www.gsma.com/mobilefordevelopment/resources/scaling-digital-health-in-sub-saharan-africa/

3. User Adoption & Engagement

Engagement metrics reflect how embedded a startup is in user behavior.

• Monthly Active Users (MAUs) vs. downloads or registrations

• Net Promoter Score (NPS): User satisfaction and loyalty

• Repeat Use Rate: Especially for apps, teleconsults, or diagnostics

• Time to Value: How quickly users see measurable benefit

Case Study: Hello Doctor in South Africa increased monthly consultations by 400% after integrating WhatsApp-based services (PwC, 2020).

4. Financial Sustainability & Business Model

Startups must survive beyond grants. Metrics here help investors assess business viability.

• Revenue per User (RPU) or Gross Margin per Service

• Customer Acquisition Cost (CAC) and Lifetime Value (LTV)

• Funding Mix: Equity vs. donor vs. revenue

• Unit Economics: Profitability at per-user level

Insight: Briter Bridges (2023) reports that over 65% of African health startups are donor-funded but only 18% reach breakeven.
https://briterbridges.com/healthtech-startups-in-africa-report/

5. Interoperability & Integration

Digital health solutions must integrate with public systems and other tools.

• Compliance with FHIR, HL7, or OpenMRS Standards

• APIs Available & Documented

• Integration with National Health Information Systems (NHIS)

• Data Interoperability Readiness Assessments (DIRAs)

Rwanda’s integration of Babyl’s telehealth platform with the national ID system demonstrates exemplary interoperability.

6. Policy & Regulatory Alignment

Compliance with data protection, licensing, and health ministry requirements is essential.

• Data Privacy Compliance: POPIA, GDPR, NDPR, etc.

• Licensing: Registered with national medical bodies or authorities

• Alignment with National eHealth Strategy: Endorsement or recognition

• Regulatory Readiness: Legal support for medical claims or AI use

In Kenya, the Digital Health Act (2023) provides a licensing framework for telehealth and mHealth platforms.
https://www.health.go.ke/wp-content/uploads/2023/03/Digital-Health-Act-Kenya.pdf

Proposed Evaluation Framework: The EASIER Model

Conclusion

Investors, donors, and governments evaluating digital health startups in Africa must use a multidimensional metric system that goes beyond downloads and prototypes. By focusing on real-world outcomes, scalability, sustainability, and integration readiness, stakeholders can better identify and support innovations that will shape the future of healthcare across the continent.

References

Briter Bridges. (2023). State of HealthTech in Africa: Investment, innovation, and impact.
https://briterbridges.com/healthtech-startups-in-africa-report/

GSMA. (2022). Scaling Digital Health in Sub-Saharan Africa.
https://www.gsma.com/mobilefordevelopment/resources/scaling-digital-health-in-sub-saharan-africa/

LifeBank. (2023). How we save lives in Nigeria.
https://www.lifebank.ng

MobiHealthNews. (2023). African health startups struggle with scale despite innovation boom.
https://www.mobihealthnews.com/news/emea/african-health-startups-face-scaling-challenges

PwC. (2020). The future of healthcare in Africa: Innovation, integration, and inclusion.
https://www.pwc.com/ng/en/assets/pdf/africa-healthcare.pdf

World Health Organization. (2016). Monitoring and evaluating digital health interventions: A practical guide to conducting research and assessment.
https://apps.who.int/iris/handle/10665/252183