12 years ago, I proposed to Gillian on the island overlooking Lake Baringo, in Western Kenya. This was the birth of the Madiro Foundation. Lots has happened in the intervening years. We got married. We had two beautiful and capable children - Chloe (9) and Damien (7) – who have grown and are thriving. Courtesy of the growth and success of my 8 year old old start-up, AlayaCare, we have been able to capitalize Madiro and watch it grow into an organization that is itself growing and thriving in its mission to identify transformative innovations in global health and help drive them to scale.

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I am writing this blog on the flight home from a two week trip in Kenya and Uganda with Gillian, Chloe, and Damien, and I’ve never been more fired up about Madiro’s mission and impact potential. The purpose of our trip was to:

- Continuously re-build context – staying in touch with the needs and opportunities on the ground in the communities we are looking to impact;

- Meet with our partners in the region – to understand what is working well, and where we can provide more assistance;

- Network with other entrepreneurs and capital sources looking to solve similar problems – both with existing contacts and to meet new ones; and

- Expose our kids to the realities of the rest of our global community.

We eased into our trip with a couple of days in Nairobi. We were both blown away with the progress that Nairobi has made in the 12 years since we’d visited. When I was in Uganda in 2021, I didn’t have the same sense, and a quick look-up of the past 10 years of economic growth in Kenya vs Ugandas hows how the economic trajectories of these two neighbouring countries have diverged.

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Jesse Moore, founder/CEO of M-Kopa, and board member of Madiro graciously hosted us for dinner. We were travelling with our friends, fellow tech entrepreneurs, and again hearing the origin story of M-Kopa and the massive impact and scale that they have achieved was inspirational.

As our networking and journey through the East African start-up scene progressed over the course of the two weeks, we came to realize how much of a shining light M-Kopa is the for the region. Although Nairobi has earned the monicker of Silicon Savannah, we know that thriving ecosystems need star companies that get to scale, generate shareholder returns, and serve as proof points for future investments. We are lucky to have Jesse sharing with Madiro his hard-won perspective on how to identify and scale impactful innovations in the region.

We continued the theme of invading the back yards of ex-pats, having dinner with Ben Peterson – founder of Purple Elephant Ventures - the following night. Although in a different domain, TravelTech, Ben’s work building a venture studio for travel-related tech startups in Nairobi was equally edifying. This is something I could imagine Madiro doing in Health Techdown the road. Ben also introduced us to Steve Sewu who is launching an Africa-focused HealthTech fund. More on that later.

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We then travelled to Uganda to spend time with Healthy Entrepreneurs. From the early days of rebooting Madiro and bringing on James Fraser as CEO, Healthy Entrepreneurs was a guiding light for us on how impact-oriented entrepreneurship is one of the surest paths to sustainable ladders of opportunity. It was on my last trip to Kampala in 2021, that discussions with HE’s founder Joost van Engen, led to the pivot of Madiro from a granting organization, to granting organization that also makes strategic investments in social enterprises. Every minute I spend with Joost leaves me more educated and more inspired. Back to our time with Healthy Entrepreneurs.

We brainstormed about additional services that could be offered in the home, drawing on my AlayaCare experience in home-based care in Canada, the US, and Australia. Gillian compared notes with Dr Mary Moussa on pediatric best practices. We also discussed innovation in supply chain models to support the growth of HE from 10k to 90k Community Health Entrepreneurs:

- Cluster model vs regional distribution centers,

- Consignment vs Cash on Delivery (COD),

- And how different the context is when transportation costs impose a far larger percentage of the costs than the good being distributed.

Finally, we did a deep dive with our travel companion, Simon Ferragne, of the Technology & Data stack. Some of the topics discussed were:

- Coverage model – how to leverage 3^rd party data in conjunction with order data to understand how well our distribution networking is covering the country?

- Demand forecasting – how can we increase the efficiency and resilience of the distribution network with better demand forecasting algorithms?

- Identifying the end consumer (or household) – despite limitations in digitization of the last mile, can we use GPS, NFC, or other technologies like issuing cards with QR codes to gain visibility at the end consumer (or household) level?

- And we explored the merits of partnering with organizations like Medic.org who work with implementation partners to provide data collection services for Ministries of Health.

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The next day we went out on a field visit to the Kikandwa province, accompanied by Joost and Julie (pictured on the right).

On the field visit, we were the excuse for a partial cluster meeting, where Community Health Entrepreneurs (CHEs) in the region got together to chat with each other, with a specific focus on the eDispensing program for Chronic Disease Management that is being rolled out.

We heard the daily challenges of the CHEs, but also heard how empowered they are (both economically and socially) by being the health experts and purveyors of health and wellness products in their communities.

We visited a Level 3 Community Health Center, giving us a good sense of the state of play of publicly delivered healthcare in rural communities:

We visited the new maternity ward built by an NGO, saw the challenges with maintaining stocks of medication in the dispensary, visited the Lab and got a sense of what is being tested for locally and via samples sent to a central laboratory. We were also able to observe the distances that need to be traveled for many of the 60,000 citizens in the catchment area.

We saw a level 2 CHE deliver care to member of her community at her place of work / residence.

We then went out for a home visit and observed the Chronic Disease Management offering in action involving eDispensing and ePrescribing, capturing of vital signs, and health coaching. The story behind this particular case was especially interesting. The patient in question was an elderly woman who had been living alone, and when her sister took her in, she wasn’t able to stand and was confused and delirious. She was diagnosed with high blood pressure. Courtesy of the CHE’s treatment, her blood pressure had been coming down and she’s regained her strength and mental acuity.

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On our final day in Kampala, we met with two other projects that Madiro is supporting.

Golden Center for Women’s Rights (GCWR) is one of the winners of our 2021 call for proposals*. They are doing amazing work with some extremely vulnerable populations of women in Uganda, a mission made all the harder by stigma and prejudice. Shira and her team are amazingly purpose driven; in her words, they are a "for us, by us" organization. We were humbled by the support they are providing in their community.

We then met with Signalytic at their Nairobi office and assembly plant. Seeing the technology in action – as well as the assembly – was a great way for me to deepen my understanding of the technology. Having seen the lack of inventory control in the Community Health Center the day before made the solution they provide all the more tangible. Simple outcomes such as the ability to have centralized inventory visibility and the ability to re-order supplies could drastically reduce stock-outs which would have very material impacts on the lives of those living in rural communities.

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