Ensemble Pour La Difference and Fjord


The Democratic Republic of Congo (DRC) is one of the world’s poorest countries. It means healthcare is thin on the ground, and what little healthcare that exists is out of reach for most people. However, funded by our very own Fjord Innovation Fund, we’ve been helping one doctor who is working hard to change that.

The project forms part of a bigger initiative called ‘First Light’, a collaboration between Fjord, and a fantastic not-for-profit called Ensemble Pour La Difference. Ensemble is an organisation founded by one of Fjord’s own founders, Mike Beeston. It provides design and innovation mentorship and loans to SME’s in the northeast of the DRC. Its aim is to help Congolese people build sustainable businesses and own their own development.

Read more about our work on Idjwi here.


When we started working with Dr Pascal he had recently returned to Kavumu after having worked in large hospitals. The Kavumu area badly needed a clinic. Malnutrition, malaria, injury, violence and lack of family planning were all big problems, and for many the only support was traditional medicine. Dr Pascal’s vision was to provide modern healthcare across the region, and with a loan from Ensemble he had set up Kavumu’s first dependable hospital.

More than a medical challenge

Why were we involved? As patient numbers grew, Dr Pascal’s most urgent need was to introduce a digital patient-management system. All records were being documented in notebooks and stored in lockers, and those lockers were filling up! He needed a digital solution – but also one that could deal with the unique challenges of the area, including daily power cuts. Dr Pascal also wanted to provide medical services that extended the reach of the hospital. For example, how could he set up an affordable ambulance service? And how could he help patients follow courses of medication once they got back home? It needed a team experienced in both creative technology and service design – and that team was us.


Our first step was to install the much-needed electronic medical records platform. After much research we settled on the OpenMRS system. One of the big advantages of choosing open-source software is that it’s accessible to a global network of contributors, who will be able to help the hospital solve issues and develop capability in the future.

To overcome the daily power cuts, Dr Pascal often switches to solar power and even motorcycle batteries. So we needed to make sure our technology choice was low power. To do that we repurposed a discreet low-power home-entertainment PC to act as the server hub, and provided rugged Android tablets to nursing staff. We also used the rugged internet router, BRCK, designed in Kenya, to regularly back up the patient database to the cloud. A low-power, highly efficient solution.

Fjord’s work to introduce OpenMRS brought an immediate step up in patient care and accelerated the hospital's reputation for quality. As a result the UN agreed a major health care contract and Dr Pascal is planning to expand the hospital. That’s progress!
Mike Beeston Founder, Ensemble Pour La Difference


Dr Pascal’s new IT system went live in February 2016, and after just two weeks all his patients were successfully registered.

Now the system has been running for over three months and over 500 patients are being managed in the system. Due to the knock-on effect of lowered admin time, the hospital is now able to treat between 20 to 30 patients a week, three times more than before the implementation where 6-7 patients were treated a week.

Crucially, the introduction of the system has been pivotal in Dr Pascal securing a contract with the U.N. to treat 1000 Congolese U.N. employees.

Scaling healthcare to a wider customer base

This service is both scaling the reach of the hospital’s services and building trust.  Dr Pascal has been energetically marketing the hospital to a wide area, but we need to help both introduce and educate the importance of modern healthcare to very isolated communities.

Automated telephony healthcare, powered by SMS

The next step was to think about services to extend the hospital’s reach. One particular challenge for Dr Pascal’s team was that many patients weren’t able to read the instructions on medicine they were given, and couldn’t afford to phone the hospital to ask. So one of our goals was to find a way to make prescribing drugs more manageable for patients – and sustainable for Dr Pascal.

In many developing areas of the world, SMS – texting – is proving a really effective tool for service delivery. Indeed, in Kavumu most people have access to a low-cost mobile. So we prototyped a service that allows patients to text a reference number to the hospital, and get an automated telephone call back to their mobile. This call will include a pre-recording from Dr Pascal, explaining their prescription and what they need to do. This prototype has gone down really well, and our next step is to scale it, introducing an operating model, so Dr Pascal can provide automated messages for a variety of emergency situations, like immediate treatment of malaria, malnutrition and pre/post-natal care.

Seeing the immediate impact of our intervention has been tremendously rewarding. We can tangibly save lives by finding innovative ways to onboard isolated communities onto modern healthcare
Euan Millar Creative Technology Lead, Fjord


There are no ambulances in Kavumu. Patients can only walk, be carried, or be bounced along on the back of a bike. Clearly there is a huge need to get patients to and from hospital more comfortably, and this was our next challenge. We also needed to figure out how people could explain where they lived without formal addresses – and how to set up an easy payment model to cover the service’s costs.

In a Fjord Makeshop we held in Nairobi, Kenya we researched and designed a service utilizing the ‘eRanger’, a motorcycle with a sidecar ambulance pioneered in South Africa. Then to help patients explain their location, our Ensemble colleagues came up with the idea of people simply texting their local chief’s name! It was a perfect low-tech solution: a chief looks after one village, and can therefore become a place marker.

We are now moving forward into the implementation of these services that we are confident will help. Most of all, it will mean that for the first time many patients surrounding Kavumu will be able to access care and support regardless of distance or education.

We are now hoping to partner with health providers, governmental and non-governmental organisations, to try to scale our activities. To find out more about our work with First Light in the Democratic Republic of Congo and how we have helped bring the Internet to a remote island, visit our microsite here.