Bloomwell Healthcare Workforce Solutions

Here in Uganda, the US, and worldwide, burnout is a significant problem among nurses who leave their job or consider leaving their job. Health systems have no choice but to focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift. At more than 6 million in 2019, nurses are the largest segment of our health care workforce, making up nearly 30% of hospital employment nationwide. The prevalence of burnout among nurses in Low and Middle Income countries ranges from 49 to 57% while the burden of burnout in sub-Saharan African nurses range from 40 to 80%.  Here in Uganda, there is limited evidence on the burden of burnout among nurses in a manner that undermine advocacy and policy formulation; the reality is that burnout is a public health problem that disproportionately affects nurses in sub-Saharan Africa because of the weak health systems that create an unconducive workplace environment. That's why we are committed to strengthening this ecosystem through a well-managed community mental health program for health care workers (CHW).

Bloomwell Health is a mental health tech company that partners with nonprofit organizations and government agencies to curate user-friendly platforms that give users direct access to screening tools and an individualized plan with evidence-based, culturally & linguistically tailored self-help resources & wellness experiences, all of which are AI-generated and gamified for continual engagement. Our platform uses human-centered design and large-scale product experiments to improve outcomes like healthcare worker wellbeing. We also use learning engineering techniques to improve learning and motivation. 

Bloomwell Healthcare Workforce Platform can be thought of as an emotional wellness playground. It has three main components that all work to reduce stress and burnout in healthcare workers:

1) Connecting healthcare providers with a toolbox of pre-recorded module and culturally tailored resources for clients (inclusive of Children, Adolescents, and Adults). This component provides resources to help clients handle their daily obstacles with ease. These culture-specific tools are usually developed by clinicians and teachers with decades of experience working within a particular environment, region, culture etc. 

2) Offering weekly mental health check-ins and/or coaching to health care providers like nurses. Users on the platform sign up free of charge by sending a text the Bloomwell Buddy Helpline. Users are then assigned to a team of coaches that proactively check in daily, weekly, bi-weekly, or monthly depending on their choice. Upon enrolling in the systems and completing mini self-assessments, these coaches are expected to listen without judgment, offer support, and help healthcare workers to build skills to manage their emotions and stress while on the job. As needed, the Bloomwell Buddy program is also able to connect their users to additional clinical interventions and resources.

2) Linking healthcare workers to monthly trainings and/or workshops that are developed with feedback from health partners on where increased capacity is needed. These programs can be used as a means to obtain access to continuing education credits.  

Through in-product nudges and coaching modules, the idea is that healthcare providers will be updated on best practices and updates on the latest information that will ensure they are well equipped to help clients build trusting, respectful relationships through effective communication, without language, tech or cultural barriers.

Through our leading-edge cognitive behavioral therapy delivery model, we use short-term, goal-oriented evidence-based methods that focus on solving problems and building skills to identify unhelpful thinking, modify beliefs and change behaviors in those struggling with post-traumatic stress. 

There are many organizations across Uganda that provide extensive programming centered around psychosocial support services. We are not interested in re-inventing the wheel at all. What many of these organizations fail to do is provide culturally tailored self help tools or direct linkage to community-based resources. Instead, it focuses too much on the individual and therapists, and not enough on using a collective approach for healing and growth. In partnership with Center for PEACE (Psychosocial Education & Community Engagement), we are working directly with members of the communities to decolonize many of the commonly used assessment tools and to curate comprehensive culture-specific services that addresses the full range of mental health problems affecting refugees and 1st, 2nd and 3rd-generation survivors of conflict in Northern Uganda. Our clinicians are all 100% African and have extremely interdisciplinary backgrounds (social workers, nurse psychiatrists, mental health counselors, birth doulas, death doulas, midwives, public health researchers, epidemiologists, UX/UI designers, and the list goes on). This pilot will be used to measure the validity of this tool for healthcare care workers in this region. 

We are currently on the ground, collaborating with stakeholders to build a better system through our work in implementation, knowledge exchange, evaluation, information management, health equity and engagement. In October 2021, we conducted a week-long workshop where 10 mental health practitioners (psychiatrists, psychiatric nurses, mental health counselors, lay counselors, etc) worked to adapt evidence-based psychological assessments that are commonly used in clinical settings and to transform them into culturally appropriate screening tools for identifying emotional and behavioral disorders among adolescents and young adults in Uganda. The mayor of Gulu City- who has a public health background- attended the opening and closing ceremonies and is in full support of this initiative. Additionally our three main Leaders all have affiliations with Gulu University, Makerere University School of Public Health, and the United States Centers for Disease Control. Upon completing a pilot intervention/study and presenting proof-of-concept, stakeholders from all three institutions including the Uganda MoH, Mental Health division have agreed to consider providing institutional support.

In as much as we would like to just dive in with the mental health interventions that we have developed, we also realize that the sustainability of this project will rely heavily on the implementation of programs that concurrently focus on training competent and confident mental health care workers and effectively supporting government agencies such as the Uganda Ministry of Health (MoH) Mental Health Division to employ, deploy, and retain these workers. Our team has had extensive conversations with the Director of Mental Health at MoH and the biggest takeaway was that in order to improve access to mental health testing, care, treatment, and support for the populations that we service in conflict-affected regions, we have to bridge health workforce gaps by creating communities of practice through tele-mentoring and case-based learning, as well as mental health programs for providers at the facility level (burn-out is the number one cause of high turn-over rate). Center for PEACE will provide programmatic and technical support for regional tele-mentoring network scale-up activities, which include: implementing a regional mental health tele-mentoring network for cost-effective capacity building to improve provider care for refugees and ; scaling up national tele-mentoring networks through technical assistance, coordination, and direct support; and strengthening the capacity of MoH and hubs to implement HIV and TB tele-mentoring programs and lead strategic planning to strengthen the HIV response. Utilize information technology platforms to support health care worker learning and performance, thus expanding the scope of training, continuing education and performance support activities. Provide joint oversight in coordination with the MoH Mental Health Division to the project implementation team (staff and interns) through supervision and clinical reviews, consultation, training and support to ensure program quality in accordance with MoH policies and procedures and implementation of best practices. Although there are many youth enrolled in educational programs and receiving some level of mental health and psychosocial support, there is currently no comprehensive culture-specific service that addresses the full range of mental health problems affecting 1st, 2nd and 3rd-generation survivors of conflict in Northern Uganda.

In 2020, We won 3rd place for the MIT Solve x CUNY Mental Health Solveathon. Our biggest challenge that we are looking to address is developing strong methodologies for measuring the impact of the work that we are doing on the ground and ensuring that is inevitably strengthens health care systems and the people that are both serving and being served. There are a few other SOLVE winners that are doing similar work and it would be great to learn more about best practices and how they went about addressing common challenges that are faced in low and middle income countries.

we are committed to tackling rampant disparities in our health system and reimagining access to quality care for under-resourced and and low-income communities of color in Africa and the Diaspora. There are many organizations in Northern Uganda that provide extensive programming centered around psychosocial support services. We are not interested in re-inventing the wheel at all. What many of these organizations fail to do is provide culturally tailored self help tools or direct linkage to community-based resources. Instead, it focuses too much on the individual and therapists, and not enough on using a collective approach for healing and growth. We are working directly with members of the communities to decolonize many of the commonly used assessment tools and to curate comprehensive culture-specific services that addresses the full range of mental health problems affecting refugees and 1st, 2nd and 3rd-generation survivors of conflict in Northern Uganda. Our clinicians are all 100% African and have extremely interdisciplinary backgrounds (social workers, nurse psychiatrists, mental health counselors, birth doulas, death doulas, midwives, public health researchers, epidemiologists, UX/UI designers, and the list goes on).

CO-CREATION WITH COMMUNITY

A comprehensive and coordinated response for mental health requires partnership. One of our long-term goals is to connect with sectors such as  health, education, employment, judiciary, housing, social welfare and other relevant sectors, including the  private sector as appropriate. Here in Uganda, there is a big push to promote interdisciplinary engagement across NGOs, CBOs, and other organizations. Through cross-sectoral engagement, Bloomwell would like to work in partnership with these organizations to support the interruption of negative cycles of poverty, violence, environmental degradation and mental disorders, with opportunities  for action in demographic, economic, neighbourhood, environmental events and social domains. Example of community partnerships are: 

• enhanced family support programmes; 

• available debt relief programmes; 

• accessible and responsive primary care services to support people at risk and prevent mental health effects;  and 

• increased alcohol prices and restricted alcohol availability to reduce the harmful effects on mental health  and save lives. 

Upon downloading Bloomwell, there will be a survey to acquire demographics, interests, and needs in order to create a customized user experience. In an effort to make Bloomwell culturally competent, we will create mutually beneficial partnerships with Ugandan owned businesses for wellness experiences, provide Ugandan audio guided meditations, and incorporate local languages (i.e. Luganda, Swahili, etc.) Hence, Bloomwell’s digital mental health and social wellness platform will be hyper-localized for our demographics and provide social, justice, welfare and economic development of the local community by leveraging technology solutions such as artificial intelligence. Through Center for PEACE’s clinical mental health upskilling programs and YouBelong’s infrastructure platform (https://youbelongcommunity.org/), Dr. Richard and Dr. Brian Mutamba’s local know-how and support, we as a team, will be able to leverage value-added support to steer our business idea in a time-efficient manner with a profitably scalable business model. As we partner with service providers, we also generate significant job opportunities for our community. 

Development of Hyper-localized Tools for Measuring Positive Mental Health

Scales and assessment tools have been developed internationally to measure positive mental health. However Uganda has not developed a framework to measure positive mental health within the Uganda population in response to the data gap for this type of information. Hence we plan to engage leading subject matter experts in the development of tools that can be used to measure positive mental health. All of the tools will be available in different languages to cater to the various ethnic groups. 

DEMONSTRATED COMMITMENT TO PUBLIC HEALTH EQUITY

The biggest threat to public health equity in Uganda is the lack of data to truly link negative mental health outcomes with increased policies and programming. Through Bloomwell, we plan to conduct an analysis of the return on investment in effective treatment coverage for depression and anxiety disorders, showing that for every Ugandan shilling (UGX) spent there is a benefit of X UGX as a result of restored  health and productivity of affected individuals.  In order to ensure equal opportunity and reduce inequalities of outcome, the Ugandan Ministry of Health must acknowledge that mental ill-health is both a  consequence and a cause of inequalities. 

Adverse social and economic conditions, including poverty, income inequality, low levels of  education, exposure to violence and forced migration, are key determinants of mental health. The characteristics of the built environment and neighbourhoods where people live have been  found to have an impact on mental health. Studies have established an association not only with  socioeconomic neighbourhood characteristics but also with population density and access to  public transportation, local services and public spaces. Through mobilization of our community partners and our users, we hope to ensure responsive, inclusive, participatory and representative decision-making at all  levels and promote and enforce non-discriminatory laws and policies for sustainable  development: stigma and discrimination are major barriers for people accessing the mental health services they need.

We have developed a full-blown evaluation program with indicators associated with the UN Sustainable Development Goals here.

Our Theory of Change is based on scientific research which tells us that early trauma and adversity lead to biologic changes in the young child that damage the developing brain and metabolic systems, leading to long-term problems in mental health, learning, and physical health. Center for PEACE works from two directions: prevent or ameliorate this damage, and at the same time, enhance the child’s development. We also seek to digitize our interventions and transform them into e-learning modules and tools that can be utilized for training frontline workers to ensure sustainability.

There are two major strategies that Center for PEACE employs to prevent or ameliorate damage due to toxic stress:

Directly decrease the stress experienced by the family by connecting them to needed services through intensive care coordination.

As needed, provide coaching psychotherapy and group therapy to repair the impact of trauma on healthcare providers and strengthen the caregiving relationship, which prevents the biologic changes that lead to long-term damage to overall health, mental wellbeing, and metabolic systems.

There are three major strategies Center for PEACE provides to enhance the growth of the caregiver:

1) Build the executive capacity, self-regulation, and mental health of the provider/caregiver, so that she/he is able and available to nurture their patient and provide a safe, growth-enhancing environment.

2) Connect the healthcare workers and other family members with community services that stimulate growth and learning.

3) Provide guidance and strategies that enrich the learning environment and enhance development.

Our approach is unique in combining comprehensive, coordinated services, psychotherapeutic intervention for child and caregivers, and increasing adult self-regulation and executive functioning in a single model, resulting in long-term positive outcomes for healthcare workers, children and families.

Our platform utilizes an evidence-based approach that delivers scientifically-validated programs which positively impact behavior to help manage chronic conditions alongside providing access to solutions such as telehealth, AI-powered coaching and access to therapeutics, as required, to improve peoples’ everyday lives. Bloomwell Health offers two core solutions for its customers and end-users; Digital Therapeutics and Care Delivery solutions and services across the healthcare ecosystem, including enterprises, health plans, health systems, pharmaceutical manufacturers, and individuals.

We have a passionate team of gaming programmers, AI data scientists, clinical psychologists and researchers with a diverse set of skills, cultural backgrounds, and experiences. Currently, we are seeking to ramp up the technology associated with our application to include the development of AI algorithms and data analytics capabilities. We have also commenced broader marketing efforts.

Unfortunately mental health programming is severely underfunded in Uganda. Furthermore, Uganda’s current infrastructure and system doesn’t have efficient systems and resource capacity to provide impactful end to end mental healthcare solutions. Most solutions are imported from the west which are not customized to the local demographics and are a complete mis-match which results in incorrect, inefficient and incomplete diagnosis. This results in providing temporary solutions without evaluating the key root-cause or reasons that impact mental health. In this collectivist society, our application's social utility helps people communicate more efficiently with their friends, family and coworkers.

Bloomwell Health's implementing partner Center for PEACE has health plan partners pay a monthly fee for each covered member active on the platform. Healthcare workers covered by the health plan partners sign up free of charge by sending a text to number. Users are then assigned to a team of coaches that proactively checks in every day by text message to listen without judgment, offer support, and help users build skills to manage their emotions and stress and perform better on the job. By connecting every day, Bloomwell’s coaches, also know as the Bloomwell Buddies, both support users through their challenges and celebrate their wins. As needed, Bloomwell is also able to connect its users to additional clinical interventions and resources.  

Through human-like empathic AI, any user can take advantage of the freemium model that allows them to access basic services for free; there are no obligations and takes just one minute create an account.

Our user is not only internally motivated by the desire to feel better through the  culturally tailored videos, meditations, but also by the external reinforcement of the peer networks, providers and alternative therapies that fit their particular culture, language, and insurance situation. 

We offer a freemium model to our user where they will have immediate access to assessments and pre-recorded videos for free. According to the Uganda Annual health sector performance report 2014/2015, Uganda had a total of 81,982 health workers employed in the health sector.  0.01% of our total addressable market is 80,000 users. If only 10% of those 80,000 users subscribe to the Basic subscription plan, we will generate a revenue of at least $105K. Additional income will come from our strategic partnerships with universities, insurance companies, government agencies, and more.

We have generated funding through consultancies and pitch competitions. To date, we have raised about $20,000.