Vula Mobile

1: Our vision is for all people to have access to the best possible healthcare in their area. With a focus on rural, remote and underserved areas.

2. We achieve this by connecting health workers with each other, with a focus on connecting primary health workers with specialists. This facilitates specialist guided healthcare at primary settings. When they connect via our apps or web portal to refer or discuss a patient this is called a Vula. In 30% of the time the specialist can help the primary health worker manage the patient.

3. To date we have enabled 509,498 "Vulas" between health workers and there are 20,500 health workers on the Vula network. Currently we are active in South Africa. We want to scale globally, with a focus on developing countries.  

Vula was created to solve the twin challenges of the lack of specialist health resources in rural and underserved areas as well as the overloading of specialist clinics in urban settings. 

In South Africa and many other developing countries there is a scarcity of specialist medical practitioners. Compare the USA with 2.6 physicians per 1,000 people and Sub Saharan Africa with 0.2 per 1,000 people. (data.worldbank.org). This scarcity is more extreme in rural and underserved areas. In the Eastern Cape Province there are only 2 Neurologists. The scarcity means that people have to travel long distances to get the care they need. For example in the Northern Cape the nearest eye clinic is a 7 hour drive away. In South Africa 25million of the population live in rural areas and face these problems.

Vula helps solve this problem by connecting health workers to specialists so that specialist guided healthcare can be delivered in rural areas. This means fewer people need to travel to specialist centres. Only the most appropriate patients arrive at the specialists centres so that the use of scarce specialist resources are optimised.

Primary health workers use the Vula app or web portal to refer and discuss patients with specialists in their area. They are connected directly to the specialist on call in their area, so they don't waste time trying to find the right person. 

The primary health worker then completes a form that is specific to each specialty and submit the information and pictures. There are currently 63 specialties on Vula. Some of the forms have clinical tools eg a vision test for ophthalmology referrals, or a burns management calculator for surgical referrals. 

The specialist on call receives a notification with the structured information. The specialist responds via the secure Vula chat between her/his patients. Typically asynchronous communication is most practical, although there is the option to call. Together the specialist and primary health worker manage the patient. The response times of specialists are published within their teams and the average is less than 15mins.

Health administrators and senior specialists have access to the web portal for clinical governance, monitoring and evaluation.The referral pattern data is visualised in monthly reports. Areas with high numbers of referrals or areas in need are identified for out reach.

Target beneficiary population for impact: people living in rural, remote and underserved areas.

Target Vula users: health workers. There are currently 116 types of health worker using Vula, from community health workers, allied health workers, nurses, doctors and including 63 specialties. There are currently 20,500 health workers on the Vula network.

Target Vula users - primary health workers: They use Vula to make referrals and discuss patients with specialists. They are currently underserved in terms of access to specialist knowledge and services. Vula's CEO was a rural doctor for 5 years in South Africa and Swaziland and experienced the needs and challenges. We continue to work directly with the Rural Doctors Association of South Africa.

Target Vula users - specialists: They use Vula to receive referrals and discuss patients with primary health workers. They are currently overwhelmed by many patients attending their clinics who could have been managed remotely. This means that many people who need urgent specialist care have to wait or don't receive the care they need in time. Vula's CEO specialised in ophthalmology and experienced the challenges of trying to make sure that the scarce specialist resources were used efficiently and weren't overwhelmed. We spend a large portion of our resources on user experience, working directly with the specialists to ensure that the forms submitted by the primary health workers have the fewest fields possible, but contain the right information to enable quick and accurate decisions to be made on the chat.

Target Vula users - health administrators: They use Vula to monitor the conversations between health workers in real time for clinical governance as well as using collated information to analyse referral patterns. The health administrators can then make data driven decisions. Typically they are underserved in terms of having access to referral data between health workers, which until recently has been on paper/fax/landlines/social chat. Every week Vula provides Provincial Departments of Health with aggregated referral data. Every month each Clinical and Specialist Department receives their referral data as easy to understand infographics.

Target Vula users - machine learning researchers: With over 500,000 referrals there is a lot of data. In terms of research and machine learning most AI tools are being created on datasets from developed countries and not clinically useful in African setings. This year Google released their AI Dermatology tool. https://www.forbes.com/sites/robertglatter/2021/05/21/google-announces-new-ai-app-to-diagnose-skin-conditions/?sh=7edc035ee4a0  “the researchers used a training dataset of 64,837 images of 12,399 patients located in two states". The only issue was that out “of the thousands of skin conditions pictured, only 3.5% came from patients with Fitzpatrick skin types V and VI—those representing brown skin and dark brown or black skin respectively.” 

Vula has 15,044 dermatology cases with over 70,000 images, most of which are on dark skin. We are looking for support so that we can use machine learning to create clinical tools for health workers in developing countries. This will help create African AI clinical tools, built locally and globally relevant.

Challenge 1: Vula equips last-mile primary healthcare providers with the necessary tools and access to specialist knowledge to detect disease outbreaks quickly and respond to them effectively. 

Since 2014 Vula has been used in multiple specialties including infectious disease such as TB and HIV. When the COVID pandemic started Vula has been used in a range of ways. 

Start of pandemic: Health workers on the Vula network communicated directly with COVID experts via a special portal to learn how best to manage their patients. We hosted webinars to ensure that all health workers were able to respond to the needs in their areas. Health workers used Vula to report their needs for protective personal equipment, which were then delivered through a partnership with a NGO "Gift of the Givers". 

As the pandemic progressed: Through a partnership with pharmacies and laboratories health workers used Vula to request free COVID tests for themselves. Through a partnership with another NGO "Ubuntu Beds" health workers were able to request AirBnb homes if they needed to isolate from their families. These initiatives helped care for the health workers at the front line. 

During the COVID waves: Vula was used as the referral system to COVID treatment facilities, referrals to COVID palliative care and COVID physiotherapy services. 

To date: 56,000 of the 500,000 referrals on Vula to date have been related to COVID.

4: The health workers on the Vula network have access to 4 free mental health sessions per person during the pandemic. 

Growth:

Vula was established in 2014 with ophthalmology only. Currently it is available in 63 specialties. We started in the Western Cape Province of South Africa and it is now used in 6 of the 9 Provinces. With 500,000 "Vulas" sent to date, a "Vula" is currently sent every minute.

We are looking to grow faster, into all Provinces in South Africa as well as into other developing countries. We would like to get to a Vula every second and help as many people as possible get access to specialist guided healthcare.

To quote others who consider Vula as innovative:

UNDP selected Vula as one of four health companies as "Global Impact Ventures" for 2021 https://www.sgsgeneva.org/page...

During 2020 Vula was featured in local media for its innovative responses to the COVID pandemic. https://www.dailymaverick.co.z...

MTN (main mobile provider) voted Vula Mobile as the Best Health Solution in South Africa 2019

Our view:

Vula was built from the ground up by health workers to solve the challenges they face on the ground. Vula has changed the ways that health workers communicate, making health systems more efficient, saving time and improving outcomes.