Vula Mobile

For the more than 400 million people living with rare diseases, the journey towards diagnosis is often long and complex. Health workers themselves are often not sure about what to look for and how to make a diagnosis. "As a medical student I remember that my very last lecture was on rare diseases. I can't remember the content, just the interesting title" - Dr William Mapham (Founder of Vula Mobile). Vula Mobile is designed to connect health workers with each other to help provide holistic care. Since starting with two types of health worker in 2014 there are now 126 types of health worker using Vula. By connecting health workers efficiently doctors can connect with social workers, who can connect to geneticists, who can connect to psychologists, providing a network of care around each patient. This helps to optimize holistic care for people with rare diseases—including physical, mental, social, and legal support. Every month, each team of health workers on Vula receives a data visualisation report on their referral patterns, their response times and clinical data. The visual nature helps them use the data in reports to managers in order to motivate for resources. Thus, Vula coordinates care and strengthens data sharing between health care professionals and specialty services.

The focus must always be the impact on the patient's life. In addition to the connections between health workers on Vula's apps and online services, there is the provision for patients to receive messages via SMS (which require no data connection) messages from their health workers via Vula's dashboard. These messages are often the results of blood tests, information on conditions and dates for future appointments. This helps to mitigate barriers to accessing medical care after diagnosis which disproportionately affect disinvested communities and historically underrepresented identity groups.

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.

The health workers use the Vula app and online dashboard.

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. 

Vula's current target is the uninsured population in South Africa living in rural, remote and underserved areas. This accounts for approximately 80% of total population typically living in deep rural areas, townships, shanty towns and poor peri-urban areas. This group is served by the government funded public health services.

The public health sector has dedicated health workers in the rural, remote and underserved areas, however they are often under resourced and have little support themselves. See: How Vula is revolutionising healthcare

To meet the needs of the population Vula's solution helps at 5 levels. 

1. Patient: When a patient attends a health facility the health worker that attends him/her has access to specialist advice on Vula, so he/she receives specialist guided healthcare at a primary facility. This is especially important for rare and highly specialised conditions. 

2. Health workers: Having easy access to specialist advice or to coordinate services means that they learn every time a cases is discussed on the secure platform. Feeling supported they stay for longer in public facilities and will be able to help more patients. 

3. Specialist services: Being able to coordinate care asynchronously and remotely vis Vula helps more patients get managed at their first visit and helps to ensure that the patients most in need are prioritised for journeys to specialist clinics. Testimonials

4. Health managers: The monthly data visualisation reports help motivate for resources. This is especially important in areas that were marginalised during the Apartheid regime in South Africa. Data results in data driven decision making during budget and human resource allocations. In addition research can now be conducted to drive further systemic improvements. Read more here: Research publications on Vula's impact

5. Awareness of rare diseases in the health system: Every month, the departmental data visualisation reports contain information on specific rare diseases, how to make a diagnosis and how to start to manage patients. This is done as part of an impact contract with the rare disease division within the pharmaceutical company Sanofi. Raising this awareness is critical and this approach is also part of Vula's sustainability.

Although our current reach is within South Africa, we are now expanding into Namibia and Botswana. The next phase includes Ghana, Kenya and Rwanda.

The Vula team are passionate about healthcare. All of us have either experienced the need of being a patient in the public health sector, have a relative who is dependent on the public health sector or has worked in the public health sector. Of importance, one of our team has a rare disease, giving us first hand experience of what it is like to be a patient in the system.

Our approach is to improve the lives of our users, the frontline health workers, and to improve health systems so that is better care for their patients. Our support team is in touch with health workers on a daily basis, our technical team conducts weekly usability testing. Our data team communicates  with the health managers every month to ensure they get data that can drive decision making. Every month a selected health worker from the frontline presents at our all hands company town hall meeting. This all helps us very close to our users, their challenges and helps us drive solutions. 

Our Head of Product previously founded South Africa's first usability company (Flow UX). This drives a real focus on user centric design and usability. As a company we also focus on diversity. We come from a range of cultures and unusual for a tech company we are more female than male.

In recognition of the focus on health workers, the local mobile network provide MTN voted Vula the Best Health Solution in South Africa. The UNDP, in 2021, voted Vula one of the top 4 most innovative entities improving access to healthcare as part of the Sustainable Development Goals UNDP

We want to move from being a start up to a scale up. In order to do this we have known requirements that we need to meet in order to scale faster and help more people. I Hope that this Challenge will help me overcome obstacles to scale in Africa.

Scaling in the public sector in more African countries requires Vula to find funding and partners to work towards:

1. Legal compliance: Vula has already done a lot of work on compliance and we aim to set the standard in our area. See: Vula's current compliance To expand faster and into more countries we need a formal assessment of each country and to adapt Vula to all localised requirements.

2. Interoperability: African countries' public health systems all use a health IT system called DHIS2 DHIS2 countries in Africa. To scale faster in this sector we need to invest in our technology to create easy integration options for a variety of settings.

3. Language flexibility: We need to enable Vula to be used in a wider variety of languages. In South Africa there are 11 national languages with 2 most commonly used in medical practise. Growing into more geographies will require greater flexibility.

4. In-country partnerships. We believe that healthcare is best delivered through partnerships. In South Africa we already have agreements with public sector health departments. The Vula service is offered in the public sector at no cost.

5. Sustainability partnerships. To keep Vula sustainable we have commercial contracts eg related to rare diseases with Sanofi. Moving into more countries I hope that this Challenge will connect me more companies and funders so that we can grow sustainably in the long term.

Vula runs software to connect health workers. This is different to telemedicine systems that connect a patient directly to a health worker. Typical telemedicine can help one patient at a time. 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. 

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

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

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. An example is the rare disease division within Sanofi. They recognised that many people with rare diseases were not being diagnosed, no tests were being done and people were not receiving treatment. We ran a survey with the health workers to see what they knew. We demonstrated that health workers had little knowledge about rare diseases, were unaware that free rare disease testing kits could be delivered to their facility and were not sure how to manage patients with rare diseases. 

Commercial impact collaboration. Combining with Sanofi we ran in-app ads related to patients with rare diseases, links to how to order testing kits and more information on management. Using digital marketing is easy to improve and every month the ads were assessed and the results used as a catalyst for updating the creatives to help more health workers find the content appealing. The campaign has focused on the Lysozyme Storage Disorders. The first two sub campaigns were on Gauchers and Pompe. With further campaigns to follow in Q3 and Q4 2022.

Vula's impact and capacity to change health systems has been recognised locally as well internationally. See UNDP award

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. 

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: 798,843

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 

We have been working with a pro-bono part time consultant 

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:

Core technology per type of person:

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.

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.

Vula is a double sided network of health professionals. 

On one side we connect health workers with each other. They use Vula at no cost. On the other side we have customers. Customers include companies wanting to market to health workers, organisations who want to have impact in healthcare and health data companies. 

It took us a while to realise that out users are not our customers! We now have product market fit in 3 streams and have demonstrated revenue. 1. High performance medical marketing 2. Health systems impact 3. Health data contracts.

1. High performance medical marketing. We started to offer in-app advertising space in 2014 as well as advertising on the monthly analytic reports in 2021 . We have sold these opportunities to a curated range of health companies. Customers like Vula because it is highly targeted, highly relevant and delivers content that health workers find useful. Below are some images from our marketing media pack.

*(Note: The Gaucher in-app advert above is a GIF that rotates as puzzle pieces that put together the diagnosis).

2. Health systems impact: Vula's second product market fit is 'selling the impact'. There are organisations, businesses and occasionally government institutions that want to fund impact in healthcare. Examples from Vula include foundations like the Johnson & Johnson Foundation - they want to see improvements in the public health sector in South Africa. The collaboration is focused on supporting nurses by connecting them to specialist services and strengthening data analytics for referrals and health communication. See the link: Below is an infographic produced by the J&J Foundation

Another example, outside of South Africa is with Novartis. We have a strategic contract with their global division to scale Vula firstly in Namibia and Botswana. This is a commercial contract, specifically for ophthalmology, with the long term goal of their in-country brand managers having high performance medical marketing contracts with Vula in the future. See Novartis and Vula partnership. "“Novartis is committed to actively engage patients and healthcare systems, enable broad and fast access to innovation as well as improve health outcomes,” assured Racey Muchilwa, Head of Sub-Saharan Africa at Novartis. Customers like Novartis like Vula because we can demonstrate impact, track the change in health systems and over time offer new innovative attractive digital marketing opportunities.

3. Health data contracts: Now that Vula is scaling we are collecting a source of data that is different to that typically collected in patient records and hospital management systems. Vula collects the data related to discussions between health workers, across different facilities. With our strong focus on compliance, which is required for all research on Vula data. See the 5 current publications We have a way for health data to be analysed at a macro leve in order to help train AI services. eg Most Dermatology AI systems have been primarily trained on white skin data in Europe or America. This makes many of the current tools irrelevent in an African setting. However, all our dermatology cases are on 90% dark/black skin. This is one of the reasons why the data customers like Vula. We realise that we need to partner with institutions that want to produce globally relevant AI tools and services. In addition to our current contracts I hope that in the future, through this challenge, we can find partners to help look through the 780,000 cases on Vula and find the patients with rare diseases that may have been missed and to actively improve the care for people with rare diseases in the future.

Vula is a double sided network of health professionals. 

On one side we connect health workers with each other. They use Vula at no cost. On the other side we have customers. 

It took us a while to realise that out users are not our customers! 

We now have product market fit in 3 streams and have demonstrated revenue. 1. High performance medical marketing 2. Health systems impact 3. Health data contracts.

Historically

2014

Vula approach to financial sustainability has changed over the years since 2014. From 2014 - 2018 Vula won a series of innovation competitions and this provide enough capital to bootstrap development with Dr Mapham working full time as a Dr. 

2018 

Awarded our first high performance medical marketing contract and warded a government health impact tender.

2019 and 2020

Raised capital in seed equity rounds.

2020-2021

Awarded first data related contract - related to COVID operations on Vula

2022

If we achieve our revenue targets for all three revenue streams we aim to break even (with no growth in team) in 2023. However, if we secure funding from this challenge we can both grow the team, grow our commercial activities and scale our impact faster.

Vula is a double sided network of health professionals. 

On one side we connect health workers with each other. They use Vula at no cost. On the other side we have customers. 

It took us a while to realise that out users are not our customers! 

We now have product market fit in 3 streams and have demonstrated revenue. 1. High performance medical marketing 2. Health systems impact 3. Health data contracts.

1. High performance medical marketing customers include: Sanofi Rare Diseases, Essity, Next Biologics, Sanofi Mental Health, Ingress Practise Management and Western Cape Department of Health.

2. Health systems impact customers include: Novartis, Johnson & Johnson Foundation, Astra Zeneca, Clearly Vision

3. Data related customers include: Clinton Health Access Initiative (demonstrating that Vula can be used to guide specific campaigns during COVID)

Grant funding: We count grant funding from foundations as health systems impact, but in accounting terms not as revenue. It is used to fast track growth and to scale systems. This then increases our commerciality in the long term. I sincerely hope that we are accepted for this challenge. It is the only application that I have found so far that focuses specifically on the combination on tech, low resourced areas and rare diseases. Having the existing high performance medical marketing contract with Sanofi Rare Disease division in South Africa could be model for other countries once we have established Vula. I hope to be partnering with you soon.