Speetar

Sickle Cell Disease (SCD) is a genetic disorder with lifelong debilitating effects including but not limited to anemia, chronic pain crises, organ damage and more. With high mortality and morbidity, access to continuous specialized and primary care as well as emergency care in times of crisis (e.g. pain crises) is necessary to properly manage this rare disease. In Sudan where the prevalence of SCD is highest in Darfur at 30.4% as a 2014 study in the Pan African Medical Journal reported (relatively high compared to similar countries in the region), the lack of access to care for SCD patients is exacerbated by 1) a collapsing health system and 2) a low number of healthcare providers in general.

Sudan’s health system is on the brink of collapse. Years of conflict, privatization of healthcare, genocide, brain drain, and systemic racism/structural violence have decimated the public health system in Sudan which the majority of Sudanese people depend on. Just as recently as 2020 access to health fell among the top 3 areas of extreme need in Sudan according to a 2021 UN Humanitarian Needs Review, with no end in sight.

According to the World Health Organization World Health Report of 2006, a minimum of “2.5 medical staff per 1000 people are needed to provide adequate coverage with primary care interventions”. As recently as 2017, the number of medical staff per 1,000 people in Sudan is 0.3– this includes primary doctors and specialists– an astounding 8 times below the recommended number. With the number of physicians insufficient to even cover primary and emergency health care, those requiring specialized health care such as SCD patients are completely overlooked by existing health solutions in the region.

Speetar is a Telehealth platform that provides accessible, affordable quality healthcare in adverse conditions and creates centralized health data to protect increasingly mobile populations.We created Speetar to help limit exposure and provide quality care at a lower cost both on the patients’ end and at the point of care thereby, alleviating some of the strain health systems face in conflict-affected areas in an innovative way. Our pilot country of Libya showed tremendous success with Speetar and we will innovate even further as we turn to Sudan with its similar country profile, pronounced need, and regional proximity, with a particular focus on SCD. 

We offer accessible, affordable quality healthcare particularly in the adverse conditions of conflict-affected communities through our three-pronged model rooted in a drive for greater social, racial, and gender equality. It is (1) a patient mobile app (2) a doctor web-based app, and (3) an on-ground patient site so patients simply schedule, pay and receive timely medical consultations regardless of the low-resource setting they live in. 

Our App currently offers three main services:

1) Flagship Doctor-Patient Telemedicine Platform 

2) Electronic Healthcare Record System

3) Clinic Scheduling Platform

Our mobile and website app, developed by local medical professionals in our Pilot country of Libya, is embedded in a unique, local support ecosystem and integrates language- and culture-matched UX/UI. Speetar’s unique platform is tailored for patients with low technological, financial, or health literacy and marginalized communities who would otherwise be prohibited from receiving comprehensive health services. Our patient-to-doctor platform enables underserved patients (currently in Libya, with imminent expansion to other countries regionally) to access affordable, language/culture-matched specialists (practicing locally or abroad).

Speetar addresses brain drain and builds capacity by training local specialists and mobilizing the large Libyan medical diaspora. Our most used specialties serve senior citizens and women (chronic disease, OB/GYN) and mental health, which is a particularly underserved taboo specialty in the region. Our approach opens a new trajectory for systemic change of the collapsing healthcare systems in conflict-affected countries and equalizes access for underserved and intentionally overlooked populations.

Of particular importance is the improvement of equitable health care access for migrant/refugee/IDP communities and women/girls. Informed by our team’s experiences (over 65% women or displaced/marginalized individuals) we architect locally owned,  transformative approaches to health equity. Speetar has partnered with the two national mobile companies in Libya to serve those with no data/smartphones through SMS and Health Dots (tailored remote diagnostic and treatment kiosks). We provide care at no cost to those who qualify through unique health sponsorship programs. Our platform is intentionally accessible with audio and visual features for the 8% of illiterate Libyans. These principles are key to our approach to Sudan which has a similar country profile to our Pilot country of Libya. While the populations differ in size drastically with Sudan’s population outnumbering the population in Libya, the national language, Arabic, is the same across both countries, and the histories of conflict, war, displacement and disparity overlap in profound ways, not to mention the deficits in health services and proximity to total health system collapse.

A key difference between our Pilot country and our Target country of Sudan is the difference in health spending per capita and the differing sources of spending. In Sudan the health cost per Capita is 47 USD with 70% percent coming from out of pocket costs while in Libya the per capita spending is over 600 USD with the majority coming from Government spending. The high out of pocket costs in Sudan are partially due to 1) a lack of government subsidies  2) high costs of travel for those in isolated areas, especially in Darfur, due to limited health facilities and 3) high and fluctuating costs of in hospital services. These costs are even more pronounced for those requiring continued care such as SCD patients. As such, central to our model’s application in Sudan will be two key innovations: the expansion of our triaging tool, the expansion of our specialist referral system, and the long term implementation of newborn screening in the region. 

We recently worked with the Ministry of Health in Libya, with support from our partner UNDP to act as the COVID-19 triage and tracking system in Libya. Our triage tool focussed on viral transmission proving instrumental in the Government’s approach to addressing COVID-19 in Libya. 

In Sudan, in order to decrease out of pocket costs and high costs of travel, we aim to expand our triaging tool beyond COVID-19 tracking and tracing. SCD patients experience high morbidity and comorbidity (e.g. from infection) and as such are highly vulnerable to hospital settings especially considering the severity of the variant of SCD each patient lives with. Any possibility of reducing need for hospital attendance will not only lower the possibility of infection from the hospital settings themselves, but will also work to mitigate other risks and costs. Strengthening the triaging tool in this way will streamline the consultation and referral process and consequently minimize unnecessary travel time and reduce time spent in hospital to only what is deemed necessary after consultation through our telehealth service. This is of particular need in Sudan given that the current national facility-based disease surveillance system extends to only 40 per cent of health facilities across the country which greatly limits health monitoring capabilities. As such, our triaging tool innovation will work to absorb the role of health monitoring over time and work in tandem with our treatment and referral system to improve overall health in the long run. 

Our referral system currently focuses on making sure that patients have access to specialists when needed. While expanding to Sudan, we will address the staff shortages by leveraging the diaspora and higher concentration of medical professionals in key regions to expound on our referral system through inter-hospital and collaborative dialogue between providers. Expanding our triaging tool and tailoring it specifically to SCD patients while creating and implementing a strong consultation and referral system will help our patients become and remain part and parcel of their specialized care plans and provide peace of mind in limiting hospital visits to what is absolutely necessary, and providing access to quality care at home. 

The side-effect of reducing out of pocket costs and costs of care will be that the available government and Humanitarian spending will be free to go toward essential and specialized health services and not only healthcare management / operations overhead. As the WHO has established, a little goes a long way when it comes to healthcare spending in developing health settings as essential health services like vaccination can drastically improve the lives of patients: in Sudan only 0.69 USD per capita investment is needed to achieve one year of increased life-expectancy and even less, 0.045 USD is needed to Save 1 Under 5 Years Old Child from Premature death according to a 2015 analysis on differential spending in WHO’s Eastern Mediterranean Regional Office (EMRO). 

For SCD patients, this need is even stronger as early detection and access to quality specialized care with continuity is instrumental in creating better health outcomes and mitigating the impact of SCD on their quality of life. In Sudan, without an existing robust health infrastructure, the gap in access to said quality, specialized health interventions (i.e. access to a hematologist, transfusions, pain management, patient care plans, newborn screening and more) can begin to be addressed with our solution.

In the long term, establishing a new born screening program through our telehealth solution will help to establish continuity of care from the outset for SCD patients, helping providers and people living with SCD get ahead of managing the lifelong illness. We will use our consultation system as well as our patient record system to help patients in communities with a high prevalence gain access to testing, eventually using our clinical scheduling system to manage and implement new born screening. Our referral system and our patient record system will then help us facilitate continued care for newborns and families post-screening if SCD is identified. Using our telehealth solution in this way will make it possible to provide care as early as possible for SCD patients in Darfur.

Ultimately access to regular, quality telemedicine not only transforms the lives and opportunities of our constituents in the short term but the systematic data collection creates opportunity for longer-term solutions. On a human level, investing in people and recognizing their dignity and agency has an unbound impact: from ensuring better quality of life for people living with SCD, indigenous peoples, women, children, and other vulnerable populations to increasing economic opportunity and reinvestment in our communities, the impact is immeasurable.

Who we aim to serve: the most underserved 9.2 million people in Sudan’s remote areas and protracted vulnerability situations beginning with the 30.4% population of SCD patients in Darfur currently overlooked by the existing health system.

Our constituents are patients and healthcare providers, in particular the most underserved populations in Sudan and the untapped provider network they do not yet have access to, with a focus on SCD. The most recent UN Humanitarian Needs Review of Sudan identified approximately 13 million people most in need of humanitarian assistance. Of those 13 million, 9.2 million (the overwhelming majority) are identified as being most in need of health interventions. Of those 9.2 million, 2.5 million are refugees both internally displaced and otherwise and 72% are women. Of the most vulnerable population of 9.2 million, 59.9% are classified as severe health risks leading Sudan to be classified as a level 2 severity country by the World Health Organization in 2020. 50 % of Sudanese doctors are outside of the country, meanwhile inside the country the number of doctors per 100,000 was merely 54.6 in urban centers like Khartoum, the capital and only a shocking 3 doctors per 100,000 in South Darfur as recently as 2014. While the number of doctors per 100,000 people has now increased to 81 in areas like Khartoum, the disparity remains. In comparison WHO’s minimum requirements for universal health coverage is 445 health workers per 100,000  people. 

Recently, access to care for this population has dwindled even further with one in three households among the most vulnerable populations reporting a decrease in availability of health funds due to economic duress– specifically households reported having to reallocate savings to focus on sustenance and away from health (as well as education) due to higher healthcare prices, economic strain, and systemic collapse. In some cases, prices have increased by 3,000-5,000% as government subsidies decreased in the governance vacuum following the coup (Al Jazeera). As such an increasing number of patients have not been able to afford to seek treatment. High-turnover rates and low retention due to armed conflict, health facility closures and brain drain as is the case in most conflict-affected countries, particularly in the region– have led to significant staff shortages as well. 

The issues laid here disproportionately affect indigenous people, displaced people and women, especially women of reproductive age. Currently, nearly a quarter of healthcare facilities in Darfur are not functioning and nearly 30 percent of refugees are without access to primary health care services while those who do have access are routinely charged higher fees than Sudanese nationals. As we stated before, 30.4 % of the population in Darfur are affected by this rare disease, this includes refugees, indigenous people, and a plethora of underserved populations. It is impossible to fully understand the need for the population affected by SCD without understanding the larger context: patients hoping to access regular care in the region already face pronounced barriers to care, patients requiring specialized care face even more barriers and thus require assistance urgently. A 2019 study in Al Fashir Teaching Hospital in the capital of Darfur found that 14.8% of the hospitalized pediatric patients that were tested presented with SCD. The study identified a pronounced need for newborn screening and research considering the context in the region and the lack of data as well as access to care.

Our Telehealth solution will enable our vulnerable, hard-to-reach communities/target audience to access quality/specialized care that otherwise requires thousands of miles of dangerous, costly, and burdensome travel. Amid active conflict, these challenges have caused many to defer care or not access care at all. In settings like these, preventive care is almost entirely inaccessible.  

By renewing our focus on expanding our triaging tool, our innovation will protect the health of vulnerable populations. It will 1) reduce unnecessary travel, 2) streamline point of care processes for providers and 3) ensure that, if travel is required, patients will not be refused care at their destination as we’ve been able to demonstrate in Libya through our viral transmission-focused triaging tool during COVID-19.

For SCD patients, reduced hospital visits, shorter wait times, lower costs, and centralized medical records will promote earlier diagnosis, better treatment outcomes, and accessible follow-up care. The efficiency and collaborative approach of our innovation will build capacity and allow for holistic care for our providers. 

Complementing its direct service delivery, Speetar creates a sustainable Telehealth infrastructure and communal literacy to establish a more equitable system. Facilitating new streams of systemic investments in marginalized communities and driven by inclusive data collection and incentives (e.g. through government partnership, Speetar provided COVID-19 support and care for previously overlooked populations in Libya and similar work can be done in Sudan looping in B2NPO partnerships). 

End-state health equity will improve the lives of millions without healthcare access or who have to travel exorbitant distances to see a doctor– an issue that currently disproportionately affects indigenous peoples in Sudan, particularly in Darfur . Our solution also has particular implications for women: from improving access to family planning tools & making it possible for women to meet at least the minimum requirement of four antenatal care visits during pregnancy to providing proper CRM in relevant contexts. The benefits of our innovation will potentially go beyond health as well, benefiting all vulnerable communities including the elderly by reducing the burden on patients and providers through increased economic opportunity and community reinvestment in health in general.

My family escaped to Yemen when I was only one year old as we fled the brewing conflict in Sudan that would later become the Darfur Genocide. From Yemen, we came to the US on the Visa lottery where I saw my parents work to recreate a life for us here, heal from the trauma of escaping the war, and work to end the violence back home as our family members perished. Growing up in Philly as an indigenous African woman, I came to realize that it isn’t enough to end literal violence, but we must address the deeper systemic, structural violence if there is any hope for lasting change. It isn’t enough to stop destruction, but we must also rebuild if there is any hope for a return to peace, to safety, to home. Finding refuge in education and healthcare advocacy work, I’ve worked to foster and facilitate the inclusion of marginalized voices in every aspect of my work. In developing healthcare context I've found that the most marginalized tend to be overlooked socially, economically, and by the very healthcare system they depend on msot.

Whether it’s the Sickle Cell Organization I co-founded at age 19 which served the marginalized, indigenous Tharu population in Nepal or my continued work with UNHCR as a Goodwill Ambassador, my passions are deeply rooted in uplifting our communities across contexts. Having personally lost many family members not only to the genocide but also to the collapsing health system in Sudan– as recently as this January 6th, we lost my great uncle, he’s buried in Hydrabad where he was forced to seek care due to a lack of access in Darfur and Sudan at large– I am intimately familiar with the problem we are aiming to solve. Having lived a life deeply informed by loss, by grief, but also by hope, I can firmly say that the honor of serving our communities on a team lead by people from our communities is something I never knew I would live to see. My hope is to see this mission through, addressing the needs of our communities and opening the door to a drastically improved quality of life.

At Speetar, there is no greater resource than our people, with their extraordinary collective talent, vision, and experience. Our forward-looking, dynamic and diverse leadership team of dedicated medical providers, engineers, and business leaders, bring 50+ years of professional experience in global health access and social innovation, with a proven track record spanning across leading tech, nonprofit and humanitarian organizations such as Harvard Medical School, MIT, UNHCR, WorldBank, Google, Walmart Ventures, and the Danish Refugee Council. 

Our CEO and Speetar’s founder, Dr. Mohamed Aburawi, for example grew up amidst Libya’s tribalist dictatorship, spurring a passion for equity. When war broke out in his final medical school year, Mohamed mobilized ad-hoc teams to organize frontline clinics for the many civilian casualties. This experience informed both Speetar’s foundation and today’s progress: 90+% of Speetar’s team are local care providers who gained a thorough understanding of the health system and patient demographics during protracted conflict. 

Many organizations parachuted in (and out) during the wars in both of our countries. Our team thus works to highlight that those most impacted are the most informed and have unique credibility, networks, and experiences to create sustainable change. Speetar’s local ownership focus, KPIs, and staff composition (53% women leadership) are an inclusive reflection of Speetar’s partner communities; e.g. Speetar’s most effective teams comprise local practitioners, mental health patients, senior citizens, and displaced people and I can’t say enough how meaningful it is to be a part of this.

Rare diseases, such as SCD have inherently small and dispersed patient pools, putting them at a low priority for governments and funding agencies. Historically, this has led to insufficient shares of national health budgets worldwide being allocated to treat rare diseases, resulting in continuous and increasing financial impact for patients, health systems and economies. This statement is true for all countries worldwide but has particularly deadly implications for SCD patients who live communities affected by protracted crises. Accordingly, it is estimated that 50% to 90% of infants born with (SCA) in sub-Saharan Africa die before 5 years old Combating a legacy of racism, studies have also shown that the global and local underinvestment in SCD is additionally aggravated compared with other rare diseases that mostly affect white people. 

Without the support of this challenge there would be no way that a service like ours could be funded and launched in Sudan. If successfully launched and scaled, Speetar’s open partnership approach could also promote replication and change the lives of patients in similar difficult healthcare environments. For Speetar to do so, not only Horizon Prize’s funding support is of importance but also its unique expertise, experience and mentorship that will guide the complex questions associated with the proposed project’s implementation. 

As an activist, advocate and author with a background in Anthropology and Molecular, Cellular & Developmental Biology as well as a Certificate in Global Health I operate at the intersection of the humanities and sciences, often bringing together humanitarianism, health and advocacy in support of my work. In the past 6 years, this work has often come in the form of my role as a Goodwill Ambassador for UNHCR, the UN Refugee Agency. In this role, I continue to help grow and uphold strategic partnerships with communities, sponsors, universities and more; advocate for refugees, meet with stakeholders, decision-makers, fieldworkers and families on the ground; and contribute to the evolution and representation of UNHCR’s message on a global scale, helping raise millions in funding for refugees the past 6 years. Through my own lived experiences and through the lenses of my various professional “hats” including during my SCD work in nepal with the indiginous Tahru population, I have witnessed not only the financial barriers that confront our SCD initiative in Sudan but also know how the overall support and awareness surrounding the Horizon Prize will be instrumental in mobilizing key stakeholders, encourage government buy-in and overcome educational awareness barriers related to SCD diagnosis and treatment. 

Speetar’s community-centered ecosystem, design, and implementation methodology is at the heart of Speetar’s approach to telehealth and truly distinguishes Speetar’s innovation. Speetar, led by Libyan medical practitioners who worked for years at the Civil War's frontlines, reflects the needs of the population it serves and is co-architected by the community. This landmark innovative approach will be applied as we expand to Sudan as well with our team lead not only being experienced in fieldwork in the region as well as refugee and IDP advocacy, but also herself is an Indigenous Darfuri woman with family members in the most affected regions. Her experience and personal ties to our constituents deeply represents our pedagogy at Speetar: promoting ownership in our communities and advancements in health led by the people for the people as we facilitate the inclusion of marginalized voices in every aspect of our work, from research to point of care. Our team lead’s experience working in Nepal with the indigenous Tharu tribe establishing an international SCD research initiative that has since become an organization focused on addressing SCD in the region, now spearheaded by the indigenous community in the area, including people living with SCD– a goal from the start of her initiative– speaks to our mission to ignite a people-centered, locally driven solution that works to support autonomy in patients and the community alike.

What’s more, Speetar’s Telehealth solution (full IP ownership) combines language- and culture-matched design with a tailored focus on conflict-affected markets shaped by low financial/health/ technological literacy; restricted connectivity, as well as complex governance and risk environments. We embed our technological innovations in a community-owned approach, creating a programmatic architecture centered on local ownership and multi-stakeholder partnership. We architect an equitable, sustainable, innovative transformation of health systems in conflict-affected countries to manage capacity, effectively triage and reduce viral transmission.  

Traditionally, in conflict-affected communities, few alternative approaches exist to sustainably address the healthcare collapse amidst insecurity, fragmented governance, and resource scarcity. With a system in crisis, those requiring specialized care are overlooked.

Complementing insufficient humanitarian aid patchworks, few Telehealth providers typically operate in these high-risk markets; where they do, they, like medical tourism companies, focus on high-income patients. None of these current approaches address systemic inequities or leverage diaspora resources. In our context in Sudan, the affected population is at the intersection of economic, structural, and health disparity, which essentially makes them invisible to the market and the system. In most cases, people with rare diseases such as SCD in these settings are expected to wait for quality healthcare to trickle down or in other words to suffer until the entire health system is strong enough to support specialized care. Our solution turns this notion on its head, addressing the gap in specialty healthcare from the outset, creating the robust health network needed to support specialty care with the advent of technology and the creation of a system that leverages doctors in different areas. In this way, one specialist can access many patients and even work with primary doctors to coordinate care remotely through our consultation and referral system. Our solution brings change to the lives of SCD patients who are often neglected by the system and not in a position to find support networks in the community or otherwise.

Neglected by the market, vulnerable and conflict-affected communities stand to benefit most from Telehealth since they are most impacted by expensive/dangerous travel to receive the necessary care - and often end up receiving no care at all. 

What's more, our long term goal of implementing a new born screening program and ensuring early detection to provide care from the outset has never been done before in Sudan and has not been supported by telehealth solutions in the past. Our system which combines consultation, referral, a healthcare record system, and clinical scheduling makes it possible to establish newborn screening in a region where it was thought to be impossible because of the lack of infrastructure. We are rebuilding a health system while leapfrogging years of continued disparity with the help of our technology.

All in all, the introduction of Telehealth services constituted a breakthrough in the Libyan healthcare ecosystem and will be completely transformative in the Sudanese healthcare ecosystem, especially for people with SCD. Regionally and globally, Speetar’s design, community-led approach and systems change rooted in conflict-affected countries’ complex realities, is proven and unparalleled. By strengthening our triage and referral system and using our telehealth platform to create a new born screening system, we will establish and bolster a patient and provider network through our services in Sudan that mitigates risk for our people on the ground and leads to better health outcomes for SCD patients in Darfur.

Impact Metrics

One-year target:

• 100,000 acquired users with a retention rate of ≥30%, with each of them having at least one paid consultation.

• On-board ≥1000 providers.

• Cover ≥5 Darfur regions beginning with Al Fashir 

• Setup ≥4 patient sites for specialized care

Five-year target: 

• 2 Million (~30% of the Darfur population affected by SCD) acquired users with a retention rate of more than 60%, with each of them having at least two paid consultations.

• On-board ≥2,000 providers.

• Cover ≥ all regions of Darfur and expand to other affected regions of Sudan.

• Setup ≥20 patient sites for specialized care

• Setup complete new born screening

Breakdown down:

1. Platform development/optimization

2. Sales and Marketing

3. On-ground patient sites

The immediate impact of the 12-months period will be providing direct and, beyond the project period, sustainable, scalable healthcare access to an estimated 100,000 individuals in vulnerable communities in the rural, politically marginalized Darfur among other areas living with SCD, with statistically significant improved health and financial outcomes for beneficiaries.

Following an adjusted model of Speetar’s scale-up plan, the desired impact will require an investment in (1) offline marketing, (2) financial/health/tech literacy (3) the creation of “Health Dots,” with on-site diagnosis technology, access to partner clinics for transfusions and pain management, etc, access to pharmacies, internet hotspots and (4) the expansion of Speetar’s triage and referral system through research and product development. Each Health Dot features a micro-partnership with a local, under-resourced clinic/health service point in the target area. The training of the affiliates combined with the resources of the Health Dot (i.e., expensive internet access), the Health Dot infrastructure overcomes the current access barriers for Speetar’s comprehensive adoption in Sudan. 

Longterm

Speetar will deploy the scale-up plan through its existing and growing partnership ecosystem: 

1) Key international stakeholders: Speetar has closely partnered with UNDP; complementing other engagements (i.e., GIZ, Japan MFA), this partnership will look to leverage UNDP’s previous central role in rebuilding Libya’s health systems to create inroads into Sudan’s humanitarian infrastructure. .

2) Clinical partnerships; business partnerships with local clinics and hospitals as well as communities affected by SCD. 

3) Pre-existing relationships with local Indigenous and IDP populations among the vulnerable constituents we aim to serve

4) Knowledge partnerships. Strategic, technical, and evaluation support through Speetar’s partnership ecosystem with Harvard Innovation Labs and MIT Legatum Center and if given the opportunity, MIT Horizon/Solver Network

Complementing Speetar’s overall KPIs framework and impact measurement efforts (quantitative and qualitative data collection), Speetar will develop a project-specific methodology for internal monitoring and evaluation of the project, presented at the end of the inception phase. For this purpose, Speetar will contract an external and independent Monitoring and Evaluation Consultant who, jointly with Speetar’s Chief of Staff, will be responsible for the Monitoring and Evaluation of the project and associated data gathering. Speetar will additionally leverage its existing support networks at MIT and Harvard University to support impact monitoring and evaluation. 

The monitoring of the project will be based on the final logical framework indicators annexed to the project inception report. This log-frame will include indicators measuring health, financial, awareness/education, healthcare access benefits, and broader systems-change impacts. It will provide a clear, measurable definition of project success in line with the project’s stated objective of increasing inclusive and sustainable healthcare access to vulnerable, hard-to-reach groups in Sudan living with SCD.  

There will be one inception meeting during which Speetar will outline a baseline for the project and against which we can measure progress. The Monitoring and Evaluation Consultant will oversee the baseline, midline, and endline data collection (implemented by local Speetar staff) and synthesize the data, corresponding findings, and applicable proposed adjustments in a mid-term evaluation and a final evaluation. KPI data (i.e., enrollment numbers and satisfaction) will be captured and presented monthly. 

Healthcare providers, healthcare recipients, local community stakeholders, regional and national healthcare stakeholders will collect quantitative and qualitative data on-site in the target areas and virtually (i.e., through the Speetar platform). 

At the end of the project and following the final evaluation, we will convene a “lessons learned” workshop for the final assessment of project impact and progress. We will outline the findings in our Final Report.

At Speetar, we believe in a collaborative approach to care– partnering with communities, working to deliver equitable access to care because we are aware of and sensitive to the unique needs of communities facing health crises after conflict, with a focus on SCD patients in Sudan for this expansion. Our ambitious telemedicine service was born at an MIT Media Lab class by founders from MIT and Harvard Medical School. Speetar redesigns healthcare delivery by providing cultural-language matched high-quality specialty care for patients in underserved regions needing medical diagnosis and follow-up, through an advanced telecommunication platform that allows patients to reach remote skilled specialists practicing within their country or abroad. Matching culture and language, we provide care that is sensitive to and representative of the communities that we serve. We improve care by improving access and ensuring patients are seen by appropriate & qualified providers at the right time and setting to receive high quality, convenient & affordable care.

On a macro-level at the intersection of peace and health, multiple studies show that if individuals/groups enjoy equitable access to health services fulfilling their rights to physical and mental health AND health actors design health interventions that promote trust and dialogue AND communities are empowered to cope with violent conflict; THEN the health coverage is universal, grievances can be heard and addressed to generate trust around emergency health concerns, affected communities are more likely to make meaningful contributions to peace and reconciliation, and resist incitements to violence (WHO Theory of Change underpinning Health and Peace). As such, our technology provides patients with immediate, access, quality and secure healthcare while also recognizing the unique needs of people living in active conflict and leveraging diaspora and other language and culture matched physicians to support the national demand. 

Positive user evaluations during our Pilot in Libya underscore Speetar’s strong growth rates and app stores ratings (4.7 in 1299 reviews on Google and 4.6 in 121 reviews on Apple) as well as quantitative surveys showing an outstanding Net Promoter Score of 91.7%, a Telemedicine Satisfaction Questionnaire score of 79.25% (Journal of Telemedicine and Telecare peer-reviewed methodology) and Patient Trust Assessment Tool score of 77.93% (BMC Medical Informatics and Decision Making peer-reviewed methodology). 

Beyond Speetar’s early success in achieving broad adoption for digital health solutions in the context of COVID-19 triaging, independent research shows the need and interest of people in Libya and other conflict-affected countries in telehealth. In 2017, volunteers conducted nationwide market research in Libya in partnership with the University of Tripoli and the Ministry of Health, surveying 17,000 Libyans. The analysis revealed that 40% of respondents had traveled abroad for health-related reasons, 68% of which were seeking medical diagnosis and follow-up care. Over 90% of those surveyed were willing to try telemedicine as an alternative option to travel. In another study (Elhadi M. et al. (2021), Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis. JMIR Med Inform. 2021 Feb 26;9(2)), interviewed 2512 respondents in Libya. 1546 (61.6%) participants reported they experienced problems covering medical costs and 1429 (56.9%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5%) said that the system was an effective means of communication and obtaining health care services. This data further demonstrates the need and willingness of Speetar’s target population to use its service and the effectiveness of our Theory of Change.

Our Flagship Doctor-Patient Telemedicine Platform 

Using a simple web/mobile app, participating specialists set up a professional account which includes their qualifications, field of expertise, and availability. On the other side, patients will create an account, enter their chief complaint and request an appointment with an available specialist. When a request is received, the practitioner can accept the patient, reject the request or refer him/her to another available specialist who is better suited to respond to the specific complaint.  

Before seeing a patient, consulting physicians are given access to a cloud-based electronic health record containing the patient's medical history presented in a standardized format, including uploaded up-to-date medical reports, lab results, and radiology images. If needed, additional relevant tests/images can be pre-ordered.

If a patient request is accepted, the system will automatically confirm the appointment. If any tests, procedures or follow up are needed, Speetar directs the patient to the closest HealthSpot, where the consultation can be conducted via high definition video conferencing. HealthSpots are designated service sites equipped with advanced telemedicine diagnostic devices and supplied with broadband internet connection. These sites will have a junior medical trainee present to perform essential physical exams and resolve technical issues.

The scheduling system is strict. Appointments are restricted to the available date/time slots, patients abusing the system will be rejected from rebooking (unless a valid reason is provided). A physician can conduct the virtual consultation anywhere where there is a reliable internet and privacy.

Understanding the sensitivity of the health-related data being transferred especially in relation to psychiatric care, reproductive diseases, sexual disorders and other culturally sensitive issues, special effort has been taken to ensure privacy and confidentiality of patients is maintained at all times. In absence of local regulation, Speetar is made to comply with the U.S. HIPAA Privacy Rule which provides data privacy and security provisions for safeguarding medical information. 

The data is protected from hackers and attackers not only while in transit, but also while stored on our servers and databases. We will utilize industrial-strength 256-bit SSL/TLS encryption on all connections as well as NSA standard AES-256 encryption for data at rest, along with strong firewalls and multi-level access checks.

In-Depth Technological Solutions

As Speetar's platform integrates the patient-doctor mobile app and web browser platform (both fully developed and tested at scale), we offer the following use cases to patients. None of these services would otherwise be accessible in Libya's current healthcare crisis nor applicable in Sudan’s health crisis as we move forward:

- Digital patient engagement and outreach tools that health workers, home care workers, and providers can use;

- Responsive healthcare provision during conflict or in rural and marginalized communities;

- Centralized, secure, and accessible health data;

- Tele-consultation and care coordination platform based on personalized care plans;

- Collaboration tools to help health organizations manage chronic diseases in diabetes, heart diseases (e.g., CHF), mental health (includes specialists, treatment planning processes, and care coordination tools);

- Real-time health outcomes and health service process metrics to enable ongoing improvements in care delivery and patient satisfaction;

- Early detection and treatment planning of serious ailments with physician consultation, e.g., cardiovascular issues such as congestive heart failure (CHF);

- Facilitates referral appointment scheduling with physicians/hospitals;

- Track and trace disease outbreaks and integration into the government's disease control, prevention, and triage systems. 

Speetar provides these services by leveraging the following technological features (all natively developed, customizable, and fully IP-owned by Speetar):

(1) Speetar provides an ability to connect patients and doctors through scheduled appointments or instant consultations;

(2) The advanced consultation system allows patients and doctors to conduct medical sessions through text, audio, video, or phone calls to account for scenarios where users have limited internet access. Speetar's system leverages AI to detect anomalies in internet connectivity and upgrades or downgrades audio and video quality to provide a seamless experience to the users;

(3) State-of-the-art real-time instant consultation feature allows patients and doctors to connect in real-time. Powered by a highly robust and scalable messaging and queuing system, the platform enables doctors to be more productive and patients to have minimal wait times;

(4) Advanced scheduling system allows Speetar to review doctors' schedules in real-time and filter out any incorrect or no-show appointments. Speetar uses advanced data science, machine learning, and AI techniques to detect erroneous or no-show appointments. This increases the overall productivity of the doctors and their revenue;

(5) Leverage AI and Machine Learning techniques to triage patient complaints and match them to the correct specialty and the most appropriate care.

Demonstrated Impact

Following an initial test and product development phase (2019-2020), Speetar powered Libya’s CDC and MoH’s COVID-19 triage and information center as part of Libya’s National Response Plan (2020), serving 1.8+M beneficiaries across the country. In Q1/2021, Speetar launched the commercial pillar of its social enterprise operations. Since then, active (commercial) users of Speetar services (direct beneficiaries) have grown 61.66% in Q2 and 105.74% in Q3 to reach 12,526 as of October 2021 (including more than 4659 female users). Telehealth consultations conducted through Speetar grew 1300% in Q2 and 322.22% in Q3 to 532 consultations in October 2021, mirroring a similarly rapid growth of doctor’s availability 127.41% in Q2 and 518.57% in Q3 to a total of 1899 monthly hours (248 doctors across 38 specialties). 

Positive user evaluations complement these strong growth rates on the app stores (4.7 in 1297 votes on Google and 4.6 in 121 reviews on Apple) as well as quantitative surveys showing an outstanding Net Promoter Score of 91.7%, a Telemedicine Satisfaction Questionnaire score of 79.25% (Journal of Telemedicine and Telecare peer-reviewed methodology) and Patient Trust Assessment Tool score of 77.93% (International Journal of Medical Informatics peer-reviewed methodology).  Qualitative key informant interviews conducted with care receivers and providers underscore that doctors and patients find a high degree of utility and benefit in Speetar’s service against the backdrop of conflict and pandemic impacts.  

One example of our early impact metrics is the significant improvement of diabetic patients outcomes (evidenced by their Hemoglobin A1C levels as treatment compliance) residing in Libya’s predominantly low-income southern districts. Coupled with more frequent follow-up (type 2 DM patients need to see their doctor on average four times/year), lowered health care costs (they no longer had to travel for continued care) led to much tighter control and maintenance of their blood sugar.  

Beyond the testimonies and impact data shared in the proof-of-concept section, this is particularly clear from Speetar’s work with the Ministry of Health in the national COVID response. Speetar partnered with the Government, with support from UNDP and others, to be the triage and tracking system for COVID-19 in Libya. Speetar is also building infrastructure to create a more equitable system. Due to our partnership and advocacy, the Government is actively investing more resources in local clinics and investing in expanded technologies (a decision accelerated and increased due to the COVID pandemic). This serves millions who previously had little to no local healthcare access or had to travel 12+ hours to the capitol to see a doctor (a privilege reserved for those capable of paying). It has particular implications for women and the elderly.