Predict pregnancy complications early

Maternal and Infant mortality is at high levels in developing countries and is going to be exacerbated due to healthcare resources being diverted to COVID-19.

A network on obstetric sonography centers in rural areas in developing countries like India. The centers focus on using the 12 week sonography scan for early detection of complications during pregnancy. These centers can funnel at risk patients to specialists in urban centers. Not-at-risk patients can significantly reduce the number of the times they have to visit a clinic reducing the cost and also reduce the load on overburdened healthcare resources.

If scaled globally, it could reduce the number of visits required per patient while simultaneously reducing the maternal and infant mortality rate. Saving the global healthcare system billions of dollars.

In developing countries women have less access to household dollars budgeted for healthcare. They also don't have the independence to seek out healthcare without their spouse. Amartya Sen estimates that there are between 90-100M missing women in developing countries i.e. women who should be alive but aren't because of lack of access to resources, most prominently, healthcare.

Antenatal care in its current format was designed in 1929 and is both time consuming and expensive and thus prohibitive for women in developing countries. This is because complications show up later in the pregnancy and need to be treated immediately, hence, the frequency of visits increases as you approach labour.

Recent advances in sonography and research however have helped created indicators for early detection of future complications, as early as 12 weeks. These methods can help segment the population of obstetric patients into at-risk patients needing specialist care and not-at-risk patients who don't need to visit a clinic that often.

We want to create a network of obstetric sonography centers in Rural India who specialize in the 12 week scan and obstetric sonography in general. The technicians at the center don't need to be qualified doctors which developing countries lack. They need to be proficient in the scan which will be fed into a central server where an expert double checks the on field results. These centers can act as triage for obstetric patients - sending at-risk patients to specialists in urban centers while simultaneously acting as check ins for not-at risk patients to get scans and keep their physicians updated. 

The solution uses existing technology and research built over almost the last two decades. It uses sonography machines and cloud infrastructure to centralize the detection function. 

Our target population lives and works in rural India. They are women between the ages of 21 to 35 who don't have financial independence and lack access to education and basic healthcare. 

We run a maternity hospital in a tier 2 town in India where we get patients represented by primary care physicians from rural areas. There isn't standardization in treatment procedures and we get referrals after complications occur which increases the likelihood of mortality and the expense to the patient.

This is particularly relevant now since during pandemics access to healthcare resources is driven away from obstetrics and gynecology. During the Ebola epidemic there were 10 times more avoidable deaths from maternal mortality than there were from the disease.

Our solution is low cost in terms of the equipment and the practitioner and can pass on all of those savings to the end consumer. This will help expecting mothers in rural India get the care they need when they need it.

Our target population is underserved and does not have access to the tools to help themselves. There is historical documentation of how access to healthcare is severely restricted for women in developing countries.

By reducing the cost of healthcare by decreasing the necessity to access through early identification of risk we are creating incentives for women to get themselves checked before complications occur.

We can then focus healthcare resources to the women who will need that level of care. We can then provide access to quality healthcare to the women who really need it.

We are using existing protocol that isn't popular in developed countries due the abundance of resources and creating a business model where it can be popularized in developing markets.Our innovation is in using the hub and spoke model for care already being used in India for cancer and cardiac disease and applying it to gynecology.

Our competitors will be primary care physicians in rural areas, our solution is more standardized and due to scale we can provide better services at lower costs. 

The core technology is sonography and the identification of parameters that help detect complications like pre-eclampsia, preterm birth or cardiac defects as early as 12 weeks.

Source: Nicolaides, K.H. (2011), Screening for fetal aneuploidies at 11 to 13 weeks. Prenat. Diagn., 31: 7-15. doi:10.1002/pd.2637

Our organization will increase the base of women who seek out antenatal care by reducing the costs. This will result in better identification of at-risk patients and reduction in maternal mortality rates. This will result in more women seeking out antenatal care in underserved areas. Which will draw more resources to early detection centers at the periphery of medical care in India. 

These centers will also provide services for other gynecological problems. Which will lead to more awareness amongst women in rural areas about the need for healthcare. Leading to more resources being drawn to these areas.

We are still validating this solution. However, our center sees above 2000 women a year on the basis of which we have identified this mechanism of engagement with them.

India's rural population is ~600M with ~270M women, we think realistically in 5 years we can get to 5-10M women if we operate only in the northern states where we currently have our base of operations.

We want to start our first pilot rural center within the next year, if the solution is validated over a 6 month period, then we would like to open 10 similar centers by the end of year 2 with an exponential increase after that.

We need to know if the centers will have access to resources like electricity and water in rural centers. We also need to understand how rural women will interface with a center in their locality versus one they have to travel to.

We plan to overcome this by launching a pilot center and seeing what resources we will be able to locally source versus what we will have to transport there.