Foreword

Everything we do starts with our communities and their needs. Here’s Nelita, a resident in one of our communities in the Philippines with a message to start our 2020 review.

Introduction

At the start of 2020, I remember being in Manila for our company kick-off and worrying about the China-US trade war and subsequent recession. We planned to scale fast, connecting 2 million more users to our health services, grow rapidly in existing countries and launch into India. By March, our priorities of course had shifted. The COVID-19 pandemic challenged us to adapt quickly for the communities we operate in, regions where health systems are weaker and people such as Nelita more vulnerable.

By expanding our digital health services fast and enabling remote team working, we were able to support the fight against COVID-19 and deliver our community operations again as soon as restrictions allowed. New collaborations with new partners were at the heart of these efforts, and you can read about these in this report. In the final quarter of 2020, despite the hurdles, we still launched services on-the-ground in India for the first time, creating access to affordable insurance and medicines in underserved rural Karnataka.

In a year where healthcare and COVID-19 dominated the headlines, it’s clear that ‘health for all’ has never been more important. Beyond the devastating impact of the pandemic, the harsh reality is that many other killer diseases disproportionately affect lower-income populations. Health for all was promised by 2030, and it is more urgent than ever. I’m proud of how the global community has rallied together this year, and of the small role reach52 has played in this. From training health workers to enabling access for diseases ranging from Diabetes to Hepatitis B. From making affordable insurance available to more communities to supporting last-mile delivery of medicines into more regions. Everything we do is aimed at increasing health equity and access, ultimately to build a scalable, digital healthcare model that works for everyone on the planet.

As 2021 begins, I’m happy to share our inaugural ‘reach52 in review’ report including our learnings, progress and accomplishments in 2020. We have much to do to deliver healthcare for the 52% of the world who can’t access it, and we’ve never been more driven to make it happen.

Edward Booty, CEO, reach52

Dr. Andreas Seiter, Global Lead Private Sector in
Health, Nutrition and Population, The World Bank

Here at the World Bank, we are working with governments, private sector and civil society in countries all over the world, to end extreme poverty and promote shared prosperity. In the health sector, our goal is ensuring affordable access to quality essential services for all people. We know that this goal cannot be achieved with continuing business as usual in health services. So many health systems across the world are unable to deliver on the promise of quality healthcare for all, because the traditional approaches to health systems are too costly and too inefficient. And even in wealthier countries, where per-capita expenditures on health can vary by a factor of 100 compared to low-income countries, the inefficiencies still remain.

Traditional health systems are based on person-to-person interaction and don’t offer much in terms of economies of scale. Doubling capacity requires doubling the amount of health facilities, the staff, and the inputs such as drugs, consumables and equipment. On top of that, markets for health products don’t function well because consumers lack objective information on the value of a product and bargaining power with suppliers. The only mechanism existing so far to address this issue is the concentration of bargaining power in health insurance funds or similar funding pools, but this model again is restricted to higher income countries that have the financial means to fund a dominant buyer of products and services.

But there is hope – more and more innovators discover the power of digital tools to disrupt the traditional model. The conversation between health worker and provider doesn’t require physical closeness anymore. Images can be captured locally but analyzed in a far-away location by experts that can process them with high productivity at lower costs. Artificial Intelligence can enhance the skills of frontline health workers and assist in determining at which level of a system a patient should be treated. Smart phone apps can be used to empower patients, increase compliance and identify complications early. Social networks can boost desired behaviors and provide community support. On the product side, there are entrepreneurs that use modern logistics and information systems to cut out middlemen, increase visibility of items in the supply chain and lower costs, allowing them to be profitable at lower prices than what competitors can offer.

The digital revolution of health care is still in its infancy, although it got a strong push from the COVID-19 pandemic. The future, as we see it, will bring more patient-centered integration of systems, a different model of primary care that connects all parts of the system and ensures smooth information exchange and an efficient use of system components to the benefit of the patient. We will be looking at the experience of reach52 and other players in this arena to help in making smart systems that can enable better, more affordable and equitable health services for the entire population.

About reach52

reach52 delivers healthcare for the 52% of the world who can’t access it. We strengthen health systems, establish health services (such as screening and local health support) and provide a marketplace of over 100,000 medicines, insurance, diagnostics and other health products in communities where traditional services don’t reach.

Our services are powered by our award-winning, offline-first tech platform, which includes reach52 mediconnect for health workers, reach52 marketplace and logistics for rural workforces to run last-mile services, and reach52 access to capture data on the health needs of populations and manage local health services.

Our solutions address primary healthcare access across non-communicable diseases (NCDs), infectious diseases, maternal and child health, and financial protection. We build capacity and capability alongside our government partners and enable access by collaborating with Pharmaceutical, Financial Services, MedTech and Consumer Health organisations, translating their social and access strategies into impactful services in low- and middle-income countries (LMICs). This includes incubating and testing new services, and scaling solutions into fully sustainable, scalable models to deliver impact for communities and support partners’ growth into previously unreachable markets.

Our 2020 highlights

Amidst the uncertainties and challenges of 2020, we remained committed to our purposeof delivering healthcare for the 52% of the world who can’t access it. We continued to build health systems in rural remote settings, for a population of more than 3 million people in over 500 communities in India, Cambodia and the Philippines. The focus is on establishing sustainable business models and revenue streams that work for the communities and partners.

During the past 12 months, we collaborated with public and private sector partners to deliver 12 new services in non-communicable diseases, infectious diseases, maternal & child health, and financial protection. Innovative partnerships are essential to delivering impact at scale, and we more than doubled the number of our global partners during 2020. Whilst goals vary, all our partners bring a shared commitment to expanding access to healthcare worldwide and boldness to make it happen – through actions not just words.

Here’s some of our highlights from the past 12 months in numbers…

Our partner ecosystem

As the saying goes “If you want to go quickly, go alone. If you want to go far, go together.” Building a multi-partner ecosystem has never been more important to creating sustainable impact across the world. How we partner to deliver accessible health systems and services in LMICs during 2020…

New services for the 52%

It’s through these ecosystem partners, our health tech and community-based operations that we establish new services in previously unreachable regions – strengthening systems and enabling access. Some of these initiatives were completed in 2020, others are still in progress and we’ll report on the impact later in 2021. Think big, learn fast, scale faster is our mantra, here’s how we’re putting this into practice.

Strengthening health systems

Since 2016, we have worked hand in hand with local health systems to enhance delivery of health interventions in under-resourced primary care settings. This includes upskilling thousands of community health workers and platforms to help residents access affordable healthcare. With COVID-19, it was clear that our communities would be more vulnerable as local systems became overwhelmed and mobility to access services reduced. This was a true test of our model as we adapted the way we worked to continue delivering health services whilst ensuring the health and wellbeing of our staff was not compromised.

Spotlight 1: Leading the fight against COVID-19 in partnership with Johnson & Johnson

Our partnership with Johnson & Johnson upskilled community health workers (CHWs) and supported residents on appropriate COVID-19 measures at a time where misinformation or potentially no information was reaching rural communities. Launched in May 2020, we worked with local health systems to upskill over 1,900 CHWs using our reach52 mediconnect eLearning platform and offline channels. By equipping CHWs with the right knowledge and tools, the potential to achieve greater impact in disease response was observed to improve (+8% increase in overall knowledge amongst all CHWs as compared to baseline).

This had ripple effects in spreading awareness across the community and equipping CHWs with the right knowledge to safely continue their work, even when not directly dealing with COVID-19 patients. It is also important to recognize that community health workers are at varying degrees of experience and knowledge. As such, health systems can consider tailoring training needs and assigning roles based on competency levels.

Through Facebook, we targeted users across the Philippines, Cambodia, Senegal, Kenya and India with health ads, directing them to reach52’s COVID-19 Information and Symptom Checker chatbot. This use of health chatbots in LMICs was a novel approach. We learnt that geo-targeted Facebook advertising can drive broad awareness of health messaging in hard-to-reach communities in LMICs – over 6 million people saw the COVID-19 and general health messaging during the pandemic. Close to 100,000 people used the reach52 health chatbots during the pandemic, driven predominantly by the paid social advertising spend, with 78% of users opting in for future health services. The awareness, usage and engagement results support the rationale that health chatbot services can become a valuable digital channel for hard-to-reach regions – provided they are timely, relevant, and targeted to the specific needs of the communities.

“Covid-19 is not yet eliminated, so any support activities to our health center and CHWs is very crucial as we have limited capacity in doing this job fully by our own. This initiative provided so much support to our health center. The trained CHWs are equipped with knowledge and skills to educate residents and trace people in the village. We want our communities to be safe from Covid-19. We engage actively withreach52 to prevent Covid-19 pandemic within our community.”
Oum Sarath, Chief of a local health center, Siem Reap

Spotlight 2: Combatting diabetes and hypertension through a new model of care with Medtronic Labs

79% of people living with diabetes are in LMICs – a disease that kills 4.2 million people per year.1 The majority are unable to access the affordable medicines, diagnostics and education they need. As a resident in the rural areas, you typically have to travel long distances to expensive private clinics for basic tests for glucose, HbA1C and cholesterol. A comprehensive panel costs approximately $50 in a private hospital or outpatient diagnostic centre, 10 times more than the average daily earning of a community resident.

reach52 collaborated with Medtronic LABS to launch a new diabetes and hypertension model of care in rural Philippines. The ‘Padayon’ (meaning ‘Keep Moving Forward’) service empowers patients to continue to live their life though access to the quality testing, medicines and coaching support they need. This integrated care model combines regular testing, affordable medicines (through reach52 marketplace) and practical coaching all together in one accessible subscription service for residents. The service was developed in partnership with the Pototan Municipal Health Officer, and community health nurses have been equipped as the ‘Padayon’ health coaches.

Patients enrol in an affordable 12-week service, through which they receive blood glucose monitoring, affordable medicines via reach52’s marketplace service and coaching from trained health coaches. The coaching programme combines live group sessions, digital learning and peer support to motivate lifestyle change, medication adherence, and prevent complications. After the initial 12-week subscription, patients can continue to subscribe to monthly medications and digital health services through Facebook Messenger.

Rich Bryson, reach52’s Chief Strategy and Marketing Officer, comments “Patients in rural regions in the Philippines often can’t get access to testing and education in these disease areas. Partnering with Medtronic LABS enabled us to deliver the integrated care that patients really need – regular testing, affordable medicines and practical coaching all together in one accessible service.”

The Pototan pilot completes in early 2021, but we can report that over 300 patients were screened, and 70 patients signed up to the subscribed ‘Padayon’ service for the first 12 weeks vs the original target of 60. These patients are now enrolling in the monthly maintenance service, keeping them on their medicines and with ongoing support. We will be evaluating measurable changes on patients’ Fasting Blood Sugar (FBS), HbA1C, and systolic / diastolic blood pressure, as well as knowledge of diabetes and hypertension management post the 12 week service and over the longer term.

Anne Stake, Head of Strategy and Innovation at Medtronic LABS, adds “High-value partnerships are more important than ever before, and our work with reach52 shows how this might be done efficiency and effectively. ‘Padayon’ combines best in-class technology, a tested curriculum based on behavioral science, and excellence in local implementation to help patients achieve health outcomes.”

Spotlight 3: Improving financial resilience with UNICEF through innovative tech solutions

Access to financial services and healthcare is inextricably linked. In the Philippines, more than 70% adults remain unbanked, with the majority of all health spending in the country out-of-pocket. As a result, people put off getting the treatment they need to avoid expenses, and when they do seek treatment, are often left with catastrophic health expenditures. For this reason, we have made affordable insurance a core part of our health services for LMICs.

We are also constantly devising other innovative approaches to strengthen the financial resilience of our communities. One such initiative is with UNICEF and a range of supporting partners such as ING. We are enhancing our suite of applications and testing the feasibility of a points based incentive model where residents are rewarded based on health seeking behaviors. This will allow users to earn points as they buy our affordable products that can be used for discounts on future purchases. They will also be able to use a range of payment services (instead of cash), and we will be trialling the use of local village ‘Sari-Sari’ stores as access points to purchase products and services.

In designing the appropriate points-based system, we are studying best practices from ecommerce players and healthcare thought leaders, as well as considering local social determinants of health.

Spotlight 4 : Partnering with Gilead Sciences and the Philippines government to deliver Hepatitis B (HBV) services 

Hepatitis B (HBV) is a viral infection that attacks the liver and can cause both acute and chronic disease. The World Health Organization (WHO) estimates that in 2015: 257 million persons, or 3.5% of the general population, were living with chronic HBV.2 HBV represents a major health burden for the Philippines, which has among the highest prevalence in the world. It’s estimated that 1 in 10 Filipinos are living with HBV.3 Unfortunately, only a small percentage of people are diagnosed due to access to education and screening. Even less have access to medicines for HBV and the lifesaving treatments needed.

reach52 collaborated with Gilead Sciences and the Philippines Department of Health to launch a comprehensive Hepatitis B (HBV) solution for rural populations in the Philippines. The starting point was the development of more community health workers with the attitudes, knowledge and skills to screen and manage HBV. We assessed the knowledge of local health workers to gain insights into their management of counselling, diagnostic and referrals of HBV cases. Based on the findings, an HBV community health worker capability programme was developed in partnership with the Hepatology Society of the Philippines, and delivered through reach52 mediconnect – our virtual health worker platform for rural populations. 166 health workers were upskilled in HBV education and management.

Inadequate access to diagnostics and screening for HBV is the biggest barrier in the patient journey across low- and middle-income countries. Key to addressing the diagnostics gap is innovative collaborations between the public and private sector. We brought together Gilead and the Government of the Philippines through the Department of Health (DOH) during the design phase. As a result, the DOH supported with financial investment and resources, including 10 doctors, 8 med tech and 52 front-line health workers.

Working with the reach52 teams on the ground, they have been supporting the roll out of screening events for over 10,000 lower income individuals in the Philippines municipalities of Cuartero and Pototan. The health workers provided screening for HIV, HBV, HCV, post-test counselling and referrals. The reach52 team managed onward referrals to secondary care for confirmatory testing and diagnostics, with partial government co-pay negotiated by reach52. The screening programme was combined with awareness and education campaigns to overcome HBV stigma and misinformation at a community level.

Enabling access and affordability

The WHO UHC 2017 Global Monitoring Report4 identified that over half the world’s population still can’t access essential health services. Many live in rural regions, long distances from the skilled health providers and pharmacies they need. Affordability is an equal challenge, the WHO estimated that in 2020, approximately 1 billion people (almost 13 per cent of the global population) spent at least 10% of their household budgets on healthcare.5 The situation has been compounded by the COVID-19 pandemic, with the World Bank estimating almost 50 million more people would be pushed into extreme poverty in the past 12 months.6 Enabling access to affordable healthcare for everyone requires new mindsets and new approaches.

Spotlight 1: Making Insulin affordable with Biocon Biologics’ Mission 10 cents

The prevalence of diabetes continues to increase in LMICs and in many cases is underreported due to a lack of active screening and diagnosis. In addition, prescribed medication or treatment is expensive, making it difficult for patients to adhere to ongoing maintenance. This is especially true for insulin dependent patients who require daily dosages of insulin therapy, costing as much as ~USD 25 in the Philippines per month.

“I buy my insulin in the city because pharmacies here in town don’t sell them. It normally takes me around two hours of travel to get to the pharmacy in the city. I spend around P1,500 (~30 USD) in total monthly for all my diabetes medications. I only earn P10,000 (~200 USD) a month which is barely enough for my daily expenses, so the costs of my medications is really a huge burden for me.” Female, 53 years old, Cuartero Capiz, Philippines
“Mission 10 cents is not only about offering Biocon’s rh-insulin at a lower price but it is a partnership with diverse stakeholders that goes beyond the product to transform the patient ecosystem and contribute to achieving better health outcomes and reduce cost of care for millions of people living with diabetes in the Philippines.” Dr. Alexander Zach, Global Head of Market Access & Policy of Biocon Biologics

Launched in November 2020, we partnered with Biocon Biologics to pilot the first-ever service to make recombinant human insulin available for less than USD 0.10 per day. At ~USD 3 per month, a cost reduction of over 80% will solve the affordability issue and is expected to improve quality of life for the patient. The service is also designed to tackle barriers faced by residents to seek treatment and ongoing maintenance – one being the cost of diagnostics which can be expensive due to a fragmented market and lack of subsidies from national health insurance. Another key consideration is the need to store Insulin within a cold chain environment. A key goal of the pilot is to enable last mile delivery and storage in order to provide effective and timely care to patients. This is an exciting challenge for reach52 and will pave our delivery model for transporting other essential products such as vaccines to rural areas that supply chains don’t typically reach.

The pilot program is in the process of reaching >10,000 residents in Western Visayas and is expected to scale starting the second half of 2021.

Spotlight 2: Expanding access to quality maternal health services in the Philippines

One of the vulnerable groups most affected by the limited access to health facilities are pregnant women. They need regular consultations and care to check on their baby’s development, and identify potential risks early. During 2020, we launched two new maternal health services for different communities in the Philippines. The first of these was a partnership with Save the Children. Through our research interviews, we identified the majority of pregnant women were not able to access the required number of consultations, prescriptions and needed laboratories.

Rich Bryson, reach52’s Chief Strategy and Marketing Officer, comments “Everyone should have access to quality ultrasounds to check for risks and provide the reassurance their babies are developing well – as I know myself as a parent. This new service removes the barriers for expectant mothers in our rural communities, so they can undergo the ultrasound they need to protect their babies and ensure timely treatment of pregnancy risks when needed”.

With Save the Children, we launched a telehealth consultation service from August 2020 for pregnant women to speak with licensed gynecologists – providing 450 pregnant women the consultations, prescriptions, and laboratory requests to support their healthy pregnancy. This was accompanied by a referral system within the local health units and a digital community of over 500 pregnant women to share positive pregnancy knowledge and practices.

Later in 2020, we collaborated with Philips to launch a new ultrasound service for expectant mothers in rural regions in IloIlo. Typically, only private clinics or hospitals provide ultrasounds in rural regions in the Philippines, which are too expensive and too far away for over 80% of expecting parents in rural communities.6

We equipped community midwives with the Philips Lumify, a portable ultrasound device, which delivers high quality ultrasound images even in remote settings. The ultrasound service was offered on reach52’s marketplace service at half the price residents would pay in a private health provider. This new sustainable service is in pilot, and full results will be shared later in 2021.

Spotlight 3: Enabling access to insurance and medicines through new service across rural Karnataka

In India, out of pocket health expenses remain high in Karnataka at 74.3% of the population, with many families unable to afford the cost of hospital treatments. Current public and private insurance options for these rural communities have been limited up to now, meaning people are a left with the choice of going without or disastrous expenditures that can wreck livelihoods. Many rural communities are also unable to access the affordable medicines they need due to cost, distance and poor availability at pharmacies.In India, out of pocket health expenses remain high in Karnataka at 74.3% of the population, with many families unable to afford the cost of hospital treatments.8 Current public and private insurance options for these rural communities have been limited up to now, meaning people are a left with the choice of going without or disastrous expenditures that can wreck livelihoods. Many rural communities are also unable to access the affordable medicines they need due to cost, distance and poor availability at pharmacies.

In October, reach52 launched on-the-ground health services in India for the first time, providing affordable health insurance for a rural population of over 50,000 people across Karnataka through our reach52 marketplace service. We partnered with non-governmental organisations MYRADA and MYKAPS to equip their field teams as reach52 Marketplace Area Managers to drive awareness of the new service and support residents in ordering insurance plans through the reach52 marketplace mobile app. For the first phase of the roll out, the insurance plans were provided by Aditya Birla, providing affordable hospitalization and personal accident coverage for both individuals and families. Awareness and engagement campaigns were delivered through outdoor advertising and ‘street play’ events focused on the key message of ‘Protecting the ones you love’ through affordable health insurance. Since launch at the end of 2020, almost 50,000 users have been signed up to the reach52 platform, and over 3,500 affordable insurance plans purchased by members of our rural communities.

This was followed in late December by the launch of affordable medicines through reach52 marketplace, in partnership with online pharmacy 1mg. Residents in rural Karnataka can now order from over 100,000 prescription medicines, over-the-counter and everyday health products with their Marketplace Area Manager. The products are then delivered directly into their villages, removing barriers of distance and availability. We are now scaling reach52 marketplace services into new districts across Karnataka during early 2021.

Ed Booty, reach52 CEO comments “We’ve always wanted to move the needle in global health, and our launch into India is a critical step towards that. Whilst the government has made strong efforts to improve UHC, the out-of-pocket and non-communicable disease burdens remain stubbornly high across India. We are pleased that we can start to play a part in improving this, and look forward to both our NGO and government collaborations.”

Awards and Recognition

Despite the challenges posed, 2020 was a breakout year for reach52 in terms of global recognition and focus on our digital health services in LMICs. This recognition is essential to engaging like-minded partners and supporting our efforts to reach over half the world with accessible healthcare. You can watch and read some of these features here by clicking on logos (where available)….

 

Media

We were featured by the BBC, Sky News, Channel News Asia, Channels TV, the Strait Times, the Singapore Business Times, the World Economic Forum and World Bank amongst others.

Awards

We were selected as a laureate of the Global South eHealth Observatory (an initiative highlighting transformative healthcare solutions in Africa and Asia), and awarded the Financial Resiliency prize by Inclusive Fintech 50, supported by VISA and MetLife foundation. Recognising our COVID-19 response and services, we were a finalist at the #BuildForCOVID hackathon and selected for inclusion by the COVID-19 Innovation Hub.

Events and groups

Our healthcare solutions were featured at several (virtual) events, including the World Innovation Summit on Health, UNAIDS Health Innovation Exchange, Asia Health Week and the Geneva Health Forum. Additionally, our research was presented at the World Congress on Global Health and Health System Research 2020.

We were selected by the World Economic Forum’s UpLink initiative as an advisory impact partner, became a signatory to the UN Global Compact, and received support for our work from the UN Capital Development Fund, Google and Impact Collective.

Accelerating progress in 2021 and beyond

2020 demonstrated to the world that health is our most precious asset. Universal access to healthcare was rated as the top priority post COVID-19 in a recent United Nations survey of 1.5m people in 195 countries.9

We are passionately committed to building scalable health systems and services that deliver health and opportunity for all. Not stop gaps, but sustainable solutions that benefit everyone – communities, governments, private businesses and civil society organisations. 52% of the world can’t access healthcare, and together we can solve this.

As we move to 2021, we are accelerating progress in existing and new countries. Expanding user growth through implementation partners on the ground, connecting many more underserved communities to our health platforms. Collaborating with partners to launch and scale services to combat disease, mortality and catastrophic health expenditures. New tech services ranging from insurance claims processing and health symptom checking to a marketplace for diagnostics and screening services.

The COVID-19 pandemic has taken a terrible toll on the world, but it can and should spur us on to work together to deliver healthcare for everyone, everywhere on the planet.

We are incredibly grateful for all the support we have received so far, and excited about making this happen together in 2021 and beyond.

If you’re interested in partnering together during 2021 and beyond, please get in contact

Edward Booty, CEO – edward@reach52.com

Rich Bryson, Chief Strategy & Marketing Officer – rich@reach52.com

1- IDF Diabetes Atlas Ninth edition 2019
2- https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
3- https://www.who.int/philippines/news/commentaries/detail/ph-must-act-to-eliminate-hepatitis
4- WHO Tracking Universal Health Coverage: 2017 Global Monitoring Report
5- World Health Organization and World Bank. 2019. Global Monitoring Report on Financial Protection in Health 2019.
6- https://www.worldbank.org/en/news/press-release/2020/10/07/covid-19-to-add-as-many-as-150-million-extreme-poor-by-2021
7- reach52 primary research 2020
8- Brookings India report 2016
9- UN75 Report 2021
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