Luvelo

TLC is working to deliver adaptable, sustainable, high-quality patient-centered healthcare using high tech solutions in challenging low tech environments.

TLC is a health care nonprofit operating in Eswatini (formerly Swaziland), population 1.2 million, one of the poorest and most vulnerable countries from a healthcare perspective worldwide. Eswatini has the highest HIV prevalence rates worldwide and ranks as having the highest TB (co-morbidity with HIV), and cervical cancer rates. 70% of children are orphans or vulnerable children as a result of the HIV pandemic. Delivering high quality healthcare in a nation with such a high rate of disease, and such a high rate of poverty (7th highest Gini Index of 54.6 worldwide) presents unique challenges.

 TLC provides free patient-centered healthcare across the full continuum of care to 220,000 patients a year through mobile outreach and facility-based care (providing 1.3 million medical services in 2022). During the COVID-19 pandemic, TLC treated 90% of all critical care patients in the country, built a 2500 PSA oxygen plant and cylinder filling facility, and turned the entire 138 beds of the hospital into ICU and critical care beds, reducing the mortality rate from 4.4% during the second wave to 2% during the third wave of COVID nationwide.

Luvelo, the TLC operating data management system, enabled TLC to accomplish that feat using the same staffing levels while adding an oxygen plant and 55 ventilators and other breathing equipment to the biomedical department.

 Eswatini is also facing destabilization of the government due to pressure for the King and the government to change the monarchy. The healthcare system is melting down due to strikes by the nurse’s union and corruption in the Central Medical Stores.

Healthcare system resilience is challenging in Eswatini, facilities are understaffed, under-resourced, and corruption affects availability of medicines and equipment. What resources they have for health are not well-managed. The lack of money for fuel for ambulances means they don’t run even though drivers sit idle, failure of nurses to show for work or failure to provide care means patients die, incapacity to provide ICU and critical care means they couldn’t provide ICU beds during COVID. The current national software system for electronic medical records has been decades in development and still doesn’t work nationwide. Existing data management systems are not used to improve transparency and accountability in either healthcare services or overall organizational efficiency and management.

Insufficient numbers of trained healthcare professionals (doctors, nurses, aids, laboratory, radiology, biomedical technicians, etc.) and poor maintenance of existing medical equipment means the government healthcare system does not respond well to shocks, it is already struggling to provide basic levels of care.

Over 50% of patients do not present with or possess a national id, and continuity of care is critical to minimizing ART drug resistance and preventing duplicated patients who appear as lost to follow up.

Supply chain issues for essential pharmaceuticals, laboratory and medical supplies also continues to be a challenge. For example, the nation has not had insulin available for several months.

Luvelo is a high-tech, low-code data management platform that empowers the complete digital transformation of healthcare organizations and networks with fully integrated modules in personnel management, supply chain, fleet management, logistics, electronic health records and services, and other administrative operations. It utilizes modern progressive web app technology alongside native iOS and Android to support any device and minimize the impact of unstable or low bandwidth connections. Luvelo is built mobile-first with significantly reduced training times (compared to a laptop) and improved data entry speeds on mobile devices due to staff with limited exposure to laptop keyboarding.

The comprehensive electronic health record system currently supports 650,000 patients and permits online registration, self-check-in, medical history, demographic info, phone number validation, over 45 medical services, labs and diagnostics, and full inpatient and outpatient care. The system employs a layered biometrics approach with facial recognition, phone numbers, names, birthdates, and IDs to suggest the most likely patient match and minimize duplicate patient records. This solution is particularly important when 50% of patients present without a national ID or known birthdate.  

Every employee interaction is coordinated from initial application, recruitment, interview, onboarding, skills development, certification renewals, routine scheduling, time and attendance, payroll hours, and provides high touch feedback mechanisms to counsel and unlock the potential of every staff member, often presenting with deep woundedness from the HIV/AIDS pandemic.

An integrated scheduling system links medical outreach events, vaccinations, and fixed site service offerings with multi-disciplinary teams in counseling, healthcare, and critical support functions such as biomed, supply chain management, finance, procurement, ICT and specialized trades. With nearly 700 staff, the system ensures every staff member is assigned to meaningful work each day and that trainees are paired with trainers for practical, on-site skills development.

 Tablet based clock-in and clock-out terminals leverage facial recognition to provide high accountability and enable regular communication with staff through announcements, assignments, job descriptions, and feedback forms. On the same tablets, all employees are able to report maintenance issues, ask a question, ask to speak with a counselor, or report challenges to senior management if uncomfortable raising with an immediate supervisor. Many of the ideas for the Luvelo platform have originated from this all-staff feedback portal where team members regularly suggest new ideas and features to best align the digital ecosystem with the healthcare challenges in Eswatini.

The supply chain module facilitates transactions from requisition, quotation, purchase order, item receipt, transfer, restock, and dispatch to provide end-to-end supply chain accountability from purchase to patient distribution, tightly coordinating with electronic health records to minimize warehouse and pharmaceutical shrinkage. All inventory transactions can be completed on a phone including barcode scanning and Bluetooth integration with Zebra label printers for one-click item and bin printing.

All data captured in the system automatically feeds into Tableau analytics reports that consolidate program metrics and generate a daily PDF report sent to all senior team members to continuously improve all programs and health interventions to maximize resources and extend the highest quality of care to every patient.

TLC has been providing free comprehensive compassionate healthcare to all patients, with a special focus on the most vulnerable and underserved populations in Eswatini. Eswatini has a population of 1.2 million, with an HIV prevalence rate of 29.7% (WHO), the highest in the world and a COVID mortality rate of 4.4% during the second wave. Eswatini has the 7th highest Gini index rate, more than 70% of the population lives in rural areas with limited healthcare access. The nation’s healthcare system is currently destabilized because of political insurrection efforts to topple the last absolute monarchy in the world. TLC increased its patient load by 60% from 130,000 in 2021 to 217,000 in 2022 in response to the instability in the government healthcare system.

TLC’s conviction is to treat every patient as a father, mother, sister, brother or child. TLC also commits to ‘reach every last one,’ meaning TLC does not leave a mobile outreach in a community until every patient has been treated, even if it’s midnight. TLC continuously looks for ways to topple barriers to health care.

The target population is improved through the provision of more than 5.6 million free medical services since 2006 to more than 1 million patients in a country with a population of 1.2 million. But the key is how care is delivered. TLC’s patient-centered approach serves as a center of excellence for the rest of the nation. And TLC’s organizational and operational excellence eliminates corruption, promotes transparency, and efficiency and fills current gaps in the Eswatini healthcare system, especially for ICU/critical care. This year alone, TLC will treat as many as 220,000 patients through mobile outreaches and facility-based care. The TLC platform allows TLC to serve more and more patients with a high level of efficiency and excellence, with TLC reaching 60% more patients in 2022 with the same level of staffing.

TLC has played a unique role in Eswatini in helping the country to become the first of two countries to achieve the global 2030 HIV/AIDS target of 95-95-95 wherein 95% of the population is tested, 95% of those tested know their HIV status and 95% of those who test positive are on treatment and have their viral load suppressed. By reaching the most underserved patients and the hardest to retain in treatment, TLC has helped Eswatini achieve this remarkable outcome for the nation with the highest HIV prevalence rate worldwide.

TLC uses the Luvelo technology-based platform to fully track all patient medical records, send SMS messages as reminders, consult international experts using tele-medicine, follow up with patients who do not show up for appointments, and receive patient feedback to improve the ongoing provision of healthcare through TLC’s many healthcare platforms.

Luvelo also enabled TLC to develop the ESWAVAX National Vaccination data management system in 1 week in 2021 when COVID vaccines became available. This comprehensive platform manages all aspects of supply chain, logistics, scheduling, delivery, record keeping, provision of e-vaccination records, follow up and reporting requirements.

TLC was founded by Dr. Harry and Echo VanderWal in 2005 to respond to the needs of rural patients in Swaziland at the peak of HIV/AIDS pandemic. TLC began with 8 staff doing mobile medical outreaches to rural communities. Today, TLC has 665 staff, delivering 10-12 outreaches a day and has fixed facilities (hospital, surgical center, clinics, pharmacy, radiology services, oxygen plant, hospice care, commercial kitchen, training center, staff housing and warehouses) that have provided 5.6 million medical services since 2006. The TLC Miracle Campus is located in the center of Eswatini, on a campus of 175 acres.

The TLC DNA organizational culture is as critical as the high tech/high touch interoperable data management platform that TLC developed to reinforce and support the culture of learning, problem-solving, supervision/coaching and mentoring, task shifting, and leadership development of the staff. TLC now has a staff of 665 that carries out a wide range of critical care services, including the only operating oxygen plant in Eswatini (built by TLC in 2021 in response to COVID), providing 95% of ICU/critical care beds (138 beds) in the country by turning the entire facility into an ICU facility using the same level of staffing as before the COVID pandemic hit. TLC reduced the mortality rate for COVID from 4.4% in the second wave to 2% in the third wave. TLC currently treats over 1,300 patients a day through a wide range of facility-based and outreach models.

TLC staffing is 98% Emaswati, making up the vast majority of the TLC team. More than 90% of the management team is also from Eswatini. More than 50% of the staff and management team are female. This gives TLC a direct link to the most vulnerable populations with many of the TLC team being adult survivors of the HIV pandemic as orphans and vulnerable children. TLC visits rural communities nationwide to conduct mobile hospital outreaches. TLC has now been in these communities on a regular basis since 2006, reaching every inkhundla (subregion) and more than 600 communities several times over.

Quality assurance and quality improvement are high priorities for TLC. They seek feedback from patients on an ongoing basis, through a 24/7 hotline, SMS messaging, and in person feedback during visits. TLC seeks feedback from staff who observe and participate in service delivery to identify system barriers that need to be addressed. TLC also works closely with the Ministry of Health, USAID/PEPFAR partners, faith-based and business partners to identify gaps in service, barriers to care and treatment, and opportunities for innovation.

In addition, the TLC Luvelo development and support team is led by Sam Riggleman, senior systems engineer and a local team of software systems managers, support and customer service staff developed under his leadership. They are complimented by a small consultant team as Luvelo has transitioned to a more scalable platform. This team was awarded the Global Community Development Award by Apple in 2021 for the extraordinary use of their Claris product to develop the initial Luvelo platform.

TLC Staff: 665

TLC Patients 220,000/year

Nationwide: Vaccination System supports the entire population of 1.2 million

National COVID Vaccination Program (ESWAVAX): Healthcare workers (1,115), Ministry of Health and Partners (100)

Patients in Luvelo (650,000 and growing)

Patient MyHealth App Users: 65,033

TLC is seeking to determine the best way to replicate and scale up the TLC Luvelo platform to other settings. The Ministry of Health, the Kingdom of Eswatini, Global Fund, UNICEF and USAID/PEPFAR are very interested in replicating the TLC Luvelo model in other settings and systems, both in the public and private sectors for healthcare, and beyond. Many national and international business and government leaders who have seen the Luvelo platform in action are blown away by how it covers every aspect of the organization’s medical, supply chain and administrative functions, increases transparency and accountability, works in a very low-resource setting, takes task shifting to a whole new level, integrates quality assurance and quality improvement into every task, and serves as a very user-friendly adaptable and flexible platform that can be implemented quickly and easily by staff with limited experience. The Luvelo platform enables an organization to be excellent, in the most challenging circumstances and to turn on a dime to respond to changes or shocks.

The challenge is that TLC built the platform over time and was able to implement the platform in segments. Determining the best way to help new users to adopt and adapt the platform or segments of the platform is the next business development step.

Financial resources and technical guidance are both important to fully consider the most efficient way to manage the scale up of the platform that TLC has developed, how to manage an open nonprofit/social impact platform versus a platform that has some business applications and revenue generation attached to it. TLC is looking for help in developing a hybrid model that supports the social impact aspects of the product, strengthening health systems across Africa, with sustaining the long-term funding for TLC itself to deliver free comprehensive healthcare for vulnerable populations.

This MIT Solve Challenge and international development as a sector are seeking solutions to improve health care systems resiliency and ability to withstand shocks. Luvelo offers a significantly improved approach to health care data management systems by taking a whole-of-organization, whole-of-service delivery integrated approach to addressing all the data management needs of a healthcare program, organization or network.

In order for health care organizations to be strong, sustainable and adaptable, they need to focus on the quality and quantity of health care services, but also on their own capacity as an organization to operate efficiently, effectively, and ethically. Both the culture and the administrative functioning of an organization determine its capacity to sustain high quality care and adapt effectively to destabilizing situations.

TLC developed the Luvelo data management platform to address patient care (Electronic Health Record) and related systems, administrative organizational systems, and organizational culture and ethics. TLC has built each of these into its medical, patient record management system built on a user-friendly highly adaptable low-code technology. The system is mobile-device based using phones and/or tablets to make adoption easier with 100% uptake.

Organizational Culture: Luvelo is designed to enable supervisors to review and approve every task using Luvelo as a quality assurance and a quality improvement function. Supervisors and managers monitor both healthcare service delivery and operational administrative tasks, signing off on quality assurance using tablets. This provides rapid quality assurance with coaching or reteaching to support staff performance. Luvelo also serves as a way for staff to share reflections on ways to improve service, identify and address problems and hold each other accountable in a healthy, safe environment.

Administrative/Operational Systems: Luvelo integrates all organization functions into the data management system, this provides transparency, accountability, and quality improvement functions. Efficient, effective systems reduce costs, increase productivity, and address the risk of corruption. Finance, HR, fleet management, time sheets and work assignments, procurement, maintenance, logistics, and supply chain are all part of the integrated system.

Healthcare Service Delivery: All aspects of patient care are captured in Luvelo. Doctors and nurses are able to access all patient information in real time, including test results, appointment history, and medical history. This tool improves quality care for the patient and is a management tool for patient service delivery, monitoring and managing queues, tracking no-shows for follow up, SMS messages for reminders, and vouchers for patient transport costs. Luvelo allowed 3-4 doctors to manage 138 critical care/ICU patients during COVID-19, monitoring vitals, oxygen levels, flagging patients in need of immediate attention, and constant tracking of patient status with SMS updates to their families daily.

Luvelo empowers all staff as problem-solvers and quality assurance champions. It eliminates almost all opportunities for corruption as every task and transaction is transparent. It facilitates task shifting non-essential tasks to less-trained care providers, shifting the most technical medical tasks to doctors and nurses. Luvelo made it possible to set up a national vaccination program under one week that manages all aspects of operations/reporting.

TLC is wrapping up a complete full code rewrite of the Luvelo ecosystem as we migrate from Claris FileMaker to Outsystems low-code platform to support enterprise scale. We will continue to engage users to understand what works well, what could improve, using a robust but flexible process creating user stories, Figma design mock-ups, and development of all remaining modules in the system. Going forward, TLC plans to replicate the Luvelo platform through a business model and/or an open-source sponsor like USAID.

TLC’s Impact Goals for Luvelo for Next Year (2024)

1.    Launch completed enterprise scale model of Luvelo for replication in at least two other settings.

a.    Develop User Toolkit for replication of Luvelo by other users.

b.    Onboard at least 4 third-party organizations and health networks to begin the adoption of Luvelo to other nonprofits, businesses, governments, and health networks.

c.     Begin with Eswatini for expansion of Luvelo to other government healthcare systems.

d.    Develop a Luvelo solution to create a national ‘ARV injectables’ data management tool for Eswatini.

e.    Scale up technical assistance capacity of TLC Luvelo team to support new Luvelo users.

f.      Develop case study, peer-reviewed journal article and website to support Luvelo replication.

2.    Finalize the replication and scale-up model for Luvelo through consultation with experts.

a.    Consult with MIT Solve and others to finalize a scale-up replication model that is sustainable for Luvelo expansion.

b.    Implement the business development model for Luvelo through public-private partnerships and private sector investors.

TLC’s Impact Goals for Luvelo over Five years

1.    Replicate the use of Luvelo in every country in Africa, not only in healthcare systems, but other government, corporate and nonprofit settings.

a.    Launch a Global Innovation Hub at TLC to build out future innovations and applications of Luvelo in for-profit and nonprofit, government and private sector settings.

b.    Create a community of practice and global clearinghouse for Luvelo users as part of the Global Innovation Hub.

2.    Reduce corruption in public and private systems in Africa through the use of Luvelo.

a.    Host webinars and host conference presentations on how Luvelo increases transparency, accountability, and efficiency for any program, organization or system.

b.    Monitor the performance of Luvelo on corruption indicators for users.

3.    Increase the sustainability and productivity of healthcare systems across countries in Africa and beyond in the face of shocks or destabilizing events.

a.    Monitor the performance of Luvelo on qualitative and quantitative indicators from the implementing healthcare systems.

4.    Partner with USAID, Global Fund, UNICEF and other international entities to scale up Luvelo across programs and agencies.

a.    Build on current relationships with international entities to develop the funding and commitment to pilot and evaluate Luvelo in multiple types of settings.

Currently, Luvelo tracks all performance measures for healthcare system service delivery, operational/administrative functions, quality assurance and quality improvement indicators for TLC and for ESWAVAX (Eswatini’s National Vaccination Platform for COVID-19).

Given that this challenge is about scaling up a platform like Luvelo, there are performance measures for the users and performance measures for TLC as the service provider.

Sample Luvelo User Indicators:

·      Number of patients treated,

·      Number and types of services provided

·      Patient demographics

·      Patient retention in care

·      Patient satisfaction

·      Patient outcomes

·      Cost of care per patient, per service

·      Mortality and morbidity rates

·      Compliance with policies and procedures

·      Staff training records

·      Staff demographics

·      Number and types of reflections, feedback from staff, patients

·      Reductions in loss through corruption

·      Improvements in supply chain stock outs, inventory shrinkage

·      Number and type of problem solving/quality improvement activities

·      Staff morale-survey

·      Vehicle fuel usage, tracking

·      Vehicle maintenance and usage

TLC Service Provider Indicators:

·      Number of users of the Luvelo system beyond current levels

·      Number of people/patients impacted by Luvelo systems in use

·      Types and quantities of technical assistance provided to users

·      Satisfaction survey of users

·      Number of fixes to the software system

Our theory of change is that by utilizing the Luvelo online interoperable platform, organizations will increase efficiency, accountability and transparency in ways that dramatically improve their capacity to deliver high quality patient-centered and staff-driven healthcare in low/medium income countries. Even in times of destabilization.

Our solution is built in Eswatini and draws on 18 years of interactions with patients and healthcare workers to understand how patients and staff think, feel, learn, and excel. During COVID-19, our developers brought laptops to the hospital ward, put on PPE, and deployed new code in real time to help doctors and nurses carry out their work more effectively. Users engage with the system because it requires no redundant paper record keeping and is purpose-built for the challenges they face. Change is actualized through reduced operating costs and improved patient health outcomes and feedback.

The ecosystem coordinates all organizational functions including administrative, financial, management, human resources, supply chain and healthcare service delivery. No off-the-shelf electronic medical records system was found to be robust or adaptable enough for field conditions, nor integrated with other organizational systems.

The ‘activities’ include:

·      Utilize a mobile-first solution that empowers complete digital transformation of health networks with fully integrated modules in personnel management, supply chain, logistics, and electronic health records.

·      Complete a full code re-write of the Luvelo ecosystem as TLC migrates from Claris FileMaker to Outsystems low-code platform to support enterprise scale.

·      Develop community of practice

·      Develop Luvelo user toolkit, clearinghouse and website

Outputs will include:

·       Enterprise scale solution for the Luvelo platform tested and ready to scale

Short term outcomes include:

·       Easy adoption in low resource environments due to reduced training times (compared to a laptop) and improved data entry speeds on mobile devices due to limited exposure to laptop keyboarding

·       Task shifting will improve costs and quality of care

·       Eswatini applies Luvelo in at least one new setting in 2024

·       Luvelo is applied in at one other non-Eswatini setting in 2024

Long term outcomes include:

• A sustainable enterprise that produces income to sustain compassionate healthcare operations of TLC in Eswatini and foster continued development of life saving interventions into the Luvelo digital ecosystem
• TLC imparts its commitment to patient-centered care as a center of excellence in both operations and healthcare service delivery to the most vulnerable and underserved.
• Luvelo is applied outside of healthcare systems, in other sectors, corporate and nonprofit settings.
• Support for users in every country in Africa through TLC’s passion and commitment to remain teachable, humble, and forever focused on confronting every challenge with a solution.
• Incorporate additional languages, expand geographic divisional structures, and grow local developers to apply their context and ideas to challenges faced every day.
• Corruption is reduced in the public and private sectors.
• Patient-centered care becomes the culture of healthcare in Africa.
• Healthcare systems in low- to moderate-income countries maximize limited resources efficiently and increase their capacity to provide critical care and primary care for all.

• Outsystems High Performance Low-Code built for enterprise scale
• Reactive Web, Progressive Web Apps, Native iOS and Android
• SMS
• Facial Recognition
• Integrations with Slack, Office 365
• Hardware Integrations with ATM

TLC prioritizes diversity, equity and inclusion both for staff and for beneficiaries.

Staffing: TLC is an equal employment opportunity employer. All qualified applicants receive consideration for employment and will not be discriminated against on the basis of race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin. Over 98% of TLC’s staff is from Eswatini; the remaining 2% are from other African countries or the US. Women make up more than 50% of the staff and 50% of the leadership/supervisor cohorts. TLC works hard to ensure that all staff work in a safe, healthy environment that provides each one an opportunity to thrive and develop new skills. TLC provides opportunities for training, professional growth and leadership development for all staff. Many of TLC’s staff are adult orphans who have experienced great loss and trauma as a result of the HIV pandemic in Eswatini. TLC provides ongoing counseling and support to all staff to help them heal from difficult life experiences and where appropriate to heal broken family relationships.

 Beneficiaries: TLC provides free comprehensive compassionate medical care to all patients with no discrimination based on any criteria. TLC seeks to be intentional about reaching the most marginalized and underserved populations, particularly rural and poor populations and those key populations that tend to be stigmatized and isolated. TLC sees every patient as a VIP (Very Important Patient). Patient-centered compassionate, respectful care is essential to our provision of services. Reducing stigmatization and increasing access to care and retention is care is at the heart of our work.

TLC currently operates as a nonprofit organization focused on providing free, comprehensive compassionate healthcare to the most vulnerable populations in Eswatini. In addition to providing a panel of over 45 health services, TLC also provides emergency care, surgical service, critical care, snake bite care, specialty care, treatment of advanced disease (including HIV, TB, and COVID-19), rehabilitative services, and palliative care.

TLC does not receive revenue from beneficiaries but from donors (institutional such as USAID and UNICEF, foundations and individual donors/churches/businesses). TLC receives millions of dollars’ worth of gifts-in-kind to support the delivery of medical services. TLC also collaborates closely with the Ministry of Health and receives some pharmaceuticals and laboratory supplies from the Central Medical Stores.

Recently, TLC expanded from solely providing medical services to supporting the health care system through the development of a digital solution—the ESWAVAX online national vaccination platform for Eswatini. TLC is preparing to expand that portion of its services by building on their learned experience and expansion of the Luvelo platform’s capacity to manage millions of users.

The Luvelo platform was developed with support from USAID. Going forward into scale-up, TLC is exploring the best way to transition Luvelo to a social impact business model.

TLC sees the potential of applying the Luvelo platform to other organizations, to other sectors, to government and to corporate users. This deployment could happen through an entirely open source/free platform providing organizational support or it could happen through a service subsidization model where TLC could spin off Luvelo as a for-profit service or product. That for-profit option could include the cost being paid for by government or by groups like USAID to expand access and the application of Luvelo to other organizations, sectors, businesses or government units.

TLC is evaluating approaches for replication and broader dissemination of the Luvelo platform through service contracts to governments, corporations, and nonprofits. Some funding will be necessary to move into a framework for raising capital for expansion if that is the choice made for replication. The for-profit approach would then provide ongoing sustainable funding for TLC operations in Eswatini beyond our current grant and foundation funding.

One model under discussion, particularly for the healthcare sector is a service contract that includes all aspects of using Luvelo, from the development of Luvelo to be fit-for-purpose for a healthcare system in a country (software side) and the launch of the platform to support the hardware side of Luvelo that would include supplying and maintaining the phones and tablets and the internet capacity to sustain the program, provide the training and ongoing technical support to ensure that Luvelo has 100% uptake and successful application in a specific setting. The benefits would mean that the entire healthcare system is patient-centered, efficient and effective, making the most of limited resources to provide the best healthcare service possible with transparency and accountability. Savings from the elimination of corruption alone would more than pay for the cost of the service.

The Kingdom of Eswatini has expressed interest in using the Luvelo platform across the public health sector and in other sectors in government. TLC is currently in discussions to develop a preliminary scale up model for Eswatini.

TLC is also exploring ways to support the nonprofit sector through grants as Luvelo makes the most of limited resources and ensures better operational outcomes for any organization. 

TLC has received funding from USAID to support the ongoing development of the Luvelo platform since 2017 through a series of grants with a total of about $2 million spent since 2017 to develop and expand the platform.

USAID invested $500,000 in the new ESWAVAX national vaccination platform based on the Luvelo platform and maintains operational support for the system, similar to a service contract.