Section 1: Issue Identification

1.        What health inequity does your initiative aim to address? Which specific regions, populations, health disparities, etc.? Please be as specific as possible.

Every year, an estimated 17 million lives are lost that could have been saved with access to safe surgery—a burden 5x greater than HIV/AIDS, malaria, and TB combined. When taking into account the full costs of accessing healthcare including common social-economic barriers such as transportation or food during hospitalization, 81 million people face catastrophic expenditure each year trying to pay for the surgical care they need. 

Women and children are especially vulnerable and at risk, with an estimated 1 in 3 women requiring medical or surgical intervention while giving birth - yet access to this care is often financially out of reach. While the cost to provide high-impact surgical care is relatively low in the Global South, failing to invest in this care as part of Universal Health Coverage could cost LMICs as much as $12.3 trillion in lost GDP by 2030.

At Watsi, we’re building an innovative health financing mechanism that brings people and companies together from around the world to directly fund life-changing surgery for people who otherwise would be without access to care, including critical maternal and women’s healthcare in Uganda. While we will not be able to bring healthcare to every person on this planet alone, unlocking private capital through crowdfunding to fund evidence-based healthcare can be a critical part of the solution in bringing health to all.

2.        Why did your organization choose to prioritize this specific inequity/initiative for action?

While the challenge we are addressing impacts millions of people, access to safe surgery that saves lives and unlocks livelihoods is vastly under-supported and overlooked. The impact of investing in access to this critical healthcare is immediate, tangible, and transformational. Watsi’s health financing platform directly bridges those who want to help with those who are in need. Through listening to community and patient needs, sharing these stories authentically and with dignity, and then getting resources to people as directly, efficiently, and transparently as possible, we have built a remarkably simple solution to a pressing global need. In Uganda, where we have worked with communities for ten years, the impact has been tremendous: 4,000 lives changed, including unlocking more equitable access to life-changing healthcare for nearly 2,500 women and girls.

For example, meet Caroline—a 30-year-old farmer from southwestern Uganda. She is a mother to one son and three daughters, who are all students. When she was young, Caroline dreamed of becoming a teacher but her parents couldn’t financially support her school fees and she had to drop out before her senior year of high school. Currently, she farms on a small scale, growing food crops for her family to eat and selling off the limited surplus to generate an income for her family. She also has two pigs, providing her with some additional income. Her husband is in the boda-boda (motorcycle taxi) business and their family has a double-roomed rental house for shelter.

Caroline was living with persistent lower abdominal pain, backache, on and off needles and pins radiating across her back, and other worrying symptoms. She had never been to any hospital due to limited finances. However when the pain became unbearable and she could no longer farm, she traveled to our medical partner’s care center Nyakibale Hospital where a scan revealed that she had a right ovarian mass. A simple surgery costing $220 would cure her condition, however this cost was entirely out of reach. If born in another country, Caroline may have had access to free healthcare or been able to pool together support from her family and friends. But for Caroline and others in her community who don’t have access to these networks and resources, the price means that access to life-saving healthcare is entirely out of reach. Learning that our global Watsi community and our local medical partner African Mission Healthcare would raise private capital to fund her treatment, Caroline shared, “my surgery will be like a dream come true because I have dreamt of the day I will wake up only to find that I no longer have this pain.” With financial support in place, Caroline underwent the surgery she needed. She is now healthy and back to taking care of her family and working on her small farm.

Section 2: Initiative Overview

1.        Please provide an overview of your initiative / approach and which department owns it. (200-300 words)

Watsi is a small, passionate, 100% remote team that is building technology to create a world with health for all. Our platform helps the world’s most vulnerable patients access private capital through people-powered philanthropy to fund the life-changing surgery they need. 100% of crowdfunding investments made through our innovative technology platform — the first of its kind in the healthcare space — directly fund surgical care. Since our founding we’ve raised over $16 million for patients, with an average donation of $52. In Uganda and globally, we work entirely with local medical partners to create sustainable, locally-led programs that are meeting urgent healthcare needs of the people in their communities.

While there are countless social, environmental, and economic determinants of health that play a role in the health-poverty cycle, at Watsi, we are focused on the economic piece of the puzzle: unlocking private capital to remove the financial barrier at the point of care in hopes of shielding people from generational medical debt, delaying needed healthcare, or not having treatment at all. We leverage our platform to connect individual donors and companies anywhere in the world with patients spanning 31 countries who are in need of life-saving surgical care but cannot afford it. One of our largest and longest-standing initiatives is aimed at serving people in need in Uganda.

At Watsi, we are 100% committed to being radically transparent, impact-focused, and patient-centered. Leveraging the best of technology and humanity, on our platform, people can:

1) Meet a patient who needs life-changing healthcare

2) Help directly fund their treatment

3) Receive an update on their impact after the patient has surgery

2.        Which of the four domains of health equity action (organization, offerings, community, ecosystem) does the initiative target? For additional context, please visit the GHEN website.

Section 3: Impact & Accountability

1.        What impact has the initiative achieved? Please be as specific as possible, focusing on outcomes rather than outputs.

First and foremost, we measure our impact in lives changed through more equitable access to healthcare. For every low-cost, high-impact treatment that we support, this intervention results in additional health, wellbeing, and opportunity for that patient. Even further, the positive benefits often ripple across a whole family and reach the community level, strengthening the health and productivity of the community more broadly.

At Watsi, we have served more than 25,000 patients globally with 4,000 patients in Uganda, including 2,500 women and girls and more than 1,100 women in need of critical and often life-saving maternal care such as C-section deliveries.

Our partner care centers across East Africa also report a significant positive impact (5/5 rating) from our investments on the:

-Training and capacity building related to safe surgical care.

-Ability to provide patients with high quality of care.

-Ability to provide patients timely access to care when they need it.

-Efficiency of administrative and record keeping systems.

-Optimal utilization of surgical facilities, equipment, and trained healthcare professionals.

-Credibility and overall perception by the local community (e.g. Increase in people demonstrating health-seeking behaviors or knowledge of healthcare access).

-Incidence of community-based referrals from other hospitals and community health workers.

2.        How was impact measured: strategy, metrics used, tools employed, relevant standards, etc.?

How we measure and define our impact is guided by the communities we work with. We begin by listening to the people we serve, understanding their priorities and challenges and working to ensure that we do not add additional burden and administrative paperwork to their already full plates. We learned early on that traditional approaches to impact measurements would likely be onerous for our patients and local medical partners, complicated and inefficient, at times not culturally appropriate, and still may not even provide certainty around our true impact on the real lives of the people we are trying to help. Our own values of people over path (putting our patients, health workers, and community partners' needs first), listen & learn (understand problems before prescribing solutions), and move forward (be creative in finding even small ways to keep moving forward, adapting as you try things out) guide how we track and measure impact at Watsi.

On a tactical level, we track surgical outcome data for 100% of Watsi patients, including whether the surgery took place, if the treatment is progressing as planned, if additional treatment is expected to be necessary, if there were complications during or after the procedure, and if we maintained communication with the patient for follow-up. We also receive a post-operative update on all patients that focuses on patient and family-reported outcomes. Understanding impact through their lens and in simple terms that have real meaning in their day-to-day lives is essential.

Our local medical partners also carry out a number of impact-related measurements which vary by community and include:

●     Medical-related follow-up questionnaires and/or visits

●     Qualitative interviews with patient and family member(s) at approximately one month following treatment, including questions such as:

○     How do you feel now compared to how you felt before the treatment?

○     Are you still experiencing any of the symptoms you had before?

○     Do you have any new symptoms?

○     Are there things you can do now that you could not do before surgery but hoped to?

○     How will the treatment you received help you and your family?

○     How will your life be different after treatment?

○     What are your plans for the future?

●       Follow-up with random sampling of patients within one year of treatment to check on patient experience and further verify financial and medical-related needs.

3.        How and where are you reporting impact (internally, externally)?

We value radical transparency and report publicly on 100% of patients we serve, including health-related outcomes with a focus on patient-reported outcomes and impact. We also publish all payments we make for healthcare in real-time on our site in our transparency doc and regularly share impact-related updates on our blog and via social media.

Section 4: Partnerships

1.        What organizations (e.g., civil society, public sector organizations, businesses, governments) did you partner with to complete this initiative? How did these partners contribute throughout the initiative’s lifecycle? What role in this partnership does your organization play (e.g., funder, convener, etc.)?

As a leading health equity advocate, funder, and convener, we know we cannot bring health to all by ourselves, but seek to bring more people together as part of the solution. For ten years, Watsi has teamed up with a leading African organization African Mission Healthcare and partner care centers/hospitals across Uganda to reach women—especially in last-mile, rural areas— who are in need of surgery.

Beth Wangigi, who is our leads our partnership with African Mission Healthcare, shared this about our work together and its impact:

“Those lacking sufficient income channels and savings often end up foregoing treatment due to the cost factor. Poor health forces the patient and their family to choose between seeking treatment and meeting other basic needs. It is not uncommon to find assets being sold to offset medical bills. Where a chronic illness is involved, seeking treatment has led many households into further impoverishment…Productive partnerships with frontline hospitals and donors like Watsi supporters enable communities in need to access quality health care. Programs like Watsi contribute to restoring the well-being of individuals and their community, and protects them from the health-poverty trap by facilitating access to safe, high-quality, and respectful medical care. The result is a gradual process of breaking barriers to healthcare accessibility which creates a ‘butterfly-effect’ that further shields communities from the health-poverty trap.”

2.        How is the initiative actively involving impacted communities throughout the initiative lifecycle (e.g., in the identification and alignment of priorities, (co-)creation and delivery of interventions, in measurement and review, etc.)?

Since our founding in 2012, Watsi has embraced a local and patient-first model. We focus on actively listening to our medical partners, local communities, and patients, and then we work to get resources to them as directly, transparently, and efficiently as possible to support the cost of medical treatment.

Every step of the way, we have built a system that rests on a foundation of radical trust and transparency in which we support local communities and medical teams in setting their own priorities on what will have the most impact on patients’ lives. This has led to an open and effective relationship between Watsi and its medical partners in communities around the world.

We also believe in the importance of people-powered philanthropy, which our innovative technology platform is built for, in addressing health inequities. Global health has always been about eliminating health disparities in vulnerable communities. While this is catalyzed through global cooperation, it can only be achieved by making space for local voices and perspectives in both the development and implementation of solutions and moving away from traditional bureaucratic, top-down approaches.

Section 5: Learning & Next Steps

1.        How has the initiative evolved over time based on ongoing learnings, if at all?

While the core of our model has been consistent, we have worked with communities and partners to further focus our health investments into the area of safe surgery. This sector has high need, inequitable access, and tangible, lasting, cost-effective health outcomes for patients.

2.        What is the future vision for the initiative / approach? Will it scale to other regions, translate to other drivers of health? What is the strategy for long term sustainability?

While Uganda is one of our largest programs, we have served patients from 31 countries globally. Our aim is to continue to expand to communities most in need, including those impacted by conflict/crisis or where healthcare is still out of reach for vulnerable and marginalized populations.

Our success has largely been rooted in individual investments in our work and, as we grow in the future, we hope to unlock more strategic partnerships and build relationships with networked communities that can help us scale to reach more patients in need.