Noncommunicable diseases, or NCDs, such as hypertension, diabetes, and cancer, have become a major health crisis in low- and middle-income countries, or LMICs. Treating them has long been a challenge: Unlike infectious diseases, which often require short-term treatment, NCDs demand continuous, lifelong care, making them complex and costly to address.
Yet health systems in many LMICs remain designed to fight acute conditions, not chronic ones, and global health funding has historically prioritized communicable diseases, leaving NCD programs underresourced. The consequences are stark: In 2021 alone, 18 million people died prematurely from NCDs, and 82% of those deaths occurred in LMICs, where difficulty providing goods and services to remote, underserved, or hard-to-reach communities is compounded by inadequate funding.
According to Joanna Bichsel, founder and CEO of the health-tech startup Kasha, locally founded startups like hers are uniquely positioned to help close the gap in NCD care — and they’re stepping in with innovative solutions that improve access to care.
“Startups and entrepreneurs have the agility to iterate quickly and test new models, something that’s hard for large corporations or governments to do,” Bichsel told Devex. “Our goal has always been to flip the traditional health supply chain upside down and make it consumer-driven and data-driven.”
Founded in 2016 in Rwanda, Kasha develops innovative solutions that improve access to essential health care across Africa, with a particular focus on optimizing last-mile delivery — the final step of getting goods or services from a central location to the end user, often in remote or underserved areas — and women’s health. However, Bichsel said that meaningful impact isn’t possible without effective collaboration with impact investors and other stakeholders.
“There’s no doubt that technology will disrupt health systems across LMICs — and local entrepreneurs are leading that charge,” Bichsel said. “But partnership is critical to scale that innovation sustainably.”
One example of this collaborative model in action is Kasha’s partnership with Sanofi’s Global Health Unit, which supported an ambitious NCD treatment initiative that combines community outreach, digital screening tools, and home-based delivery of medicines. To date, the program has delivered NCD awareness and education to over 50,000 people across Rwanda, and more than 18,000 have been screened for diabetes and hypertension.
Speaking to Devex, Bichsel shared more on how the company is drawing on partnerships to reshape health care delivery through technology, what impact investors should know about supporting innovation in LMICs, and why cross-sector collaboration is critical to building more equitable health systems.
This conversation has been edited for length and clarity.
When you founded Kasha in 2016, what gap were you aiming to fill in the health care landscape in Rwanda and across Africa?
The mission of Kasha today is the same as when we started in 2016. Global health systems across Africa and other emerging markets haven’t evolved much — they’re still very top-down. Decisions about what health products are delivered, in what quantities, and how are often made in wealthier countries, with little understanding of what’s actually needed on the ground. I saw this firsthand before founding Kasha, when I worked in those spaces.
There’s also a lot of talk about women in health, but very little is optimized for their specific needs, despite women representing more than half the population and often being the key to unlocking household health. That insight was central to launching Kasha.
What advice would you give to impact investors looking to make a meaningful difference in health care access in Africa? Where should they focus their efforts?
Impact investors vary widely. Some are deeply committed to social outcomes but less attuned to what it takes to run a sustainable business. Others lean heavily on commercial metrics. The sweet spot is finding those who understand both. Sanofi, for example, is a commercial company that’s also purpose-driven, just like Kasha. It understands that you can’t scale impact without financially strong businesses — but also that patience and flexibility are needed to allow entrepreneurs to iterate and refine their models.
Kasha is one of the Sanofi Global Health Unit’s investees from its Impact Fund. How has this investment influenced your growth or strategic direction, particularly in reaching more people with health products and services?
[One of] Sanofi’s focuses is NCDs; the Global Health Unit, in particular, is focused on access. Early on, we noticed a large and growing demand for NCD medications. People were paying out-of-pocket because many of these treatments aren’t covered by insurance. So, by aligning with a like-minded manufacturer like Sanofi, that segment of our business grew significantly.
While we’re not exclusive to Sanofi products — we sell and deliver a variety of health products from multiple manufacturers and work with community partners to organize health education sessions, as well as health screening and testing events. But the partnership with Sanofi works especially well because we’re aligned in our mission, and we don’t have to waste time explaining local challenges — [Sanofi] already understands them. That allows us to focus on cocreating solutions.
NCDs often get less attention in LMICs compared to infectious diseases. How is Kasha changing the landscape of NCD care in East and South Africa? What do you consider to be the greatest barriers to care?
There are a lot of complexities around NCDs in general, especially when you’re in an emerging market. To give an example, my daughter has type 1 diabetes and, living in Kenya, we experienced firsthand how many health workers aren’t trained to recognize diabetes symptoms. Many medical schools only began including NCDs in their curricula about five years ago.
Then there’s supply, as medications need to be consistently available across pharmacies, clinics, and hospitals, including at the “last mile.” We’re building that infrastructure. Patient adherence is another major issue — people stop taking medication when they feel better. Kasha’s digital platform enables subscription services and sends reminders to help with that consistency.
There are so many areas within NCDs that need to be worked on, and I think a lot of people are still not even aware that they have an NCD.
Your partnership with Sanofi’s Global Health Unit has made significant progress in the development of the digital platform for NCD treatment in Rwanda. Can you explain what you’ve learned about making partnerships like this succeed?
Sanofi has really been a fantastic partner, because we get together regularly to share our learnings and they provide ideas and feedback, and we've actually also been able to find more cost-effective ways of enabling access. For example, it’s very common to utilize mobile clinics for screening and testing, but we found that mobile clinics weren’t reaching the right demographic. When you look at the age groups that have the highest prevalence [of NCDs], it’s usually older people. So we shifted to door-to-door screenings in partnership with community health workers. Not only did we reach more of the right people, but it was also more cost-effective.
We’re now scaling that program across Rwanda. Kasha already delivers to all 30 districts and is the government’s logistics partner for public health products. Being able to bring these programs in on top of the infrastructure that has been built is going to be very powerful.
On the sidelines of the 78th World Health Assembly, Sanofi and Devex organized a roundtable with key stakeholders exploring the role of cross-sector collaboration in improving access to NCD care. One of the main takeaways was that coordinated, cross-sectoral partnerships are the only way to ensure lasting impact. How have you seen innovative partnerships filling the healthcare gap in Africa?
Partnerships are essential — especially with the government. Public health systems often aren’t built for logistics or tech innovation, and that’s where companies like Kasha come in.
In Rwanda, for example, we’ve replaced a more expensive warehousing model by managing last-mile delivery of public health products. In Kenya, we’re helping local governments with HIV medication delivery, enabling patients to receive treatment without spending hours at a clinic.
Those patients may also have diabetes or hypertension — or need contraception — and Kasha can deliver all of it in one go. This kind of cross-sector coordination is more sustainable and better for patients.
Visit Accelerating Action — a series highlighting pathways for funding NCD prevention and control, spotlighting innovative financing models and cross-sector collaborations.
This content is sponsored by Sanofi as part of our Accelerating Action series. To learn more about this series, click here.