Vula Mobile

PROBLEM: The problem we solve is that patients in rural and underserved areas in Africa do not have access to the right healthcare services. eg a patient in a rural area with an eye condition does not have access to specialist ophthalmology services which are only available in a distant city. Or a patient in a peri-urban township does not have access to physiotherapy services after an orthopaedic operation. 

CHALLENGE PROBLEM: The problem that is most applicable to this challenge: health managers and health administrators have no access to the communication data between health workers and have no way of measuring the quality and demand of referrals. So their problems is that they no way to allocate human resources between different facilities or to measure the demand for medical equipment, transport for patients and especially training needs of health professionals.

FACTORS: The problem of access to the right healthcare is affected by factors at different levels within the health system. Primary health workers do not have easy access to refer to or get advice from different health care professionals and specialist services. Specialist services are overwhelmed by patients who could have been managed at primary facilities. 

SCALE: We focus on solving the problems in the public health sector (as opposed to the private health sector). In South Africa, where Vula started, 71% of the population relies on the public sector, see "Healthcare in South Africa: how inequity is contributing to inefficiency" https://bit.ly/3QaRvzF. Meaning that in South Africa alone approximately 42million people are not able to access the right care in an efficient manner. Beyond South Africa, our focus is on Africa. Across multiple countries the % of patients relying on the public sector is either similar, or higher. So the scale of the problem in Africa is approximately 863million.

SOLUTION: Vula runs software that connects health workers

Vula connects health workers to each other at the right time with the right information so that the right action is taken for the patient.

TECHNOLOGY: The health workers use the Vula app and online dashboard. Data analysis and reporting is provided to health managers, surfacing insights on previously unrecorded referral and chat data. 

PROCESSES:

How it works

1. Health workers use the app and web portal for free and are directed immediately to the most appropriate specialist on call in their area.

2. The health workers complete a form specific to that specialist service, ensuring that a clinical decision can be made efficiently.

3. The health worker and specialist use our secure chat to discuss the patient and manage the patient. Typically there are three outcomes:

• The patient is transferred urgently

• The patient is given an appointment

• The specialist teaches the frontline health worker how to manage the patient

Data analysis and reporting is provided to health managers, surfacing insights on previously unrecorded referral and chat data. 

INCLUSIVE HUMAN-CENTERED DESIGN: Vula has been user focused since the beginning. Designed by a health professional (Dr William Mapham CEO) who experienced the challenges faced as a rural doctor as well as a public sector ophthalmologist. Since the initial use in ophthalmology the system has been adapted by over 50 types of specialist medical services and is now used by over 120 types of health worker. Vula has avoided being imposed on health workers as part of a funded "pilot project". There has never been a financial incentive to use Vula. This means that if Vula doesn't solve a problems for health workers then they wouldn't use it. Testament to the usability, adaptability and user approach problem means that Vula is used by over 10,000 health workers in 3 African countries. Please listen to interviews health workers using Vula. This was filmed by Sanofi, a pharma company, with the Department of Health. Interviews with health workers

HUMAN CENTERED DATA PRESENTATION: With the health workers and specialists using Vula to communicate it became apparent to health managers and administrators that Vula was collecting useful data. 

Working with the health administrators we experimented with a range of data presentations. Starting with a simple csv / excel download of raw data, which was useful but needed skills and time to analyse and find the useful segments. We moved to an online web dashboard, but even this took took too long for administrators to understand and download. Although we still iterate we have found a means by which to share data in a meaningful way that enables health administrators to strengthen health systems. This solution is a simple monthly 4 page PDF with infographics. This is easy for busy health workers to understand their data and is in a form that is easy to share with colleagues as well as for improving their health systems and motivating for human and financial resources. 

Health administrators often request specific reports. "I am once again most grateful to the VULA Team for formulating this useful 6-month report. The information is of huge benefit in terms of determining where we can improve our service. Thank you for the excellent service". - Albert Luthuli Breast and Endocrine Unit (Kwa-Zulu Natal). On average we produce 53 bespoke reports per month to meet the additional needs of health administrators.

Vula supports health workers have used data collected by Vula to conduct and publish research. To date 6 papers have been published. User driven research like this measures impact and also shows where the system can be improved.

 https://www.vulamobile.com/research

COMPARISON WITH EXISTING METHODS: Pre-Vula most communication between health workers used legacy methods or non-medical grade software.

Legacy systems include: e.g. Fax, Email, Letters, Landlines, Bleeper systems. Vula provides a better system that connects the right health workers at the right time. All information and data is recorded.

Non-medical grade software: e.g. WhatsApp, Facebook Messenger. Vula provides a compliant platform, keeping health worker information safe and enabling accountability: https://www.vulamobile.com/legal

Vula provides health administrators with analytics and easy to understand infographics, which would not be possible with the legacy and non-medical software. "Thank you for sending through these stats.They definitely add another layer of information for us to use to run our clinic better". - Groote Schuur, Internal Medicine. This is one of the reasons Vula is loved by health managers. "Thank you. This is so valuable. We sincerely appreciate this.
This was the highlight of my crazy Friday. The report is amazing and shows us where we can do better". - Tygerberg, Virology

COMPARISON WITH OTHER HEALTH DATA COLLECTION

There are many health data systems that collect health data in facilities eg hospital electronic records. Or health data from screening programs. However Vula does something different. 

The primary health workers and specialists using Vula are often in different facilities. Some of the Vula data represents data that exists between health facilities, between different units in the same hospital and between individual health professionals. This data is used as a measure of demand for services. "I have identified where the majority of our referrals originate. This information will assist with establishing outreach clinics and supporting colleagues to run these efficiently." - Addington Orthopaedics. This demonstrates the meaning of Vula's data analytic and presentation service to health administrators.

SUMMARY

WHO, HOW & WHY: Vula's apps and online services are used by primary health workers and their local public sector specialists every day to communicate, get advice, make referrals, arrange appointments, and get urgent transport for emergencies. Vula solves real problems for health workers and specialists. Because it solves their communication problems they use it. As a result of this activity health managers can analyse the communication data to improve health systems.

TARGET POPULATION:

Vula is designed primarily for use in the public health sector in Africa. The public health sector serves 70% of the population in Southern Africa. This is the population that do not have access to health insurance or medical aid and typically live in rural, and underserved areas eg townships and informal settlements. 

This population is underserved in a number of ways

Financial: Low levels of employment

Transport: Poor transport links eg bad roads in rural areas

Access to health services: Health facilities are typically in urban or developed areas

Health: Poor access to health services results in many conditions becoming chronic, with long term permanent disability.

HOW WILL VULA HELP

See this video for how Vula was developed in response to poor health access in a rural area. Vula's origins in rural health

HEALTH SYSTEMS IMPACT

This video above talks about the direct impact on patient care. Beyond this direct impact, the impact of the data collected while Vula is being used by health administrators to help make long term solutions "Thank you again for excellent work!! The app is improving and making it even easier to get our stats to plan on healthcare solutions!" - Karl Bremer, Orthopaedics

THE VULA TEAM

The Senior Vula team is lead by Dr William Mapham, who has lived the life of both a rural primary health worker as well as a specialist ophthalmologist in the private sector. 

Product: Debre Barrett started South Africa's first UX (user experience) company and recently completed her Masters in Public Health.

Technical: Alexandre Hardy has extensive experience, has been a lecturer at one of South Africa's Universities. In addition to his expertise he loves teaching and we have recruited junior developers who he nurtures and grows. 

Everyone in the Vula team has experienced either first hand or through a close contact the pain of not having access to appropriate healthcare in the public sector. We are all determined to make a difference.

Processes:

Senior management: Every Monday the senior team receives feedback from a user or a health administrator. Dr Mapham meets with health workers every week to understand their needs.

Product: The product team runs regular usability workshops to ensure we continue to improve the service to meet user needs.

Whole Team: Every month at our Town Hall we invite a health worker or administrator to meet with the whole company. Each person gets the opportunity to ask questions and learn more.

Summary

Making life easier for health workers helps them provide better healthcare for their patients in the public sector. While the health workers use Vula the data is collected. When the data is presented back to the health administrators in a simple format they can take action to improve health systems in the public sector. "This underscores the tremendous value of the App. I am so grateful to be one of many users of this extraordinary App. It has revolutionized our work stream and expedited referrals that previously would have had to wait many months for an appointment; simply because we as clinicians can assess the urgency according to information provided on the App. Thank you for keeping me posted regarding our performance. It is one way of ensuring we improve our service." - Albert Luthuli Hospital

“Moving toward the goals of Universal Healthcare and the National Health Insurance it is important that we all work together and use this common system”. - South African Department of Health

There are challenges that we would like to overcome with this Challenge. We believe that the Challenge will connect us with domain experts and contacts with people wanting to use Vula. The finances associated with the challenge will help Vula scale and 

Technical: Vula is scaling and we need technical assistance on how best to structure our databases to best meet the demand.

Legal: We have requests from multiple countries wanting to use Vula. We have done a lot of work on compliance, however we need legal advice or an assessment on if I have done things 100% perfectly.

Cultural/Market: Our direct personal experience and contacts in multiple countries is limited to Southern Africa. We would love to have more contact with people in other regions looking for a solution like Vula.

Financial: We need financial resources to directly improve data collection and presentation to enable measurement, monitoring and to directly help with health system improvements.

Vula runs software to connect health workers. 

DIFFERENT TO DATA COLLECTED THROUGH TELEMEDICINE OR FACILITY HEALTH SYSTEMS

Vula is different to telemedicine and facility systems that connect a patient directly to a health worker or a facility. Typical telemedicine can help one patient at a time, typical facility systems can only record what happens within the facility. However, with Vula, each time health workers communicate with each other they learn, meaning that health care delivery improves incrementally. Vula also enables a connected network of health workers that can help individual patients as a team. It is impossible for one health worker to know everything and Vula's innovative approach is especially importance for improving healthcare for patients with specialised and rare conditions. Vula is now used in over 50 specialties by 126 types of health worker. 

CHANGING THE MARKET

Health workers use Vula every day, collecting valuable data every time they use the app. There are many services that collect hospital level, clinic level or patient record systems. However, Vula collects data that is different. The Vula data is the communication between health workers, getting advice from each other often across multiple health facilities, making referrals between health facilities, prioritising appointments and organising urgent transfers. This data and the way it is visualised before sending to health managers helps catalyse better decision making. Testimonials

MEANINGFUL DATA FOR CATALYTIC CHANGE

We aim for broader impact. Broader impact requires research and publications that can demonstrate findings to t a wider audience. To work towards this we offer technical support for busy health workers at the frontline to conduct research on their own Vula data. We help them with their ethics applications and if needed any data analysis. This approach has resulted in 5 publications so far... Publications

STRATEGIC PARTNERSHIPS FOR INNOVATION

Vula has a sustainable approach to impact. Working with a wide range of specialties opened up Vula to partnerships with a range of organisations, government departments and businesses. Our goal is to improve health care in the public sector, so Vula is offered in that setting at no cost. However, we look for commercial partners to sustain and grow our efforts. 

RECOGNITION OF INNOVATION

Vula's impact and capacity to change health systems has been recognised locally as well internationaly. In South Africa MTN, the main mobile operator, voted Vula as the Best Healthcare Solution. Internationally the UNDP voted Vula as one of the top 4 global innovations improving access to healthcare. See UNDP award To see the awards in previous years see Vula innovation awards

Our Big Hairy Audacious Goal is to connect 1million health workers active on Vula daily 2035.

Vula is a network of health professionals.

To provide value and impact at a patient level we need to increase the number of connections on Vula. We measure both whether the health workers use the app or dashboard as well as how often and what they like to use Vula for.

Impact metrics: 

Our primary metric is "patients helped in the last 24 hours". This is collated and presented monthly to the whole team. 

Goal for 2022: reach a total of 1million patients (2014-present). We are on track to reach this goal.

Goal for next five years: reach a total of 3.5million patients 

Impact evaluation metric: 

The real value of Vula is best demonstrated by the health workers using Vula. Typically health workers in Africa find it difficult to find time and help to conduct research. Therefore we offer support with ethics processes and data analytics. Our goal is then to take their independent views of Vula and improve our services.

Vula is a network of health professionals.

To provide value and impact at a patient level we need to increase the number of connections on Vula.

Connection metric: Number of health workers actively connecting on Vula per 30 day cycle.

Current: 10,000 out of 26,600 registered health workers.

Next five years:  100,000 out of 250,000 health workers

Impact metrics: Patients helped

Total to date since 2014: 830,004

2021 total: 310,000

2022 goal: 500,000

Next five years: combined total of 3,500,000

Impact evaluation metric: Number of publications by African health workers using Vula data

Total to date: 5 

2022: 5 pending publication

Next five years: 20 

SUMMARY:

We have been working with a pro-bono part time consultant and we are working to finalise our theory of change this year and present it in an organised format. This process is incomplete and it would be great to be involved in this challenge to learn more from your expertise. 

Attached is our current summary:

Patients: receive SMS messages from health workers (requires no data connection)

Health workers: use the app and web portal for free. Can be used offline, but connection is required for chat messaging or calling.

Health workers at specialist services: use the app and web portal for free. Can be used offline, but connection is required for chat messaging or calling

Health managers: use the data reporting and Vula's data visualisation services.

Commercial partners: receive de-identified statistics from surveys and data related to how well their content performs. For example Sanofi rare disease division can better understand the needs of health workers as well as how to improve their content to meet those needs. 

These services are constantly adapted to best serve the user needs. This helps to ensure that Vula is scalable and facilitates networks between health workers.

Health workers use Vula to connect and as a communication system. They do this because Vula solves their problems. So their incentive is linked to the function. They don't think of themselves as data collectors, but as health workers that use Vula to improve care for their patients. 

As a by-product they continuously collect data. This data is then collated and presented in a meaningful way to health administrators. 

Vula believes diversity is essential and we drive this approach at different levels of the organisation. Currently we are a remote first company and have employees in 3 provinces in South Africa. Our country naturally has a range of cultures which we aim to represent and we we aim for gender equity.

You can see a picture of our enthusiastic team here: Vula Team

Board: 

5 members, two of which are black female, one of which is Chair of the Board.

Senior Mx Team: 

Female > Male

Entire team: 

Female > Male 

Black > White

As a team we speak most of the dialects within the 11 languages in South Africa as well as having colleagues who can speak French.