Meet Nana Twum-Danso, the ‘Angel’ of pregnant women in Rural Ghana

Her dream is to save lives of expectant mothers and their unborn children in rural Ghana. She does this through her emergency health transportation startup, MAZA.

Although MAZA has been a recipient of some funds such as Echoing Green Fellowship for social entrepreneurs, Cash prize from Clearly Vision, Innovation grant from USAID Systems for Health Project in Ghana and some individual funding since July 2016, the startup is still in need of funds and Nana makes up for that with her personal savings.

However, the danger associated with home deliveries far outweigh the amount of personal savings she has invested in her startup.

In this interview, she speaks about her motivation for studying medicine, the importance and urgency of MAZA and the challenges she has been facing.

Oyinkansola Sadiq-Mabeko of Tell us about your educational background?

Nana Twum-Danso of MAZA: I started my secondary school education in Ghana and completed it in a boarding school in the UK. Then, I proceeded to the United States for college and medical school.

Initially, I did residency training in emergency medicine. However, I was more interested in issues at the community and household levels, than fixing an immediate clinical problem in the emergency room. So I switched to public health and completed my training.

Then, I worked in the US for seven years, came back to Ghana, in 2008, worked in Ghana for about four years, then went back to the US for a few years to work for the Bill & Melinda Gates Foundation. Finally, I came back to Ghana last year to start MAZA.

OSM: What motivated you to study medicine?

NTD: A lot of factors. I come from a family of a lot of doctors. My father is a doctor, I have older cousins who are doctors , I have a sister who is a doctor, I grew up on a hospital compound, surrounded by doctors and nurses during my childhood, and I myself have had quite a lot of illnesses that got me into the hospital at different times in my life, and was grateful for the care provided.

These experiences all moved me towards the direction of medicine.

OSM: How did MAZA start?

NTD: MAZA did not come out of the blue, it came out of the fact that I’ve been working in rural health care for pretty much my whole career. I’ve been working on maternal and child health care for about 8 years now, and one of the biggest challenges in accessing health care in the rural areas are just the distance and the transportation.

I personally, and a lot of my colleagues in public health, spent a lot of our time and efforts in improving the quality of care in the facilities, encouraging people and educating them to come to the hospital early.

The logistics was always a problem. Getting the people who want to come to the hospital early enough so that the health workers, can actually do something to help them. I felt that was the neglected area.

So I spent some time thinking about what could be done sustainably and that was how MAZA came to be.

OSM: How easy was the decision to leave Bill & Melinda Gates Foundation to start MAZA?

NTD: A lot of the work at the Gates Foundation was around strategy for grants or strategy for influencing policy.

I like strategy, I like research and I love policy but I think I get more reward being closer to the problem solving and implementation aspects of the work.

It wasn’t that difficult a decision actually. Ghana is my home country; I have strong ties here both professionally and personally. The harder part is trying to figure out the best operational model for MAZA.

OSM: MAZA still needs a lot of funds, How have you been running it?

NTD: The actual practical aspect of getting MAZA running, of getting MAZA successful or sustainable is more of a bigger challenge.

We are in a new area and our model is a bit of a hybrid. We procure the vehicles and lease them on a subsidised level to the drivers on a work and pay schedule for two years. And in exchange for that subsidy, the drivers agree to be on call twice a week for health care transportation.

So every day of the week we have three or four drivers on call in case there is an emergency. We get calls through our toll free number or they call the drivers directly. We can activate the driver on call and then they go pick the person up and take them to the clinic.

That’s quite a complex model because we need to figure out the right amount of subsidy and how to make sure the drivers pay us the minimum amount on a regular basis.

So we are always asking questions like, “Have we gotten it right?” “Is it too high, is it too low?” “How do we get subscribers?” “How do we ensure the service we are providing caters to the subscribers needs?”. “We are estimating 3 vehicles per 10,000 people, is that the right ratio?” “Should we be doing more or less?” How do we mitigate against the unreliability of our telcom networks in the rural areas?” and “What response time can we commit to during rainy season when the road quality is bad?”

We are in an active learning and adjusting mode.

OSM: Considering your model, how easy has it been sourcing for funds?

NTD: It’s very difficult to get funding from elsewhere especially if it’s a new idea. Some people may be very skeptical and they wouldn’t want to put money into it.

Other people might be believers, they believe in the model, they see the logic behind what we are doing and encourage us, but they don’t want to put their money in yet until they see results.

However, if you really want to get going, the idea is to start small. Test and see if your theory is right, if the model you are using makes sense for the population you are trying to serve.

So at that point, I thought that the only way to get MAZA going is to invest personally, initially on a small scale. The idea was to give ourselves a year to demonstrate the viability of our idea, collect data, use those data to raise funds and if we are successful, we can scale up to a second and third district.

OSM: Don’t you think investing as much as 70% of the funds from your personal savings was a gamble?

NTD: If we are not successful, then it was a gamble I made. But given my knowledge of the rural areas that I’ve been working in for majority of my career, I thought there was something that potentially could work. It might not be the first model that we tried but I’m a big believer in what I do.

I’m a public health practitioner by choice, I believe that there are opportunities to make a difference in people’s lives and we need to think of creative ways to do that. The usual ways have limitations, so I was willing to take a chance on MAZA’s model of trying to make significant impact in health outcomes by giving people access to transport in a timely manner.

OSM: What has been your biggest challenge?

NTD: Our biggest challenge last year as well as this year was fund raising. Fundraising is very hard, especially for a startup, and especially for a nonprofit. I think if we were for profit and serving a slightly bigger population , or maybe if we were in small towns as opposed to the remote areas we are working in, we could come up with a for- profit model.

We want to be financially sustainable internally but we don’t anticipate making profit, having shareholders or that kind of thing.

So it has been hard for us. A lot of people we’ve approached in Ghana and other African countries are initially interested in the idea because transportation is a generic idea. But when they realise our model is not for profit, then they are not as interested.

OSM: What efforts have you made to deal with the challenge?

NTD: So we have been approaching people for grant funding rather than equity or loan. Grant funding also has its challenges in the sense that we are completely new and we don’t have much of a track record, considering we’ve only been operational for about 10 months.

Well we do have a track record but a lot of grant givers who find us interesting don’t want to take the risk. We get a lot of “come back to in a year or two when you have more traction”. So it is a very sensitive place to be just because we are new and our model is untested.

OSM: Can you tell me one moment that has made all the sacrifices for MAZA rewarding?

NTD: This young woman was pregnant and it appears she wasn’t accessing prenatal care. She didn’t know she was pregnant with twins.

The labour started. According to her she had gone relieve herself, it happened very quickly, and the baby came.

After the baby came, she screamed for help, somebody came to help her. The person realised there was a second baby inside her, and at that point they needed to get to the hospital.

This woman lived in the district where one of our MAZA drivers lives, and he drove them to the hospital at 1 am. The mother and babies are fine.

So a story like that makes you realise the value of access to emergency transport when you have a health crisis. Especially with the second baby coming, she couldn’t have sat on a bike or on a bicycle and she couldn’t have walked the 6 km to the hospital. That validates what we do.

OSM: What would you tell young people who are looking to start their own businesses?

Nana Twum-Danso

NTD: Being an entrepreneur is exciting, it can be rewarding but it also has it challenges.

I would also say that when you have a paid job that is challenging, that can be exciting as well.

The issue about entrepreneurship is when you have an idea that you believe will make a difference and isn’t being done anywhere else, you should be willing to give it time, attention, money – whatever it takes to test the idea. That’s a long-term thing. It’s not something you do half way.

I couldn’t have started MAZA while sitting in Seattle at the Gates Foundation. Most of my attention would have been on my job. You have to really believe in your idea. You need to give it your time to succeed. Of course it could fail, but it could also succeed. But at least give it a chance.

Don’t drag it on for 3, 4, 5 years doing it half-heartedly. You can do it as part time for a while to see if it has enough traction. Find out if you are able to gain customers or raise money. That can give you the financial capacity and confidence to leave your paid job to pursue your idea full-time.

I didn’t have that given how far Seattle is from Ghana. I took a risk but for me it was worth the risk. It’s hard though. I think you need support from your family, you want to make sure they are behind you especially because of the financial risk you might be taking. There might be a one- or two-year period where your income is limited or even zero. So if the family cannot survive that period of zero income or limited income then it’s harder to take the financial leap.

Asides from that it is very time-consuming. I haven’t had a real day off since I started MAZA. As an entrepreneur you will be working very long hours. It’s a very individual decision but it’s all about the idea. Start small, learn quickly. Then based on what you are learning, decide if you are going to continue and if you need a different approach.