At the Johnson & Johnson Center for Health Worker Innovation, we believe that solving the challenges of frontline health workers will help improve healthcare for everyone. To achieve this goal, we collaborate with our partners to build tools, deliver interventions, and strengthen systems that center health workers’ needs and perspectives.
Digital technologies are a key enabler. Our hope is to see connected frontline health workers equipped with the tools and resources needed to deliver care that is efficient, patient-centered, and responsive to data, trends, and community feedback. By partnering with social innovators, particularly those with their own experience on the front lines, we aim to improve the accessibility and quality of health services while helping health workers—and the communities they serve—to thrive.
Vula Mobile is one such partner. In 2004, Vula’s founder—Dr. William Mapham—was working as a recently qualified frontline health worker in a remote part of South Africa’s Eastern Cape province. He saw a patient with an eye condition that he did not know how to treat, so he responded in the only way possible at the time—by writing the patient a referral letter to take with him to the nearest urban center more than 80 kilometers away. Seven years later Dr. Mapham returned to the rural area as a qualified ophthalmologist. He was shocked to meet the same patient still carrying the original handwritten referral letter in the hopes of finally seeing a specialist. In the intervening years, he had gone blind in his eye. The great tragedy was that the medication that he needed was available in the rural facility all along. A little advice at the right time could have saved his sight.
Galvanized by this experience, Dr Mapham founded Vula Mobile in 2014 to fill this critical gap in communication between primary and specialist care. Instead of writing letters or wasting precious time on the phone attempting to access a specialist via a hospital switchboard, frontline health workers in primary care settings can now submit their patient’s information via the Vula Mobile app to initiate an asynchronous mobile chat with an appropriate specialist. By posing relevant questions and reviewing imaging, the specialist can determine whether the referring health worker can be advised on how to manage the patient locally, or if the patient requires a referral to a specialist. In this way, Vula allows frontline health workers to deliver specialist care, even at a local facility.
Today, Vula has expanded from its origins in ophthalmology to 53 different medical specialties. It has supported a wide range of frontline health worker cadres, including primary care nurses and midwives, to manage over 333,000 patient cases across the country. Most queries receive a response in under 11 minutes. Each interaction is securely stored and can be audited for clinical governance or training purposes.
I sat down with Dr. Mapham to learn more about how Vula Mobile is revolutionizing primary care and empowering remote health workers in South Africa. Read on to learn how they are utilizing data, collaborating with health providers, and making a lasting impact in rural communities.
JP: What insights do you see emerging from the data that has been collected through Vula?
WM: Vula is a rich data source, because we have quantitative data about the types of users and referrals, qualitative data through the individual interactions between health workers, and then the overall referral pattern data, which makes things really interesting. We can look at the referral pattern data to streamline things. For example, Frere Hospital in the Eastern Cape receives referrals from a variety of places in the surrounding area. However, when they looked at the Vula data, they could see that 50% of the referrals came from just one hospital in Butterworth, an hour and a half away. Armed with this data, the emergency medical services are now planning to rotate one doctor once a month to Butterworth rather than transferring all the patients to Frere Hospital. We had a sense of this data before, but by being able to demonstrate it to administrators and managers, we’re able to create systemic change.
There is also a new research study underway in the Western Cape showing how Vula data can be used to plan which trauma services should be made available in district hospitals to decrease the number of patients being transferred to tertiary services.
JP: How does Vula Mobile support efforts to deliver equitable healthcare for all?
WM: South Africa is moving towards a single National Health Insurance scheme, which requires much closer collaboration between public and private health sectors. Our data shows the flow of patients across facilities, which can support this planning. For example, outside of Cape Town we see frequent referrals between Karl Bremer and Tygerberg Hospital. Though they are only about five kilometers apart, when patients are referred they typically wait two weeks for their surgical procedure. Meanwhile, on the driving route between them there are two private sector hospitals that have completely empty operating theaters on Sundays. South Africa has several private health facilities right next door to public health facilities. This means we have untapped resources, and hopefully Vula can be used to make the most of them.
JP: How does data from Vula Mobile empower and validate the knowledge and experience of frontline health workers?
WM: In one instance, we looked at the referral patterns around Worcester hospital outside Cape Town. There were many pregnant women being referred to the hospital from the surrounding maternal health units and clinics. When they started using Vula, the number of referrals dropped by 52%. It turns out that the nurses were already doing the right thing locally—but they just weren’t certain. All they needed was the reassurance from a specialist that they had taken the right course of action or started the right treatment and did not need to transfer the patient. Simply by supporting nurses and linking them to doctors and other types of health workers, we can really make a big difference in quality and efficiency of care.
JP: Can you share any personal testimonials from nurses or midwives who have benefited from using Vula?
WM: There is a nurse in Vredendal, which is about five hours north of Cape Town. She learned how to manage different conditions, case by case, from specialists through Vula. When she stopped referring through the app, we thought perhaps there had been an accident, or she had moved. When we called her, she explained that everything was fine, but she no longer needed Vula because she now knew what to do! Now as a nurse, she accepts referrals from the people in her area, including doctors, because she has been upskilled to a near-specialist level. She then used the Vula data to motivate for an eye clinic to be built in Vredendal with a visiting surgeon once a month. Her story proves that if you start empowering primary healthcare workers, you really get magic starting to happen.