The innovative use of community health teams equipped with ‘offline-first’ mobile health apps enabled the Padayon subscription service to deliver target outputs in terms of patients enrolled, BP and RBS tests provided, and prescribed medicines delivered.
Impact on healthcare
Equipping networks of community health workers and members with ‘offline-first’ platforms and mobile health apps can overcome traditional access barriers for non-communicable diseases (NCDs) in low-income and middle-income countries.
Integrating coaching, screening and medicines into a simple subscription service delivered by ‘digitised’ community members has the potential to significantly improve health outcomes in low-connectivity, low-resource settings.
There is patient willingness to pay for digital subscription services for diabetes and hypertension even in populations on an average daily income of $3–7 per day.
Quality health data can be collected through community teams with ‘offline-first’ platforms, enabling remote patient monitoring and analysis for population-level precision healthcare.
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bmjinnov-2021-000900.full_
Non-Communicable Diseases (NCDs) account for 60% (35 million) of global deaths every year, with the largest burden in low- and middle-income countries (28 million). In Cambodia, people have a 1 in 4 chance of dying ‘prematurely’ between the ages of 30 and 70 from an NCD.
However, health system services for the prevention, education, screening, and treatment of NCDs remain inaccessible to billions of people living in rural regions in low- and middle-income countries. The World Health Organisation (WHO) has reported that over half the world’s population still lack access to the basic health services they need. The global health unit of Sanofi has joined with reach52 and Medtronic Labs to address this pressing NCD challenge in Cambodia.
reach52 has delivered health services in Siem Reap province in Cambodia since 2018 through its reach52 access platform and products. Leveraging population data captured by reach52 identified diabetes and hypertension as high-risk conditions in the province, and the discovered gaps in affordable, accessible care for the diseases.
Previously, Medtronic Labs had implemented “Prerna”, an integrated subscription model for diabetes and hypertension in India, and worked with reach52 to adapt this model into the impactful “Padayon” service in the Philippines through the reach52 platform. The opportunity to collaborate with Sanofi and evolve these models into a scalable, new initiative for diabetes and hypertension in Cambodia resulted in “SAKAM” (meaning keep progressing).
“SAKAM” is a fully integrated health solution for low-income, rural districts in Siem Reap, providing health education, screening and affordable medicines in one accessible subscription service. The service is enabled by the “offline-first” reach52 access platform and suite of products for low-connectivity, low-income markets.
Village Health Support Group workers (Community Health Workers) are equipped with “offline-first” reach52 access apps to engage and enroll target residents in community-based screening sessions for diabetes and hypertension, conducted by public health nurses trained as “Health Coaches”.
Enrolled members pay for an affordable monthly subscription service receiving coaching and testing (HbA1C, Blood Pressure and Rapid Blood Sugar) from the Health Coaches and Village Health Support Group workers equipped through the reach52 access platform, and affordable medicines delivered directly into villages through reach52’s network of agents and partners.
After the first 12 week “Intensive Service”, members can continue to receive support through a monthly “Maintenance Service”, receiving ongoing monthly testing, medicines, and support to sustain their lifestyle changes and keep their conditions under control.
The focus is on establishing a fully sustainable service through building the capacity of public health and community health workers, the use of reach52’s health tech platform, and an affordable monthly “patient pay” model. By task shifting to community health teams and equipping them with mHealth apps, the goal is to improve clinical outcomes much more effectively and efficiently than traditional healthcare models.
The Cambodia Heart Association and the EpiMaCT research team (Inserm U1094 IRD U270) from the University of Limoges have been recruited as academic partners to develop a robust study of SAKAM, evaluating how “offline-first” health technologies and community-based health teams can enable effective, scalable interventions for Diabetes and Hypertension in low-connectivity regions.
With significant, growing NCD prevalence worldwide and comparatively low investment in NCDs across global health, new collaborations and scalable platform initiatives such as SAKAM are essential to address the major NCD challenge across low- and middle-income countries.
The initiative launches on the ground in February 2022.
“The urgent NCD challenge in low- and middle-income countries won’t be addressed through conventional primary healthcare models. It’s essential that new healthtech platforms and community-based health teams are harnessed together to close the system gaps and ensure everyone on the planet can access the NCD services they need” Rich Bryson, Chief Strategy and Marketing Officer, reach52
Existing footage of relevant Cambodia communities available.
Photography and video footage from the first phase of SAKAM will be available at the start of February.
We are an innovative global healthcare company, driven by one purpose: we chase the miracles of science to improve people’s lives. Our team, across some 100 countries, is dedicated to transforming the practice of medicine by working to turn the impossible into the possible. We provide potentially life-changing treatment options and life-saving vaccine protection to millions of people globally, while putting sustainability and social responsibility at the center of our ambitions.
Medtronic LABS is a health systems innovator that develops community-based, tech-enabled solutions for underserved patients, families, and communities across the world. Our programs strengthen and extend health systems into local communities, delivering sustainable outcomes for underserved patients worldwide. Our current focus is transforming care for chronic diseases including hypertension, diabetes, mental health, and disabilities. By bridging hyper-local services with cutting-edge technology, we provide sustainable and localized healthcare solutions. Our team of 150 field operations experts, health coaches, clinicians, technologists, and designers support our growing portfolio of programs across 5 countries.
reach52 is a tech social enterprise delivering health services in markets others don’t reach through its reach52 access health platform and products. Community-based organisations and health workers are equipped as networks of agents with ‘offline-first’ mobile apps to manage and run the services, in partnership with governments and public health providers. reach52 partners with businesses (Pharma, Medtech, Consumer Health and Financial Services), Multilaterals and Civil Society Organisations, leveraging the reach52 platform to deliver repeatable, scalable health campaigns across low- and middle-income countries.
By Logan Ansell, Head of Partnerships
In my role as Head of Partnerships at reach52, I have the pleasure of engaging with hundreds of NGOs from around the world. Many of these NGOs are smaller, community-based organizations who are making a big impact in their immediate geographies. Despite this, many of these organizations have very little experience using digital tools to support programme implementation, particularly at a community-level.
When we dig into the stats about NGOs in Asia (in our part of the world), only 20% are using project management software; and only 30% use some kind of CRM solution. Perhaps this shouldn’t be surprising as smaller NGOs are often stretched to capacity to fulfill their funding obligations. This makes it challenging to invest in the time and money required to go digital (planning, training, devices). Despite this, organizations who eschew a digital approach do so at their own peril.
Remaining relevant and attractive to funders
Whether your NGO is big or small, the pressure to ensure ongoing sources of funding is a constant concern. Organizations are always looking for ways to differentiate themselves and demonstrate their value to funders. We are seeing increasing amounts of funding for ICT4D and eHealth projects each year with large funders and stakeholders making digital interventions a central component of their health and development strategies.
In 2019, Rockefeller Foundation committed $100M for ‘precision public health’ based on data science, seeking to save 6 million lives by 2030. In 2020, USAID launched their first ever ‘Digital Strategy’ which promises to “change the way it does business”. Earlier in 2021, the WHO released their ‘Global Strategy on Digital Health’. It’s increasingly clear that those organizations without previous experience, and capacity to implement digitally-enabled projects risk losing out on this growing pool of funding.
Measuring impact
Introducing digital tools dramatically simplifies and improves monitoring and evaluation processes. In a 2020 report on the use of digital tools in programme evaluation, Rockefeller Foundation argues that technology now allows studies to be completed “more rapidly and cheaply while advancing our understanding of the complexity of social problems”. With digital dashboards, real-time programme monitoring is now possible at a glance. Depending on how digital systems are implemented, much of the data can be collected passively, reducing reporting burdens on staff and improving data fidelity.
We experience this firsthand at reach52. With the “offline-first” reach52 access mobile platform used by our Agents, health and demographic data are collected from beneficiaries and seamlessly synced to the cloud when internet access becomes available. Programme administrators and authorized partners can view these aggregated data on web-based dashboards. This provides sortable, filterable insights which instantly give robust details of operational outputs. Insights which would be impossible without the use of our digital architecture.
Engaging beneficiaries
The adoption of digital technologies creates additional engagement channels for community NGOs in the business of frontline service provision. Particularly with the continued challenges that COVID-19 presents to face-to-face services, digital can help fill gaps through channels like SMS, WhatsApp and other social media platforms. Even in rural areas of LMICs, populations are increasingly expecting to access information and services through digital channels from government and the private sector. This is driven by explosive internet growth in these regions. Take India, where rural internet users overtook urban users for the first time in 2020. NGOs need to develop a digital strategy to ensure they are remaining consumer-centric and relevant to their beneficiaries.
Practical steps for digitizing your NGO
Many smaller non-digital organizations might find it intimidating to make the migration to digital platforms, weighing the cost of devices and staff training against expected increases in efficiencies. However, it need not be a challenging or resource intensive transition. We partner with NGOs to digitize their organisations and capabilities, and there’s 3 practical steps I would recommend based on our experience.
1) Define the role of digital in delivering organizational goals
Hopefully by now you are convinced that your org needs to go digital. However, it’s important to make sure that the goals are clearly defined and the entire organization and is aligned on the objectives for this transition. Perhaps you want to streamline data collection activities or you want to open a new channel to engage with beneficiaries. Whatever your reasons might be, they need to be clearly stated.
Ensure that you work to involve staff as well, so the transition is not viewed as a top-down decision. In our early days in working with NGOs, we had a partner whose management failed to get buy-in from their frontline staff. This occurred largely because the role of the digital transitioned was not clearly defined by this organisation. The process was perceived by staff as adding additional workload and complications to their already busy days. Ultimately, the project was unsuccessful and the partnership was later ended. In the end though, it taught us an important lesson about how to engage with our NGO partners to clearly define the objectives of their digital strategy, strengthening our work for the better.
2) Digitize tools and ways of working
It’s vital that your organization selects the right tools for the right job. Context is incredibly important. Be sure to consider technical matters, like hardware and network capacity, but also the tech literacy of the end users. At reach52, many of our community Agents are using smartphones with older versions of Android OS. In addition, mobile internet connectivity can be extremely slow, patchy, or non-existent. There’s also a wide range of technical abilities among these individuals. As such, we’ve specifically developed our mHealth app to work on Android 6+, along with fully offline-first functionality. Just as importantly, the app is designed with a very simple user interface, making it accessible to people of all abilities. Make sure you consider the same, or you’ll be left with tools that nobody uses.
In addition to features, costing will no-doubt be top of mind. Before you open your wallet, consider the vast repository of free software. For example, take KoboToolbox, a free opensource digital data collection tool that is has benefitted an estimated 23 million people across all 195 countries. With deployment in every major humanitarian crisis since 2014, it has fostered more efficient resource distribution and faster response times.
3) Develop digital skills and mindsets
The process of digitizing your organization is not going to happen overnight. Rather, this exciting transformation needs to be an ongoing and iterative process. Even with the best planning, there are going to be bumps along the way. Start with a limited scale pilot and be prepared to adjust your processes along the way. Plan a comprehensive socialization and capability programme for your teams. Create mechanisms for getting feedback from all stakeholders to understand how the technology is working (or isn’t working!), then adapt. Finally, work to continually reinforce and support this work through ongoing engagement and training with your staff that integrates seamlessly into their routines and environments. To support these aims, acquaint yourself with the Principles for Digital Development. This framework of nine principles is designed to promote the adoption of best practices for organizations undertaking digitally-enabled impact work.
Rather than one-off classroom training, the focus needs to be on continuous learning support for your teams to help them deliver on the ground. This means combining group learning sessions with mobile learning resources to support use of digital apps and tools on the front line. There can be reticence to using mobile vs paper-based tools amongst less digitally literate team members. We found recently in a Barangay Health Worker programme in the Philippines that these barriers were best overcome through practical hands-on experience and peer support – getting the teams to use the mobile tools in groups quickly built confidence. Role modelling from NGO leaders is also essential in encouraging the adopting of new technologies.
The world is digitising at rapid rate, and it’s essential that NGOs keep up with this pace of change. Don’t get left behind, use these practical steps as a guide to accelerate your path to digitisation and harness digital to scale your NGO’s impact now and in the future.
About reach52 Growth Partnerships
If your organization is seeking to expand your experience implementing digitally-based health interventions for rural populations, consider applying to be a reach52 Growth Partner. reach52 provides selected applicants with funding, support, and digital tools to implement our award-winning eHealth solution. Using our innovative output-based model, successful Growth Partners can attain scalable, sustainable funding. In turn, beneficiaries gain access to a range of health products and services, helping to address complex health access challenges.
Much fanfare about the acceleration of digital health services during the pandemic, but most don’t work for billions living in low-connectivity regions. We need to also accelerate digital health services that work for everyone on the planet!
The acceleration of digital health services during the pandemic has been accompanied by growing concerns about the ‘digital divide’ in global healthcare. The growth in virtual care has been predominantly in more affluent, urban populations.
Rural communities across low- and middle-income countries have found themselves even more isolated from health support during lockdowns. Vaccine drives have also been hindered by digital barriers, such as in India where poor rural communities lack information on how to register and the internet access to book through the online system.
3.7 billion people live in regions in the world without internet connectivity, and so many digital health services just don’t work for these populations. This is a huge barrier to achieving Universal Health Coverage for all and missed opportunity for healthcare businesses unable to reach emerging markets for their services and products. These are three priorities for building digital health services that work for everyone on the planet.
Current Covid19 vaccine rollouts aren’t working quickly or efficiently enough in many regions we’re focused on across low- and middle-income countries, but through more effective use of digital systems, community health workers and data we can address this…
A little over six months ago, five startups based and working in the Philippines were onboarded into ING and UNICEF’s first ever Fintech for Impact cohort.
These companies were chosen through a competitive process for this opportunity because they are building innovative open source solutions with potential to provide families and youth in the Philippines with better financial stability and opportunity.
In addition to investment, the cohort has also received individualized support from UNICEF mentors to strengthen their business strategies – as well as in how to “work in the open” – how to set up, grow, license and sustain their open source technology or content solutions. They have also met with experts at ING, which is providing access to the core business skills of their staff to support the growth of the startups.
In addition, Manila-based startup accelerator IdeaSpace is providing wrap-around support to the cohort, to monitor progress, needs, and challenges – and match the startups with the many mentors and resources they have available in their network.
Working throughout the pandemic and shifting lockdowns, as well as facing numerous weather events, the startups have had to find new ways of working and engaging with users on the ground, while accelerating the development of their solutions given the clearer need and urgency for social protection and financial stability.
AsianScientist (May. 15, 2021) – In rural and lower-income communities around the world, the proverbial saying “health is wealth” takes on a grim reality. Between paying hospital bills and medication fees, an estimated 100 million people annually are driven to poverty from out-of-pocket expenses for health services.
While some fret between receiving treatment and putting food on the table, others are blocked by distance to healthcare providers and the lack of transportation options.
Exciting news… we’ve been selected as one of the ten organisations for the WhatsApp #ChatforImpact Accelerator after pitching our WhatsApp health service demo to a prestigious judging panel at the May event!
Look forward to launching the service for users across existing and new countries later this year…
Big thanks to http://Praekelt.org http://Turn.io Devex and congratulations to the other organisations selected.