Mobility

Mobility tackles the medical last-mile challenge. Four billion people lack access to essential medicines daily, many due to the distance to their closest healthcare facility. In South Africa, our initial market, 40% of communities in South Africa have to travel an average of 25 km to get access to healthcare. Individuals in these communities are 50% less likely to obtain chronic medications. Mobility delivers essential care directly to underserved patients through our two-part solution. Our micro-financing model provides community health workers (CHWers) with motorbikes without need for upfront payment. Our software platform allows pharmacies to request deliveries of medicines to households through our CHWers. We also seek to couple the delivery of medications with additional forms of care such as screening, diagnosis, and collection of essential health data from vulnerable populations that are often forgotten. If scaled, Mobility will revolutionize the way care is provided to rural populations globally. 

Four billion people lack access to essential medicines on a daily basis. This problem is particularly evident in South Africa where healthcare access is difficult for many due to geography and distance. 40% of communities have to travel an average of 25 km to get access to healthcare. 9 million South Africans live more than 5 km away from their closest healthcare facility. This distance serves as a barrier to receiving medications, as South Africans living 5 km away from their closest healthcare facility are half as likely to obtain chronic medications. Those who do make their way to a provider are typically met with long waiting times and frequent stockouts. This is especially true for patients with chronic conditions, as they must refill their prescriptions consistently over months. Difficulty in accessing healthcare results in patients often foregoing their treatment plan, which is incredibly detrimental for their own well-being and for the public health system in general, as long-term complications of non-adherence severely overburden already under-resourced healthcare facilities. 

Mobility’s software platform consists of three separate interfaces that utilizes community health workers (CHWers) to deliver chronic medicines from public health providers to households as well as provide care to patients at their homes. The provider-facing interface is a web platform allowing pharmacists to sign up patients for Mobility’s service, keep track of upcoming deliveries, and ensure proper flow of medicines. Patients are on an SMS-notification system that informs them of upcoming deliveries, allows them to re-schedule deliveries, and confirms that deliveries have been completed. Prospective community health workers are connected to microfinance institutions who provide them with loans to purchase motorbikes in exchange for a proportion of the future income they generate through Mobility. Once registered, community health workers are also on an SMS-notification system that informs them of delivery requests nearby, provides them with medicine dropoff locations, and allows them to track the income they have generated. 

Eventually Mobility will expand our services beyond medications by providing CHWers with the capabilities to conduct screenings for serious conditions, collect biometric data on vulnerable households and disseminate health education. Additionally, the crucial epidemiological data we collect will be provided to governments, foundations, and research institutions to strengthen health systems. 

Over 4 million patients in South Africa have HIV and over 2 million are regularly on antiretroviral therapies (ARTs). Even more patients suffer from chronic illnesses such as hypertension and diabetes. These patients with chronic conditions such as HIV, diabetes or tuberculosis who live far away from their closest healthcare facility without any transportation options have to walk through rough terrains, wait in long lines and leave behind their families and stable sources of income just for the smallest chance that their closest pharmacy has the medication they need. These barriers are often too large to overcome and patients eventually stop taking their treatment even when the government is willing to provide them for free. During our visit to South Africa last summer, we spoke with more than a hundred of these patients to understand their needs and the feasibility of our solution. Since then, we are showing various prototypes and functionalities to pharmacies and clinics to gauge the capacity of integrating our technology into their existing workflow. By delivering medications directly to households through trusted community health-workers, we hope to provide patients all across the globe the medications they need in the most convenient manner possible. 

Mobility seeks to empower South Africa’s underutilized workforce to make tangible change within local communities. CHWers in South Africa are currently paid minimum wage for only 4 hours a day and so many are forced to search for additional forms of employment within the informal sector to support their families. Additionally, South Africa’s youth unemployment rate of 54% is one of the highest globally. By employing existing CHWers, and in the future, training new ones, Mobility empowers South Africans to make change within their communities while earning stable wages with flexible working hours.

By employing trained CHWers, Mobility is able to utilize such a workforce to not only deliver essential medications but also act as a source of primary care. Through Mobility’s SMS platform, CHWers will be able to conduct screenings for COVID-19 and other serious conditions, collect data on the needs of vulnerable households, and provide additional support to patients. Furthermore, CHWers will collect crucial epidemiological data on patients, which will be used to create disease patient profiles amongst low income communities. This is pivotal to not only detecting an emerging outbreak but also prevent long-term complications associated with medication non-adherence. Compared to the current solutions such as Chronic Medication Dispensing Units, essentially Amazon lockers for medications, Mobility serves more patients, provides treatment options, and collects essential data.

CHWers in South Africa are currently part-time workers paid through a small stipend by local NGOs. By loaning motorbikes to these CHWers in partnership with microfinance institutions, Mobility deploys this underutilized workforce to provide healthcare to the country’s most under-resourced areas, thus leveraging the existing healthcare infrastructure to create change. Mobility mitigates risk for microfinance institutions by ensuring that individuals who receive loans from them will have a stable source of income. At the end of the repayment, Mobility provides CHWers with a motorbike, a stable source of revenue, and a credit history. The beauty of Mobility is that it builds upon the existing medical supply chain without replacing it.

The beauty of our technology is how we leverage existing means of communication and IT in South Africa to support a complex network that facilitates the delivery of medications to patients. Working in a region that commonly lacks smartphone access, WiFi, or even computers is a challenge when setting up a three-way communication system between  pharmacies, patients, and delivery drivers. We solve this problem using a system of automated SMS text messages for the patients and drivers, which work in conjunction with a webapp that manages everything on the pharmacists’ end. Once a patient signs up for Mobility and their prescription is entered into the system, we automatically calculate when the next deliveries will occur based on their treatment regimen and y text the patient to confirm a delivery date and time. Once confirmed, our system updates the webapp on the pharmacist’s end, letting them know the appropriate medication is ready to pack. Meanwhile, our system notifies all drivers in the area through an automated SMS that the medication is ready for pickup. Upon delivery of medications, health workers will also use the SMS software to conduct proper health screenings and diagnosis on patients through an automated chatbot able to record patient health data. Our technology is also in a unique position from a data collection point, as we operate in areas about which very little is known. Through targeted communication with our patients, we are able to collect extensive and valuable demographic information to make accurate community disease profiles.

We leverage Twilio’s API to control the automated SMS messages that schedule deliveries and pickups. Twilio is an industry-standard form of automated communication through text messaging. We have been piloting the use of our automated SMS platform in Philadelphia, in partnership with an organization called One Extra Bag, to help coordinate the delivery of groceries to patients in need during the COVID-19 pandemic.

Our system takes several precautions to ensure that medications are delivered to the right person in a timely fashion and that personal health information is protected.  

1. Patient and Driver Identification: We are looking to implement ID numbers distributed on an individual basis which will allow us to identify the patient at the time of delivery. Prior to their shipments, we send three different notifications to our patients to confirm or reschedule their deliveries. For drivers, their licenses are on file and at the time of pickup, the pharmacies can identify the community health worker not only with the code associated with the delivery but also with photo identification as well.

2. Data Collection and Confidentiality: Our system stores all patient details in a secure database that can be accessed only by the pharmacies when needed. No patient details are distributed through our software platform.

3. Asset Security: We plan on implementing a GPS tracking system installed in the vehicles which would give us essential information on how long certain routes may take or warn us about certain hotspots that should be avoided in the future.

Four fundamental themes define Mobility’s operations: equity in health access, economic empowerment, strengthened partnerships, and strengthened public health infrastructure.

1. Equity in health access: Inadequate transport to the clinics, the threat of losing employment, an absence of social support inhibit patients from taking chronic medicines. Long queues at clinics and inadequate mental and physical health services impede patients from seeking care (Kagee et al., 2011). By delivering chronic medications directly to patients and providing home-based primary care, Mobility improves medicine adherence. In the long-term, this will result in improved health outcomes by reducing the barriers in access to essential medicines.

2. Economic empowerment: Mobility’s loaning model provides CHWers with a motorbike and an opportunity to serve more patients in their communities. CHWers are currently only paid a part-time stipend in South Africa. MFIs are unsuccessful because they fail to show how beneficiaries can create successful businesses after receiving small loans (Datar et al., 2008). Mobility helps to create a client-centered strategy for MFIs by offering CHWer a sustainable way to pay off the loan. In the long-term, Mobility’s model allows CHWers to retain full ownership of their vehicle, provides them with a credit history, and empowers them to become microentrepreneurs to achieve economic stability. 

3. Strengthened partnerships: By working with public clinics in South Africa to serve patients, Mobility establishes partnerships with the provincial governments in the form of annual contracts measured by long-term cost-savings to the health care system. Mobility takes on this responsibility by creating incentives structures and building a distribution network. In the long-term, this partnership results in increased trust between the government and Mobility, allowing for even more room for collaboration.

4. Strengthening Public Healthcare Infrastructure: By delivering medicines directly to patients, Mobility takes the burden away from clinics. Clinics in South Africa have long waiting times, inadequate facilities and infrastructure, and insufficient staff. In the short-term, Mobility reduces the congestion at centralized clinics, increasing satisfaction among health personnel while decreasing the risk of supply shortages at the clinics. In the long-term, population health outcomes are drastically improved, lowering outpatient, surgical, and treatment costs associated with chronic medicine non-adherence.

Mobility currently serves 20 food-insecure, geriatric patients in the Philadelphia community. In a year, we hope to serve more than 50,000 patients in the KwaZulu-Natal and Western Cape provinces by partnering with a total of 10 health clinics in those regions. We have established contacts and received interest from Helimamy Moeng, Pharmacy Manager of the South-Western Districts of the Western Cape province to conduct the pilot study in the Fall 2020 and are working towards an LOI. In addition we have garnered interest from Ismail Subhan, the Senior Technical Advisor of the KwaZulu-Natal province where we hope to implement operations within a year. In five years, we hope to serve more than 3,000,000 patients across South Africa currently on ARTs and other chronic medicines. In addition, we hope to pilot Mobility in Kenya and Nigeria. With the help of our advisors from the African Resource Centre and Dr. Iain Barton, the CEO of the Clinton Health Access Initiative, we have been able to establish critical partnerships with stakeholders in the Nigerian and Kenyan healthcare supply chain. We hope to continue to harness these partnerships in the future in order to scale Mobility to serve as patients with chronic illnesses as possible.

We are currently working with the Western Cape provincial government to plan and implement our pilot study which will begin this fall. We have received strong interest from the Pharmacy Manager of the South Western Districts, who is helping us recruit CHWers, integrate Mobility’s software into their existing pharmacy workflow, and obtain approval from the Department of Health. We are currently also working with a local NGO, the Cipla Foundation, to plan the pilot. Our goal is to use our pilot study as a way to convince other provincial and national governments along with donors of the efficacy of our platform. By the end of year one, we hope to have expanded to Kwazulu-Natal where we have already established connections. We also seek to incorporate primary health into Mobility’s platform, building technology to allow CHWers to screen patients for serious, contagious illnesses, conduct essential biometric tests, and collect data on patients to better inform the decision-making of governments, foundations and the private sector. Within five years, we hope to scale to other countries in Africa in collaboration with our partner organizations such as the African Resource Centre (ARC) and the Clinton Health Access Initiative. ARC, a healthcare focused supply-chain focused NGO, has helped us establish connections with government officials in Kenya and Nigeria who have expressed interest in our solution. In addition, we hope to leverage partnerships with local NGOs to expand beyond employing solely CHWers to create healthcare training programs for youth to work for Mobility.

The primary barrier to scaling our venture is our reliance on government partnerships. While partnering with the government allows us to reach many people within one particular province and all their associated healthcare providers, it also entails significant regulatory, legal, and bureaucratic hurdles. Every government department has different needs and demands regarding the operations of Mobility and so adapting our model for new environments while maintaining our identity will be essential. Since governments are also resource-constrained, we must be able to convince them that Mobility will offer them a significant value. This will require thorough measurement and evaluation of our value to communities that can be shown to our customers through an in-dept pilot study. Culturally, we are asking patients, pharmacies, and communities to trust Mobility and our CHWers who will be entering the sanctity of people’s homes. Trust has to be built over time by ensuring any decision we make regarding services, prices and operations are approved by community leaders. Technically, we are operating in regions that may have limited wifi and cellular penetration. While we have ensured our solution is as simple as possible, technological barriers could still inhibit our growth. 

To overcome our technical barriers of working with the government, we hope to leverage our already established partnerships with local NGOs such as the African Resource Centre, Project Last Mile, and the Cipla Foundation. These partners have already established connections in the region and have a deep-rooted knowledge of the cultural landscape, which will help us better integrate into the existing infrastructure. Through our pilot study, we will evaluate the reach of Mobility, patient and CHWer experiences with the platform and changes in healthcare outcomes compared to the baseline.  We believe that conducting this pilot is pivotal to convince governments for future collaboration.

To overcome the social barriers of convincing patients and health workers to use Mobility, we seek to integrate ourselves in the South African landscape during the pilot study for 6-12 months to test patient attitudes and community perceptions of Mobility through regular, weekly household surveys and interviews with patients, pharmacists and community health workers. In addition, interviews with government officials on view of intervention throughout the duration of the study will be held. These qualitative measures along with our established community partnerships with district leaders will allow us to build trust with people and allow us to properly integrate ourselves into the landscape.

Our team has six members. We are all currently working full-time on Mobility.

Aris Saxena has a keen interest in social entrepreneurship and global health, studying finance and healthcare management at the Wharton School. He has strong interpersonal skills that allow him to efficiently move the team to the next level.

Yiwen Li is interested in the intersection of healthcare and business, studying molecular biology and entrepreneurship at the Wharton School. He is passionate about research and will take lead in designing the pilot study and creating a scalable business model.

Eash Aggarwal brings experience and knowledge from previous work with both seed-stage startups such as NeuroFlow and enterprise-level clients, studying artificial intelligence at the University of Pennsylvania. He leads the software development of Mobility.

Jacob Chidawaya is a native South African and brings a fundamental knowledge of South Africa’s political, social, and economic landscape to the team. He leads strategic partnerships and develops important connections for the team. He is also a computer science student at the University of Pennsylvania.

Corey Chan is a computer science student at Concordia University with a keen interest in designing technologies that make a lasting social impact. He brings backend software development knowledge, and spearheads Mobility’s SMS-based technology.

Sonia Shah brings creativity to the team, studying digital design at the University of Pennsylvania. She has a fundamental passion for working with socially-conscious organizations and believes that design shapes a company’s image by allowing it to better target customers and reinforce its mission.

We currently have relationships established with the KwaZulu-Natal and Western Cape Departments of Health who are helping in the design of the pilot study, recruitment of community health workers, and integration of our solution into the existing provider workflow. We also are partnering with the African Resource Centre, a healthcare supply chain focused NGO that has helped us establish relations in South Africa, Nigeria, and Kenya. We have received financial support and mentoring from the Wharton School of the University of Pennsylvania as well as the mentorship from the University of Cape Town Graduate School of Business. Lastly, we are working with the Cipla Foundation and the Clinton Health Access Initiative, two organizations that have worked in South Africa for years and have experience launching successful healthcare interventions, to establish further connections with local partners and adjust our solution to optimally serve our target patient base. 

By delivering chronic medications and providing primary care directly to underserved patients through trusted Community Health Workers, we seek to improve medicine adherence and healthcare outcomes. By improving adherence, we prevent long-term outpatient, surgical, and treatment costs for the government and patients, amounting to  150M USD for HIV alone. In exchange for these cost-savings, Mobility will charge governments fixed annual contracts to provide deliveries to a specified number of public health clinics and pharmacies. In addition, we will charge patients a small fee of 10ZAR for every delivery. Over time, Mobility hopes to expand its services by providing screenings for serious conditions ranging from COVID-19 to hypertension, collect basic biometric data such as blood pressure and sugar levels, and obtain epidemiological data such as the vaccination status of a household. This will not only help rural communities take ownership of their health in the comfort of their homes but will also provide valuable data that can be used by governments, foundations, pharmaceutical companies and insurance providers to improve healthcare outcomes globally.

In the short-term, Mobility seeks to fund its pilot study through individual grants and partnerships with organizations such as the Wharton School, the African Resource Centre, and the Cipla Foundation. 

In the long-term, Mobility hopes to generate financial sustainability through a fee-for-service model as well as through partnerships with the public sector and NGOs. Mobility will charge patients 10ZAR ($0.6) per delivery in order to cover a portion of its operational costs. Next, Mobility adds value to governments by minimizing additional outpatient, surgical, and treatment costs associated with chronic medicine non-adherence, which amounts to 150M USD for HIV alone. Through this, Mobility will charge the government annual contracts across their clinics. In addition, Mobility aims to collect patient data upon each delivery, recording it into Mobility’s private database. Using this data, Mobility will create patient disease profiles, conduct epidemiological analyses, and map consumption behaviours across low-income communities and sell its research findings to insurance companies, research institutions, NGOs, and governments. We hope to also partner with donor agencies that have vested interests in strengthening public healthcare systems and who can also act as a potential funding source for our work. Finally, we also seek to raise investment capital in order to scale our operations across multiple countries and develop new technologies that help respond to and prevent outbreaks.

After conducting extensive research on the need for a loaning-based delivery service for chronic medications in South Africa in the summer of 2019 and throughout this past year, our team feels that now is the right time to apply to Solve. Proving a strong need for the platform, we have already finished the development of Mobility’s prototype platform. Solve will allow us to further our mission by providing us a strong network of mentors and like-minded entrepreneurs to share knowledge and ideas as well as resources to bring our service to a historically underserved market. Using these resources, we would be able to both design and implement the best possible pilot study with the South African provincial governments throughout the next year. For example, through the MIT Humanitarian Supply Chain Lab, Mobility will be able to maximize the financial sustainability of our business model by optimizing operations. Beyond the pilot, the mentorship and the network at Solve will help Mobility scale its operations to affect the lives of more people around the globe.

Mobility seeks to employ CHWers that are currently trained and recruited by various local NGOs throughout South Africa. Mobility will seek to partner with these NGOs to recruit CHWers who are interested in earning additional income. Mobility’s long-term growth will require significant capital to allow us to sustain initial operations. To do this, we will partner with foundations and philanthropic organizations who seek to improve health outcomes globally. Mobility’s immediate next goal is to conduct a pilot study to quantify the value that Mobility adds to local communities. To do this, we have brought on board a Co-PI from the University of Cape Town, Dr. Richard Chivaka, professor of Healthcare Supply Chain. To rigorously evaluate our operations, we will seek to partner with global health organizations focused on evaluation such as PATH to ensure we have validated data that can then be used to pitch future customers and funders.

Mobility is looking to partner with local NGOs and implementation partners in South Africa (i.e. Project Last Mile) and international global health organizations (i.e. Global Fund, PEPFAR, Gates Foundation). In particular, we are seeking to implement our pilot study along with the Cipla Foundation which has established a set of dispensing medical stores throughout South Africa from which Mobility drivers will be completing deliveries. The Cipla Foundation will not only provide us with expertise in navigating relations with the government but also has an established workflow and CHWer base which we can draw on to maximize our impact. In addition, we are looking to partner with other implementation partners such as local NGOs who employ CHWers and outreach organizations who can help us spread word and build trust within local communities. The African Resource Center, an international healthcare supply chain NGO, is an essential partner with deep connections with ministries of health who is helping us present our solution to governments and gauge interest so that we can scale quickly when ready. Lastly, the MIT Humanitarian Supply Chain Lab has immense experience in evaluating and assisting distribution oriented ventures to optimize their operations and we would love to work with experts such as Dr. Jarrod Goentzel who has a proven track record of successfully improving deliveries globally. 

We would love to be considered for the Future Planet Capital Prize. Mobility is a for-profit venture that seeks to utilize both equity and grant funding to maximize its impact and maintain financial sustainability as it scales from South Africa to the globe. While being a for-profit, our venture is mission-driven and wholeheartedly focused on improving medical access to the world’s most vulnerable populations.