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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
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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".
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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.
FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017
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