In 2019, a largely uncharted and coveted field in Nigerian healthcare saw a shift with the establishment of the first indigenous subspecialty radiology reporting company. DR. CHINEDUM ANOSIKE and DR. HAMMED NINALOWO, both astute medical doctors, came together to make this a reality. Contracting over 25 radiologists of Nigerian descent practicing internationally, their vision was to empower Nigerians with access to accurate radiology reports interpreted by homegrown experts who understand their specific needs.
In this interview with TEMITAYO AYETOTO-OLADEHINDE, BusinessDay’s senior health Journalist, they elaborate on their vision and expansion plans.
What did Accuread set out to achieve?
Anosike:
Accuread Radiology was established four years ago to be a teleradiology company providing specialist and subspecialist radiology reporting services to hospitals and diagnostic centres in Nigeria. At the time we established, subspecialty radiology was not available in Nigeria. There was general radiology to clarify. We are talking about subspecialty radiology, which is specific to different aspects of medicine. So just like you don’t have a general surgeon, you have surgeons that specialise in other different aspects of surgery. The same thing has happened in radiology as well.
We were the first company in Nigeria that was set up to provide services to diagnostic centres and hospitals. Before we started Accuread in Nigeria, these services were being provided by Indian and Egyptian companies. We were the first indigenous company to provide the service and we have managed to displace a lot of those foreign companies, making it a great addition to the Nigerian healthcare space.
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Another positive about our ideology is that we make use of radiologists of Nigerian descent practicing in the West and Middle East to reverse brain drain. We are getting Nigerians who have left the country to be able to contribute.
Most of your partners are health facilities specialised in cancer care. Do you major in cancer reporting or analysis of cancer cases?
Anosike:
I think why you noticed that we have clients who are in cancer hospitals, is because cancer is one of the most subspecialist aspects of medicine. The hospitals that provide cancer care have seen us as a good partner in looking after their patients and interpreting those reports. In addition to cancer care, there are other specialties that we also take care of, like cardiology for instance. A lot of centres that have clients who do a lot of cardiology work also do a lot of imaging that involves scanning the heart. And we have specialists within our group that can also interpret scans that have to do with the heart as well as the chest. And these are not cancer patients. We also look after orthopedic patients. A lot of orthopedic surgeons get some of their studies read by us because we have subspecialists who also have a therapeutic interest. Then we have neurosurgeons as well, people who do brain operations. They would also require people who are specialised in reading those types of scans to be able to interpret that and offer those services.
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What enables you to deliver this service?
Anosike:
We can do this with technology. We integrate specialists from across the world through technology. So teleradiology, which is what our core business is, is the use of IT solutions to bring healthcare closer to people living in far areas of the world. It’s more popular when people talk about telemedicine: consult and stay up all night and talk to patients anywhere in the world. What we are doing is also bringing radiology to people in sub-Saharan Africa, using specialists from around the world with technology. So we do this through a platform that enables us to upload images to the cloud. The doctors can access those images, interpret those images, and put in a report and the report is sent back again through the internet to the various centres where they were sent from. So technology is a big part of what we do.
Apart from the reports, we also provide technological support to enable them to transfer those images to us and also get their readings on time.
Is this initiative a product of private capital, venture capital, or private equity?
Ninalowo:
This has all been private capital. So I and Dr. Anosike founded the company in 2019 and what we have done since that time is we run a lean system to build a company from the ground up. We have grown organically without having to use external funds. This is possible in the future as we start expanding. And we are looking to expand outside of Nigeria now with the first expansion going to Ghana. The most important thing to understand about teleradiology is it is very common everywhere else in the world. But in Africa, we are still really back in the day. What we have seen recently is that there has been a lot of capital investment in big machines in Africa, recently in CT scans and MRIs. But we don’t have the human capital to be able to read scans, at least not one radiologist for a hospital. If you look at Nigeria now, there are only about 500 radiologists for a population of over 200 million people. So you cannot expect each hospital to have a radiologist. However, if you aggregate scans from multiple centres to be going to radiologists, basically sitting at home or sitting in an office somewhere where they don’t have to be present in each hospital, then we could solve that problem of each hospital not having to have a radiologist.
And if you look at the way teleradiology is in Africa currently, there are already some companies in Egypt, in Northern Africa, and in Eastern Africa. We are the only teleradiology company that is indigenous in sub-Saharan Africa or Western Africa currently. And we want to be able to grow that market if we get the proper investment to come into the company. But we are willing also to continue to back the company. As we have grown organically, we have been profitable from our second year. We have remained profitable and we believe this is very valuable to the continent as a whole and we are going to grow it.
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How do you ensure that your interpretations meet international standards, especially considering the potential risks associated with misinterpretations in the diagnostic segment of Nigeria’s healthcare sector?
Ninalowo:
We are already at international standards. If you look at doctors who adopted our service very early, they are doctors who have worked in the diaspora and understand what it means to get a subspecialty report. Those are the doctors who were employed in our services very early and helped us grow by spreading the word that there is something better than just a radiology report. There’s a subspecialty report where you get feedback from a radiologist. The other thing that is very specific for us also is we are reading for Nigerian patients. Most of the radiologists that read for us, over 90 percent of our radiologists are Nigerians. We have a few non-Nigerians read for us based on the subspecialty, but mostly Nigerians. We ensure that every radiologist who reads for us can be contacted by a hospital through our administrators if they have specific questions.
Given the persistent shortage of radiologists and radiotherapy machines in Nigeria, how do you assess the impact of this deficiency on the healthcare system, particularly in terms of unaddressed damages that may be overlooked but require urgent attention and government intervention for resolution?
Ninalowo:
We have heard from our government recently that we cannot stop people from leaving our shores. Right? Medicine is a universal skill, meaning if people see better lifestyles and better livelihoods for their children, they will leave our shores. They are going to leave Nigeria. If you look at most of the training programs for radiology in Nigeria now, they will tell you that most of their registrars don’t finish residency anymore. As soon as they have an opportunity to go abroad, they are going abroad. 60 percent of the people studying go abroad before they finish residency. That is very scary which means we are getting fewer and fewer radiologists every day and we still have only about 500 radiologists for over 200 million people. If you go to most private hospitals, forget the public centers, and go to most private hospitals in Nigeria now, you will see it is an endemic problem.
How do we ensure we can continue to serve Nigerian patients even though we can’t stop people from leaving? The only way is technology. And we have shown that we can do that with technology. Most of our clients, about 90 percent of our clients do not have a radiologist that sits in their hospital. But they have 25 different radiologists that work for them at all times. And what if you think about finances for most hospitals? You cannot hire a subspecialty radiologist in every specialty.
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How would you describe the Nigerian market’s growth potential and where do you see Accuread with additional investments injected?
Anosike:
When talking about healthcare, we are now talking about healthcare as a commodity. So it is tied to the economy. A large percentage of people pay for their health care out of pocket. Our health insurance scheme is not yet very robust. This means that many people are paying for these services out of pocket. New scanners are coming in regularly. In the Victoria Island area where we are, in the last three to four years, we have had more than 10 CT scanners. You get more work coming through. New hospitals are being built. We are not producing enough specialists. So from that perspective, I think the opportunities are abundant because ultimately as new hospitals come on, with new diagnostic centres, they will be able to get people to use our services.
What do you consider your biggest challenges?
Anosike:
We are not also immune from the economic challenges. We have talked about technology, which is a major part of how we do our work. A lot of that cost is dollarised. Some of the technologies we use are hosted in the West, meaning that they need to be paid for as a dollar cost. Most of our specialists are Nigerian so they get paid in naira even though they are abroad. But we do have certain specialties like cardiac MRI where the specialist we use is non-Nigerian for the simple reason that there are a few hundred people who do that type of reporting worldwide.
We are competing for services with the international market because as my partner said earlier healthcare is an international business. We have managed to secure somebody who does that service for us among the few there is in the world and he needs to be paid for it. So all of that is a dollar cost. Those are challenges to our business because ultimately, we have to keep the costs down to keep it affordable for the centres to be able to make a profit from what they are doing.
But at the same time, we need to keep the service afloat. So we are practicing in Nigeria where there are economic challenges at the moment, but we think that there is a brighter future on the horizon. We think as more healthcare investment comes in, more people will require our services, and as the economy turns around, people will be more comfortable embracing our services.
So in terms of your expansion, you talked about Ghana, going to Ghana, and all that. Are you looking or are you already bidding for some level of investment to come into happy with your expansion?
Ninalowo:
We are expanding into Ghana now. However, we are looking to have a major expansion in sub-Saharan Africa and also look at French-speaking countries in sub-Saharan Africa shortly. We have had investors look at us recently and look at our business model and we are considering taking up some investments to make sure that we could have the workforce that could do the work, the marketing machine that could get our business out there, because we believe that we can be doing 10 times the work we are doing right now if it is properly scaled.
