Rocket Health Telemedicine Service

Neglected tropical diseases (NTD) constitute a group of diseases caused by parasitic worms, protozoa, or bacteria and are rare globally and in many parts of Sub-Saharan Africa, however, they remain endemic in some parts of Uganda. They include diseases like soil-transmitted helminths (STH), schistosomiasis, lymphatic filariasis (LF), and onchocerciasis. Despite a number of interventions to eradicate these diseases, they continue to be of public health concern in Uganda with over 80% prevalence rates for STH, over 400 million cases of leishmaniasis are reported annually, lymphatic filariasis has a 0.4% to 30.7% prevalence rates in school going children and up to 4 million schistosomiasis cases are registered each year.

A number of factors contribute to these observed trends NTD prevalence rates in Uganda which include distant health facilities, scarce health professionals (doctor to patient ratio 1:25,000), and scarcity of specialist services especially for diagnosing these rare illnesses. This creates a divide in accessing quality and reliable healthcare, especially for improvised rural communities that are greatly affected by these illnesses. In addition, the impact of these illnesses goes beyond the physical well-being to socioeconomic owing to the loss in productivity and days off work due to sickness and in the worst-case scenario deaths.  When expressed in disability-adjusted life years (DALYs), NTDs account for approximately one-quarter of the global disease burden from HIV/AIDS and for almost the same burden as malaria an infectious disease that kills over 80,000 Ugandans annually and causes about USD 200 million annual lost productivity.

Rocket Health offers an end-to-end digitally supported platform for patients with NTDs along their care-seeking journey from prevention, diagnosis, care, treatment, and follow-up. This is achieved through a 24/7 medical call center manned by qualified and licensed health professionals and specialists who offer remote consultation (teleconsultation) services to beneficiaries via text, voice, and video platforms. Where a teleconsultation results in requires a laboratory test, a lab technician is dispatched to the beneficiaries’ location to collect the sample and have it processed with results interpretation done, and prescription filling and deliveries of medicine and other non-medicinal pharmaceutical products are delivered at the last-mile. We also develop health content on the majority of the NTD covering different domains like awareness and knowledge creation, prevention, care-seeking, and treatment which we contextualize for local understanding and also translate into local languages. The health content is disseminated via mobile messages on a prepaid (toll-free) messaging short-code. 

Neglected tropical diseases (NTDs) typically affect the lower tier of the Ugandan society, who are the rural poor communities that lack purchase power and access to quality and affordable healthcare for diagnosis, treatment, and care to achieve healing and recovery. Typically, the time to travel to a health facility, queuing in waiting rooms, and medical consultation in Uganda averages 4 hours with no more than 10 minutes spent with the Doctor. Compare this to a 10-minute telemedicine consultation that requires no travel and waiting time. This is a 90% time saving for patients combined with reduced congestion in health facilities. The average expenditure per outpatient visit in Uganda is 40 USD compared to USD 20 per telemedicine encounter. This is a 50% cost savings per visit. 

The team at Rocket Health is of diverse professional backgrounds including medical professionals, communication specialists, software and technology engineers, and a quality assurance team. This diversity in professional backgrounds creates complementary synergies within the team and helps close up any deficiencies. Rocket Health has a past performance track record in implementing regional and nationwide public health projects in Uganda and this experience will be central in the execution of the Horizon prize project. Some of our past projects have been in the affected district, for example, the USAID-funded Regional Health Integration to Enhance health services in the North-Lango region exposed us to the scourge of NTDs in the Lango sub-region. To this end, we have undertaken a series of implementation research studies to understand the determinants and influencing factors to the persistence of NTDs in the Lango sub-region which has informed the design and implementation of our proposed solution. 

We expect the challenge to support the expansion of our medical services and reach through;

1.  Establishing our own courier (transport): we shall purchase and brand motorcycles and a van to be utilized in delivering our last-mile medical services to the rural communities.

2. Human resource recruitment: we shall recruit critical human resources needed for the business growth including the health care professionals (doctors, laboratory, and pharmacy technicians), marketing, and data analysts. 

3. Setting up satellite drop-in points: in collaboration with laboratories and pharmacies that have widespread chain location points across the country, this will widen our geographic reach. 

4. Participation in the challenge will provide us the opportunity of building partnerships with more experienced people and grant us exposure to potential mentorships needed for our growth.

Typically, the time to travel to a health facility, queuing in waiting rooms, and medical consultation in Uganda averages 4 hours with no more than 10 minutes spent with the Doctor. Compare this to a 10-minute telemedicine consultation that requires no travel and waiting time. This is a 90% time saving for patients combined with reduced congestion in health facilities. The average expenditure per outpatient visit in Uganda is 40 USD compared to USD 20 per telemedicine encounter. This is a 50% cost savings per visit. Data collection and analysis through telemedicine technology makes it more efficient for stakeholders including the Ministry of Health and partners to plan and predict different trends in NTDs prevalence to guide strategy and informed decision making. Furthermore, medical records collected and stored electronically enable clients to remotely access their personal medical records which supports continuity in accessing healthcare beyond the boundaries of Rocket Health.

Next year:

- Expand to 3 new regional locations in Uganda: through grants and venture capital investment we plan to expand our national reach to 3 new upcountry locations. 

- Grow the number of users served annually to at least 380,000 through marketing and promotion campaigns like community outreach activities. 

- Launch a prepaid low-cost healthcare plan for rural communities informed by end-user survey findings.

Next 5 years: 

• Expand Rocket Health services into Kenya: through grants and venture capital investment, we plan to expand into Kenya.

• Build a mobile phone application to support diagnosis and care for community health workers through end user-centered design sprints.  

We use a number of performance indicators to monitor our progress towards achieving the impact goals and below is a summary of some we track.

a. The number of community outreach activities conducted

b. The number of tele-consultations handled

c. The number of medicine refills for NTD patients completed

d. Number of functional satellite hubs/centers launched

Our theory of change is known as the path to transformation which is illustrated in the infographic below.

We use an integration of technologies in the delivery of Telemedicine and last-mile medical services in our innovation as described below;

1. Our text messaging platform is built off an open-source software called Rapidpro which we customized to meet our local needs. It allows for a 2-way messaging between the healthcare providers and the beneficiaries.

2. The voice call-in platform is built from asterisk which is open-source software, voice call interactions get to be recorded in our locally built electronic medical records system that is built using PHP framework.

3. We also have a self-service online e-Shop built using WordPress that allows for the privacy purchase of any medical services for beneficiaries including pharmacy products.

4. We have also integrated artificial intelligence (AI) into our patient journey leveraging 3rd party AI platforms called Ada health which was added as a self-triage tool onto the eShop to allow clients with access to the internet to be able to input their symptoms and get a quick guide on likely symptoms and course of action to take. Ada health chatbot is built off PHP botman and we plugged it via an API onto the e-Shop.

As an institution, we have developed and approved policies that ensure the incorporation of gender within the day-to-day operations for example the gender equality and sexual harassment policies. In addition, our human resource policy has clauses that ensure inclusivity and non-discrimination as guided by how we communicate both internally and externally, recruitment approaches with a gender non-bias across all company positions. The board of directors has 6 people with 2 being female; senior management positions are 11 and 7 of these are held by females. Our model of healthcare delivery leverages low technology platforms like voice call-in and mobile messages allowing poor rural communities with no internet access and yet heavily impacted by the NTDs access to quality and affordable healthcare. In addition, only self-services platforms like the e-Shop and last-mile model allow for privacy and easy access to medical care for stigmatized patient groups in a more confidential manner.

Our business model is a hybrid of Business-to-Business-to-Customers (B2B2C) and the direct Business-to-Customer (B2C) models as explained below;

1. B2B2C: This typically involves partnerships with developmental partners like USAID, UNICEF, John Snow Inc, and private sector players like private health insurance companies or with private health insurance companies like UAP Old Mutual, Prudential, Sanlam, and Jubilee among others who cover the end beneficiaries’ costs of accessing our health care products. This serves as a pre-paid service where the end-users have premium health coverages. 

2. B2C: Through our consumer-facing brand name, Rocket Health, we provide direct medical services to clients/end beneficiaries through direct purchases of medicines, laboratory tests, and tele-consultation services. In addition, healthcare premiums packaged as subscription products are sold to clients

Our sustainability plan is a combination of approaches as described below;

- Sales of Rocket Health medical services- Rocket Health medical services including tele-consultations, Labs, and pharmacies are sold to beneficiaries like private health care insurances, corporate entities, and out-of-pocket one-off purchases.

- Raising investment capital- Through fundraising series as we have recently closed a Series A fundraising round led by Creadev. 

- Research grants- As part of our core mandate on data use, we shall be deliberately strategic in creating partnerships that ensure the sustainability of research grants that will be critical in evaluating our interventions and inform or guide decisions. 

1. We successfully completed a series A fundraising round where we raised USD 5 million, led by Crevdev.

2. We have also attracted developmental partner grants from USAID, UNDP, and others which we have leveraged to deliver public health services. For example, USAID funded Regional Health Integration to Enhance Health Services (RHITES), North Lango, UNDP funded PEARL innovation in COVID-19 response with a USD 25,000 grant.

3. We have also attracted research grants from donors, such as the University of Minnesota, and USAID DIV among others.