Bridgr: One-stop Health Centre

In Uganda, homosexuality is illegal.  Adolescent Girls and Young Women (AGYW) especially those part of the LGBTQ+ community, fear seeking healthcare in public health facilities, as it often results in extortion, arrest, violence, and denial of services.  Recently, LGBT rights are further deteriorating in Uganda with the passing of the Anti-Homosexuality Act, 2023 (AHA, 2023).

In 71 countries worldwide, being a homosexual is, in fact, more than just an issue, it is considered to be a crime. Most of these countries are located in the Middle East, Africa, and Asia. In 11 countries, the death penalty is imposed, or is at least a possibility, for same-sex sexual activity. Uganda’s recently passed AHA, 2023 imposes life imprisonment for same-sex sexual acts, the death penalty for “aggravated homosexuality”, and harsh penalties for attempted or promoted homosexuality. The Act also restricts freedom of speech on LGBT civil rights and encourages homophobia. 

Unsurprisingly, LGBTQ+ populations still exist in Uganda and continue to have health and wellness concerns for example mental health, human rights, Sexually Transmitted Infections (STI) management, HIV testing, prevention and treatment, contraception, Sexual Reproductive and Health (SRH) information and legal support.

Bridgr is a digital one-stop centre for AGYW that are part of the LGBTQ+ communities in Uganda to access sexual and reproductive health services and information. Bridgr is a digital platform that unifies the different services, information and products offered by multiple LGBT led organizations in Uganda. It acts as a one-stop centre where AGYW can access health services and supplies or be linked to a friendly service provider. Bridgr basically

• brings together health workers from within our communities to provide culturally appropriate and competent healthcare.

• makes services accessible 24/7 to make sure busy schedules of work, school, and other commitments don’t limit access to healthcare.

• increases reach to cover distance issues, respect anonymity and reduce the cost of access to services for AGYW.

• ensures service delivery to the last mile that is to different communities in their safe spaces for cases where accessing the clinic in-person threatens their safety especially for transgender persons.

Bridgr works like an online shopping website but with more to offer especially SRH information directories such as handbooks, locally translated videos and audios. Users can create accounts and peruse the website to find individual specific services or products or information. Once they are set on their need, they are able to automatically self-book an appointment at a desired health facility or request a home delivery for supplies. They can also view any information available and also be referred to more specialized and friendly service providers for example legal entities and shelters. Bridgr will be zero rated implying that it is accessible to all visitors at no particular cost to the viewer.

LBQ communities continue to have health and wellness concerns for example mental health, human rights, Sexually Transmitted Infections (STI) management, HIV testing, prevention and treatment, contraception, Sexual Reproductive and Health (SRH) information and legal support.

This platform will provide services and information safely and remotely and promote anonymity to address Adolescent Girls and Young Womens’ fear of persecution while accessing services. We hope to bypass stigma, improve safety while accessing services and information, provide healthcare for the AGYW in Uganda hence reducing the prevalence of HIV and other sexually transmitted infections. We will also be able to improve the mental health and well-being of LBQ individuals who are still affected by the continued criminalization, state-orchestrated homophobia and human rights abuses.

Ark Wellness Hub (AWH) was founded as a place to seek health care in a physically and emotionally safe space. AWH is an LGBTQ+ youth-led clinic that aims to provide appropriate, quality, accessible, and community-led health care to the LGBTQ+ community in Uganda. AWH provides health services through deliveries, telemedicine, and walk-ins 7 days a week till late evening. Our modes of service delivery reinforce our readiness to leverage technology for healthcare delivery. This includes online consultations and the use of LGBTQ+-friendly apps and sites, which demonstrates a proactive approach to embracing digital tools. In the past year, we have had 1057 clients access our services through telemedicine. We are using Yamzit app to book client appointments and recently acquired an Electronic Medical Records (EMR) system to store personal/medical information.

We have established a Healthcare Call Center which indicates a willingness to embrace innovative solutions for healthcare access and support. We also have a robust feedback mechanism that collects data and feedback after every visit on the services and products provided. Feedback is routinely reviewed and changes are made to enhance our service delivery. Many of our clients would prefer not to walk-in to the facility and would rather access services remotely, unfortunately not many service providers are able to provide and maintain remote service delivery. Bridgr is a more comprehensive and precise mode of service delivery, we have been doing the same exact thing but now can be able to do it on a larger scale with more benefits for the community.

We have recently acquired a website or platform that can be able to provide the solution we are suggesting. Our focus is currently creating different info directories, collaborating with other AGYW led organizations, adding SRH commodities and available services, and integrating the platform into the already existing systems and workflows. Here is a link to the website: https://thebridgr.store

Bridgr employs an e-health approach that has not been taken advantage of by the Ugandan population especially among SRH service providers. Once the platform is rolled out and fully functional, AGYW will definitely find it easier to access SRH information and services, and eventually health outcomes shall be evident. Bridgr can accommodate many access points which gives other young people led organizations room to adopt and collaborate with our team to avail their services to AGYW. 

This platform makes it easy for a girl or woman without the internet to access information and for anyone in a remote area to access services at low cost as long as they have a smartphone. Telemedicine is still a new mode for service providers to venture in because it requires both financial and human resources to implement and sustain, however, Ark Wellness Hub has been providing services through telemedicine for a while now and will leverage our experience to help other organizations to integrate the platform into the already existing workflows. 

Impact goals in the next year include;

• Fully functional digital platform (Bridgr) where young people can access SRH information, schedule an appointment  with a doctor at a health facility and request a delivery of SRH supplies and commodities.

• Established SRH content and educational directories that are locally translated such as videos, audios, posters, handbooks, leaflets etc

• Service provision to 800 Adolescent Girls and Young Women through the Bridgr platform

Impact goals in the next 5 years include;

• 6500 Adolescent Girls and Young Women accessing services through the Bridgr platform at national level

We plan to do this through;

• Increasing the numbers of partnerships that are either providing services on Bridgr or linked to another service off the platform.

• Hiring dedicated staff to manage, maintain and coordinate the platform to ensure that it remains active 24/7. This will guarantee availability and accessibility of the platform thus enhancing efficiency and effectiveness in services delivery

• Broadening the catchment area, the platform is originally available to any one with a smartphone irrespective of where they are located. Efforts will be made to sensitize AGYW outside the current catchment area to utilize the platform.

• Trainings and campaigns will be done to sensitize communities and create awareness about the platform.

Theory of Change:

The overall evidence linking increased access of Adolescent Girls and Young women (AGYW) to SRH services, information and products through a digital health platform thereby improving health outcomes is medium.

How it will work: 

We will develop comprehensive SRH information and services, refurbish a digital platform/website, support new products and modes of service delivery. We will avail the platform to multiple users at a zero-cost rating and collaborate with other service providers to be a part of this one-stop SRH centre. A coordinator will be hired to mitigate any issues and concerns that may arise while using this platform. Many LBQ individuals in Uganda would rather access services digitally because there is a guarantee of anonymity which encourages health seeking behaviour and promotes a healthier community.

Evidence underpinning activities to short and medium Outcomes:

In 2001 Gulliford, et al. provided four aspects of access to health services which include;

• If services are available, in terms of an adequate supply of services, then a population may ‘have access’ to health care.

• The extent to which a population ‘gains access’ to health care also depends on financial, organizational and social or cultural barriers that limit utilization. Thus, utilization is dependent on the affordability, physical accessibility and acceptability of services and not merely the adequacy of supply.

• The services available must be relevant and effective if the population is to“gain access to satisfactory health outcomes”.

• The availability of services, and barriers to utilization, have to be evaluated in the context of the differing perspectives, health needs and the material and cultural settings of diverse groups in society.

Evidence underpinning Outcomes to Impact: 

Access to healthcare services has been impacted by a number of innovations including electronic health record, artificial intelligence, sensors, wearable devices, Internet of (medical) things, Blockchain, big data and other applications. All these digital health innovations aim to support the health system to be more resilient and more capable of meeting the demands of people for more cost-effective and secure solutions. Digital health has been used to empower people, in general and patients in particular, to enable them to access healthcare services at the point of care or remotely.

6 full-time staff and 2 part-time staff

For 2 years now

Ark Wellness Hub is an LGBTQ+ led clinic that provides culturally appropriate and competent health care services to the LGBTQ+ community in Uganda. Our team has one female staff at the moment but more efforts and opportunities are being made to bring on female staff to the work that we do. We have 3 medical staff and 5 non-medical staff which clearly indicates how diverse our skills and backgrounds can impact the community. We are welcoming of all individuals irrespective of their identity and provide an inclusive environment for all persons to seek services in a respectable and supportive manner.

In Uganda, homosexuality is illegal.  LGBTQ+ populations in the country fear seeking health care, as it often results in extortion, arrest, and violence.  Recently, LGBT rights are further deteriorating with the passing of the Anti-Homosexuality Act, 2023.

AWH is an LGBTQ+ led sexual health and mental health clinic founded to provide appropriate, quality, accessible, and community-led health care to the LGBTQ+ community in Uganda. Some of the services we provide include comprehensive screening, STIs treatment and management, Hepatitis B vaccination, emergency contraception, mental health and harm reduction services, and SRH information. Since 2019, we have provided services to 4500+ people, 100+ health workers trained on SOGIESC and LGBTQ health needs, 2078+ reached with STI treatment and management, 1700+ people accessing PrEP, 65420+ HIV services conducted. AWH provides health services through deliveries, telemedicine, and walk-ins 7 days a week till late evening.

Our strategies include:

• Bringing together health workers from within our communities to provide culturally appropriate and competent healthcare.

• Partnering and utilizing public resources in safer settings for our communities who are stigmatized and discriminated against in public health facilities.

• Making services accessible 24/7 including public holidays to make sure busy schedules of work, school, and other commitments don’t limit access to healthcare.

• Using digital approaches to increase our reach to cover distance issues, respect anonymity and reduce the cost of access to services for LGBTIQ individuals.

• Delivering services to the last mile that is to different communities in their safe spaces for cases where accessing the clinic in-person threatens their safety especially for transgender persons.

To ensure sustainability, Ark Wellness Hub will:

• continue to fundraise for healthcare through application for proposals.

• enhance our service package which will continue to support the community for years to come for example purchase of medical equipment.

• establish partnerships with other organizations or government institutions to provide free supplies to help sustain the activities post-implementation.