reach52 ID Access Program

52% of our planet, or 3.7 billion people cannot access healthcare and most do not hold a digital identity. reach52 has built offline-first apps, training 1-2 women per village to actively identify local offline people in Philippines, Cambodia and India. Our digitally enabled local agents serve as an offline bridge to the digital world for the many without digital access. Our focus so far has been on healthcare, but the reach52 ecosystem can be utilized by any entity committed to SGD goals. We already create a reach52 ID that accompanies the user. While national digital ID programs are being launched, physical engagement and access to individuals remains a fundamental bottleneck. We propose to make our solution compatible with systems such as MOSIP, to ensure that as we scale across millions of users in 2021, we contribute to solving the global identification problem.

Giving a digital identity to the world population has become an important priority with national initiatives ongoing to create foundational IDs. Unfortunately, the key bottleneck still remains finding and engaging everyone to apply and register for an ID to initiate their digital existence, and making it easy and accessible in low-connectivity regions.

At reach52 we are driven by the fact that 52% of the planet cannot access essential healthcare, while a further 100 million are forced into extreme poverty each year due to out-of-pocket payments. By delivering a local, offline-first, model in rural areas of LMICs, supported by a strong digital ecosystem backbone, we have been able to effectively identify and engage people in rural communities. This is achieved by empowering local women with mobile tech and training, to become reach52 agents.  Similarly, we also engage existing local village store owners, creating a network of representatives through multiple touchpoints. Thus we also supporting the creation and enhancement of local micro and small businesses.  

Our main target 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. Many of our beneficiaries lack any form of foundational ID. We currently operate in Philippines, Cambodia, and India, and are on track to scale to 3 more developing economies by the end of 2021.

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
• 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

The lack of healthcare access goes hand in hand with lack of ID as well as overall digital access. Our platform already provides beneficiaries an ID within the reach52 ecosystem. With support from the ID4D program we can provide millions of people with a true foundational ID, in line with national programs and emerging standards such as MOSIP, with incentives to engage through healthcare access.

Vulnerable and marginalized groups with limited access to technology and no digital identity also lack primary healthcare services. reach52 has created a successful model to reach these communities by engaging local women as agents, providing them with a smartphone and connectivity, allowing them to become the bridge to the rest of the population. The first step in providing access to health services is digital identity. So by linking our existing program to secure and recognized ID systems, while also providing health services, we allow the local community to gain a digital identity and improve their overall health.

A vast majority of solutions and interventions tackling offline marginalized communities are paper-based, vertical programs that are generally grant funded. We do not find any start-ups or innovators working in our communities.

Our approach is highly innovative because we are:

• Tech and data driven, allowing for personalised and relevant targeted interventions, that can be tracked and monitored
• Implemented by the community and local women, making our model community-led and localised to the context
• Generating reoccurring revenue already, allowing us to sustain and scale our operations
• Focused on a true end-to-end model not a vertical program, that holistically addresses digital identity and healthcare
• A true ecosystem where public and private sectors are integrated. We always ensure we leverage all publicly available services first, but then supplement gaps with affordable private sector products and services. This provides a unified experience to community members, in an regions where accessing government services, healthcare and financial services is incredibly challenging

We have successfully launched and grown in 3 countries (Philippines, Cambodia, and India) and are growing successfully also by supporting local communities during the Covid-19 pandemic. We are on track to launch to several other countries and to scale to 1 million patients in the next 12 months.

To exemplify this further, we have:

• Run programs and campaigns with over 20 global organisations (ex: Hepatitis B screening with Gilead, MCH services with Philips – all coordinated by our technology)
• Delivered public health campaigns for over 2 years in 200+ 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

An external evaluation found that reach52 has an SROI of 2.10, meaning we generate $2.10 worth of social value in communities for each $1 of investment. It was found that impact was being generated through:

1)            Increased access to quality healthcare

2)            Increased affordability of healthcare

3)            Improved resilience

These 3 outcomes are aligned to our 3 core sustainable development goals: SDG3 (good health and wellbeing), SDG5 (gender equality), and SDG8 (decent work and economic growth).

For external evaluations, please see:

• https://alliedworldhealth-my.sharepoint.com/:b:/g/personal/logan_reach52_com/EcG66ZQSN-FEnAtvoSoG4XMBvcTadlkSAMAY8dcpnizFDg?e=uffcGs
• https://alliedworldhealth-my.sharepoint.com/:b:/g/personal/logan_reach52_com/EYG3DBQ6zvNJt6csHXS8d1gB_o6toX4TlqOL2mE6h84p1w?e=13aDKY
  

Our activities, outputs and outcomes are highly integrated. Our organization is fuelled by the drive for longer term outcomes at scale globally. We ensure our impact is measured also through third party studies and that our assumptions are validated in specific programs that we run. As our ecosystem has grown to include multiple renowned public and private entities, the integrated push towards outcomes have become more tangible.

Activities

• Individual-level digital identity provision and demographic/health 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, health promotion events; rural clinics; and telehealth services
• Provision of a marketplace of good/services, including diagnostic and testing services; medicines; and insurance policies, delivered directly to rural/remote villages
• Digital engagement, through our interactive chatbots and other online properties
• 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
• Increased access to lower-cost financial and health services
• Improved digital linkages between outlying communities and government facilities
• Improved sectoral coordination between stakeholders by uniting on a single platform
• Creation of verified digital and physical identity and community demographic data
• Reduction in NCD-related morbidity and mortality in partner-communities
• Reduction in maternal mortality, through improved identification of at-risk pregnancies
• Improved child health outcomes, through and increase in ANC “contacts” per pregnancy and child health-focused workshops

Outputs

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

Outcomes

Our medium and longer-term outcomes include:

We strive for open technology, open standards and open source approaches wherever possible. Our current reach52 architecture is open to utilize and connect foundational ID systems that are globally supported and/or locally recognized. We recognize that currently different regions of the world are at different stages of their foundational ID systems and that while no technology has so far become the de facto standards, some standards such as MOSIP are gaining traction through the support of both the World Bank and Omidyar Networks. We are actively mapping processes to make our identity system MOSIP compatible, as the first production of version of MOSIP has become available and as several countries (including the Philippines where we operate) have announced they will adopt it.

We do not aim to recreate or own any digital identity program. On the contrary, we would like to ensure that the identities we are creating and verifying on the ground can be connected to any/all ID systems that will help our local communities gain access to public and private services that can enhance their livelihood. We have also examined systems such as LifeCert, which aim to provide an “identity score”, assuming that different flavors of digital identity at times will co-exist. What matters the most to us at reach52 is to leverage that precious physical encounter between our local women acting as agents with a new, as-yet non identified person, and to record that identity in the most future-proof way possible to enhance their life.

Our agnostic solution is highly adaptable and configurable, having already been successfully deployed in several countries and communities for a range of health and development challenges. It provides node through local agents and local shops (“Sari-Sari” as they are known in the Philippines), to link offline populations and communities to a range of services; information and products. We also provide channels to engage directly with online populations (for example as we did for Covid-19 support and other programs through Facebook chatbots; and our upcoming resident-facing application). Our apps, both those for pure demographic purposes and health specific purposes store digital identities of the users. The apps have now been deployed in multiple versions in production and have been used widely by tens of thousands of users, so they are robust and tested.

As part of this proposal we would aim to make our identification system compliant with standards such as MOSIP and to add the growing list of MOSIP compliant biometric devices to the physical identification process to complement our existing non-biometric based process. The system would leverage the current user-friendliness already experienced by our agents, and the physical process would remain largely unaltered. However, as part of this project, if funded, we would be able to provide a more robust, secure and globally relevant foundational ID system such as MOSIP further reinforced by biometric identity rather than relying on basic data collection on the ground.

Our architecture is open and interoperable. Given that foundational ID systems have been fairly recent and even the ones that have received more support such as MOSIP only recently launched their first production grade code release, we have been ensuring that our architecture is open and can be easily plugged into any system that will be relevant to our communities on the ground. These systems may include government issued digital IDs, digital ID systems supported at local level, or our own system where none are available. We are particularly interested in MOSIP given its launch in the Philippines, Morocco and Ethiopia and its foundational nature and the support received. As such, we have started an internal project to verify how requirements to make our system fully MOSIP compliant. If funded, we will proceed to test in one community first, and then scale the provision of MOSIP foundational IDs supported by MOSIP compliant biometric devices.

We comply to all common data standards (FHIR etc.) and are already aligned with best-practice global standards, providing ease of integration with existing solutions. We have the ability to provide a custom API, so that our data functions can be mapped into their existing systems. We use Kotlin (and historically Java) for Android development, Couchbase as our database, and then nodeJS for our web and backend. We host on AWS and Azure. We have other tools such as Docker for containerisation and Elastic/Kibana for data pipes and visualisations, and also use R and Python for this.

Through our award-winning offline-first apps and platforms, we create access to communities in areas where traditional government services don’t reach. We achieve this through bringing together communities, government providers, and non-profits with the private sector to deliver an end-to-end solution that is accessible and affordable for all. By leapfrogging developing public systems, we’re building new sustainable, primary care systems, powered by data, digital and the communities themselves. 

The deployment of 2-3 local women as agents within each community is crucial to our model in low connectivity environments where literacy, numeracy and digital access are low. Our smartphone apps built for older Android version to be deployed on affordable phones, in the hands of our agents, become the gateway for a whole community to bridge the divide between their no connectivity environment and the digital world of services and programs available to them. Residents with lower-literacy or lacking digital literacy are not excluded, as all of the tech is mediated through our network of community agents. The apps are offline-first to ensure that the agents also are able to work with local community members regardless of connectivity and then utilize limited bandwidth when and where available to transmit information. Our applications also support peer-to-peer data syncing between devices, meaning that the solution is viable even if some members of the network never have access to internet connectivity (provided they are working with peers who can occasionally connect). 

spent 2019 building the partnerships and end-to-end service model we now have, focusing on the user experience and building a digitally-enabled identification and primary health system that can be delivered anywhere on earth. This involved adding financial services such as insurance, as well as diagnostics and managing last-mile supply chain solutions to really address the root cause of primary care barriers.

By the end of 2021, we will serve 2 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 40 million people to essential healthcare. This is based on our realistic growth model, leveraging the existing partnerships we have to enter new communities. 

We align our impact goals with SDG 16 (by providing identity, access to information, strengthening the role of institutions in rural areas and shifting informal work to formal work in the healthcare sector), SDG 3 (Good Health and Wellbeing) as well as 5 and 8 (Gender Equality, and Good Economic Opportunity). In addition, as we make identity more accessible and healthcare more accessible and affordable, we measure the impact of our programs and services quantitatively. 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.

Over 5 years we will continue to scale our proven impact through three core channels:

a. Continuing to implement the services ourselves, hiring and training women in communities, and engaging directly with government 
b. Working through partners on the ground, such as NGOs/cooperatives/village stores (already doing this with 2 NGOs in Cambodia)
c. Scaling through our Facebook Messenger and patient-facing app, using Facebook Ads and organic digital marketing, to connect newly digitally-literate users directly 

We ultimately look to drive a high number of users, allowing them to gain a digital identity, and enabling them to access high quality services, and saving money. This supports lower-income communities to gain digital presence,  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 focusing on deep research and understanding the root causes of identity & 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, these are the 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, an area where using foundational digital identity could help tremendously.
• Working with governments is complex (with barriers ranging from straight corruption through to just slow pace and bureaucracy)

In the same order:

• We are manging our costs well, applying for grants (whereas we used to solely rely on business financing and contracts) and just generally trying to maximise our channels and partnership options through a fast-paced focus on business development. Regarding residents’ ability to pay, we are focusing on lowering the cost of essential products, versus discretionary health services/products
• We already understand how to either 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 looking at foundational ID systems as a way to enhance this area.
• 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 

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 I4D. 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 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 have built partnerships in eight main categories:

Government and healthcare providers

• Philippines, Cambodian and Indian 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, focusing 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
• Services are delivered directly in the community where beneficiaries live, saving the cost and time of travel to towns and cities
• The resident can access care, and save money compared to other options for accessing care
• 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 

reach52 generates revenue in four ways:

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. However, the price is still much cheaper than the pregnant mother going to a hospital (where the same scan 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

Sponsored programs and patient engagement. Private sector partners, including pharma companies, 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

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

Grants and in-kind support. While we originally eschewed grants, we started applying in late 2019 to support scale-up and have now won 5.

• 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 (such as free SIM cards and data from Globe Telecom, free Facebook Ad credits from Facebook, and free hosting of our apps from Microsoft on Azure)

As a summary of our most recent funding:

• Johnson and Johnson, $150,000 grant, for health worker education and scaling our digital/Facebook solutions for COVID-19 and system strengthening
• Pfizer, $100,000 grant for dengue prevention and case detection
• Innovate UK, $75,000 grant for
• Gilead Sciences, $50,000 revenue, for Hepatitis B screening program and health worker education
• DBS Foundation, $200,000 grant, for expanding our services into India and promoting health equity there
• Grand Challenges Canada and IQVIA, $60,000 revenue, for gender-based violence reporting and policy work
• Singtel, $10,000 revenue, funding to scale digital solutions for COVID
• Verge Capital and Zuellig Pharma, $500,000 equity, funding to scale up

If possible, we would kindly request this is not made public or we can remove the figures as it is confidential information 

We are actively raising funds at the moment. We are working to raise $2-3m USD, covering our growth and expansion into new communities (ex: user growth, connecting more lower-income residents to MCH and other health services) and expanding our marketplace (ex: more business partnerships and projects, to offer more affordable MCH services, as well as services for non-communicable diseases and infectious diseases in the key partner categories listed in our earlier answer).  We will also continue to invest in our tech product, services offered, and key management/core team hires to enhance the core of our organisation.

At present, we are looking at convertible debt as the main financing instrument, and have 3-4 partners currently doing due diligence on reach52 for this.

At present our costs are around $60,000 USD per month ($720,000 per annum). With new hires planned and additional growth expenses our costs will be approximately $100,000 USD per month ($1.2m per annum) in the coming months. We expect this to roughly increase 2-3x year-on-year as we grow and scale to new regions and markets and expand our core team. 

While reach52 is partially motivated by the opportunity to compete for up to $150,000 in cash prizes, this is not our chief reason for applying to the Mission Billion Challenge. Instead, we see two main benefits of competing in this prize, which will help to increase our impact with our target beneficiaries:

• Exposure and networking opportunities for reach52: Presenting our solution at the World Bank Group Annual Meeting would provide us with the opportunity to network with similar organizations as well as influential key-opinion leaders at a high-level forum. This is important to an organization such as reach52 which relies on strategic partnerships to scale our impact. Opportunities to participate in the wider community of practice also help shape future development of our model, and ensure that we are aligning with global agendas and best practices.  
• Wider adoption of reach52 tech and model: More importantly, reach52 is interested in the open-source use of our tech and model by the wider development community. We firmly believe that we have the systems and tools to solve some of the biggest health and development challenges. We are eager for opportunities to share our learnings with the wider development community.

We are seeking partners in the following areas:

• Private sector- We are interested in additional partnerships with companies offering goods and services for our social marketplace (including insurance, medicines, diagnostics, and consumer health). We are also interested in strategic partnerships to help us reach additional communities with our digital solutions and/or social marketplace
• NGOs- Increased partnership with community NGOs, to deploy using their existing resources and relationships, creating additional social impact for their beneficiaries
• Government/healthcare systems- The public sector is an important partner, as we first seek to strengthen community’s ability to access existing health services. We also promote quality of care through upskilling of community health workers
• Academic organizations- Additional academic partnerships would allow us to grow the body of evidence for our solution and improve our M&E framework
• Multilateral orgs- Allows us to grow recognition and allow us to have a voice in the global health community

We are interested in specific introductions to major global health foundations, specifically the precision public health initiative at Rockefeller Foundation