MCH in rural Southeast Asia: reach52

52% of our planet, or 3.7 billion people cannot access healthcare. We are not on track to meet the Sustainable Development Goal of 70 maternal deaths / 100k live births.

reach52 has built offline-first apps allowing us to train 1-2 women per village to collect indicator data, then run targeted public health programs and 1:1 campaigns in partnership with government. We work with private sector to access discounted medicines, insurance plans and diagnostic services. Our key work pillar is on MCH, working with Philips to deliver rural prenatal ultrasounds (75% cheaper than in hospitals, done in the home), distribute vitamins and deworming pills with global NGOs, and provide gender-based violence reporting services (with a leading global donor).

Scaling supports SDG 3 (access to essential health services at low cost in rural areas), and SDG 5 and 8 (creating good, paid jobs for women in rural areas, to support health access).

An estimated 2.8 million pregnant women and newborns die every year, or 1 every 11 seconds, mostly of preventable causes.1 The lack of skilled health personnel and the unavailability of adequate healthcare facilities, equipment, medicines, and emergency care increase health risks associated with pregnancy and childbirth in least developed and lower-income countries, particularly among marginalised communities and families.2 

In Region VI, Philippines, maternal mortality is at 86 deaths per 100,000 live births; under-five and neonatal mortality are at 46 and 33 deaths per 1,000 live births, respectively. These figures are significantly higher than the country average and well below 2030 SDGs targets. Pregnant women in these rural communities typically only receive three out of the recommended eight ANC contacts from visiting midwives (who typically lack basic equipment). They only access four out of eight diagnostic tests that are required of them, and half are not able to undergo an ultrasound due to barriers of cost and distance. These diagnostic tests can only be accessed in private laboratories, costing between $10-20 (often a whole month income for most families). 

Sources: 1UNICEF, the World Health Organization (WHO), | 2UNICEF 

• We build technology (offline-capable Android apps) that enable women/community health workers (CHWs) in disconnected communities to provide health services
• They first go door-to-door and conduct individual health surveys with all residents
• Based on this data and insight, we work with local government and health providers to run precision primary health services. This includes health promotion events, clinics, public health campaigns
• Village stores and local NGOs also use our apps, partnering to delivering programs in a targeted way to their clients Through these channels, residents can order products from our virtual health marketplace
• Our marketplace focusses on access to MCH services (diagnostics and ultrasound screening), low-cost insurance and access to prescription/OTC medicines
• We work with local distributors to manage the last-mile delivery of these products, directly into the village through the field-force network of women we have trained
• We generate revenue through small margins on our orders/ deliveries. We also do research and sponsored programs for health worker education and designing access programs (paid for by pharma companies mainly)
• We have integrated Facebook / Messaging app for direct-to-patient support (i.e. mothers can use chatbots to get health support, or check what they should do to support safe pregnancy)

Our main community archetype is families living on $2-8 USD per day, generally 1-5 hours from the nearest primary health facility and 3-8 hours from the nearest hospital/secondary care facility.

To understand needs, we comprehensively blend four main elements:

• Hiring in local markets and from local communities, so our core team is embedded with our beneficiaries and close to them
• When we launch in a village, our peer workers go door-to-door and collect data about resident needs (approx. 70 World Health Organisation aligned health and socio-economic indicators)
• We blend this with rich qualitative research from our dedicated research team, allowing us to position any interventions in a socially and culturally sensitive way
• We conduct ongoing monitoring, speaking with residents, as well as community and healthcare leaders to gain iterative input
• Partner with external organizations on project evaluation activities

Ultimately, the needs boil down to the fact that MCH services are far away (with a cost and time of travel), too expensive, and unreliable with frequent stock outs of commodities etc. In addition to access issues, quality of care is a concern, including counterfeit/substandard medicines.

We have built a suite of offline-first technology to train women in communities to provide health support, filling-the-gaps and extending services to where they don’t currently reach. We have a dedicated focus on maternal and child health interventions across OB-GYN (with Philips), access to high quality and accessible care (through community-run programs and events, driven by local data – for NCDs and infectious diseases too). We have proven this model in two countries, delivering essential MCH services through our tech-enabled service model where access is low to non-existent, with all beneficiaries being lower-income ($2-8 USD per-family per-day) in underserved communities.

A vast majority of solutions and interventions in our space are paper-based, vertical programs that are grant funded.

We don’t find any startups or innovators working in our communities, but we do face competition. Most notably this is ‘do nothing’ (i.e. mothers simply choose to not travel and get recommended services). Additionally, there are quack doctors and herbal healers; unlicensed midwives and birthing attendants; and home remedies (sometimes including self-medicating with consumer health products). If a person/pregnant women does want to engage in health services, our main competitors would be travelling to the nearest town or city to a primary or secondary health facility; which involves the time and cost of travel. There are also occasional, sporadic NGO programs (such as medical missions, or newborn malnutrition assessments).

We are innovative because we are:

• Tech and data driven, allowing for personalised and relevant targeted interventions, that can be tracked and monitored
• Run by the community and local women, making our model community-led and localised to the context
• Generating sustainable revenue already, allowing us to sustain and scale our operations
• Focussed on a true end-to-end model not a vertical program, that holistically addresses MCH needs from nutrition, to screening and testing, through to emotional support – whilst supporting all other primary care
• Integrating public and private sector, ensuring we leverage all publicly available services first, but look to marry them with affordable private sector products and services. This gives a unified patient experience, in an area where accessing healthcare is incredibly challenging

Our service delivery model is enabled by six integrated web and Android apps (that have won multiple awards from Facebook, Accenture, Singtel and the United Nations), created by 10 in-house developers.  

• Reach52 Access: offline Android application used by women or CHWs to collect data, run health outreach programs, organised health events, book appointments and generally coordinate primary healthcare at a community level, as well as connecting people to primary health facilities. We have started building telehealth functionality.
• Reach52 Marketplace: This offline Android app can be used to order medicines, insurance plans, consumer health and diagnostic services. We can also manage payments, and any onboarding questionnaires (e.g. specific data items needed for a new insurance plan).  There is an accompanying web app used by pharmacies to view and accept orders, as well as insurers to track sales.  
• Reach52 Logistics: For physical products (medicines etc) they can be marked as dispatched in a central location (such as from our pharmacy partner, or within reach52) and then tracked through a number of states as we transport the products to the sites, and then manage the last-mile delivery to the village through the integrated Android application
• Reach52 insights: Collects data from all of the above and anonymises it, providing integration across the apps (e.g. a medicine delivered in Logistics would go in the health logs of Access) and generating reports
• Social media integration, linking Facebook Ads and Facebook Messenger for patient self-service and self-support in our service, as well as SMS reminders 

Our technology has been deployed in the field for over 2.5 years. It is available in 4 languages, in 3 countries. We have trained over 1000 health workers, and we have 53,000 active patients currently being supported.

To exemplify this further, we have:

• Run programs and campaigns with over 20 global organisations (such as Hepatitis B screening with Gilead, or MCH services with Philips – all coordinated by our technology)
• Delivered public health campaigns for over 2 years in our sites
• Had external impact evaluation, including an assessment of the tech
• Worked closely with our users to design the app, and then completely rebuilt certain parts in V2.0 so they better met our user needs (for example, offline working with periodic syncing of the Android app was an enhancement based on the woefully inadequate internet coverage)

A product demo can be viewed here: https://vimeo.com/407041452

Activities

Our activities include:

·         Individual-level data collection of residents in our partner-communities

·         Community learnings through employment of participatory research methods to understand needs and priorities of residents

·         Empowering women in the community through recruiting and training to serve as our frontline peer workers, to co-facilitate reach52 programs and solutions at the local level

·         Engagement with local health systems, through sharing tech and data; providing stipend for CHWs; frontline health worker training; facilitating integrated outreach activities

·         Cooperation with the private sector, in helping them to understand community needs, to help to implement CSR initiatives, and create social impact aligned to their core business

·         Facilitation of services, including pre-natal at-home POCUS ultrasound; soil-transmitted helminth infection control campaigns; ANC/MCH health promotion events; rural clinics; and telehealth services

·         Provision of a marketplace of good/services, including diagnostic and testing services; medicines; consumer health products; and insurance policies, delivered or provided directly to rural/remote villages

·         Digital engagement, through our interactive chatbots and other online properties

Outputs

As a result of our activities, we produce the following outputs:

·         Availability of Qualitative and quantitative data involving health indicators, as well as knowledge attitudes and practices involving a range of health and health-system related topics

·         Provision of new services directly in community, which previously did not exist, including point-of-care ultrasonography

·         Increased access to lower-cost medicines

·         Improved digital linkages between outlying communities and government health facilities

·         Improved sectoral coordination between stakeholders by uniting on a single platform

Outcomes

Our short-term and longer-term outcomes include:

·         Reduction in maternal mortality, through improved identification of at-risk pregnancies

·         Improved child health outcomes, through reduction of soil-transmitted helminth infections

·         Improved child health outcomes, through and increase in ANC “contacts” per pregnancy and child health-focused workshops

At present we serve 53,000 users. All these users were acquired and onboarded in 2018. We spent 2019 building the partnerships and end-to-end service model we now have, focussing on the user experience and building a digitally-enabled primary health system that can be delivered anywhere on earth. This involved adding insurance, diagnostics and managing last-mile supply chain solutions to really address the root cause of weak healthcare access for MCH.

In the next year we will serve 1.8 million people, over half of which will be women. This is based on our current agreements with government and partners (i.e. the agreed scope of work we have with our sub-national government partners).

In 5 years, we aim to connect 38 million people to essential healthcare. This is based on our realistic growth model, and leveraging the existing partnerships we have to enter new markets and communities. 

We align our impact goals with SDG 3 (Good Health and Wellbeing) as well as 5 and 8 (Gender Equality, and Good Economic Opportunity). In addition, as we make healthcare more accessible and affordable, we focus on how many screenings and health services are accessed, as well as the number of marketplace transactions (i.e. number of sales of diagnostics and other health services) as key output indicators. To measure our impact within these core outputs, we track our SROI (Social Return on Investment); which is currently $1:$2.10 (i.e. for every $1 we make in revenue, we save lower income people $2.10 in their costs of accessing healthcare.

We will continue to scale our proven impact through three core channels, all of which have been trialled or ramped up in 2020:

• We continue to implement the services ourselves, hiring and training women in communities, and engaging directly with government
• We work through partners on the ground, such as NGOs/cooperatives/village stores (already doing this with 2 NGOs in Cambodia)
• We scale through our Facebook Messenger and patient-facing app, using Facebook Ads and organic digital marketing, to connect digitally-literate users directly (Facebook Messenger bots and ads launched, patient facing app in development and due Q4 2020)

We ultimately look to drive a high number of users, accessing high quality services, and saving money. This supports lower-income communities to access healthcare, whilst also helping businesses sell affordable products to a new customer/patient segment (if they discount/make products affordable). 

As we have spent last year focussing on deep research and understanding the root causes of healthcare access, social barriers, cultural norms and then building a solution and supporting partnerships to address these, we are confident that our model is unique and can be scaled. That said, there are of course barriers that we face.

• Financial, with a global recession looming, raising capital is likely to get harder and local spending power might go down as lower income communities are hit harder from the economic fallout of COVID-19
• Regulatory and licencing, as we deliver medicines (pharmacy/distribution licences) and insurance (insurance agency licences) we need to make sure we comply to regulations – that are often inflexible and do not support pro-poor innovations (e.g. telehealth and ePrescriptions are banned in the Philippines – and have only recently been permitted while COVID-19 is blocking physical movement of doctors
• Quality control, as we are using non-medically-trained women in communities to provide health support, which is easier at a small scale but we need to ensure quality is maintained as we scale
• Fraud and gaming the system, such as for affordable medicines meant for poorer communities, we need to manage ‘leakage’ and black/grey markets as we scale up
• Working with governments can be tough (with barriers ranging from straight corruption through to just slow pace and bureaucracy)
• Competitors could enter our markets that will affect our cashflows and financials

In the same order:

• We are managing our costs, applying for grants (whereas we used to solely rely on business financing and contracts) and generally maximising our channels and partnership options through a fast-pace focus on business development. With the residents ability to pay, we are focussing on lowering the cost of essential products, versus focus on discretionary health services/products
• We already understand how to either a. get the licences ourselves, like we are in Cambodia, or work through partners, like we are in the Philippines (as foreign owned companies cannot run a pharmacy without high capitalisation costs). There is no single answer for outdated regulation, apart from coming up with new ideas, doing constant checks with legal and compliance, and accepting that the most efficient solution can sometimes not be used in certain environments/tolerating inefficiency
• We are embedding checks and balances into our apps and processes to give clear tasks and monitor effectiveness, as well as train people well and conduct random spot-checks/audits to check we are following suitable processes
• We are investing heavily in supply chain and inventory tracking, which helps solve this problem and in turn creates a strong value proposition for our business partners
• We work with governments directly, but also look to leverage partners such as NGOs who are already approved to operate
• Competitors are generally not focusing on our area, but given the nature of our work we welcome the entry of additional resources and organizations to support the health of lower-income populations

We are 34 full time staff in our offices in Singapore, the Philippines and Cambodia. We also work with a range of interns and other volunteers who support our solution (with current volunteers ranging from Facebook Data Scientists to software development MSc students at the National University of Singapore). We have approximately 150 staff in the field (97% of which are female), and are employed on a paid, contracted basis (they cannot generally be fully employed as they lack government tax and other employment registrations). We also have outsourced resources for finance, accounting and legal. 

The reach52 team brings a multi-disciplinary approach to the issue of digital public health. We are unique in our space, as 90% of our staff are host-country nationals, providing important cultural insights into problem solving. reach52 was founded by Edward Booty.  Mr. Booty has Edward has extensive experience in areas across digital healthcare; patient access; financing and payment systems; business model innovation; healthcare performance improvement and pathway design; business development; and new service delivery approaches. A graduate of LSE, he has worked in developed health economies and emerging markets - spanning the UK, Europe, India, Singapore, the Philippines and Cambodia.

Our tech solution is managed by our CTO, who brings 20 years of experience designing solutions for England’s NHS. He manages our team of 10 in-house developers. Our COO is a Singapore native, who was Chief of Staff and Board Secretary at Fullerton Healthcare Corporation. She spearheaded developmental initiatives and strategic projects that were integral to helping the company develop internal capabilities and sustain growth. Business strategy is led by our CSMO, who brings 18 years’ experience in business strategy and marketing, specialising in global healthcare. Prior to joining reach52, he was a member of the Executive team at global consultancy Brand Learning (part of Accenture since 2017), where he led the Life Sciences business.

This C-suite manages a team of public health professionals, project managers, researchers, and innovators, who in-turn supervise our field team of ~150 community-level Access Managers

We’ve built partnerships in eight main categories:

Government and healthcare providers

• Philippines and Cambodian local government, working with them to prioritise launch sites, extend their services to rural areas etc

Medtech

• Philips, providing Lumify ultrasounds and funding for our maternal health programs
• Medtronic, providing funding and devices for diabetes screening
• Abbott, for hepatitis B testing kits

Pharma and consumer health

• Novartis, access to NCD medication
• Gilead, access to discounted Hep B medication
• Johnson and Johnson, providing funding for health worker education and scaling our COVID-19 digital solutions
• Zuellig Pharma, for distribution and supply chain support

Insurance and financial services

• Malayan, low-cost insurance in the Philippines
• Forte, and Prevoir, low-cost insurance in Cambodia

Local community partners

• NGOs (TGF, KHANA etc) who are well-embedded in rural communities, and we work through their network to implement our solution
• Vitamin Angels, providing pre-natal and early childhood vitamins (17,000+ doses so far)
• Small village store owners, who provide our tech to, becoming a health access channel

Telcos and tech companies

• Globe Telecom, free data and sim cards for service delivery in Philippines
• Facebook, part of their Accelerator, now giving Ad credits to promote our services
• Microsoft, hosting our platforms for free on Azure

Academia and research

• National University of Singapore, giving tech and big data interns/students
• IQVIA, data analysis and policy work for gender-based violence
• Singapore Management University, interns in digital and comms space

Multilaterals and donors/grant makers

• DBS Foundation, provision of funding to grow into India
• Grand Challenges Canada, funding for gender-based violence reporting

When we launch in a community, a resident can:

• Access our services through a channel of their choosing, focussing on building a great experience – through a local woman that we hire and train, through Facebook Messenger, or through their local village store. This builds familiarity and trust
• Regardless of channel, the residents can then share their needs and problems
• Based on this, we then offer health events, targeted and relevant health advice, free and low-cost screening services, access to discounted medicines, insurance plans and other health products
• These channels provide a single and easy to understand single point of contact for government health services, improving the reliability and transparency of accessing services
• The services are delivered in the community generally, saving the cost and time of travel to towns and cities
• The resident can access care, and save money compared to other services
• This is specifically true for MCH, where we already offer targeted services for nutrition, prenatal screening, telehealth, online programs and access to other high-quality services for pregnant mothers and young children
• To provide these services, we work with businesses to get access to discounted products/services, as well as supply chain companies such as DKSH and Zuellig Pharma to provide last-mile supply chain to real rural areas 

We already make money in four ways.

1. Marketplace commission and delivery fees

• Diagnostic fees, such as ultrasounds performed for ~$5 USD. This cost includes a 35% margin for us to cover overheads (the same scan in a facility is around $10, plus around $5-10 in transport fees)
• Around $1.20 per medicine or consumer health product delivered from the marketplace
• 20-30% commission on selling insurance plans

2. Sponsored programs and patient engagement. Partners (such as big pharma) sponsor programs and activities. These focus on:

• Public health and disease awareness, such as screening programs or health events
• Health worker education and system strengthening
• Sponsoring to scale up our digital services, such as scaling our chatbot services

3. Market research and insights. We work with private sector to help them understand what rural communities need and then design access/discounting programs. This includes:

• Collecting data on patient needs, and sharing this anonymously (disease burdens etc)
• Understanding patient needs, willingness-to-pay and helping partners get products people want and are willing to pay for
• Doctor and pharmacy insights

4. Grants and in-kind support. We have never traditionally taken grants but we started applying in late 2019 and have now won 3.

• We focus on grants for things that are hard to fund through a business model, such as training community health workers or expansion to new markets
• We get a lot of in-kind support to keep our operational costs low 

As we grow, our service is becoming multi-faceted and complex – across both the technology elements (software coding, integration and scaling), public health, partnership management, new market entry and growth strategies. We are interested in accessing the community of peers and mentorship that Sover offers to help improve the efficacy of our model, especially around quality of care.  We know we can attain heath outcomes that are equal to those enjoyed by urban residents in the MCH space. We are specifically looking to increase our work in the clinical space, to support the prevention, diagnosis and disease management work that is currently ongoing in a collaborative way. We also would benefit from improved tracking of program outcomes. In working with our evaluation partner, we are able to track outputs, and have data to demonstrate the efficacy of our work. However, we are always looking to grow the evidence base to support the impact of our model on mothers and children.

We want to work with the main partner categories outlined above. 

Private sector

NGOs and multilaterals

MIT

• 2 of the grant judges are from the following MIT faculties/departments: 

• Center for Gynepathology Research 
• Urban Science & Planning 

• Data + Feminism Lab 

• MIT's Abdul Latif Jameel Clinic for Machine Learning in Health or J-Clinic 

• specializes in developing new healthcare AI tools 
• earlier this year, Takeda announced that it will work with MIT’s school of Technology to establish an education program focused on developing new machine learning approaches to drug development and more; the program will be based on J-Clinic 

• MIT Sloan Health Systems Initiative 

• faculty that conducts research in areas such as healthcare analytics, operations, and incentives, collaborating with industry partners to produce work that has practical application and measurable impact 
• mission is to improve health by discovering transformative and sustainable innovations through research and education with leaders in the field

Details on our suitability for prize provided in body of application. 

Funds from prize would be used to support scale-up of our programs to additional countries/regions, through the hiring of more community-based female peer workers, as well as general field implementation staff.

Details on our suitability for prize provided in body of application. reach52 works to strengthen health systems through upskilling of frontline CHWs as part of our OKRs. We are currently facilitating a program, sponsored by Johnson and Johnson to virtually train community health workers in LMICs through our MediConnect Platform on topics involving COVID-19 prevention, diagnosis and treatment. 

Funds from prize would be used to support scale-up of our programs to additional countries/regions, through the hiring of more community-based female peer workers, as well as general field implementation staff.

Details on our suitability for prize provided in body of application. 

Funds from prize would be used to support scale-up of our programs to additional countries/regions, through the hiring of more community-based female peer workers, as well as general field implementation staff.

Details on our suitability for prize provided in body of application. 

Funds from prize would be used to support scale-up of our programs to additional countries/regions, through the hiring of more community-based female peer workers, as well as general field implementation staff.