Perrine Legoullon, StartupBRICS Avril 2017, Udaipur, India · Arriving in Udaipur, flying directly from Delhi, Vijendra Banshiwal (Programme Manager) and Pawan Singh (Programme Associate)

FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017

Field survey carried out by StartupBRICS for the e-health Observatory in the

Southern countries of the

KHUSHI BABY, FOR BETTER VACCINATION OF

CHILDREN AND BETTER MONITORING OF

PREGNANCIES IN INDIAN RURAL AREAS

Perrine Legoullon, StartupBRICS

Avril 2017, Udaipur, India

The Actu Tech and Start Up of the Emerging Countries


I. Performance of the field survey

The Khushi Baby project field survey was held in Udaipur and surrounding areas

from 12-14 April, in the presence of COO Mohammed Shahnawaz, and the rest of

the team based in Udaipur.

Arriving in Udaipur, flying directly from Delhi, Vijendra Banshiwal (Programme

Manager) and Pawan Singh (Programme Associate) welcome me warmly at the

airport, and we head straight for their office in the centre of Udaipur.

For this first day, we have scheduled a meeting of several hours, during which

Mohammed Shahnawaz (COO Khushi Baby) who manages the team based in

Udaipur, explain the history of this NGO founded in May 2014. The team show me

their technologies: pendant with integrated NFC chip, NFC tablet with integrated

biometric fingerprint reader, as well as the dashboard of their website, on which

you can find all the data and statistics about Khushi Baby's patients.

The next day, we went to attend a "camp", a hundred kilometres South of

Udaipur. A "camp" is a travelling medical clinic which goes from village to village,

for the medical consultations of babies and mothers/pregnant women living in the

area. In just two hours, the landscape changes drastically. Once in the nearest

city, we are obliged to ask passers-by at each intersection, as there are no street

signs.

Surroundings of the village of Raghunath Pura


Finally, we arrive in the village of Raghunath Pura. A few houses, some villagers, and

the Rajasthan sun which is beating on our shoulders, temperatures reaching 45

degrees. We are headed to a small room that looks like a primary school. There, we

find the ANM (Auxiliary Nurse Midwife) dressed in a white sari, uniform of the

profession, as well as pregnant women, mothers and babies who came to attend the

camp that day, about twenty people.

Perrine Legoullon with some patients and the ANM (in white)

For several hours, we were able to attend the mothers' consultations, vaccinations for

babies, all using the tablet and Khushi Baby pendants provided by the initiative. We were

able to talk to the ANM, who explained to us how much the Khushi Baby system had

simplified its work.

This field visit proved very valuable. It not only allowed a better understanding of the

functioning of the Khushi Baby system, observing the role of the ANM within this

community, and also better realising the living conditions of the patients targeted by

Khushi Baby. It was also an opportunity to interact with the ANM and mothers (some

speaking Hindi) to obtain their feelings about this new system.


II. The genesis of Khushi Baby

"1.5 million babies die each year from diseases which could have been

prevented by a vaccine. 500 million of these babies are Indian."

This is the conclusion which

Mohammeh Shahnawaz shares with me

from the beginning of our meeting, and

the statistics on which the genesis of

Khushi Baby is based. Faced with this,

the CEO and founder Ruchit Nagar,

then a student at the Yale School of

Public Health decided to embark on the

adventure, and to prepare his Master’s

thesis in Epidemiology and Global

Health.

Since then, Khushi Baby's mission

has been clearly defined: to

encourage and follow the health

services of mothers and children

up to the last kilometre.

In order to tackle this statistic, it was

necessary to understand the source of

the problem. The problem identified by

the Khushi Baby team is divided into

three points:

1/ In the most remote places, mothers do not always realise the importance of prenatal

medical visits, how many vaccines are needed before and after birth, etc. There is a lack

of information and an urgent need to raise awareness of the importance of these

medical visits.

2/ The medical system is still very much based on paper documents. At the birth of her

child, each mother receives a paper file concerning the health of her baby. However, she

may forget it during the visit, or it may be damaged or lost or destroyed. The registers

used by the ANMs during their visits are also large paper files, which weigh several kilos.

These are bulky, can be damaged, and are hard to amend in case of error. In the event of

an error in the register or absence of the child's paper file, this can lead the ANM to make

ineffective or even completely erroneous medical decisions.


A child's paper vaccination notebook

3/ In the most remote places, data collection methods are out of date, unsuited to

context and inefficient. This means that public health authorities do not have

access to reliable data about patients. Which babies have missed their

vaccinations? Which pregnant women have "at risk" pregnancies and need more

follow-up? These are all missing data which could allow public health authorities to

make informed decisions and better allocate their resources.

This solution is therefore aimed at mothers and babies from poor and geographically

isolated communities living in rural areas of India.

III. What is Khushi Baby? How goes the system work?

Khushi Baby is a "patient-centric" system, unlike other systems which are usually health

organisation centric focused on managing the resources and data collected. The idea

was to create a system which allows patients to keep health data about them at all

times, while informing them, making them aware and encouraging them to attend

medical visits at the "camps".


The team is quickly directed to the connected objects trail, a solution which would

allow patients to keep information on them at all times, serving as a visual reminder.

After several tests, the team created a pendant with an integrated NFC chip. This

chip stores all the health information about the patient. It has a capacity of 800 KB,

which to date allows the storage, for example, of all the information concerning the

four prenatal visits required for a pregnant woman.

These pendants are waterproof, require no battery or charge, and cost less than one

dollar to produce (per unit). But the strong point of this necklace undoubtedly lies in its

adaptability to the local context. Indeed, the black thread used is similar to that of

necklaces which babies in this region of India are already accustomed to wearing

(according to beliefs, it drives the evil eye). The pendant has therefore been very well

accepted and adopted by rural communities where the system is already implemented.

While remaining discreet, it serves as a visual reminder and generates conversations.

During our visit, a patient told us that she had seen her neighbour wearing this necklace,

and wanted to get one too.


The system includes three people or organisations: the

ANM (medical staff), the patient and the public health

organisation.

The operation begins with the ANM, equipped with her

NFC tablet. These tablets are able to record and read

information stored on the NFC chips, and are also

able to record and recognise biometric fingerprints.

They are equipped with a GPS system which makes it

possible to geolocate the ANM in the camp.

The tablet requires an internet connection to identify itself

and to synchronise information with the Khushi Baby

database, otherwise the interface works without the

internet. Once the ANM has logged into her account, she

could technically use the tablet for years without ever

connecting to the internet. In order to facilitate the regular synchronisation of

information, Khushi Baby provided a 3G card to each ANM. Once the ANM is connected

to her account, she receives a list of the patients she will meet during her next

intervention. She also receives a "check list" of the equipment (vaccines, medical

equipment, etc.) to be kept in mind in anticipation of her visit.

Upon her arrival in the village, the ANM indicates on the application that she has

arrived. She also has the option of saying that she could not go to the camp, and must

give a reason. Her GPS coordinates are then recorded, and she must take a picture in

front of the building. The camps are at fixed times. If the ANM arrives late or leaves

earlier, she must also justify this information.

At first, the ANM, during her visit to a village, records the information on new patients

(mothers and children) in the Khushi Baby interface thanks to the tablet which has

been provided. Once all the information is entered and saved in the system, she scans

an NFC pendant and gives it to the patient.


The ANM also takes the mother’s fingerprint (right thumb if it is for her information, left

thumb for her child’s) to secure the data. The fingerprint will be required at the next

medical visit in order to access the patient's health data. For patients already

registered, she can simply find their information by scanning the pendant, then taking

the mother’s fingerprint.

The ANM scans a mother’s fingerprint with the tablet

At the end of the camp, once all the medical visits have been completed, the information

collected, the vaccines and medicines distributed, the ANM returns home and synchronises

the camp's data with the Khushi Baby system. The data is loaded into the interface and

can be viewed by the team from their dashboard.


The data collected on the patients:

● For the mothers: name, age, sex, home, date of the last menstruation, expected

date of delivery, prenatal visit information, etc.

● For the babies: name, date of birth, sex, parents' names, place of birth (hospital or

home), weight, height, vaccines given and to be given, etc.

NB: Once the information has been entered, it can be modified (by the ANM) in case of

error, after scanning the NFC chip and the biometric fingerprint of the patient.

For each "required" action (prenatal medical check, child's vaccination, etc.), if the

action cannot be completed at present, the ANM must enter a reason in the interface

(lack of vaccine, mother did not go to antenatal visit, etc.)

From the dashboard, the Khushi Baby team has access to accurate information, in real

time, on the activity of all the ANMs, as well as on the patients in the areas concerned.

This allows them to know: How many ANMs visited their camp for a given week and

synchronised their data? How many new patients have been registered this week? How

many pregnant women are close to giving birth? How many at-risk pregnancies? All of

this information can be viewed by district or village, and can be downloaded as an Excel

report.

To date, Khushi Baby has partnered with the Udaipur District Health Society, a

local government which manages public health for Udaipur and its region. The

information is thus reasserted to this authority.

IV. What health benefits?

For the patients: better access to information, awareness of health issues such as the

importance of vaccination of babies and prenatal medical visits, better monitoring of

patients with data collected by the system (reminders and reminders by voice

messages in local language)

For the ANMs and health staff: Khushi Baby is a simpler and more convenient system

than old paper files (which can be damaged, heavy and bulky to carry, etc.). The

system also allows having a checklist of materials to take away before a visit, a list of

patients sorted by colour codes (depending on the level of risk), and to have access to

all the past information of the patient even if the patient forgets the collar, since there

is a search tool in the database.


For the medical administration: the system offers a tool for better management of

their employees (ANM) which must "point" at the beginning and end of the visit and

enter their GPS coordinates. Data on the health status of mothers and babies in the

area are more accurate and easily viewable, allowing for better resource allocation and

informed decision-making in real time.

V. What about financing and the business model?

Khushi Baby is an NGO registered in the United States (50 lc 3) and India (Section 8

Company non-profit) Today, Khushi Baby's funding is mainly based on the various

awards received by the project (Tech4Raj, Isif Asia, Digital Trailblazers Awards,

Wearables For Good, etc.)

Khushi Baby has also established strategic partnerships, such as a hardware partnership

with Safran that provides the team with NFC/biometric tablets. Khushi Baby hopes to

eventually be fully integrated into the Indian government's public health department so

that he can have constant financial support while expanding its business to the rest of the

country.

Fiscal year 2016


VI. What impact to date?

Khushi Baby is present in more than 70 villages in the Udaipur region, thanks to its

partnership with a local NGO Seva Mandir. Thanks to its partnership with the local

government, Khushi Baby is in a second phase of expansion and is expected to reach

300 villages in the coming months.

Today, the system has already tracked and registered more than 15,000

vaccinations of children.

The pendants have been very well adopted by the population, about 5 times more (*)

than the old paper cards (MAMTA cards) distributed to mothers at the birth of their

child, according to a field study conducted by Khushi Baby in 2015.

Thanks to its digital system and the almost automatic synchronisation of information,

Khushi Baby reduced the time of data transmission from the field to the public health

organisation, which went from one month (with the old paper system) to 2.5 days.

(*) we are talking here about the number of mothers who come back after their first

visit (or that of their child) always equipped with the MAMTA pendant/card.


VII. What objectives for Khushi Baby?

By the end of 2017 or early 2018, Khushi Baby aims to expand its solution to 600

villages in Udaipur district, reaching 30,000 mothers and babies.

Khushi Baby is a solution that wants to revolutionize the management of maternal and

child health around the world. Although the project started in India and its primary

geographical objective is to expand to the rest of India, Khushi Baby is convinced that

this solution could be replicated in other countries with similar backgrounds.

After India, Khushi Baby would like to connect and propose its solution to institutions or

governments in Africa and the Middle East.

VIII. What relevant supports and partnerships for Khushi Baby?

What Khushi Baby needs most to fulfil its mission are:

- Financial resources to develop its operations

- Public partnerships with public institutions (NGOs, Government, etc.)

Conclusion

A simple solution, aimed at the most destitute and isolated, adopted by the

populations concerned, centred on the patient and which has already proved itself in the

district of Udaipur.

«We are not looking to become another lost mHealth pilot. We hope to transform the way

maternal and child health is tracked in rural regions around the world. And ultimately it

starts with a simple and powerful idea, to keep the medical history with the patient» - R. Nagar

Left to right: Vijendra Banshiwal, Perrine Legoullon, Pawan Singh and Mohammed Shahnawaz

Documents

Perrine Legoullon, StartupBRICS Avril 2017, Udaipur, India · Arriving in Udaipur, flying directly from Delhi, Vijendra Banshiwal (Programme Manager) and Pawan Singh (Programme Associate)