Bridgr: One-stop Digital Clinic

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 Anti-Homosexuality Act, 2023 (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. Queer Ugandans are reluctant to access public health facilities as it often results in arrests, extortion and stigmatization. Public health facilities lack culturally appropriate and competent care tailored to LGBTQ+ populations. Only a few health facilities offer friendly services to queer Ugandans, however, they are also crowded and often bombarded with clients from the general population.

Due to these issues, 13.2 per cent of Men Who Have Sex with Men live with HIV and infections continue to increase.

Many LGBTQ+ individuals have recoiled back into the closet and are reluctant to seek health services until symptoms are severe, however, a few prefer to access services through digital approaches that guarantee anonymity and ensure their safety.

Bridgr was built to incorporate 4 already existing systems; an Appointment system, an Automated reminder system, a Communication system, and a Delivery System. To ensure Bridgr reaches those who need it most, we have been using it at Ark Wellness Hub and want to scale it up, and increase its usability and usage with vibrant community campaigns through digital posters, banners and info hubs. Bridgr ensures access to health services is fast, private, and reduces stigma. The dashboard is user-friendly, letting the user track their delivery journey from when an order is confirmed to when the rider is at the delivery point. 

Bridgr basically;

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

• increases reach to cover distance issues, respect anonymity and reduces the cost of access to services for queer people.

• 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 is open for other service providers to join in, creating multiple avenues to access SRHR services. Bridgr comes in at a time when many LGBTQ+  organizations are missing crucial data tools for managing daily client interactions and reporting. Bridgr is not just improving service delivery but also guiding organizations with real-time insights on their modes of service delivery. Clients could also view any information available on the platform and 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 site visitors at no particular cost to the viewer.

LGBTQ+ 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. Bridgr promotes anonymity to address queer people’s fear of persecution while accessing services. We hope to bypass stigma, improve safety while accessing services and information, provide healthcare for LGBTQ+ persons 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 LGBTQ+ individuals who are still affected by the continued criminalization, state-orchestrated homophobia and human rights abuses.

Ark Wellness Hub (AWH) was founded to provide free and culturally competent 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 service delivery. This includes online consultations and the use of LGBTQ+-friendly apps and sites, which demonstrate a proactive approach to embracing digital tools. In the past year, we have had 2366 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 and made an android app that is being tested out with a few clients (20) at the moment. We have created different info directories, and added SRH commodities and available services, and integrated the platform into the already existing systems and workflows. 

Bridgr which an LGBTQ+ innovative platform aligns perfectly with the MIT Solve’s interest. Bridgr addresses critical health challenges faced by Criminalized and marginalized communities, particularly LGBTQ+ populations, by providing a confidential and stigma-free gateway to essential HIV-related services. By participating in this challenge, we aim to scale Bridgr's impact, reaching more individuals in need and advancing global health equity.

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, queer folks will find it easier to access SRH information and services, and eventually health outcomes shall be evident. Bridgr can accommodate many access points which give other LGBTQ+ led organizations room to adopt and collaborate with our team to avail their services to the community. 

This platform makes it easy for a queer person without the internet to access information and for anyone in a remote area to access services at low cost as long as they have access to a smartphone or computer. 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. 

• Bridgr bypasses Stigma and discrimination often faced by LGBTQ persons seeking healthcare

• Bridgr is also an online pharmacy that is easy for clients to get access to free products like ART and PrEP refills.

• Bridgr has an option to upload a prescription for clients to be able to receive medication from our pharmacies

• The delivery option is automated and a bike rider automatically receives a request to deliver once the nearest clinic confirms the order.

• A person using Bridgr is only capable of seeing clinics closest to them.

• With Bridgr, you can demarcate boundaries for each clinic to work anywhere in the world. Clinics have an independent interface to manage and serve their clients

• The app/platform can accommodate both private and for-profit clinics.

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 center. 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 behavior and promotes a more healthy 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 records, 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.

Impact goals in the next year include;

• Fully functional digital platform (Bridgr) where queer 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 5000 LGBTQ+ through the Bridgr platform

Impact goals in the next 5 years include;

• 2m LGBTQ+ 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 community members outside the current catchment area to utilize the platform.

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

Our solution, Bridgr, harnesses the power of digital technology to address pressing healthcare challenges faced by LGBTQ+ populations. Bridgr is both a web-based and mobile platform that enables remote consultations and telemedicine service delivery. We are able to provide essential healthcare services to those who face barriers/challenges while accessing public health facilities. Our platform utilizes advanced encryption protocols to ensure the security and confidentiality of user data, promoting trust and confidence among users. Bridgr's intuitive interface is designed for ease of use, enabling seamless access to HIV-related services, including testing, treatment, and support, thereby empowering individuals to take control of their health journey.

6 full-time staff and 2 part-time staff

1 year

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.