Zenysis aims to be government 'operating system' in low-income nations

A Silicon Valley startup that has developed a data interoperability platform to improve the delivery of health care and other public services is expanding its work in Mozambique.

Zenysis Technologies, with financial support from Gavi, the Vaccine Alliance, will work with Mozambique’s government “to strengthen national childhood vaccination programs and outbreak response capabilities.”

The move builds on past work Zenysis has done on the country’s health system analytics platform, from helping coordinate an emergency vaccination campaign amid a cholera outbreak to partnering with the government on its COVID-19 response efforts.

The company’s work in Mozambique is just one example of how it brings together a large volume of disparate data sources, uses its open-source platform to integrate them into a single point of access, and provides decision-makers with a more actionable picture of what is happening. Zenysis’ vision is to be “the operating system for governments,” said Sara Pacque-Margolis, the company’s vice president of growth.

Zenysis works in low- and middle-income countries where data is often fragmented, due in part to projects that are developed according to outcomes that donors want to see and then phased out when grants end.

While electronic reporting of patient health data is on the rise, capacity is sometimes limited for processing and applying that information. Government decision-makers in lower-income countries have reason to be suspicious of outside technology companies, which can sometimes make health systems more siloed. So Zenysis has to build trust with partners and prove how it can provide a holistic view of the problems they are trying to solve.

“Zenysis builds relationships by starting small, and solving data and interoperability problems, identified by users,” John Fairhurst, the head of private sector engagement at the Global Fund to Fight AIDS, Tuberculosis and Malaria, told Devex by email. “This model has proved effective in a range of operating and digital maturity contexts."

In addition to Mozambique, Zenysis works in Brazil, Pakistan, South Africa, Zambia, Benin, Ethiopia, and Rwanda, as well as for the RBM Partnership to End Malaria, which operates globally.

Rwanda Biomedical Centre, a government organization affiliated with Rwanda’s Health Ministry, used to have separate tracking systems for different health priorities, with one for HIV/AIDS, another for malaria, another for tuberculosis, and so on. It is now partnering with Zenysis, which is working on a new agreement with the Rwandan government.

RBC said Zenysis’ approach is different from those of other tech companies that have come and gone over the years.

“We attribute most of those failures to a lack of ownership or long-term vision,” said Albert Tuyishime, division manager for planning, business strategy, and monitoring and evaluation at RBC. “We’ve had some partners pull out, saying: ‘Our time here has elapsed. The resources we had are now finished, so we have to step out.’”

RBC worked with Zenysis to bring these disparate information sources together in one place and make them more visible to all levels of health care decision-making. For example, Zenysis has supported RBC staffers in identifying and addressing data collection issues at their source, including eliminating outdated indicators and double reporting that would have skewed data.

One team found that malaria data analysis took a matter of minutes with this technology instead of two days of manual effort.

Automated analytics on the Zenysis platform can allow staffers to focus on the potential insights from their data rather than more administrative tasks.

“The technology is the easy part,” Pacque-Margolis said. “Turning the technology into applications requires a lot of other interactions: diplomacy, understanding the political economy, behavior change.”

Zenysis works to build what it calls a “data-use culture” in its partner governments. The company says this is critical to ensure that decision-makers make use of the data.

It hires user engagement specialists to help partners effectively use generated insights to tackle outbreaks, manage health supply chains, and save time, money, and lives.

Often, that means Zenysis is hiring experts who can serve as a bridge between software engineers and public health practitioners.

Jean-Paul Uwizihiwe, regional director of growth for Zenysis in Rwanda, previously worked for RBC. He said he was impressed by how Zenysis does not put its name on the technology. Harmony, its data integration software, is open source. And in Rwanda, it’s called the Rwanda Health Analytics Platform.

Zenysis starts by learning what a government’s priorities are and then exploring how the platform can support those goals, from the initial “discovery” stage to implementation and long-term sustainability, Uwizihiwe said.

“By sitting together, working on the concept note, and applying for funds together, the government feels ownership of the project,” he said.

Zenysis has received grant funding from groups such as Gavi, the Global Fund, and the Bill & Melinda Gates Foundation. The company says private funding allows the company to be more flexible — and its projects more sustainable.

“We don’t have to pack up and leave when the funding ends,” Pacque-Margolis said.

Zenysis can enter a country before funds are allocated, make changes to product development in response to unforeseen needs, and sustain work between funding allocations. This has been particularly critical for the company amid financing delays caused by the COVID-19 pandemic.

As it seeks to scale its work, a major challenge for Zenysis involves gaining access to the data it needs — particularly in times of crisis, when the company has to work through chains of approval in the context of rapid change.

“One of the absolute most important innovations over the next few years will be getting to a place where we can create these data-sharing agreements in a much faster way than the nine months that it currently takes,” said Clay Sader, chief operating officer at Zenysis, in a recent webinar.

He added that digital infrastructure faces a “tragedy of the commons” problem, in which no single entity is responsible for ownership or improvement. But Sader said he hopes the COVID-19 pandemic might change that.

“We need focused investments on the system itself and not just trying to address the system in the periphery of other programs,” he said. “Without that, we’re not going to put into place the kind of technical infrastructure that we need to be prepared for the next time, or the human systems.”

This coverage, presented by the Bay Area Global Health Alliance, explores the intersection between technology, innovation, and health. How are tech, innovation, and cross-sector partnerships being leveraged to accelerate equitable access to health care?