YelloCure

El Salvador, the smallest country in Central America, ranks third in terms of population (6.5 million) among the six Central American countries. It is the most densely populated country in Central America.

In El Salvador, there are still significant gaps in terms of housing, access to drinking water, sanitation services, and nutrition. In child population, for example, diarrheal, parasitic, and respiratory diseases predominate, as well as illnesses associated with malnutrition. Infant mortality in the country amounts to 17.5 per 1,000 live births.

Historically, the health system in El Salvador has faced a decrease in investment in public health, with a special deficit in preventive and primary care. There is low coverage by the network of public health services, fragmentation and lack of coordination, soaring prices of medicines, and lack of infrastructure and equipment. In non-communicable diseases, medical services do not usually cover all the expenses that patients must incur. Only 18% of the population has access to the Salvadoran Institute for Social Security and only 2% has private insurance.

Cancer is one of the leading causes of death for children and adolescents worldwide. Every year, more than 400,000 children are diagnosed with cancer worldwide. In the region of the Americas, there is an estimated 32,065 new cases of cancer in 2020 in children aged 0 to 14 years. Of these, 20,855 cases occurred in Latin American and Caribbean countries. According to data from the Pan American Health Organization (PAHO), 80% of children with cancer survive in high-income countries and only 20% in low- and middle-income countries.

El Salvador’s National Childhood Cancer program, funded by the non-governmental organization Fundacion Ayudame a Vivir (FAV), was established in 1993 and receives 200 new patients yearly.  Survival rates have increased from 5% in 1994 to 70% in 2020 and treatment is free of charge for patients. El Salvador´s pediatric cancer program is a level 2 cancer center, within a tertiary pediatric hospital. The program has 100% national coverage of cases of cancer in children under 12 years old.  Without FAV, the majority of Salvadorean children with cancer would not have access to treatment.

The yearly cost of the childhood cancer national program is approximately $3.7 million per year.  FAV’s sources of income are varied, from events, in-kind donations, and fundraising as well as having investments from essential stakeholders, mainly the Ministry of Health.

FAV’s biggest source of income is from individual donations through a membership program called Movimiento Amarillo. These regular donors make a monthly contribution and in exchange, they have access to Movimiento Amarillo’s benefits, mainly promotions by corporate partners. Our problem is the weak source of income faced by FAV, which provides treatment to all Salvadorean children with cancer. 70% of the revenue comes from sole donations, which are not guaranteed. Historically, FAV has operated with the deficit, accumulating high levels of debt in the past. The percentage of new donors in Movimiento Amarillo is small and our costs are bigger than our revenue. 

FAV has had a regular donor program to cover the operating costs of the cancer program since it was born 30 years ago. The donor program enables FAV to have a long-term, predictable income on a regular basis. To move from simple donations to a more sustainable revenue, FAV created Movimiento Amarillo in 2021, the same donor program but with benefits for donors. Movimiento Amarillo made alliances with local businesses, to create a more reliable and stable recurring revenue by offering incentives. Donors receive perks for their donation and a closer information exchange allows donors to be more involved with the cause. Movimiento Amarillo currently operates through a membership card. Donors must know and remember what businesses are part of Movimiento Amarillo to enjoy the benefits. They must show their card to every business that offers promotions. This methodology has not been efficient and proved complicated for donors. Our solution is to create an application to get more added value from Movimiento Amarillo for FAV, donors, and corporate partners.

YelloCure will allow FAV access to the list of all donors in a simple form. This will allow FAV to communicate on a regular basis with donors. YelloCure will have content about how donations help the cancer program and show donors how they support the organization, developing a sense of identification with FAV.  By posting photos, videos, and news about the cancer program will bring donors closer to the organization’s mission.

Donors can join Movimiento Amarillo by entering simple personal information and choosing between different membership packages (the more you donate, the more benefits available).  Enrollment will be able to click a button as opposed to calling FAV’s offices or communicating with a representative who takes them through the process. This makes the signing-up process user-friendly, potentially gaining more donors. YelloCure will have information on the businesses which are part of Movimiento Amarillo and current promotions. The app will also keep a tab of what each donor saves by being a member. Donors can also switch between membership packages or cancel their membership at any time.

Corporate partners receive tax-free receipts for their donations. Being a part of Movimiento Amarillo is also a free marketing strategy, as their businesses are being exposed to all FAV donors. 

El Salvador is the smallest country in Central America. It has a land area of 20,721 km2, the size of Massachussets. The country has registered persistently low economic growth levels due to violence and poverty.

El Salvador´s National Childhood Cancer Program, supported by Ayúdame a Vivir Foundation in alliance with Children´s National Hospital Benjamin Bloom and St. Jude Children's Research Hospital, was established in 1993.  The program seeks access to comprehensive treatment for Salvadoran children with cancer, improving their quality of life and their family in all stages of the disease. The program has national coverage of pediatric cancer and receives 200 new childhood cancer cases annually and treats 350 patients per year in an age range of 0-<18 years. Treatment is free of charge for patients, but the disease incurs a lot of out-of-pocket expenses. Leukemia (48%) is the most frequent pediatric cancer, followed by Lymphomas (13%) and Central Nervous System Tumors (12%). The treatment for patients can last a minimum of 9 months to a maximum of 2 and a half years.  According to socioeconomic interviews, 51% of our pediatric cancer population lives in extreme poverty.  Most families live from informal jobs.  47% of families also have some kind of social risk, meaning they live in gang dominated territories, have family members who are gang members, or are gang members themselves. 20% do not have access to drinking water, 44% do not have access to restroom/ toilets inside their homes, and 12% do not have electricity.  75% of children with cancer in El Salvador must travel between 2-12 hours to reach the hospital, and only 25 % of the patients live in the surrounding cities near the hospital.

Progress in childhood cancer treatment has resulted in survival rates of over 80% in High-income Countries (HIC). The reality is different in low and middle-income countries, where approximately 80% of children with cancer are diagnosed but only 20% are cured. InIn El Salvador, cure rates are 70%.  Abandonment of treatment rate in low and middle-income countries is high due to poverty, lack of access to treatment, and socioeconomic factors.  El Salvador has an abandonment of treatment rate of less than 1%, primarily fostered by education to the caregiver and a tracking protocol that allows healthcare personnel to detect absences in real-time.

The pediatric cancer program in El Salvador is funded mostly by Fundación Ayúdame a Vivir and it is an underfunded cause. In El Salvador, cancer care in general comprises less than 3% of the health care budget for all the population with most resources being allocated for adult cancer prevention and treatment. Historically, institutions tackling adult cancer have seen a growth in their infrastructure increasing the number of centers and services while the pediatric cancer program has increasingly improved its outcomes and dealing with increased prevalence with the same infrastructure and staff.  El Salvador´s childhood cancer program has been deemed an example of a cost-effective program by the World Health Organization.

The team has been very involved in searching for solutions to deliver the best quality care to pediatric cancer patients.  The team is composed of a multidisciplinary group, including healthcare workers and administrative staff.

Our team has experience designing technological solutions for pediatric cancer care. The software used to track patient’s treatment in our program has been conceived, designed, and implemented by our team. This software includes modules for every discipline. A highlight of this software is that it has helped the team ensure chemotherapy safety, by ensuring it is administered to the right patient at the right dosage. Our system keeps growing every year, adding more features and functionalities. Another important contribution is that the software developed by our team has been a valuable tool to track absences and helped reduce treatment abandonment from 13% to around 1% (Salaverría et al, 2015). Abandonment of treatment is the most severe form of non-adherence and a negative predictor of clinical outcomes. 

The particulars behind each idea are constructed by different disciplines, including oncologists, psychologists, the IT Team, and in this particular solution the team includes members of the administrative side of FAV, the people in charge of fundraising and Movimiento Amarillo. Each person brings in a different view of the problem with the needs each person may contribute to the solution.  The execution of the software creation is the responsibility of the IT software engineer.

The oncologist, psychologists, nurses, and the rest of the clinical staff have contact with the pediatric families every day and the administrative people are close to the financial needs of the organization.

Children with cancer are an underserved population. The pediatric cancer program in El Salvador is funded mostly by Fundación Ayúdame a Vivir and it is an underfunded cause. In El Salvador, cancer care in general comprises less than 3% of the health care budget for the population with most resources being allocated for adult cancer prevention and treatment. Historically, institutions tackling adult cancer have seen a growth in their infrastructure increasing the number of centers and services while the pediatric cancer program has increasingly improved its outcomes and dealt with increased prevalence with the same infrastructure and staff.  Our solution has the potential to impact every pediatric-aged individual who has cancer.  The program has national coverage of pediatric cancer and receives 200 new childhood cancer cases annually and treats 350 patients per year in an age range of 0-<18 years. Additionally, approximately 500 patients are in remission and receive follow-up care. 

Childhood cancer is a rare disease and has become one of the leading causes of death in children. There is a global inequity in its treatment. with 20% of childhood cancer cases being diagnosed in high-income countries, while 80%  come from low and middle-income countries where access to treatment is challenging due to financial difficulties, distance to treatment centers, countries lacking the capacity to provide quality care, and unavailability of medicines, among others. El Salvador is a low-middle income country with success in its program. The oncology team, from the doorman to the oncologist, is devoted to the project.  We have implemented projects that benefit our patient population with few resources, being an example globally of a cost-effective childhood cancer program.  We believe we can always do something more to improve our service and attention to the pediatric cancer population. 

FAV has a good product with Moviemiento Amarillo, but financial and technical support is much needed to take advantage of this idea. Currently, no other NGO in El Salvador has a benefits membership program. As the sole NGO implementing this, FAV aims to make the best experiences for its donors and corporate partners while solidifying a permanent revenue for FAV. 

Although nonprofit membership software programs exist, these are mainly focused on recruiting new members, collecting member information, and collecting member fees. These software programs can be used by nonprofits for a price. YelloCure aims to be FAV's personal membership application which will be able to do all of the aforementioned, but will also be linked to partner businesses that offer benefits to donors. Collaborations have already been made with businesses such as restaurants, bars, salons and spas, pharmacies, toy stores, pet shops, and museums, among others. Partner businesses offer special discounts and promotions to donors. By using the app, donors will be able to keep track of current promotions. Metrics for insight and analysis will allow FAV, donors, and businesses to assess and evaluate data such as the number of new monthly members, the amount being donated by month, the number of promotions used, the amount saved by the donor by using promotions, and the stratification of members.  

The app will enable donors to interact with the childhood cancer program by having access to news, stories, and donation information, informing members how their donations impact the cancer program. 

Geolocation API will allow the app to detect donors' locations and show them the promotions near their locations. 

The app will allow donors to join, modify, or cancel their membership, ensuring members the liberty of a user-friendly and fast method to join or unjoin. 

Donors will also be able to receive their donation receipts through the app, which is used for tax exemption in our country. 

Productivity will be enhanced by making joining Movimiento Amarillo easier and more efficient for members, allowing human resources to focus on other tasks. 

Our impact goals for the first year are the creation of the app, launching it, and recruiting new members of Movimiento Amarillo. By doing this within the first year we hope to:

1. Strengthen the existing donor program by increasing monthly donors.

2. Help members develop a sense of identification with the cancer program.

Our impact goals for the next years are:

1. Gaining financial stability and independence

2. Ensuring access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines for the Salvadorean pediatric population with cancer. 

3. Increase the number of partner businesses collaborating with Movimiento Amarillo. 

4. 

Gaining financial independence will allow the program to focus on growing. One example of this is the much-needed expansion of the infrastructure of the childhood cancer program which would allow adolescent patients to be admitted into the pediatric cancer program. Currently, adolescents are treated in adult cancer facilities, where there is a lack of essential medicines and patient survival rates are low. 

Metrics from the app will allow FAV to track the recruitment of new members and increase of donations. Examples of indicators are:

1. Number of new members per month.

2. Increase in monetary gain from donations per month.

3. Number of promotions used by members per month. 

4. Number of donor interactions in the app per month. 

5. Increase in raised funds from donors per year. 

6. Number of new businesses who collaborate with Movimiento Amarillo.

7. Ensure all children with cancer have access and coverage to quality essential healthcare services. 

8. Ensuring all children with cancer have access to all essential medicines needed to treat cancer. 

Our problem is the weak source of income faced by FAV, which provides treatment to all Salvadorean children with cancer. FAv depends on monthly donors to cover the expenses of the national pediatric cancer program.  Movimiento Amarillo, which gave donors some benefits, was expected to be a success, but since its launch, it has failed to create the impact it was believed to have. 

All pediatric cancer patients in El Salvador need FAV to receive treatment. If FAV has financial difficulties, all Salvadoran children with cancer suffer the consequences. 

Our desired state is creating a successful donor program that would allow FAV to have a stable source of revenue. With stable revenue, all pediatric cancer patients benefit, ensuring their access to essential treatment for cancer.  Also, partner businesses benefit by 

The core technology used in YelloCure is a mobile application development platform (Apphive) that has allowed our team to develop this application using drag-and-drop elements to build an UI and graphic interphase to set databases rather than coding in IDE's using standard programming languages. This platform allows us to create native versions of YelloCure for Android and iPhone users.

The platform we use has scalable plans and allows development free of cost, it also provides great customer and technical support. It includes API functions, Firebase and Apple compilation, and an option to convert FAVapp into a Web App compatible with other mobile operating systems.

The project team has worked together for many years and on many projects, sharing common goals, expectations, and a passion for the pediatric oncology program. We have respect and appreciation for the contributions each team member delivers and with this respect for each other comes a fair distribution of power, recognition, and risks. We share the same values and goals: union and passion, respect and compassion, and honesty. We belong to the same team and we work together to achieve our mission to help all children with cancer in El Salvador live. Each one of us is a key piece to achieve our goal and we are united by our passion for the cause. We believe we are equal. That is why we treat all of our patients, staff, volunteers, visitors, donors, and stakeholders with respect, kindness, and compassion. We are committed to the responsible and ethical management of our resources. 

The pediatric cancer program in El Salvador was initiated and is presided over by Fundacion Ayúdame a Vivir(FAV), a non-profit organization that provides treatment and care for all Salvadoran children with cancer, who would otherwise not be able to pay for the treatment. The impact of the program is saving the lives of hundreds of children each year. With St Jude Children's Research Hospital and the Ministry of Health as stakeholders,  FAV can offer a comprehensive cancer diagnosis within days, all chemotherapy free of charge to patients, psychosocial support, and lodging for patients who come from outside the city, among others.  Human resources have been trained in pediatric oncology, including oncologists, nurses, and psychologists to deliver a comprehensive standard of care to all Salvadoran children with cancer. The majority of patients cannot pay for cancer treatment and there is no treatment in private hospitals in El Salvador so their child's chance of survival is made possible by FAV´s work. Funding for the national cancer program comes from the government, through the Ministry of Health, and fundraising by FAV. From this funding comes all chemotherapy, antibiotics, and staff salaries. Patients from all over the country are referred by primary and secondary-level hospitals and once a cancer diagnosis has been established, they are immediately admitted to the program. Patients might have out-of-pocket expenses, like travel expenses, which are sometimes covered by FAV and its allies. One of the major sources of revenue is the donor program which has existed for 30 years. In 2021 Movimiento Amarillo replaced the existing donor program and it came with benefits for our donors.

Financial sustainability can be achieved in two different stages. In the first stage, funding comes from grants and is oriented to building, promoting, and implementing our innovation. This funding is key for developing a strong, secure, and amicable program that will prove user-friendly for donors and attract potential new donors. The grant money will be used to pay for the service of the development of the app.  Testing is also important to make adjustments. 

When the software is up and running and results, as well as indicators, are achieved, we plan a two-way strategy: this software can be shared as individual licenses to other pediatric cancer programs in the region that are willing to increase their capacities to detect pediatric cancer in early stages. Central American countries all have a national pediatric cancer program that survives through their non-profit organizations. All countries share their success stories regarding fundraising. The objective is to share YelloCure with these countries and have them implement similar membership programs with benefits. 

This aligns with the WHO's Global Initiative for Childhood Cancer (GICC), whose target is to achieve at least 60% survival for children with cancer by 2030 by involving governments and increasing countries’ capacity to provide quality services for children. Different levels of subscriptions to the software can be offered to fit the needs of any program.

Fundacion Ayudame a Vivir is a 30-year program that has received funding from different sources. Some examples include funding from Fundacion Gloria Kriete, which provided funds for a Flow Cytometry Laboratory valued at approximately $100,000, which provides a timely diagnosis of pediatric patients with leukemia. The leukemia immunophenotype determination allows the treatment assignment based on the risk stratification of the disease. Before acquiring the Flow Cytometry, diagnoses were made in Guatemala and took up to 3 days.  Today we can make a leukemia diagnosis in 24 hours. 

 In 2013, grants totaling more than $636,000 over two years were awarded to two physicians. One of them was Dr. Soad Fuentes Alabi, who studied the epidemiology and biology of childhood cancer in South America and worked to establish a cancer registry in the region. She set up a cancer registry in Central America, demonstrating that the incidence of childhood cancer was higher than previously thought and showing that, as in other countries, governments need to allocate more resources to cancer programs. 

 Another important grant of $100,000 was given in 2021 for infrastructure. With this funding, the day patient clinic was completely renovated. Built in 2008, the day clinic had become small for the patients and personnel. Caregiver's bathroom areas were improved, a resting area was created for caregivers, an area for adolescent patients was made, a school space was renovated, office spaces were created for staff who had no working areas, and the play area for children was improved.