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'Let's Talk': Leveraging the Consumer Activation Resources of MNOs & FMCGs to Stimulate Caregiver-Centered, Tech-Enabled Demand Creation.

We help drive demand for vaccination by linking caregivers to trusted women (lady health workers, local women retailers and female doctors)

Photo of Asher Hasan
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Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

doctHERs creates tech-enabled, caregiver-centered demand for vaccination by leveraging: (i) FMCG capacity and (ii) trusted intermediaries (lady health workers, women-retailers and remote female doctors) in emerging markets such as Pakistan.

Explain the idea (less than 2,000 characters)

"Lets' Talk" is a public discourse campaign that is linked to a vaccination demand creation initiative powered by doctHERs that leverages the full marketing/consumer activation/demand creation resources of Unilever & Mobile Network Operators (MNOs) such as Telenor. Unilever's rural market development/brand activation/demand creation field team of 650 female brand activators, 4500 male sales reps, 1600 rural women retailers (Guddi Bajis) and 150 last-mile rural distributors ('rahbars') will be leveraged in this RMNCH-oriented, vaccination initiative. Telenor has the capability to deliver free airtime, IVRS and sms-based reinforcement 'nudges' to the target caregiver population of 3 million lives via the 'Let's Talk' campaign. According to Imran et al, (https://doi.org/10.1093/inthealth/ihx067) immunization rates for infants between 12–23 months of age are estimated to be only 58.0%, 87.7% and 72.6% in Punjab (Pakistan) for the pentavalent vaccine, OPV and Measles Vaccine (MV), respectively. This leaves a significant portion of children exposed and vulnerable to life-altering diseases such as hepatitis, polio, diptheria, tetanus and measles. The 'end-users' of this vaccine demand creation program include children from underserved, low-income communities (household income less than $3/day) in both rural areas across 36 districts in Punjab. Both doctHERs and Unilever have been interacting with these communities since 2015 and have built up trust between caregivers of these children and the demand-creators: (i) 600+ female brand activators who conduct door-2-door and town-hall style interactive gatherings (including immunization camps) and (ii) women retailers (Guddi Bajis) who operate fast-moving consumer goods (FMCG) stores across 1600 villages. Our primary target population are caregivers who are typically women homemakers in 3000 villages across 36 districts of Punjab (target reach: 3 million caregivers in 2019 and 2020).

Which part(s) of the world does this idea target?

  • Southern Asia

Geographic Focus (less than 250 Characters)

3120 Villages in 36 Districts across Punjab, Pakistan (reaching a target population of 3 million caregivers in 12 months).

Who are your end users and how well do you know them? (750 characters)

Our end-users include underserved, low-income communities (household income less than $3/day) in rural areas across 36 districts in Punjab. Both doctHERs and Unilever have been interacting with these communities since 2015 and have built up trust between caregivers and the demand-creators: (i) 600+ female brand activators who conduct door-2-door activations and town-hall style interactive gatherings (including immunization camps) and (ii) women retailers (Guddi Bajis) who operate fast-moving consumer goods (FMCG) stores across 1600 villages. Our primary target population are caregivers who are typically women homemakers in 3000 villages across 36 districts of Punjab (target reach: 3 million caregivers in 2019 and 2020).

How is the idea unique? (750 Characters)

"Lets' Talk" leverages the full marketing/consumer activation/demand creation resources of two major, multinational corporations, Unilever & Telenor. Unilever's rural market development/brand activation/demand creation field team of 650 female brand activators, 4500 male sales reps, 1600 rural women retailers (Guddi Bajis) and 150 last-mile rural distributors ('rahbars') will be leveraged in this RMNCH-oriented, vaccination-focused component of the Transform initiative. Telenor has the capability to deliver free airtime for caregiver-focused, peer-to-peer interaction as well as IVRS and sms-based reinforcement 'nudges' to the target caregiver population of 3 million lives via the 'Let's Talk' campaign.

Idea Proposal Stage (Select 1)

  • Pilot: We have started to implement the idea as a whole with a first set of real users. The feasibility of an innovation is tested in a small-scale and real world application (i.e. 3-15% of the target population)

How many months are required for the project idea? (140 characters)

12 months.

Organization Name (less than 140 characters)

doctHERs

Type of Submitter

  • We are a For-Profit Startup or Startup Social Enterprise

Organizational Characteristics

  • Female-led organization
  • Women’s health/rights focused

Organization Location (less than 140 Characters)

We are headquartered in Karachi, Pakistan. Our field teams are currently active in 20 districts of Punjab & 5 districts of Sind.

What is the current scale of your organization’s work?

  • National (expansive reach within one country)

Website URL

http://www.docthers.com

Tell us more about your organization/company (1-2 sentences)

doctHERs is a digital health venture that matches the underutilized capacity of female doctors to the unmet, healthcare needs of underserved communities (including unmet immunization needs). In collaboration with large multinational corporations (MNCs) such as Unilever and Telenor, doctHERs deploys tech-enabled frontline health workers in rural villages and urban slums and leverages the demand creation assets of its MNC partners to create sustainable, scalable demand for vaccination services.

Who will work alongside your organization in the project idea? (750 characters)

(i) Telenor (voice, IVRS, SMS & Mobile/Internet Connectivity) (ii) Unilever (600 brand activators, 4000+ sales reps, 1600 women retailers, 150 large distributors, 50 small distributors) (iii) UN Foundation (Universal Access Project) We are currently working with Unilever in the UKAID-cofinanced TRANSFORM initiative that is creating demand for essential healthcare services and products in 3120 villages in 36 districts across Punjab reaching 3 million women caregivers in 2019 and 2020. This 15-month initiative leverages the 1600+ women ('Guddi Baji')-operated retailer hubs supported by Unilever, that connect to the 5000+ brand activation/demand creation 'spokes' (600+ female brand activators, 4500 male sales reps, 150 micro-distributors

How many people are on your team?

90

Tell us more about you and your team

The team includes the following key personnel: Dr. Asher Hasan: a US-trained digital health innovator who is a medical doctor and MBA with a 10 year established track record of sustainably taking social enterprise models to scale. Sabeen Haque: Gender consultant; women-centered design thinker; has accelerated over 200 women-led businesses as a consultant to the World Bank's WomenX project. Tanzeela Naz: RMNCH-focused project manager recruited from Marie Stopes. Dr. Komal Rizvi: spearheads public-private health partnerships; public health expert Dr.Samia Dittu: family practice physician who liaises with our network of remote female providers Mariam Maqsood: Internal Audit, Impact Evaluation & Business Process Optimization Nawal Maredia & Salima Lakhani: patient care coordinators; help coordinate immunization schedules, etc. Rani Bhamani & Milia Samson: Customer Service & Tech Support Reps; liaise with female frontline health workers & female retailer

Overview of How Your Concept Has Evolved (5-6 sentences):

Based on the User research we conducted during gathering of beneficiary feedback and the user experience map activity (see attached survey analysis), 2 issues came to the fore: (i) it is very important to educate/sensitize caregivers on the need to complete the EPI vaccination schedule beyond 2 years in order for their children to be adequately protected against infectious disease such as measles, varicella (chicken pox), polio, diptheria, etc. Accordingly, having an accurate mechanism of tracking immunisation records (digitally) combined with longitudinal follow-up is crucial to any effective vaccination campaign; (ii) in order to accelerate immunisation uptake rates, we need to provide caregivers with access to door-2-door vaccinators.

Viability (3-4 sentences and activity upload):

https://canvanizer.com/canvas/wt4PCT2uzw7e5 Over the course of the next 15 months, doctHERs will be engaging the Punjab government to fully integrate this tech-enabled delivery model into the LRMNCH program (the national, Integrated Reproductive, Maternal, Neonatal, Child Health) program. In addition, doctHERs will be enlisting additional health-focused, private sector partners that are interested in expanding their rural market presence, to help sustain and scale this program prior to large-scale, public sector adoption.

Feasibility (3-4 sentences):

Our recent user research has uncovered the following two key insights: (i) community trust is critical to the success of any intervention. By training/upskilling local, trusted intermediaries such as female frontline health workers who speak the local dialect, are typically from the same ethnic group and are historically known to the community), we are able to bridge the trust gap; (ii) Catering to other unmet needs (both clinical and non-clinical needs) the target community may have beyond immunisation increases the probability of success for a vaccination campaign.

Desirability (3-4 sentences and activity upload):

(i) Over 50% of the caregiver responders stated that they did not have practical access to the government's EPI immunization program. (ii) Caregivers indicated that 76.9% of the children in the sample population were 'immunised' (iii) 64% of caregivers who had indicated that their children were 'immunised', reported that their children had not completed their immunisation schedules beyond 2 years of age. (iii) 65.4% of the caregivers surveyed were women

Community Focus (2-3 sentences):

Our target communities understand that immunisation campaigns - especially for polio continue to are an important but controversial topic, especially in the aftermath of well-publicized incidents of polio workers being targeted by both governments and religious extremists (https://www.nytimes.com/2019/04/29/world/asia/pakistan-polio-vaccinations-campaign.html). By proactively engaging religious and community leaders, our frontline health workers are encouraging our communities to take co-ownership of these campaigns, promoting their security, integrity and efficacy.

Community Impact (2-3 sentences):

The concept of Female Frontline HealthWorker (FFHW)-assisted telemedicine/HD video-consultation has the potential to transform the way in which primary, preventive healthcare is delivered to these rural communities. Our new 'continuity-of-care' model integrates primary prevention, screening, diagnosis, treatment and secondary prevention and is currently being evaluated by the Punjab government in a pilot program with doctHERs. If successful, this tech-enabled, human-centered, immunization strategy will be sustained by the Punjab government beyond support from the Gates Foundation.

4 comments

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Photo of Marichu Carstensen
Team

Hi Asher, empowering women within any community is always a strong move. I am impressed with the partners that you have already. Bringing back women doctors into the fold is also a good step since you have so many of them not practicing. Finding out why they stopped practicing and finding solutions to minimize it could also be something to look at.
How will they be compensated? Are they being paid or supported by Unilever?
Congratulations and good luck on your project.

Photo of Asher Hasan
Team

Hi Marichu - thanks for your insightful question. The female doctors that we employ in this healthcare delivery model are compensated directly by us (doctHERs) and are either flexi-time, salaried employees or fee-for-service, independent contractors. The Punjab (provincial) government is financing the HD video-consultation component of this model as part of an innovation project and the path to scale is for the Punjab government to take over the complete cost of the HD-video-consultation (~$3.50 per consult) in order for this model to become completely sustainable.

Based on women-centered design thinking immersions we've conducted in the recent past, we've identified 3 primary reasons for female doctors not participating in the workforce: (i) Perceived security concerns with relocating to and/or practicing medicine in unsafe work environments in urban centers, post-conflict zones, urban slums and remote rural communities; (ii) socio-cultural barriers that discourage women from actively participating in the workforce - these include an outdated but still quite prevalent social belief system that views work as something that is done out of sheer, economic necessity (i.e for self-survival and not for self-actualization) - many parents/in-laws believe that they have the financial resources to care for their daughters/daughters-in-law; therefore, according to their logic, she should not have to work; (iii) transitional exclusion due to pregnancy/childbirth/raising a family or family care - this 'voluntary' exit from the workforce typically lasts anywhere between 6 weeks to 6 years depending on the situation; the longer the exit, the harder it is to re-enter the workforce, due to the rapid advancement of clinical knowledge and systemic bias. Rigid health systems have yet to adapt to the needs of a more agile, gender-inclusive workforce, but technology (assisted telemedicine) is enabling women to leapfrog or circumvent many of these systemic barriers.

Photo of Temba Vicent
Team

Dear Asher Hasan 

Thank you very much for your idea which uses the existing marketing and demand creation initiatives from the large corporation such as Unilever. My question is how will you manage the demand creation of Unilever products at the same time demand creation for Immunization? Do you think the Unilever corporation will put more time on demand creation for immunization rather than their products which is sound like their core business pathway? You mentioned that "Both doctHERs and Unilever have been interacting with these communities since 2015 and have built up trust" What kind of trust please add more information.Do you think the same team which used by Unilever for demand creation of their products will be used in demand creation for your immunization campaign? How will you managed the conflict of interest? Thank you.

Photo of Asher Hasan
Team

Hello Temba - thanks for your question. You raise some important issues. The way we've addressed the potential conflict of interest is that we've embedded female frontline health workers with each brand activation team. The female frontline health workers (FFHWs) do not market Unilever products .- their primary responsibility is to create demand for health & wellness services (including vaccinations) via medical camps and in-home, town-hall style gatherings. Unilever's consumer brand activators play a secondary, supportive role in informing the community of these events (the immunisation camps also offer free medical screenings, check-ups, etc. in addition to the vaccination services and connect beneficiaries to remotely located, qualified female doctors via FFHW-assisted telemedicine). The brand activator's consumer brand messaging remains their primary focus.

The rural communities that we work in have historically had have a number of misconceptions and myths around vaccines, e.g. vaccines may cause infertility. Multiple, interpersonal and trust-building exercises were required to gain the confidence of these communities - that we're genuinely concerned about their welfare and health. The brand activators and female frontline health workers (who usually originate from similar communities, are from the same ethnic group and speak the local dialect) play a critical role in bridging this initial trust gap.
These trusted intermediaries are also an essential component in the effectiveness of our HD video-consultation model with remotely-located female doctors - directly connecting end-users to these doctors would not have had the same impact.

Another aspect of trust that we've built up with these communities is that we will not violate their individual privacy by circulating any videos of their clinical interaction with our female doctors on social media without their informed consent (we use HD-video-consultation as the interface between our doctors and these communities and a random sub-set of these interactions are recorded for medical education purposes and quality control/clinical audits by specialists/consultants so this is a reasonable concern).