The Vula App – a massive force to improve patient access to specialist care

Designed to provide the best possible patient access to scarce specialist healthcare, the Vula phone app started out by enabling 20 local cyber referrals per month eight years ago. Today, it manages more than one referral per minute and reached one million referrals nationwide this October.

Vula has a network of 30 000 healthcare professionals, treating 35 000 patients every month. It has eliminated the traditional need for a fax machine and landline and dramatically reduces the frustration and time it takes to see a specialist. The documented average response time is 15 minutes. One in three rural Vula patients in rural areas are now treated using specialist supervisory advice only.

It’s eloquent testimony to innovation meeting dire needs in South Africa where the ratio of specialists to patients is 1 to 18 000.

The now ubiquitous app follows in the stellar tradition of pragmatic healthcare innovations in South Africa. From ground-breaking TB and HIV drug research and treatment to plastic soft-drink bottles converted to inhalants to enable low-income asthma-afflicted children to inhale medication, to drones delivering blood supplies in remote areas, to CAT scans and heart transplants, SA’s multiple challenges have inspired local physicians to tailor make globally admired solutions.

A vision for all

Vula designer, ophthalmologist Dr Will Mapham, wanted to leverage his incipient knack for technology to make eye care in the patient drainage area of Swaziland’s Good Shepherd Hospital more efficient and accessible. It dramatically expanded the referral net for eyesight restoring cataract surgery and was initially named “Vula Amehlo” (Nguni for ‘Open Your Eyes”) after the hospital’s eye clinic, the only one of its kind in Swaziland. Vula has helped eliminate cataract blindness in that country.

Enthuses rural healthcare outreach guru, Dr Jono Pons, the veteran ophthalmologist at Good Shepherd Hospital who tutored Mapham and leads Eswatini’s cataract surgery; “Vula Amehlo” in rural Eswatini meant bringing vision to blind people through the provision of high-quality eye surgery. “Vul’ Indlela” is the encouragement for those contending with obstacles along this route. Indeed, the difficult paths to medical excellence require both vision and exhortation. And so was Vula birthed, named, and travelled: What better guide to better health for innumerable sick people and their resolute physicians!”

Precisely addressing a dire need

The app addresses a need for instant advice, patient information and consultation so basic and enormous that its ubiquity across all disciplines today, particularly in the recent Covid pandemic is unsurprising. Like most healthcare innovators, Mapham was trying to find the best answer to a daily challenge, in his case communication and care in a rural setting where too few under-skilled healthcare staff in outlying clinics and community health centres struggle to cope. With cell phones everywhere, it was an instant hit, lessening the referral workload of district hospitals and relieving pressure all round.

First called ‘Operation Sight,’ then ‘CatarApp (Cataract App), it became known as Vula when it launched in app stores in 2014. Vula first connected a health worker with a specialist in October 2014.

Says Mapham; “we were so excited because there were 20 referrals in that first month. Now, 8 years later to the day, the 1,000,000th referral was made and we’re running at more than one referral per minute. This is a major milestone, and our audacious goal now is to have one million health workers using Vula every week.”

Hard work meets good fortune

With a top user-experience designer streamlining and broadening his app, (without reducing simplicity of use), it was little wonder that disciplines besides ophthalmology quickly took an avid interest. Mapham’s tech adviser friend got her company to donate R200 000 of design time while an admiring colleague of hers entered Vula in a competition, which it won, adding a million rand to the design pot.

“We started adding more specialties in 2016 with Burns, Dermatology and Orthopaedics. Today there are more than 60 specialties using Vula, ranging from cardiology, emergency medicine, endocrinology, general surgery, oncology to allied health services such as physiotherapy and to community services including community based palliative care,” Mapham says.

One illustration of Vula’s growing popularity is that ten percent of its current users joined since the beginning of this year. Referrals doubled between the last two quarters of 2021 and 2022. Mapham puts the rapid acceleration from 2016 down to expert design input.

Grateful rural healthcare workers

Two of the first health workers in the field to use Vula were Sr Elizma Anthoniseen in Vredendal and Caledon Hospital family physician, Dr Paddy Gloster.

Says Sister Anthoniseen, “the app brought the whole field of specialist care to the rural areas and the patients now have access to specialist care, which they never had before.”

She’s learnt so much through Vula that she’s set up and runs an eye clinic, seldom needing advice anymore.

Gloster, was so taken with Vula that he conducted and published seminal research entitled “Investigating the effect of the Vula Mobile app on coordination of care and capacity building in district health services” in the South Africa Family Practice online journal soon after it was launched.

How it works

Here’s how the app works; a rural doctor or nurse simply clicks on the specialty they need and fills in a unique form designed to give the relevant specialist the information they need. There’s built-in chat and picture posting functions which enable dialogue at the convenience of the user, eliminating the more time-honoured but inconvenient use of a landline.

Dr Faried Abdullah, a Covid specialist, set a new record of handling 125 referrals on Vula in one day, while performing his daily ward rounds. In his words “It is a godsend. Vula is an integral management tool for all our admissions at Brackengate (a temporary Covid treatment facility set up near Tygerberg Hospital in Cape Town). I’m thankful that I can manage incredibly high volumes of referrals easier and with improved accuracy because of it.”

Mapham’s doctoring career began in the picturesque deep rural Madwaleni Hospital on the coast 92 kilometres from Mthatha. As a young community service officer, he was a regular collegial recruiter at medical conferences showing videos of the envied Wild Coast recreational rural lifestyle. It was thus fitting that the 1,000,000th referral took place in the Eastern Cape at 9.26pm on October 8th with a frontline health worker receiving emergency advice from the orthopaedic surgeon on call at Livingstone Hospital.

Dr Menitha Samjowan, the Acting CEO at Queen Nandi Regional Hospital in Kwa -Zulu Natal, observes, “efficient, timeous, appropriate referrals are a key factor in ensuring decent quality health outcomes. Vula ensures this.”

National Department of Health former Deputy Director General, Dr Yogan Pillay, described Vula as “the glue that holds the health system together and the oil that makes it run efficiently.”

Mapham and his growing Vula team are looking forward to partnering with more key healthcare stakeholders as they journey towards the one million health workers using Vula weekly.

Watch: William Mapham: How the Vula app is revolutionising the South African healthcare system – YouTube

Link to article on Med Brief Africa: https://bit.ly/3OTrRA7