2012 Triangle Global Health Case Competition

Opportunity Health Ambassadors Hearty Gardens ImpactSMS Med

Adam JuthaGladys ManzurJoel LugonesLeena PatelHans Peng

2012 Triangle Global Health Case Competition

UNC Team 4

Prevention of Cardiovascular Disease (CVD) Risk Factors in KenyaENGAGE. EDUCATE. EMPOWER.

1

Opportunity Health Ambassadors Hearty Gardens ImpactSMS Med2

Executive Summary

Recommendation: Develop public health prevention programs and strategies to target Kenyans under age 45 in urban areas

Impact: $12.3MM grant from Gates Foundation will initiate sustainable programs for the prevention of CVD risk factors in Kenya

ENGAGESMS MED

EDUCATEHEALTH

AMBASSADORS

EMPOWERHEARTY

GARDENSOPPORTUNIT

Y

• Under 45 years• Urban Areas• Risk factor:

obesity

• Widespread mobile use• Effective

health education channel

• Personal community approach to care• Culturally

sensitive• Low-cost

training

• Sustainable, fresh and healthy alternatives• Local job

creation

Objective: Prevent and manage cardiovascular disease (CVD) risk factors in Kenya


Agenda

• Urban areas and <45 yrs• Leading factor: obesity

Opportunity

• SMS Med• Financial Cost: $4.5MM Engage

• Health Ambassadors• Financial Cost: $1.3MMEducate

• Hearty Gardens• Financial Cost: $6.5MMEmpower

• Total Financial Cost: $12.3MMImpact


1965 1975 1985 1995 2005 2015

9.5 13.5

19.7 27.4

35.6

46.4

Kenya’s population (M)

2.6%

As Kenya’s population grows, CVDs are expected to increase unless public health programs are expanded

3.5%

Kenya’s population growth rate, average

Kenya’s population has steadily increased

The growth rate will likely slow down in the coming years

1966-1975 1976-1985 1986-1995 1996-2005 2006-2015

3.64%

3.78% 3.0

9% 2.62%

2.68%

4


Annual deaths from CVD are projected to increase 86%, reaching 80,000 deaths by 2030

2002 2015 2030

14.8 20.327.8

13.718.5

25.2

2.3

3.1

4.1

12.1

16.8

22.8

Cerebrovascular disease

Other

Hypertensive heart diseaseIschemic heart disease Cerebrovascular

disease

88%

Ischemic heart disease

84%

Forecasts suggest

significant increases in

CVDs

Projected deaths from cardiovascular disease in Kenya (’000s)

42.9

58.7

79.9


Obesity is one of the leading factors for CVD and affects a large portion of Kenya’s growing urban population

2005 20157.5M people

(21%)11.1M people

(24%)

Increasing urbanization

Rural Urban5.1%

15.5%15.8%

39.8%

Overweight (25<BMI<30)Obese (>30 BMI)

Overweight/obese populations

Not Affect

ed

Overweig

htObe

se0

2

4

BMI

Rela

tive

Ris

k of

CV

D

Correlation between obesity and CVD


Effective public health and CVD programs should target Kenya’s largest demographics

< 20 yrs20-44

yrs

45-64 yrs

> 65 yrs

Population by age

53%

9%3%

35%

< 20 yrs 20-44 yrs 45-64 yrs > 65 yrs

21.9

14.2

3.8 1.1

26.8

18.5

5.2 1.6

20102015

Population Forecasts (M)

88% of Kenya’s population is under age 45

Under age 45 is also fastest

growing demographic

Public health programs should

focus on prevention of

CVD

7


Successful CVD prevention programs should target three key demographics

CVD prevention:

target market

Location: urban areas

Population:< 45 yrs

Leading factor: obesity


Agenda


Opportunity






Widespread use of texting presents an opportunity to communicate with majority (75%) of Kenyans

2001 2003 2005 2007 2009 2011

2% 5%14%

31%

50%

83%Phone Calls

Text Messages

Take Pictures

Internet Usage

98%

75%

50%

23%

Sending: $0.06/TXTReceiving:

FREE

Cost-Effective

EfficientCommunica

tionYear (2012)

Cell phone penetration Cell phone usage

Text message costs in Kenya (USD)


Texting has been proven to be an effective channel of health education

Maryland California Illinois

Purpose

Prenatal and postnatal care

educationSex education Sports injury

prevention

Content

3 TXT/week Reminders,

tips, advice

1 TXT/week FAQ, clinic

location, ask Q

1 TXT/week FAQ, clinic

location, ask Q

Read TXTs:100%

Found it educational: 95%

Complied with msg:

66%


SMS Med engages Kenyans to learn more about CVD prevention through texting

• Ambassadors for their respective community

Author• Community

members

Subscribers

• 78 texts per year

• Average 1.5 texts per week

Frequency

• Weekly educational email

• Event info• Find

ambassador

Features


SMS Med can expect to reach over 200,000 people in its first 4 years of programming

Year 1 Year2 Year 3 Year 4 -

50,000

100,000

150,000

200,000

250,000

$100

$200

$300

$400

$500

$600

$700

$800

$900

$1,000

# Med TXT SubscribersCost of Sending TXT ($)

Num

ber

of M

ed T

XT

Subs

crib

ers

Tota

l Cos

t of

Sen

ding

TXT

s ('0

00s)

Community reach forecasts for SMS Med


Agenda


Opportunity

• SMS Med• Financial Cost: $4.5MMEngage





Despite rising obesity and CVD, Kenya lacks a cohesive prevention plan and personnel resources

Rise of early indicators of obesity and CVD

Has an operational integrated program for:

Cardiovascular Disease NoUnhealthy diet/Overweight/Obesity

No

Physical Activity NoTobacco No

Physician: Patient RatioWHO Recommended 1:1000Kenya (Year 2011) 1:10,000

Lack of prevention programs

Significant lack of trained

personnel

1980

1984

1988

1992

1996

2000

2004

2008

1919.5

2020.5

2121.5

2222.5

23

123124125126127128129130131

Growing CVD FactorsBMISystolic Blood Pressure

Aver

age

BMI

Syst

olic

Bloo

d Pr

essu

re

(mm

Hg)

15


Lay Health Advisors (LHA) model shows proven results in curbing health issues factors in culture driven communities

4 year program 2 year program 2.5 month pilot program 1.5 year program100 Advisors 200 advisors 500 advisors 50 yearsTreating Malaria Hypertension Heart disease &

strokeInfant mortality

• Immunization• Family health

planning• Medication access• Referrals to

physicians

• Monitor blood pressure

• Modify diet, physical activities

• Check blood pressure• Monitor symptoms of

stroke & heart attack• promote healthy

living

• Mental health counselors for black mothers

Diagnosed: 85%Treated: 91%Mortality: -49%

Decreased average

systolic BP from

140 - 108mm Hg

Reduction in hospitalization for

stroke, heart attack: 9%

Initiate primary care: 98%Mortality: -23%

16


Training represents the highest cost in this relatively inexpensive program

Year 1 Years 2 through 4

Total

$1,021

$91

$1,293

Costs for Health Ambassador’s Pro-

gram in USD (’000s)

Health Workshops

7%Training Costs for 400 Ambassadors

93%

Workshop and Training Costs

Opportunity Health Ambassadors

Hearty Gardens ImpactSMS Med18

Agenda


Opportunity







Accessibility to healthy alternatives should complement educational programs to allow for lifestyle modifications

Education Healthy Alternative

s

Educational programs through SMS Med and Health Ambassadors provide awareness for people to try new alternatives

Accessibility to healthy food alternatives enable people to practice new habits



Urban food gardens (including “Hearty Gardens”) provide access to fresh and affordable produce

Fresh, organic produce

Improved access to food alternatives

Targets at risk urban population

Community Empowerment

Decreased risk of CVD

MicroGardens use Woolly

Pocket system



“Hearty Gardens” can use Woolly Pockets, innovative and cost-effective technology, to enhance urban gardening

The Woolly Pocket SystemA Modular Gardening System

Space efficiency ideal for urban areas

33% less space required to grow crops

Requires 50% less water.

Made from 100% recycled plastic bottles

Easy set-up and user-friendly


Hearty Gardens ImpactSMS Med

• Largest urban center in Kenya• Targets population of 40%

overweight, 15% obese

• Potatoes, soy beans, tomatoes, salad greens, beats, onions, cabbage, beans, etc.

• Self-sustaining after initial capital investment

640 Woolly Pocket

Gardens

Actions Details and Justifications

Source: WHO, Woolly Pockets Website, Horticulture Development Centre

Woolly Pocket Gardens can be established in Nairobi as a self-sustaining business to target at-risk populations

Implement in capital city(Nairobi)

Offer cheaper produce while maintaining

profitability

Supplement produce needs for up to 30,000

people in Nairobi

22



Four-year plan of 640 “Hearty Gardens” would require $9.1MM investment (result in $3.3MM net cost after revenues)

VariableCosts

Capital Costs

Year 3360 Gardens

Year 4640 Gardens

Year 150 Gardens

Year 2120 Gardens

Net Cost

Source: Team Analysis

After 4 years, “Hearty Gardens” projected to turn $0.40MM annual profit

Cost-Revenue Structure for 4-year Implementation Plan

23



As revenues grow, investments totaling $6.5 MM are required to offset capital investments

Source: Team analysis

1 2 3 4 5 $252

$604

$1,813

$3,207

$534 $715

$2,486 $2,728

$0

Revenue Real-ized

Implementation Year

Total Investment Required: ($534K + $714K + $2486K + $2728 K+$0) = $6.5MM

Projected Revenue Growth (’000s)

24


Agenda


Opportunity

• SMS Med• Financial Cost: $4.5MMEngage





Recommendations will provide education, outreach and opportunities for reduction of CVD risk factors in Kenya’s urban population

Costs

SMS Med$4.5MM

Hearty Gardens$6.5MM

Health Ambassadors

$1.3MM

Total:$12.3MM

Cost-effective widespread outreach

Culture-sensitive community engagement

Empowering with healthy and sustainable nutrition alternatives

Impact

Sustainable programs for the prevention of CVD risk factors

26


Executive Summary

Recommendation: Develop public health prevention programs and strategies to target Kenyans under age 45 in urban areas

Impact: $12.3MM grant from Gates Foundation will initiate sustainable programs for the prevention of CVD risk factors in Kenya

ENGAGESMS MED

EDUCATEHEALTH

AMBASSADORS

EMPOWERHEARTY

GARDENSOPPORTUNIT

Y

• Under 45 years• Urban Areas• Risk factor:

obesity

• Widespread mobile use• Effective

health education channel

• Personal community approach to care• Culturally

sensitive• Low-cost

training

• Sustainable, fresh and healthy alternatives• Local job

creation

Objective: Prevent and manage cardiovascular disease (CVD) risk factors in Kenya


Appendix Index

Opportunity

• Literacy rate• Secondary

school enrollment

SMS Med

• Financial calculations

Health Ambassadors

• Benefits & case studies


• Sensitivity analysis

Hearty Gardens


• Specifications and design

Impact

• Risk Analysis• Challenges

28


Three-quarters of Kenya’s population is literate and nearly half of the population is enrolled in secondary school education

Literate74%

Illiterate26%

Literacy rate, as per 2005

Enrolled49%

Not enrolled51%

Secondary school enrollment

Literacy rates and school

enrollment will increase due to introduction of free primary

and secondary schooling in last

6 years


Financial and Impact Calculations for SMS Med

Population of Nairobi 3,130,000 Percent with mobile 83%Population of Nairobi with phones 2,597,900

Market Share Obtained Cost per text Texts per week Total Texts Total People Hit Total Annual Costs

Year 1 1.0% 0.05 1.5 78 25979 $ 101,318

Year 2 2.5% 0.05 1.5 78 64947.5 $ 253,295

Year 3 5.0% 0.05 1.5 78 129895 $ 506,591

Year 4 8.5% 0.05 1.5 78 220821.5 $ 861,204

Total Cost $ 1,722,408

Year Number of Subscribers Cost ( S 000's)Year 1 25,979 $ 101 Year2 64,948 $ 253 Year 3 129,895 $ 507 Year 4 220,822 $ 861


Texting programs for Sex Education

The HOOKUP

•Weekly sex info and life advice•Find the nearest clinic by zip code

•Privacy and casual•Has twitter, facebook, blog, and youtibe pages

•Twitter: •Tweets: 1504•Following: 1142•Followers: 1409

•Facebook: •Likes: 1,814

•Funded by Federal Office of Population Affairs and California Wellness Foundation and California Endowment and American Civil Liberties Union

Sex, Etc.

•Has a mobile site that has FAQs, terms, and rights information

•Part of a larger organization answer sex ed, honestly

Sex-Ed Loop

•Part of a larger organization answer sex ed, honestly

•Weekly sex ed tips•Find nearest clinics via text•Mary Beth Szydlowski, the H.I.V. education prevention specialist for Chicago schools, said that Sex-Ed Loop not only reinforces what students learn in class but can reach all teenagers, including dropouts.

•Teenagers write the texts and blogs

Healthy TXT

•Founded in Chicago in 2011, Healthy TXT™ is a physician-designed service that delivers healthy text messages to inspire, engage, and empower people to take action for health

•Educational concussion messages – along with football injury prevention, performance tips, and motivational messages from leading sports medicine physicians, trainers, and professional athletes – will be delivered once or twice a week.

•All subscribers will go through a mini concussion-training course, with a text message and an educational link delivered weekly. Upon completion, participants can take a concussion quiz, and be entered for a chance to win an iPad2. Winners will be announced on Super Bowl Sunday.

31


Where else is texting being used?

• A pilot study at Nationwide Children's Hospital in Columbus, OH, found that adolescent patients with diabetes who received text messages related to their medication plan were more likely to comply with it than those who didn't.– http://www.healthy-txt.com/#info

• The Pediatric Heart Transplant Program at NewYork-Presbyterian / Morgan Stanley Children's Hospital is launching a one-year program that will use a text messaging platform to increase medication adherence in its teenage heart transplant patients.

• According to BabyCenter, a social networking site for over 10 million Moms, the mobile phone is a Mom's companion that makes juggling easier. It is also changing behavior as seen in several pilot studies from Harvard and Johns Hopkins Children's Center. Healthy behaviors can be inspired and sustained by using mobile platforms where people live, work, and play.

32

http://www.healthcareitnews.com/news/study-texting-improves-medication-adherence-teens-diabetes-0

http://www.healthy-txt.com/

http://www.healthcareitnews.com/news/heart-transplant-patients-reminded-take-meds-text

http://www.hopkinschildrens.org/texting-may-improve-disease-management.aspx


Texting Case Studies

• “For better or worse, this technology is here, and sending a text to a patient’s cell phone about an upcoming appointment or a test or simply to remind them to take their meds is a great example of how we can harness new communication technology for a greater good.”

• Research has shown that up to half of patients may fail to take their daily medication properly, with forgetting being a top reason for non-adherence, so at least in some cases, a text reminder may be all that a patient needs, adds Robotham, who has encouraged the use of appropriate texting among pediatricians at Hopkins Children’s.

• one study involving children with diabetes showed improved blood glucose testing rates. These children were also more likely to share their blood glucose test readings with their doctor’s office.

• patients on immunosuppressive drugs after a liver transplant had improved medication adherence. The liver study detected measurable clinical benefits from text-messaging: Acute liver rejection episodes dropped dramatically as a result of better medication adherence.

• Chronic conditions that require daily medication, like HIV, asthma and TB, or daily testing, like diabetes, are great candidates for “SMS therapy,” Robotham says.

• “Texting is an even more popular mode of communication outside the United States, and especially so in developing countries, where most of the TB cases are, so I could see this being a great new way to reach those hard-to-reach patients,” Jain says.

• “Why wouldn’t it?” she says. “A patient can read a text instantly and respond unobtrusively, it doesn’t require Internet access or picking up the phone in the middle of class or an important meeting. Sometimes, I call patients and I get no response, but when I text, I get a response immediately.”

• “It won’t be a silver bullet but it could certainly be a nice little tool in an arsenal of many other tools,” Robotham says.

• By asking questions about glucose testing, meal boluses and frequency of high and low glucoses, Dyer said she saw an increase in teens taking their medications.

• After three months of sending text reminders she reported that they were three times less likely to miss a dose. • "This form of communication allows for real-time health management which is extremely valuable for patients that

suffer from a chronic illness like diabetes," said Dyer.• The study, which was conducted by Mt. Sinai Medical Center's Pediatric Gastroenterology Department in 2008, found

that as a result of receiving regular text alerts liver transplant patients were more likely to have higher adherence rates. The number of rejections dramatically decreased from 12 episodes the previous year to only two during the study 33


Football Injury Prevention Texting Program

“Texting is an effective way to reach teens and adults where they are today, on their mobile phones,” says Dr. Vishal Mehta, a Chicago area sports medicine orthopedic surgeon, as well as the medical advisor and co-founder of Healthy TXT, the organization behind the public service venture. “Harvard University and John Hopkins Children's Center studies show that healthy behaviors can be inspired and sustained using cell phone technology.”

34


Does texting work?

• Quantifying services is difficult. But Ms. Levine, who hosts Sex::Tech, a conference about sexual health programs for youth, said that requests to make presentations about online or mobile services had soared. Typically, she receives between 40 and 50 applications. This year, she received about 120.

• Most online services receive grants from philanthropies, like the Ford Foundation, and health and education agencies on the state and federal level.

• Real Talk held a classroom contest to see which student could send the most texts containing this prevention message: “ROFL!!!” (Translation: rolling on the floor laughing). “STDs and HIV can spread as fast as this message. Still laughing? Pass on the message not HIV/STDs. 518-HIV-TEST.” Within an hour, the message had been sent to nearly 450 phones.

35

http://www.fordfound.org/issues/sexuality-and-reproductive-health-and-rights/youth-sexuality-reproductive-health-and-rights


Technology to make this work exists

Supporting Education through SMS in Kyrgyzstan• The teachers and students we’re working with are attached to their cell phones, and therefore our team

decided to experiment with text messaging as a method of communication. FrontlineSMS software enabled us to use mass text messaging, which streamlined our communication and allowed us to use time more efficiently. It only takes about a minute to send out text messages to all of our teachers through FrontlineSMS, whereas in the past staff were making individual calls which took a lot longer.

• Few people have internet in their homes, yet everyone has mobile phones and so using SMS makes regular communication accessible to more of those we work with. When we ask teachers how they like working with SMS, they say that they find it very convenient, useful and flexible.

• We plan to collect SMS feedback reports from our program participants on how often they attend IREX trainings and where trainings are being held. We will then map these reports using online mapping tool Ushahidi, and this will allow us to visualize our impact. addition, the GCE program is also planning to use FrontlineSMS to conduct polling and short surveys among students and teachers, which will help us to further understand the value of our program and the needs that program participants have.

CareSpeak Communications Inc., a privately held mobile health company in New Jersey • The study was so successful that half of the patients that participated in the study in 2008 are still in the

program today, says Miloh. • “Before this program, we had only the power of people trying to educate the children and their families

about the deadly nature of noncompliance,” adds Addonizio. “Now we have the ability to give these adolescents a safety net to help them become responsible.

36

http://www.frontlinesms.com/the-software/

http://www.frontlinesms.com/the-software/

http://ushahidi.com/


What is the purpose of answer, sex ed ?

• They are only focusing on the risk-reduction model - Valerie Huber, executive director of the National Abstinence Education Association

• Those who run digital programs say they simply want teens to have accurate information, to help them make good decisions. Even though popular culture is saturated with sex, facts and advice can be hard to find.

37

http://www.abstinenceassociation.org/


Sensitivity Analysis for LHA Costs

Conservative Estimated LiberalEvents per Year 4 4 4Locations 10 10 10Total Events per Year 40 40 40

Attendees per Event 400 400 400Tables Needed per Event 20 20 20

Per Tables + 6 Chairs Rental Cost $ 20.00

$ 13.50

$ 10.00

Source: www.costhelper.com

Table+Chair Cost per Event $ 400.00

$ 270.00

$ 200.00

Highschool Gym Rental $5,000 $2,000 $1,200

Total Cost per Event $5,400.00 $2,270.00 $1,400.00 Total Cost of Events per year $216,000.00 $90,800.00 $56,000.00

Total Number of Health Ambassadors 200 200 200Training Cost per Ambassador $8,000 $4,500 $2,000

Medical Supplies $450 $150 $30

Source: http://www.mystethoscope.com/

Total Training Costs $1,690,000 $930,000 $406,000

4-year Total Cost$2,554,000.0

0 $1,293,200.00 $630,000.00

38


Education via lay health advisers (LHA)-led workshops will surmount to sustainable and long-term benefits

Similar programs have a track record of success

Improves access, the role of the health worker, and outcomes among at-risk population

Addresses a more effective and

communal approach that educates

preventable care

Program will train health workers in

educating the at-risk populace adopt

preventive care and adherence to

suggested treatment=


CVD risk factors are increasing

40


A partnership with the Canadian Public Health Association (CPHA) can aid the success of preventative education for at-risk populations

• Prevention• Promotion• Protection• Policy

Shared Principles

• Previously helped fund $110,000 to 100 LHAs throughout Kenya

• Extensive Training; Low Drop-out Rate

Precedent• Use budget to organize

health workshops in the community; visit households.

• Act as health facilitators and advocates

Partnership

CPHA will fund the training of LHAs while also providing them a budget for health promotion events (i.e. workshops)


Focus should be on recruiting community leaders in Kenya’s urban areas

Note: Education level of LHAs does not matter: study shows it makes no significant impact

WHERE WHO

Recruit local

community leaders

Has more knowledge of

their community health status &

needs

More respect and resources

Able to develop better

relationships

Hypertension and obesity is more prevalent in urban areas

LHA model is more needed in urban areas


Health Ambassador Program will train LHAs to budget and program health workshops

Provides and teaches basic health

services

Introduce innovate

technologies

Encourage healthy

action plans

Organize health

workshops

Acts as a facilitators


Health Ambassador Survey – Metrics

Measure awareness, comparing pre and post-event awareness from likert scale

Measure effectiveness of event and how likely you’re going to incorporate newly learned info into their daily regimen

Measure attendance of events, from those that were marketed (at-risk population). This measures response rate

Assessment of health ambassador and their confidence and respect for them. Perceived effectiveness?

How entertaining was the event; receptiveness


Information on Training and Recruiting

The CHWs in the Krieger et al., Jafar et al. and Gary et al. interventions were trained to counsel patients to adopt preventive care and adhere to the treatment of hypertension

They were taught the risk factors for cardiovascular diseases and trained to conduct blood pressure measurement

The CHWs recruited in these interventions were mostly locals from the community

Having a personal experience of managing own illness or someone else in the family resulted in producing highly significant results

45


Information on Canadian Public Health Association and Testimonial/Quotes

Community Health Workers in Kenya Stir Broad ChangesThis article appeared in the January-March 1996 issue of One Country.Active in more than 200 communities, a project to promote vaccinations has also helped to build a new level of intersectoral and interfaith collaboration - collaboration that has paid off by stimulating the construction of latrines and helping create better access to clean water

“The project is funded in part by the Canadian Public Health Association, which has provided about $110,000 to the project over the last three years.”

Testimonial: "When I attended the first community health worker training, I did not know that I would find my answer there," she said. "But since the training program, I've been able to help my family, my neighbors, all the village and the surrounding villages to understand what is primary health care and how easy they can improve their health. And I feel there is an answer to my question, that we all can do something to improve our health.Dr Santau Migiro, Division of Child Health, Ministry of Public Health and Sanitation, disclosed that currently, the doctor to patient ration is 1: 10,000. The WHO recommends 1:1000.46

http://www.onecountry.org/

http://www.onecountry.org/


Health Ambassador Program is not expensive

Adviser incentives were reported to be more on knowledge, empowerment, and public recognition

Proven that when communities take a grassroots effort---public health campaigns are more effective

Focuses on how the info diffuses and who the sender is

Not expensive


More support on Health Ambassador Program

CVDs impose severe costs on the health-care system but there is not enough present

emphasis to combat this

Essential to move to programs in that focus on risk factor prevention and initiatives for health promotion at every level (individual, family, community and national).

A Health Ambassador Program does this:Primary control and prevention of CVD risk factors helps strengthen, rather than compete, with health-care interventions for other diseases


Capital costs (land, site development, Woolly Pockets) total $4.0MM to build 640 “Hearty Gardens” over 4 years

Cost per Woolly Pocket Unit (USD) $ 30.00 Source: woollypocket.com

Meters-sq per MicroGarden (sq-m) 30

Acres per MicroGarden (acres) 0.007

Source: http://www.a4architect.com/2011/02/10/best-land-prices-around-nairobi-kenya-price-kes-600000-to-kes-700000-per-acre/

Cost per Acre (USD) $ 300,000.00 Source: http://grahamgjfencing.co.uk/GJFENCINGServices.aspx

Fencing Cost per Meter (labor included) 67.18

Perimeter per Garden (m) 22

Total Fencing Cost (USD) $ 941,460.52

Total Land Cost (USD) $ 1,337,700.00

Total Woolly Pocket Purchase Cost (USD) $ 1,718,220.00

Total Capital Cost (USD) $3,997,380.52

Capital Cost Analysis for the 4-year “Hearty Garden” Construction Plan

49


Total Produce Servings demanded 5727388Annual Produce Servings per Woolly unit 100Units Required (demand/servings per unit) 57274

Units per Hearty Garden 90Total # of Hearty Garden Required 637

Kenya Minimum Wage per month (USD) $100.89 Source: BloombergAverage Workers per garden 2Labor Cost per Month (USD) $128,533.86 Labor Cost per Year (USD) $1,542,406.32

Soil+Water Annual Cost per unit (USD) $ 15.00 Seed Annual Cost per unit (USD) $ 7.00 Material Cost per Year $ 1,260,028.00 Total Annual Variable Cost $ 2,802,434.32

Labor and material costs to build 640 “Hearty Gardens” total $2.8MM over 4 years

Variable Cost Analysis for the 4-year “Hearty Garden” Construction Plan

50


Capturing just 1% of Nairobi’s produce market at a reduced price would yield an annual revenue of $3.2MM

Market Demand Analysis for “Hearty Gardens”

Nairobi population 3,138,295 Source: World Bank

Average Servings per person per day 0.5Days per year 365

Price per serving (USD) $ 0.56 Source: http://www.numbeo.com/cost-of-living/city_result.jsp?country=Kenya&city=Nairobi

Market Size (USD) $ 320,733,749.00 Market Share 1%

Annual Revenue (USD) $ 3,207,337.49

51


Year 1 Year 2 Year 3 Year 4 Total

Number of Total Gardens 50 120 360 637

Number of New Gardens 50 70 240 277 637

Revenue $ 251,753.34 $ 604,208.00 $ 1,812,624.01 $ 3,207,337.49 $ 5,875,922.84

Variable Cost $ 219,971.30 $ 527,931.11 $ 1,583,793.34 $ 2,802,434.32 $ 5,134,130.07

Capital Cost $ 313,766.13 $ 439,272.58 $ 1,506,077.43 $ 1,738,264.37 $ 3,997,380.52

Investment Required $ 533,737.43 $ 715,450.36 $ 2,485,662.76 $ 2,728,074.68 $ 6,462,925.23

This model assumes that revenue is realized for the following year

Year-by-year Cost-Revenue Summary

Four-year plan to build 640 “Hearty Gardens” would require an investment of $6.5MM

52


After four-year development period of 640 “Hearty Gardens,” program will be sustained on annual profit of $0.40MM

After 4-year Capital Investment:

Annual Revenue (USD) $ 3,207,337.49 Annual Variable Costs (USD) $ 2,802,434.32 Profit per Year (USD) $ 404,903.17

Summary Analysis of Annual Profit

53


“Hearty Garden” Design and Specifications

“Hearty Garden” Specifications

6m 5m Lanes 6Rows 3

Units per row 5

Units per Hearty Garden 90

Example of choice of fencing

54

2012 Triangle Global Health Case Competition

Documents

Transcript of 2012 Triangle Global Health Case Competition