Watsi’s Emergency Surgery Fund

Every year, 17 million lives are lost to surgically treatable conditions—5x greater than malaria, TB, and HIV/AIDS combined. High-quality surgeries cost, on average, 5x higher than a person’s monthly salary in Kenya, 6x higher in Cambodia, 9x higher in Haiti, and 13x higher in Uganda. Despite the alarming need for this life-saving care, safe surgery remains vastly underfunded, and the reality has only worsened for marginalized communities and the world’s most vulnerable due to the COVID pandemic. 

At Watsi, we’re bringing people together around the world to change this, using technology to connect everyday people with individuals who do not have access to this critical care. We know that every patient we reach together unlocks a lifetime of potential, enabling patients and their families to have a higher quality of life and be more active members of their communities. Experts estimate that failing to invest in surgical care could cost Low- and Middle-Income Countries (LMICs) as much as $12.3 trillion in lost GDP by 2030. We also know that high-performing surgical programs help create stronger, more sustainable, and resilient hospitals and health systems - with positive impacts that will even protect communities in the face of future pandemics. In short, Watsi is moving us closer to a world with health for all.

In working to build a future where people everywhere have access to safe, dignified, and high-quality healthcare, we have seen firsthand how for many around the world, attaining good health is a complicated undertaking that depends on much more than just their ability to get to a good doctor when they are sick. At the core of health disparities across the globe is a phenomenon called the health-poverty cycle: income inequality, often perpetuated and exacerbated by historical oppression, leads to social and built environments that foster poorer health and lower educational attainment. This, in turn, puts communities we are trying to reach at higher risk of disease and early death - and the cycle continues.

If, for example, a baby is born and grows up in an area where there is poor air and water quality, limited access to fresh foods, high rates of violence, or insufficient access to essential healthcare services, they are at a higher risk of having or developing conditions such as mobility-impacting genu varum (bowleggedness), neural tube defects, or cardiac abnormalities, all of which need surgical intervention. In fact, these birth conditions along with limb conditions and hydrocephalus accounted for more than one out of every five Watsi patients in 2022.

Individuals in vulnerable communities, including our patients, are often caught in a negative feedback loop which begins with their social and built environment, the air they breathe, the food they eat, and the stressors they face. We are on a mission to disrupt this feedback loop and build a world where everyone has access to healthcare, and we are using the unstoppable power of technology and human connection to make this possible.

Watsi is building technology to create a world with health for all. Our platform helps the world’s most vulnerable patients access private capital through people-powered philanthropy to fund the life-changing surgery they need.  100% of crowdfunding donations made through our innovative technology platform — the first of its kind in the healthcare space — directly fund surgical care. Since our founding we’ve raised over $16 million for patients, with an average donation of $52. We work entirely with local medical partners to create sustainable, locally-led programs that are meeting urgent healthcare needs of the people in their communities. 

While there are countless social, environmental, and economic determinants of health that play a role in the health-poverty cycle, at Watsi, we are focused on the economic piece of the puzzle: removing the financial barrier at the point of care in hopes of shielding people from crushing medical debt, delaying needed healthcare, or not having treatment at all. We leverage our platform to connect donors anywhere in the world with patients spanning 30 countries who are in need of life-saving surgical care but cannot afford it.

Leveraging the best of technology and humanity, on our platform, people can:

1) Meet a patient who needs life-changing healthcare

2) Help directly fund their treatment with a donation of as little as $5

3) Receive an update on their impact after the patient has surgery

At Watsi, we are 100% committed to being radically transparent, impact-focused, and patient-centered.

Watsi funds life-saving surgical care for individuals around the world who do not have access to it. The majority of our medical partnerships are in East Africa, Southeast Asia and the Americas.

For Watsi patients, a healthy life is influenced by numerous factors, many largely out of their own control. A patient’s social and built environment, and the resulting educational and economic opportunities or lack thereof, either positions them with a greater chance of enjoying a healthy life or adds to the struggle of staying healthy.

Beth Wangigi, leading our Watsi partnership with African Mission Healthcare in Kenya, shared:

“Those lacking sufficient income channels and savings often end up foregoing treatment due to the cost factor. Poor health forces the patient and their family to choose between seeking treatment and meeting other basic needs. It is not uncommon to find assets being sold to offset medical bills. Where a chronic illness is involved, seeking treatment has led many households into further impoverishment.”

Such is the case with Mary, a Watsi patient who runs a small eatery and earns $2/day while her husband tends to their small-scale farm. They own one cow and rely on proceeds from the eatery and from selling milk from their cow to make ends meet. When Mary was diagnosed with breast cancer and her doctors told her she needed an urgent mastectomy to prevent metastasis, she and her husband were faced with the difficult decision of selling their cow in order for Mary to seek medical attention. Even then, they barely had enough to cover the tests and the proposed treatment thereafter. Fortunately, the Watsi community came together to fund Mary’s surgery after her story was shared on our platform.

Mary is one of the countless patients we meet where basic family needs are sacrificed in order to access essential medical care, or vice versa. In fact, a groundbreaking study by The Lancet Commission on Global Surgery estimates that 33 million people globally face catastrophic expenditure each year to access surgery, and an additional 48 million people when accounting for costs related to accessing surgical treatment such as food and transportation.

We hope that one day organizations like Watsi will become obsolete and we will have collectively achieved global health equity. Until then, the continued need for Watsi illustrates the broken systems that exist worldwide and how, as a result, patients are left behind. While we work toward long-term solutions that may take decades, Watsi has an immediate, tangible, and life-changing impact on the people we serve.

As Beth further shared:

“Productive partnerships with frontline hospitals and donors like Watsi supporters enable communities in need to access quality health care. Programs like Watsi contribute to restoring the well-being of individuals and their community, and protects them from the health-poverty trap by facilitating access to safe, high-quality, and respectful medical care. The result is a gradual process of breaking barriers to healthcare accessibility which creates a ‘butterfly-effect’ that further shields communities from the health-poverty trap.”

Since our founding in 2012, Watsi has embraced a local and patient-first model. We focus on actively listening to our medical partners and patients, and then we work to get resources to them as directly and efficiently as possible to support the cost of medical treatment. 

Every step of the way, we have built a system that rests on a foundation of radical trust and transparency in which we support local hospitals in setting their own priorities on what will have the most impact on patients’ lives. This has led to an open and effective relationship between Watsi and its medical partners in communities around the world. 

We also believe in the importance of people-powered philanthropy, which our innovative technology platform is built for, in addressing health inequities. Global health has always been about eliminating health disparities in vulnerable communities. While this is possible through global cooperation, it can only be achieved by making space for local voices and perspectives in both the development and implementation of solutions. How can we ensure that local communities lead the discussions at the table? By calling for the decentralization of both global health and philanthropy with changes such as our innovative funding model, and moving away from traditional bureaucratic, top-down approaches.

How we measure and define our impact is also guided by the communities in which we serve. (More on this can be found in the question, “How are you measuring your progress toward you impact goals?”)

Our organization is led by Mackinnon Engen, who our Co-Founders recruited for a new Executive Director role in late 2019. As a global health and humanitarian professional, her experience has spanned the UN, international and local NGOs, and academic sectors—all with a focus on putting local communities first, deeply listening to their needs, and co-creating meaningful, lasting solutions. Prior to joining Watsi, she helped to oversee international program development for a surgical NGO serving more than 1 million patients around the world through a global network of leading local medical teams. At the UN, she worked to ensure more timely humanitarian assistance reached those most in need as well as helped to coordinate the Secretary-General’s response to the Global Food Crisis. Mackinnon has lived and worked in communities across Asia, Africa, Europe, and the Americas. Her research has included topics of organizational leadership and effectiveness, economic impact of health interventions, emergency food security, and humanitarian impact of climate change. She is also the recipient of life-saving surgery herself.

Our small and mighty fully remote team is global, with team members located across the United States and in India.

We serve upwards of 2,200 patients annually, and we have supported more than 25,000 individuals since our founding 10 years ago. In that same amount of time, we’ve mobilized over $16 million to directly fund healthcare for patients who would have otherwise been turned away, delayed their critical care, or pushed further into generational poverty to access the care they deserve.

Watsi is a small, passionate team on a big mission to change how the world’s most vulnerable access critical, timely healthcare. Where you are born shouldn’t impact whether you have access to the care that could save your life when you need it. While there are millions in need, we believe there are even more people around the world who want to do good and help others. Bringing these people together on our technology platform—directly, efficiently, and transparently—is a proven solution that at scale will move us toward a world with health for all. 

Becoming a Solver will accelerate our impact and empower us to take even bolder actions to stand in solidarity with our local partners and patients, expand into new regions and high-need communities, make sound technology investments to deliver on urgent needs, and grow our passionate global community that is bringing healthcare to all.

Specifically, becoming a Solver will help us accelerate the creation of an Emergency Surgery Fund program, which will be used to create new pathways to fund critical emergency surgical care. This is a need that has emerged from listening to the local communities we serve, and we are building this new program to help solve for this need. Current barriers to piloting our Emergency Surgery Fund include technical advances needed on our platform (including experimentation with how to integrate emerging AI technology to create efficiencies), deeper exploration to co-create this solution with the communities we serve, and experimentation to create longer-term sustainable health financing mechanisms. 

Emergency surgical treatment is the most urgent, and often the most life-saving, of medical care. We aim to adapt the learning we’ve had from building our crowdfunding platform to co-create with our medical partners a new fund that can be leveraged when there is not time, for example, to create an individual patient profile on our platform before beginning to raise funds for the individual needing care. Very often, emergency surgical care is directly linked to maternal/women’s health, particularly emergency C-sections, and also includes emergency surgeries that are due to high-occurring incidents like road traffic accidents, trauma, fractures, and burns. Becoming a Solver will allow us to adapt our technology to pilot this Emergency Surgery Fund, starting with our medical partner in Uganda to enable more safe C-sections, and ultimately expand the number of lives we save every year.

We are a health-tech nonprofit powered by an innovative platform that enables anyone to directly fund life-changing surgery for those who otherwise wouldn't have access to this essential care. Since our founding, we’ve been at the cutting edge of how we build and leverage technology for good - experimenting, failing, learning, and building again. Apart from anchoring our entire model and solution around technology, we have also been one of the first nonprofits to leverage the blockchain and cryptocurrency donations in our work, and we are now exploring how to leverage AI to make Watsi and our medical partners’ time and reporting even more efficient so we can focus on our mission and providing healthcare. 

At Watsi, we love being nimble and flexible. We are well positioned to continue exploring innovative, tech-focused solutions in our sector - sharing learnings all along the journey with the broader health and nonprofit ecosystem, especially with those who may need to be more conservative with their own tech adoption and investments.

Hear directly what others have said about Watsi:

The New York Times wrote that "Watsi represents the next generation of charities,” a generation that leverages technology to enable anyone everywhere to create meaningful, lasting impact for those most in need, embraces 100% transparency, and focuses on our shared humanity by helping supporters create a direct connection with the patients they are helping. 

Watsi has also been recognized by CNN as one of its top 10 startups to watch and the White House as a "Champion of Change." Watsi’s innovative and effective approach drew the early attention of Y Combinator, a startup accelerator that provides seed money and mentorship, which selected Watsi as their very first nonprofit.

As an organization with a mission to directly connect people through technology to access life-changing surgery, our impact goals this year are to:

• Grow to reach more high-need communities that still don't have access to the healthcare that could save their lives - with a focus on the most vulnerable including refugees.

• Deepen our impact for our medical partners and patients through listening to their needs and building a robust global response to meet this unprecedented moment, especially in the area of life-saving emergency surgery.

• Share remarkable human stories that inspire solidarity, empathy, and action.

• Continue to build a first-in-class, direct, and personalized giving experience with an even deeper connection to our individual and collective impact.

• Strengthen our community-led governance so that we can show the world that people-powered philanthropy is the way forward to build a brighter, healthier future.

By 2028, we seek to:

• Scale the number of surgeries we support annually for patients in need.

• More than double our annual operating revenue directly supporting patient care.

• Reach new high-need communities and increase our number of medical partners by at least 50%.

• Inspire more generosity, increasing the number of active donors on our platform by at least 50%.

Five years from now, Watsi will be an engaged, thriving community that consistently delivers on our mission to connect people directly & transparently to fund life-changing surgery. In order to ensure this is so as we pursue our goals for growth and impact, we will: 

• Strive to be transformational, not transactional, for our patients, partners, supporters and team

• Value the quality of how we show up for people, not solely pushing to be bigger or faster 

• Leverage technology to further human connection and trust, not to replace it

First and foremost, we measure our impact in lives changed through access to healthcare. For every low-cost, high-impact treatment that we support, this intervention results in additional health, wellbeing, and opportunity for that patient. Even further, the positive benefits often ripple across a whole family and even to a community level, strengthening the health and productivity of the community more broadly.

How we measure and define this impact is also guided by the communities we work with. We begin by listening to the people we serve, understanding their priorities and challenges and working to ensure that we do not add additional burden and administrative paperwork to their already full plates. We learned early on that traditional approaches to impact measurements would likely be onerous for our patients and local medical partners, complicated and inefficient, at times not culturally appropriate, and still may not even provide certainty around our true impact on the real lives of the people we are trying to help. Our values of people over path (putting our patients, health workers, and community partners' needs first), listen & learn (understand problems before prescribing solutions), and move forward (be creative in finding even small ways to keep moving forward, adapting as you try things out) guide how we track and measure impact at Watsi.

On a tactical level, we track surgical outcome data for 100% of Watsi patients, including whether the surgery took place, if the treatment is progressing as planned, if additional treatment is expected to be necessary, if there were complications during or after the procedure, and if we maintained communication with the patient for follow-up. We also receive a post-operative update on all patients that focuses on patient and family-reported outcomes. 

Our local medical partners carry out a number of impact-related measurements which vary by community and include: 

• Medical-related follow-up questionnaires and/or visits

• Qualitative interviews with patient and family member(s) at approximately one month following treatment, including questions such as: 

  • How do you feel now compared to how you felt before the treatment? 

  • Are you still experiencing any of the symptoms you had before? 

  • Do you have any new symptoms? 

  • Are there things you can do now that you could not do before surgery but hoped to?

  • How will the treatment you received help you and your family?

  • How will your life be different after treatment? 

  • What are your plans for the future?

• Follow-up with random sampling of patients within one year of treatment to check on patient experience and further verify financial need.

We also closely track: 

• Geographical coverage

• Number and types of treatments that Watsi enables

• Revenue raised to support medical treatment and sustainability for the organization from recurring donors, corporate partners, and foundations

• Donor net promoter score (NPS) rating

• Medical partnership happiness rating

• Marketing campaign activities and conversion rates

Existing Problem: Worldwide, 5 billion people lack access to safe surgical and anesthesia care even though 30% of the total global burden of disease is surgically treatable. In addition, an estimated 33 million people incur catastrophic health expenditures to access surgery each year. Although 17 million lives are lost to surgically treatable conditions every year—5x greater than malaria, TB, and HIV/AIDS combined—safe surgery remains vastly underfunded.

Activities: Using an innovative technology platform that directly connects donors around the world with people in need of life-saving care, Watsi funds the cost of surgery for those who need it and supports local medical teams to strengthen the surgical care they provide in their communities. 

Outputs: On the patient side, Watsi closely tracks the number of surgeries funded, the number of surgeries performed, the amount of money going towards surgery, and the number of patients operated on (surgical volume). On the medical partner side, Watsi tracks the additional hospital revenue and financial stability created by Watsi’s involvement, the training programs enabled by Watsi’s support, and the level of optimal use of equipment and facilities. 

Short-Term Outcomes: Patients are healthier after surgery; there are fewer deaths and fewer individuals living with a treatable disability; catastrophic health expenditures are averted; patients report improvements in quality of life (change in pain, ability to complete day-to-day activities, emotional/mental health, participation in family/community, ability to work or attend school); individuals demonstrate more health-seeking behaviors or greater knowledge of healthcare access in communities served by Watsi’s local medical partners; hospitals and healthcare workers are better able to provide high-quality healthcare in the communities in which Watsi works; Watsi medical partners experience greater financial stability and better health outcomes overall.

Long-Term Outcome: Watsi helps move us toward Universal Health Coverage through investments in innovation, knowledge sharing, and advocacy. Our movement demonstrates for the broader health ecosystem and governments what is possible when financial barriers to life-saving surgical care are removed, ultimately paving the way toward a world where people everywhere can access quality healthcare. This serves as a foundation for full lives, thriving communities, and strengthened health systems - at scale, this is how we build a world with health for all.

Core to Watsi since our founding has been a strong technical foundation and to use technology where it hasn’t traditionally been used to amplify the good that can be created. We’ve built a reliable base of software and in doing so have been careful to build sustainably and minimize the risk of leaving those we are helping in a worse spot. We are known for our web-based interactive platform that easily connects donors with patients in need of life-saving care. We also embrace radical transparency and have built integrations that publish all our financial transactions directly funding healthcare publicly on our website in real-time.

As shared earlier, apart from anchoring our entire model and solution around technology, we have also been one of the first nonprofits to leverage the blockchain and cryptocurrency donations in our work, and we are now exploring how to leverage AI to make Watsi and our medical partners’ time and reporting even more efficient.

Our sustainability strategy and practices for tech implementation are strongly guided by three of our core values:

1. Build to last: We aim to create something that has a positive, lasting impact. We don’t shy away from having hard conversations or making short-term trade-offs if it means our organization, team, and platform will be better positioned to sustain or deepen our impact for the long-term. We also build iteratively so that what we create is usable and impactful all along the journey.

2. Move forward: We are creative about finding ways to move past obstacles. Whether by changing an approach, rethinking a goal, or taking a small action instead of doing nothing, we avoid paralysis and prioritize forward momentum.  This enables us to grow from doing and fail forward, adapting as we learn.

3. People over path: We are unwavering about putting patients, health workers, and community partners first in everything we do, but flexible about the path we take to serve their needs.  We care more about our work making an impact on their lives than we do about the programming languages or strategies we use to make it.

We are diverse makers, for diverse users. Our mission is to address a problem that impacts everyone on the planet and in order to serve people all over the world, our team also represents this diversity in background, identity, and experience. We believe that in order to serve people from the world’s diverse geographies, backgrounds, and perspectives, our team should represent similar diversity in hometown, life experience, and thought. On our small women-led team, 40% of team members identify as non-white, 60% identify as female and 20% as non-binary. Our team members are located across the United States (in the Midwest, South and Northeast) and near New Delhi, India. In addition, 60% of our board members identify as female, including our Board Chair.

We embrace empathy in our work and with each other, and this lends itself to building a culture of belonging, authenticity, and valuing everyone’s unique contributions every day. On our team at Watsi, each person brings their own gifts, and together we make magic out of them. We believe an organization really thrives when all team members feel valued and have ownership and autonomy over their work, even more so at a place like Watsi where you can so clearly and tangibly see your impact in the world. 

We publish all our financial transactions directly funding healthcare for people in need publicly on our website in real-time. And, while we are known for our transparency, being tech-forward and women-led, opening up our data, and building (and sometimes failing) in public, what we remain most proud of is being deeply rooted in the needs of our patients and our local medical partners to guide our work every step of the way.

At Watsi, we’ve never shied away from tackling big things or doing things differently, right from the start.

Resources: Our innovative, custom-designed technology platform (watsi.org), brand recognition, and extensive network of donors and volunteers power our work and enable us to directly fund life-saving surgical care for people around the world. 

Partners and Key Stakeholders: In order to reach our patients, we partner with leading hospitals and medical teams around the world, with a focus on building long-term partnerships with exceptional local leaders in healthcare who are often overlooked. Our partners are key to our work, and they connect patients in need of support with the Watsi platform.

Value proposition: For our patients, we fund life-saving surgical care that they otherwise would not have access to. For our medical partners, we offer a consistent, reliable revenue stream that enables them to serve more patients, improve their standard of care overall, and leverage additional revenues to grow their operations in service of their communities. For our community of donors, we offer a uniquely joyful, tangible, and impactful way to give back. We have been deeply rooted, since day one, in amplifying the voices of our patients in the most honest and dignified manner, empowering our frontline medical partners and listening to their needs, and sharing—directly and transparently—the impact of each donation with our community. The result: radical change in how healthcare is accessed around the world and in how philanthropy is lived out everyday.

Cost Structure: Our primary cost is direct surgical expenses for patients, which are paid to our local medical partners and hospitals. We take a holistic approach to the cost of care, so this includes medicine, equipment, human resources, as well as other common barriers to care such as transportation or food while at the hospital. Our other expenses include costs related to maintaining our technology platform, onboarding new medical partners and maintaining existing partnerships, our small team, and general operating expenses.

Revenue: Watsi maintains three consistent revenue streams: 1) funds donated through our online crowdfunding platform; 2) unrestricted support from institutional donors/foundations; and 3) partnerships with like-minded corporations who give via a number of mechanisms, including in-kind donations, financial support, employee matching contributions, and volunteer opportunities. Within the broad landscape of global health, our model is uniquely and radically transparent, as 100% of funds donated through our online platform directly fund healthcare. Our partnerships with foundations and corporations (and individual donors who leave an optional “tip”) fund our limited overhead costs and operational expenses and are leveraged to unlock additional people-powered philanthropic support.

Crowdfunded, people-to-people donations account over 70% of our revenue and will always remain a pillar of our model. On our platform, we’ve raised $16 million for patients, with an average donation of just $52 at a time. These funds allow us to serve as many patients as we can with the resources we have available at any given time — maximizing impact while ensuring fiscal health and sustainability. In addition, we strategically leverage grants and cryptocurrency donations to expand to reach new communities in need, test new and innovative patient care pathways, fund our minimal operating costs, and invest in other opportunities with a high probability of impact as they arise.

Watsi was founded in 2012 with the aim of using technology to fund healthcare. Our innovative crowdfunding platform creates a community where local medical teams and patients share their stories and raise money to directly fund their needed medical care. Watsi became the first non-profit to raise a “philanthropic seed round” of investment and was selected as the first nonprofit for the startup accelerator Y Combinator. Within Watsi’s first year, we’d processed $500,000 in donations and funded healthcare for 600 patients around the world, also closing our $1.2M Seed Funding Round shortly thereafter. In 2015, we closed our second funding round, a $3.5M Growth Fund, as we scaled and continued to hone the technology that connects everyday-funders directly to people in need of healthcare. Watsi has now raised over $16M and provided direct support for over 25,000 patients.

Key supporters of Watsi have included: Paul Graham, Tencent, YC Research, The Pershing Square Foundation, Jasmine Social Investments, Ron Conway, Ilkka Paananen and Mikko Kodisoja, Paul Buchheit, Khosla Family, Draper Richards Kaplan Foundation, Mulago Foundation, Pace Able Foundation, Bohemian Foundation, Starkey Hearing Foundation, Beloved in Christ Foundation, Sidgmore Family Foundation, Geoff Ralston, Joe Greenstein, Eric Wu, David Kolodny, the Nasiri Foundation, InnoSpring, Partners for Equity, David Weekley Foundation/Dovetail Impact Foundation, CRI Foundation, and Fast Forward.