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Khushi Baby

Empowering caregivers and frontline health workers with an accountable, decentralized health system built for the last mile.

Photo of Ruchit  Nagar

Written by

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

Khushi Baby is a platform for engaging maternal and child health in rural India to improve quality, accountability, and awareness of services by using Near Field Communication, GIS, biometrics, behavioral science, and culturally-tailored design.

Explain the idea (less than 2,000 characters)

800,000 children under the age of five die every year in India from vaccine preventable diseases. Khushi Baby is based in the District of Udaipur, in Rajasthan, India, where 40 out of 1000 infants do not see their first birthday. We identify two clear opportunities to strengthening the health system: first, generate demand from the community by engaging them using appropriate design and innovation; second, to build a frictionless, accountable interface for health providers to record and remind mothers. Under the current regime, frontline health workers maintain handwritten health records of patients on paper card (which the mothers retain) and their own health registers with identical information. Paper has its problem - it’s not searchable, never complete, and moreover data is hardly actionable. Beyond paper, community engagement of mothers is also a challenge requires, ASHA workers walk kilometers going house to house instead of maximizing their time among the sickest. With Khushi Baby we can do better, instead of a paper health record, children receive a culturally-symbolic digital necklace with black thread. This necklace contains a Near Field Communication chip which can store immunization data and biometric without needing a battery. Mothers bring this necklace to the camp and the health worker scans the necklace and verifies their biometric to read and update their health record, without the need of connectivity. Later the health worker syncs the data and from our dashboard, health officials can take action from their phones. Automated targeted reminder calls are sent in local dialect to the phones of the mothers, and also, whatsapp messages are sent to the phones of the frontline nurses, so that they follow-up with drop out children. With this patient-centric system 81 frontline health workers have used the application and tracked over 24000 beneficiaries in past 18 months in 400 villages of rural Udaipur of India.

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

  • Eastern Africa
  • Southern Asia

Geographic Focus (less than 250 Characters)

Currently: 1200 villages in 1 District (Udaipur) in Rajasthan, India; Target: Pan-India and other GAVI-affiliated countries

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

From our experience, we have seen that it takes a village to care for a child: the mother, the father, the mother-in-law, the village leader, the community health activist (e.g.ASHA), the frontline health worker (e.g. ANM), the frontline nutrition worker (AWW), and the health officials who set targets and mobilize resources. Over the last 4 years, we have individually interviewed over 10,000 of these “caregivers” across 600 rural villages in the District of Udaipur. We have co created alongside them to choose a form factor for their health record, to design a mobile application that empowers them, to customize voice messages that they can appreciate, and to present data in a form that sparks action.

How is the idea unique? (750 Characters)

There have been attempts to build mobile health applications to collect data at the last mile, sync data to a central server, and engage with caregivers over SMS. These systems assume that at the last mile connectivity will be present to identify the caregiver and child. These systems also assume that these populations can read or will read SMS messages. Conversely, there have been no-tech wearables and immunization cards that assume data can be reliably aggregated upstream. Khushi Baby builds a truly patient-centric system: digital, decentralized, and biometrically authenticated health record; a mobile app with incentives for high quality data; and voice calls in the local dialect, automated, and specific to each caregiver.

Idea Proposal Stage (Select 1)

  • Early Adoption: We have completed a pilot and analyzed the impact of that pilot on the intended users of the idea. I have proof of user uptake (i.e. 16% to 49% of the target population or 1,000 to 50,000 users).

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

By the end of 2020, we would like to track the health of all mothers and children across the District of Udaipur (200K beneficiaries).

Organization Name (less than 140 characters)

Khushi Baby

Type of Submitter

  • We are a registered NGO or Non-Profit Organization

Organizational Characteristics

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

Organization Location (less than 140 Characters)

Udaipur (City/District), Rajasthan (State), India

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

  • Regional (reach within 1 geographic region)

Website URL

www.khushibaby.org

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

We are a US-based, India-headquartered non-profit. Our mission is to track and engage the health of pregnant women and newborns to the last mile.

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

We work with partners who are leaders in health policy, design, technology, public health research, and scaling social impact. UNICEF Innovation, GAVI, and J&J provide us funding, innovator networks, and strategic support. We’ve been incubated by Yale, UNICEF, Frog, and ARM, JDFI Asia, and now NCORE in India and Harvard I-Lab. We collaborate with researchers at Harvard Medical School and Yale School of Public Health. We leverage technology collaborations with IDEMIA (global leader in identity solutions), Mobisoft Infotech (software development), and Yale’s CodeforGood club. We work closely with the local District government to implement our solution, and sit on the working committee for Rajasthan State to build standards for digital health.

How many people are on your team?

25

Tell us more about you and your team

11 comments

Join the conversation:

Comment
Photo of Marichu Carstensen
Team

Hi Ruchit, I have several questions. I am impressed with the roster you have in your team and the groups that you are collaborating with.
I have several questions. First,how much would it cost to develop this kind of wearable tracking device? In case of loss, or breakage, are they replaceable, who will shoulder the cost? Is the community ready for this technology? Lastly, what is the percentage of caregivers in your community who possess cellphones?
Good luck on your project!

Photo of Ruchit  Nagar
Team

1. $0.70 / pendant at a 1000-10K unit scale; $5.62/child/year for the entire platform and field support
2. The pendants house a battery-less chip in a hard epoxy. They are waterproof and durable - good for over 100,000 scans and able to weather the conditions at the last mile for years. If lost, data is backed up on the health worker tablet, and then on the cloud system. If the health worker happens to have the beneficiary's data in the tablet, the data can be written to a new pendant. Currently the pendant is provided at no cost to the beneficiaries. The same goes for the health care at these village based health camps. Ultimately the government will need to the decide who will bear the cost for replacement of the necklaces.

82% of mothers had access to cellphones in our baseline survey of 3979 mothers in 2016.

Photo of Marichu Carstensen
Team

Hi Richit, I saw your video. Well done and well developed. I congratulate you. It is good that you have made the system work. This battery less pendant can last for at least one year right? Once it is taken off. How can we differentiate a fully immunized child to one who isn't? What happens to the 20 percent who has no cellphone? Can this system withstand the test of time? Do you have instances when the i pad monitor got lost or stolen? In these cases when the scanning gets delayed,after the shot was administered, what is your back up system? Or in case of a probable systems failure, is there a chance that the baby may get immunized with the same vaccine twice?
Again, the best of luck in your great endeavor!
Marichu

Photo of Ruchit  Nagar
Team

1. The pendant can last for up to 100,000 scans without instability in data that is saved. This amounts to many years.
2. The pendant itself doesn't signify that the child is fully immunized. It is a digital health record that stores the progress of immunizations, along with other key health and nutrition data. Without the pendant, one could search for the beneficiary by name, mother's name, and date of birth in the backend system, but that should never be the first approach at the point of care.
3. Those who do not have cell phones do not receive voice call reminders. In our RCT number of voice calls received was positively associated with completion of full immunization
4. We've been field testing our solution for the last 4 years, with active field deployments in the last 2 years to track nearly 25,000 beneficiaries. Because our team oversees the end-to-end process from design to development to deployment, we are well-equipped to maintain and scale the system over time.
5. The backup for the pendant is the tablet, and the backup for the tablet is the cloud database. Just like if the mother loses her paper vaccination card, she is more likely to not receive the right care for her or her child, the same applies for losing the pendant. The retention of the pendant was better at 8 months when compared to the card by about 9% but overall not statistically different after 18 months. However, compared to the paper system the baby is less vulnerable to miss-vaccination given that the data is on average 20% more complete at the time of registration, including information on birth doses and birth dates.

Thanks for your questions

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