Afya Pamoja cofounders Patrick Anyanga, Robert Smith, Dr. Helga Mutasingwa, and Simon DeBere at the company’s office in Dar es Salaam, Tanzania.

In Tanzania, women are 100 times more likely to die from pregnancy-related complications than women in high income countries. But financial resources alone do not account for these outcomes of the country’s public health system. There are also disparities in how effectively resources are allocated and managed, says Simon DeBere (MBA/MPA-ID 2022), a 2021 HBS Social Enterprise Summer Fellow. In Tanzania, the government lacks the patient experience data it needs to make more effective public health decisions, an issue that became all the more apparent during the COVID-19 pandemic. “While working in East Africa before HBS, I saw the challenges of delivering public services at scale,” says DeBere, “and the need for citizens’ voices to be at the heart of public services decision making.”

That’s why DeBere and Helga Mutasingwa, a doctor and public health professional based in Dar es Salaam, Tanzania, cofounded Afya Pamoja in that country in 2020 with Patrick Anyanga and Robert Smith. The mobile patient feedback service uses text messaging to provide a convenient and confidential channel for patients to share feedback on such things as the quality of care they received and the cleanliness of the facility they visited, as well as any incidences of abuse—reports that have long been handled through pen-and-paper forms and suggestion boxes. Afya Pamoja analyzes these data to provide actionable insights to public health officials to support responsive and accountable decision making.

In the summer of 2021, DeBere’s Social Enterprise Summer Fellowship enabled him to work with Mutasingwa to set up a pilot of Afya Pamoja’s service in primary care facilities in Tanzania. The country was chosen because Mutasingwa was established there, the needs were great, and government ministers wanted to find a solution. The goal is to expand to 100 of the country’s 6,000 public primary care facilities by the end of this year.

Solving the Problem
DeBere, who worked previously in international development in Nairobi, Kenya, and consulting in his native London, incubated the idea for Afya Pamoja—which means “health together” in Swahili—at HBS and the Harvard Kennedy School (HKS), where he is participating in a three-year joint master’s degree program in Business Administration and Public Administration-International Development. “I came to HKS to define the problem I was interested in: How do you work with governments to deliver accountable public services?” says DeBere. “I came to HBS to define how I wanted to solve that problem: What business and operating models could be used to do this in low-resource settings?”

Afya Pamoja benefited from numerous programs at Harvard designed to foster student startups. In 2021, the company was a finalist in the HBS New Venture Competition’s social enterprise track and participated in the Harvard i-lab’s Venture Program, where it was named a semifinalist in the President’s Innovation Challenge. And in addition to receiving a Social Enterprise Summer Fellowship from HBS in 2021, DeBere received one in 2020, which enabled him to serve as a research intern for OpenUp, a civic technology company based in South Africa that shares Afya Pamoja’s vision for using data to better connect government and citizens.

The Social Enterprise Summer Fellows program, which debuted in 1982, funds student forays into nonprofit and for-profit organizations focused on the public good. In addition, the HBS Social Enterprise Initiative offers fellowship recipients opportunities to network with and learn from other fellows through a schedule of events and discussions.

The School provides similar opportunities to MBA students interested in exploring careers during the summer in sectors that don’t traditionally offer sufficient compensation to short-term employees. For example, the Rock Center Fellows Program subsidizes students working on an existing startup or launching their own, and the Career and Professional Development Fellows program aids career changers, such as those interested in the luxury goods sector and venture capital.

“It is a way for students to experiment safely,” explains Kristen Fitzpatrick, managing director of Career and Professional Development, which helps to administer the programs. “Through these fellowships, we can make all opportunities open to all students, regardless of financial need. That’s an important part of the HBS experience.” In 2020, in the midst of the pandemic, nearly 750 MBA students—triple the usual number thanks to alumni gifts to the HBS Fund—received funding under expanded eligibility criteria. In 2021, the demand for these programs returned to normal, with approximately 225 students participating.

“It is fantastic that HBS supports students who are going to take a slightly riskier or—at least in the short term—less lucrative path,” DeBere says of the fellowship. “It gave me the flexibility I needed to pursue the opportunities I wanted to.”

Dreaming Bigger
Within five years, DeBere wants Afya Pamoja to reach all of the 50 million patients who use the government primary care system in Tanzania. He also sees opportunity in other countries in the region such as Kenya, Uganda, and Nigeria, as well as in working with private health care providers and health-related companies, such as insurers.

“Thinking even bigger, we want to develop a suite of citizen engagement tools across different sectors,” DeBere says. “Our service doesn’t have to be just for health care. You can also think about it in the education space or the agricultural space. You can think about how citizens’ voices can be amplified to influence decisions affecting many aspects of their everyday lives.”

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