Speedback

The problem we are solving is timely diagnosis and management of non-communicable diseases, starting with type 2 diabetes (T2D) in Southeast Asia, through the provision of digital tooling that enables chat-based, speedy feedback loops for asynchronous care and health monitoring.  

T2D is a growing health problem with a significant global disease burden. According to the International Diabetes Federation, 90 million adults in the age group of 20-79 were diagnosed with T2D in the World Health Organization (WHO) Southeast Asia region in 2021. By 2045, the number is predicted to increase by 69% to 152 million. This alarming rise in prevalence causes considerable burden on healthcare systems and national economies. The incurable nature of T2D, along with its chronicity and silent progression, requires the condition to be diagnosed as early as possible and managed properly and promptly on a regular basis to prevent or delay complications. Diabetes is associated with many complications, such as blindness, kidney failure, heart attacks, stroke and lower limb amputation. This has made a new model of care a priority for many health systems, with many health system focusing on developing integrated care and empowering patient self management. 

Cambodia, a lower-middle income country in the WHO Western Pacific Region, has also been severely affected by the T2D epidemic. According to the The Institute for Health Metrics and Evaluation, diabetes ranks in the top ten causes for death and disability in Cambodia, but more than half of those living with T2D are not receiving treatment. To address the problem of growing T2D and care gaps, Cambodia has implemented the WHO package of essential noncommunicable disease interventions  integrating care components of hospital–, health center–, and community-based care in an operational district’s primary health care. Such initiatives aim to provide screening, follow-up care, and health education and counseling on healthy behavior. However, a study has found that regardless of the care initiatives present, operational districts have limited capacity to detect people with T2D and control the condition (blood glucose level control) in those with T2D despite being in receipt of treatment. 

Existing solutions are not adequate to support the needs of a new care model, as traditional healthcare systems are designed to support record keeping in a clinical setting, instead of empowering health workers in community settings and patients in home settings. Additional gaps and challenges include: 

• Low health literacy and care ownership among Cambodian patients–this affects their understanding of T2D and ability to self-manage;

• Passive screening: there is currently no proactive outreach to patients who do not visit health centers and hospitals; 

• Staff shortages: Some health centers and health volunteer support groups may not provide consultation services due to lack of capacity and motivation of local doctors, community healthcare workers and volunteers;

• Lack of longitudinal data: doctors and healthcare workers lack access to longitudinal routine data that would be vital for integrated care. 

In Cambodia, this challenge directly affects healthcare delivery to its population, estimated at around 17.1 million. 

Speedback is a tool which enables care providers to create rich healthcare experiences with their patients through chat-based interactions. Through widely available and affordable communication tools like WhatsApp, Telegram, and Facebook Messenger, providers can engage patients in lightweight, targeted interactions and empower self management and care ownership of chronic conditions, including T2D. 

Features include: 

• Chat-based asynchronous reporting of patient data: providers can set up automated nudges to prompt patients to enter data on a set schedule conveniently via the most popular messenger apps in Southeast Asia–Facebook Messenger, Telegram, and Whatsapp. The timely and consistent recording of vital signs like blood glucose, blood pressure, and weight, as well as other data points like mood and exercise forms a more complete view of the patient’s condition and supports more timely medical action. 

• Longitudinal patient data: all provider- and patient- contributed data flow into the same patient profile and forms a complete, longitudinal view of the patient’s health history, allowing the provider to deliver a more focused, patient-centric care experience. 

• Automated workflows enabling the right nudges at the right time: providers can set up automated workflows that trigger based on the patient’s behaviors or data. For example, should a patient’s blood glucose levels be outside of normal ranges for several days, they will be prompted to make an appointment with a doctor. This streamlines providers’ tasks and enables them to provide more targeted, personalized care. 

Speedback is currently partnering with the National Institute of Public Health (NIPH) in the Ministry of Health, Cambodia to pilot the solution in rural health centres in Cambodia. NIPH has good networks with health centers and referral hospitals at the sub-national level. In 2024, through NIPH’s charity fund, a health center in Kampong Thom province was selected to receive the fund to strengthen care for T2D and hypertension.  This province is located in the center of the country with mostly rural areas. In terms of health coverage, there are three operational districts that consist of one provincial referral hospital, two district referral hospitals, and 53 health centers with the population of approximately 720,000 in the catchment areas. The proportion of the population aged 40 and above (target population for screening) in Cambodia is approximately 27%, and the recent prevalence of T2D among people aged 40 and above is 11%. Therefore, in the province, the total target population for screening is around 194,400, making the total number of those living with T2D to be 21,384. 

Speedback serves two key user groups and their respective needs in diabetes management. 

First, Speedback enables healthcare professionals and community health workers to streamline workflows, scale their capacity, provide more timely and personalised care, and strengthen patients’ diabetes self-management skills. 

• Healthcare professionals can streamline patient outreach and enrolment by creating customizable forms through form builder tools, enabling the capture of structured patient data in order to guide triaging and future clinical decisions; 

• Through automated flows, they can enroll patients in programs that automatically nudge patients via chat to perform certain actions, like report on medication adherence or current vital signs like blood glucose, weight, and exercise, building a longitudinal view of patient history without requiring more manpower resources

• Intelligent databases enable clinicians to define logic that automatically monitor for certain triggers, and automatically tags patient with flags to activate timely, precise health interventions 

Second, Speedback provides patients and caregivers with a tool to self-manage their health. 

• Patients and caregivers can contribute data and monitor their own progress in managing their condition;

• Upon certain pre-defined triggers set up by their care team, they will receive nudges to perform certain tasks, such as booking an appointment, should certain events or triggers be met 

• They can also receive education and support directly from their care team via chat interactions.

During the pilot period in Cambodia, we will engage healthcare professionals, community health workers, patients and caregivers in the design and testing process to ensure that Speedback maximizes their ability to engage with and derive value from the system.  Speedback is designed for replication across other settings in Cambodia and the rest of South-east Asia. Learnings from the test-bed in Kampong Thom will guide future development for scale-up across other settings. 

The Equitech team comprises a team of operators and practitioners in service design, software development, operations, change management and impact measurement. 

We are hyper-local in the way we build: often, this means combining global expertise with local ingenuity, and leveraging resources that already reside within the communities and partners we work with. The concept of Speedback emerged from our experience in developing care models, systems and tooling in her career in public health in Singapore. While we observe similar challenges in managing chronic conditions within Singapore and other South-east Asian countries, we recognize the wide diversity in language, culture, and social norms across these countries. For this reason, almost all our products and solutions are developed  through strong partnerships with local communities and through building teams within the communities that we serve. 

For Speedback, we are collaborating with the National Institute of Public Health (NIPH) in Cambodia. NIPH is a Public Administrative Institution, under the technical supervisory of the Ministry of Health and the financial supervisory of the Ministry of Economy and Finance. Established by the Royal Government of Cambodia in 1997, NIPH has a broad public health mandate to carry out three main functions: (1) research, mainly focusing on providing the Ministry of Health with health systems research and policy support public health, (2) public health teaching and training, and (3) public health laboratory, including serving as the national public health reference laboratory. Our modus operandi in such collaboration has been to deploy product managers and engineers to work in integrated teams with the ground staff, both remotely and in-person on site to gather timely user input for the design and development of the solution. 

All stages of the development of the product, including the design, implementation, testing, and change management, are done in close collaboration with our ground partners and local team members. Our thinking and the ultimate solutions are not just guided by the communities’ inputs, ideas, and agenda, but often co-created through integrated working teams. 

In addition, our partner NIPH has been proactive about identifying the most appropriate pilot communities and sites and advocating for the joint development and use of this solution to Cambodia’s Ministry of Health leadership, and the reception has thus far been positive. Post-pilot, we plan to work jointly to scale this beyond the initial pilot group, to possibly deploying this tool at the national level. 

It is through these strategic partnerships and track record for being hyperlocal in our approach to product development (in actually embedding ourselves in the communities we serve, rather than developing systems and products remotely) that we find ourselves well-positioned to deliver this solution. 

We have built a prototype of Speedback that combines a patient management platform, a form and automated flow builder, integrations with chat-based communications providers, and a patient portal for self-monitoring. This prototype is integrated with three popular instant messaging tools in Southeast Asia: Facebook Messenger, Whatsapp, and Telegram. 

The prototype has been tested and piloted via a remote health coaching program in Manila, Philippines, in partnership with health coaches in Manila, Philippines. The goal of the pilot is to enable access to personalized health coaching for individuals who are more susceptible to non-communicable diseases such as hypertension and cardiovascular diseases due to sedentary lifestyles and habits. Through asynchronous fitness tracking and a hyper-localized coaching program, we are working with health coaches to scale their capacity to transform habits of at-risk individuals who traditionally lack access to personalized health coaching and physical training.  

Throughout the design process, we worked with a local team based in Manila, Philippines to conduct market research on our target population and derive behavioral insights from concept testing. The research insights and input from the users guided our approach to design such as the framing of messages, communications tooling, and the overall user journey. 

This pilot involved 15 individuals who enrolled in a health coaching program that included a hyper-localized coaching program conducted over video call sessions. During the pilot, a health coach used Speedback to create customized forms and workflows that enabled asynchronous tracking of health and fitness data. Participants received daily nudges to track their sleep quality, activity levels, diet and other health data over Facebook messenger. 

While this pilot is still ongoing, initial feedback from the users indicate that the prototype is user-friendly and communications flows have been stable. Furthermore, the health coach involved in the prototype was able to scale his impact more than 8x by serving 8 clients in the same time and effort required to serve one client, signaling that an asynchronous approach could be feasible and cost-effective.  

Equitech Pte Ltd was established as a social enterprise with the goal of developing a commercially viable business model, where a portion of revenues could sustain our work in developing solutions for underserved communities in developing economies. Established in January 2024, we have developed this solution through the executive teams’ own investment and resources. We are seeing positive signals from our initial pilot in Manila, Philippines, and strong interest to collaborate with NIPH to pilot this solution in rural health centers in Cambodia. 

We are applying to Solve for funding and other support for the development, pilot and roll-out in rural health centers in Cambodia and beyond. In addition to funding support, we would benefit from the advice, mentorship and support on various other aspects as we develop this business, including:

• Advice on the business model - Equitech Private Limited was set up with the intention of being a social enterprise, where revenues generated from the business could fund our non-profit work that serves underserved communities; 

• Identifying other partners and communities that face similar challenges that we could serve; and 

• Advice on market entry and product/service distribution

Healthcare systems worldwide are increasingly interested in several paradigm shifts required to manage complex chronic conditions–notably, shifting from “sick care” to “well care” or preventive care, the shift from clinicians to patients and caregivers as users, and the shift from synchronous (visit-based) to asynchronous care. Traditional electronic health systems are not adequate to support the needs of such emerging care models, as such health systems are focused on visit-based record keeping. 

Speedback is innovative in the following key ways: 

• Relationship-based, asynchronous care: Speedback equips providers with the tools to build a long-term relationship, starting with a patient management module which enables and captures all interactions and communications, activities, and health updates, and further, enables the provider to initiate asynchronous communication and care. 

• Increasing patient engagement through chat-based interactions: Traditional health services are still dependent on parties’ availability for in-person visits and phone calls, which are costly and time consuming for both parties. On Speedback, interactions are built around chat-based communications, increasing accessibility and convenience for patients and frees up healthcare providers’ capacity. The usage of chat-based communications also leverages current user preferences in Cambodia, the Philippines, and the rest of South-east Asia where the local population are more willing to engage with services and brands via instant messaging rather than standalone mobile applications.

• Empowering patient self-management: Through the app, the patient and their caregivers are empowered to contribute their health data, which could significantly strengthen clinicians’ understanding of disease progression and ability to make informed clinical decisions. We are also planning on exploring other features including appointment booking and a chatbot to answer queries.  

• Enabling precision and preventive care: The ultimate goal of Speedback is to provide clinicians with the data they need and the tools required to translate such insights to personalized care that reaches the patient earlier. With a foundation of structured data captured, and the right tooling and automations, clinicians can better monitor and detect potentially life threatening conditions at earlier, more treatable stages. We are currently developing a module which scans patient data based on clinician-defined logic, so that individuals at risk of certain conditions are identified, and clinicians can roll out timely and inexpensive interventions. 

We outline the theory of change in the following “input ➞ activities ➞ outputs ➞ outcomes ➞ goal” framework. 

• Goal: Improved health outcomes through early detection, prevention, and treatment of Type-2 diabetes.

• Outcome: Better provider-patient relationships, better-informed clinical decisions and improved patient engagement and self management of T2D

• Outputs: More consistent monitoring of individual clients’ blood glucose levels, which enables earlier detection and closer monitoring of disease progression 

• Activities: Patient-contributed data streamed asynchronously that enable clinicians to provide more targeted interventions (e.g. referrals, or care plans) in a timely way

• Input: Speedback flows initiated by clinicians trigger automated notifications to patients on a pre-scheduled frequency and time, to collect patient-generated data (e.g. blood glucose levels, or measures of subjective wellbeing and other symptoms) via communication channels such as Whatsapp, FB messenger, and Telegram.

While the above describes how the technology achieves its intended impact, it does not do so in the absence of a viable care model and a network of care providers responding to specific incentives. Together with NIPH, we actualise this therapy of change through not just Speedback the tech solution, but a care model that engages the right stakeholders - this ranges from health centres, community health workers, referral hospitals, and even pagodas which are frequented by locals.  

What makes a digital solution likely suitable in getting us to this outcome? Based on a nationwide study by USAID, the Open Institute and the Asia Foundation, 93% of Cambodians have their own phone, a trend that is likely to continue and expand in the lower-income segments of the population. These conditions suggest a large and growing opportunity for digital health solutions like Speedback to be adopted among Cambodians.

In addition, our theory of change focuses on change at the system level, not just at the level of individual patients or providers. Prior to Speedback there has not been a cost-effective way to scale a health system's presence, and trust between provider and patients. The intent of Speedback is not just to deliver a digital health solution, but to catalyse system-level transformation by enabling a new care model that brings personalised preventive healthcare to the Cambodia public health system to benefit the people who traditionally do not have access to this level of personalised preventive care. 

Below we outline key metrics at the app level that we currently track and will continue to track: 

At the user level:

• Provider: 

  • Number of interventions performed via app (e.g. number of Speedback flows) 

  • Number of provider-patient interactions
  • Number of patients served
  • Number of screenings performed
  • Number of weekly active teams (i.e. org that are getting value out of this) 

• Patient

  • Patient activation

  • Prevalence of diabetes screening 

  • Patient satisfaction score

At the system level, we intend to co-create indicators with NIPH that align with the following 2 SDGs: 

• SDG: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”

  • System indicator: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease

• SDG: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

• System indicator: Coverage of essential health services

The core technology we are deploying are custom integrations between a software application designed for clinicians to initiate speedy feedback loops with key communication channels namely Whatsapp, Telegram, and FB Messenger. 

In our product roadmap, we have also incorporated the use of AI for automated tagging and flagging of at-risk groups that necessitate more targeted and timely interventions. This is currently in progress and will be deployed in the next version of Speedback. 

A total of 5 people work on our solution team. 

Equitech’s team comprises 2 full-time staff and 2 part time staff. 

We work as an integrated team with NIPH, pilot partner, which has dedicated 1 team member to this project.

We started development of the prototype in January 2024. 

Equitech is women led, and our core team has representation across different ethnicity, geography, and backgrounds. In our midst are technologists from Singapore, India, Myanmar, Vietnam, the US, and we intend for diversity, equity and inclusion to remain a key priority in the way we build out the team. In addition, we have also created pathways for refugee and migrant populations along t to be a part of our deployment team.

Equitech Pte Ltd is a for-profit social enterprise that builds digital health products that accelerate health systems transformation. We partner impact-driven companies to elevate their capacity for innovation through technology. We source, build, and deploy software, systems, tech stacks that supercharge organisations’ capacity for innovation by journeying with them through their digital transformation journey, from discovery to delivery. In addition, we deploy in-house products such as next-gen patient relationship management systems for precision health and asynchronous care, tech stacks for personalised health coaching, and lightweight Electronic Health Records for community care. 

Our main client base constitutes hospitals, clinics, and public health systems across Southeast Asia, primarily in Singapore, Thailand, Manila, and Cambodia. Our revenue comes from contracts with hospital systems as well as individual clinics that partner us to develop technology-enabled care models that contribute to longer term health systems transformation. 

Commercial enterprise software can be prohibitively expensive, and deployment and commercial vendors tend to take a solutionist or sales-led approach, resulting in one-off deployments rather than long-term capability building. As such, organisations and enterprises often face a hobson’s choice: to adopt technology at unsustainable costs, or leave potential gains on the table by not embarking on digital transformation at all. 

The reason why many of these organisations need our technical services is because we build composable tech stacks that are more cost-sustainable over the long-run. Instead of relying on expensive, monolithic enterprise systems, we strategically assemble modular products into tech stacks that are nimble and adaptable to evolving business needs. This helps businesses avoid “lock-in” to expensive vendors that charge hefty fees for API access, or feature changes. Beyond being user-centric, we optimise at the system level: we redesign workflows to maximise business value from digital transformation.

For the moment, we are cashflow positive and profitable, financed mainly by revenue generated by service contracts for our digital health products and services. 

To fund our next-bound work, we hope to leverage catalytic grants that could help to support pilots that could potentially demonstrate product market fit, in addition to service contracts with clients.  

We have not made plans to raise investment capital but may do so in future if we have demonstrated clear product market fit and a business plan that could generate positive returns to investors.