Khushi Baby

Ruchit Nagar, 27, is CEO and co-founder of Khushi Baby, a technology non-profit dedicated towards improving maternal and child health at the last mile in India. He is also currently a fourth year medical student at Harvard Medical School. Ruchit launched Khushi Baby out of a design class project, as an undergraduate at Yale in 2014. He went on to complete his master's thesis in public health, spearheading a 2-year, 3200-mother randomized controlled trial to evaluate the impact of the Khushi Baby platform. Balancing his responsibilities as a leader and as a medical student, Ruchit has been able to grow the team to  40 full-time members. He has recently signed a 3-year contract to serve as the Nodal Technical Service Provider to the Department of Medical, Health, and Family Welfare of India's largest state, Rajasthan and to scale Khushi Baby's platform to 50,000+ community health workers.

In Rajasthan, India's largest state, there are 1.5 million deliveries every year. 60,000 Infants (40 out of every 1000) do not see their first birthday. 420,000 deliveries are at high risk. This situation has worsened in the COVID-19 pandemic, during which village-based village health camps were suspended for over 3 months, putting 2.5 million infants at risk of missing life-saving vaccinations. Supply and demand-side gaps are obfuscated by a paper-based tracking system that is neither actionable nor accountable. Khushi Baby is a novel platform designed to empower frontline health workers to better deliver longitudinal maternal and child health care at the last mile. Khushi Baby's mobile platform uses GPS, biometric, NFC, and IVRS technology to inform and authenticate health interactions for the historically left-out, guiding a precision public health response. The platform will digitally empower 20,000+ female community health workers as first-time smartphone users, to better care for their communities.

In Rajasthan, India's largest state, there are 1.5 million deliveries every year. 60,000 Infants (40 out of every 1000) do not see their first birthday. 420,000 deliveries are at high risk. This situation has worsened in the COVID-19 pandemic, during which village-based village health camps were suspended for over 3 months, putting 2.5 million infants at risk of missing life-saving vaccinations. Supply and demand-side gaps are obfuscated by a paper-to-digital tracking system that is neither actionable nor accountable. Per Central Ministry of Health reports only 50% of infant mortality is reported, and <65% of mothers and infants have been registered in the central system, as of the last financial year. At the ground level, community health workers are burdened by up to 11 registers, spending a week every month on manually tabulating and reporting indicators. Incentives are set up without accountability mechanisms, and are based on reaching inappropriate health targets extrapolated from years prior. An accountable and actionable digital continuum of care is needed to identify the gaps and make data collected at the point of care more actionable to those serving and living in underserved communities.

We have developed a platform for tracking public health with the following key components:

1. An offline mobile application for frontline health workers to support advanced planning and point of care decision making across the spectrum of family planning through early childhood

2. A digital health card for beneficiaries to carry their essential health record in a decentralized manner. This card can be scanned by the health worker's phone.

3. An analytics platform for state and district health officials to pinpoint gaps in community health delivery

4. A community engagement platform that automates dialect-specific voice calls for beneficiaries and prioritized follow-up lists for health worker teams

Our team of 40 full-time members is supporting the scale-up of this platform (technology, capacity building, monitoring, advocacy) by the Department of Medical, Health, and Family, Welfare, Rajasthan to empower 70,000+ frontline health workers.

The platform is already being used as part of a state-wide active surveillance initiative to follow-up with the most medically and socailly vulnerable groups across the state, affected by COVID-19. This effort will continue as part of the state's digital health census, from which a base of eligible couples will be tracked longitudinally from family planning through early childhood.

Our solution primarily aims to empowers 50,000 community health workers and 17,000 frontline nurses (Auxiliary Nurse Midwives) who are responsible for caring for 2.5M pregnant women and infants living in rural Rajasthan, every year. Through timely delivery of prioritized due-lists, and proactive automated voice call engagement in the local dialect with pregnant women and mothers, we hope to avert 2500 adverse maternal and infant health outcomes by catalyzing timely intervention. This solution continues to be refined by feedback we receive from our close work with community health workers on the ground and program directors at the district and state level.

Through this project, our team hopes to bring light to the gaps in the public health delivery system so that care can reach those mothers and infants who have been historically left-out. 

We look to digitally empower tens of thousands of female community health workers. With our platform, community health workers will have an opportunity to plan their work more efficiently and efficaciously, estimate their monthly earnings, and learn new and refresher content to improve their skill set on the frontlines.

Finally, we hope to empower mothers (and fathers) to better care for themselves and their infants.

This project was born out of a design course my junior year at Yale, focused on addressing the immunization gap in the developing world. Along with an interdisciplinary group of my classmates, we used a design thinking framework to explore the literature, ideate, prototype a solution for a new vaccination record. The first "aha-moment" came from recognizing there was an off-the-shelf technology in the form of Near Field Communication which could be reapplied to store an editable and digital medical record in an battery-less chip. With a prototype application for tracking immunizations, we connected with a Rajasthan-based NGO. We were lucky to win seed funding from the school, after which I reached out to local graduate students and found my COO, Md. Shahnawaz, who was pursuing his PhD from Indian Institute of Health Management Research in Jaipur. Our endeavor was launched in 2014 when we had a chance to visit village-based health and nutrition camps to evaluate the current state of maternal and child health delivery and deeply connect with barriers on the ground. From that seed of public health research and curiosity towards culturally-appropriate technology, Khushi Baby was born, and is now on the verge of scaling across Rajasthan.

Growing up I had always been interested in health care. At first my focus was limited to medicine, but through my undergraduate courses and experiences seeing health care  in underserved the US, Ecuador, and Honduras, I began to appreciate the challenges of public and global health delivery. I never anticipated I would get into the space of maternal and child health, but through founding and growing Khushi Baby, I was exposed to a very fundamental (yet complex) problem that required innovative solutions. If we cannot ensure that all women can safely go through pregnancy and infants can make it to their first birthday due to malnutrition or vaccine preventable disease, then we need to be doing more and technology can help. My connection to this geography has been personal, albeit coincidental - my father grew up in Rajasthan, India, moving to the US 30 years ago. Now I have a chance to return to strengthen the public health delivery system of my motherland. Above all, I continue to be inspired by an amazing interdisciplinary team who have come from all corners of India from very humble backgrounds to advance our mission.

My academic journey has prepared me well for this field: I completed my BS in Biology as a Global Health Fellow and went on to complete my MPH in Epidemiology of Microbial Disease and Global Health at Yale. I am now a fourth year medical student at Harvard Medical School. Along the way, and while balancing responsibilities at school, I have lead a 3200-mother, 2-year randomized controlled trial, written 2 theses, and grown the team from a public health research project to a full-time team of 40 members, now serving a three-year term as the Technical Service Partner for the Department of Medical, Health, and Family Welfare. I have raised over 1.5M USD in funding over the last five years to support our efforts on the ground, and helped the state department secure 2.5M USD to support scale-up of our platform from the Central Ministry of Health and Family Welfare, India. I have had the unique opportunity to work directly with the Chief Secretary of Health of Rajasthan over the last year, including as a member of his advisory committee on the COVID-19 response. My strength is in my ability to connect the dots at the intersection of technology and public health to deliver sustained impact at scale.

We started as a group of public health students volunteering our time, working on the side to build and gain evidence for the platform. We then graduated to working with the district government, who challenged us to rebuild the platform for scratch to meet the requirements of their frontline health workers. We invested a year in the rebuild and in order to convince the District Government we were here to stay and not another pilot. After 2 years of overcoming numerous hurdles from technology to policy to finances, we were able to successfully complete the largest randomized controlled trial in the State and demonstrate impact of our system. But as young and outsider NGO, we were thoroughly tested when we went to pitch our solution for scale-up at the state. We had to build our case against legacy digital health platforms and department officials who were less ready for drastic change. Even after being selected over incumbents, the launch of our state-wide digital health census was delayed due to COVID-19. And I have had to balance challenging medical school coursework at the same time. Through sincerity, hard-work, and evidence we will continue to face adversity head on.

This past April, after 6 months of advocacy at the Rajasthan State Department of Health, we were anticipating scaling-up our platform for community health. The first step was a state-wide digital health census, the first of its kind in India for over 70M residents. But in March, COVID-19 hit Rajashtan and India. Our technology and implementation teams, returned home as doctors were assigned to our temporary residence. With our team split and the Department's attention rightly focused on addressing the outbreak, I had to make a measured call to devote 20% of our resources towards working on use of technology for COVID-19. Initially we started with building Rajasthan's Crisist Communication WhatsApp Chatbot, after manually interacting with over 5,000 quarantined travelers. Then we adapted our digital health census application to focus on active surveillance of the most vulnerable groups (pregnant women, infants, elderly, comorbid). By not only proposing, but rapidly delivering on interventions, the Chief Secretary Health began calling us to his cabinet meetings, where we became unexpected advisors on the COVID-19 response and specifically how technology could be used to drive the response.

Previously mobile health pilots have been trialed for frontline health workers India in the states UP, Bihar, and Gujarat. These solutions – focused on offline data capture -  have not facilitated capture of a complete digital health census or follow-up across all national health vertical programs for which the frontline health workers are responsible. These solutions also do not include a continuum of care between the ASHA, frontline nurses and medical officers of the catchment area. Our solution will not only be India’s first state-wide application of a digital health census, but will also include a comprehensive a follow-up module for the frontline health workers and a continuum of care as per national program guidelines. Moreover, follow-up will be uniquely connected with an automated voice call system in the local dialect to targeted beneficiaries.

Our proposed solution further stands out for how it ensures data accountability (GPS, satellite, IVRS calls, data quality checks) and how it gamifies the experience so frontline health workers can project their monthly earnings. Finally, beyond the technology, the blended approach to training both the app and core skills is a key innovation to building the frontline health workers overall capacity to deliver better health care.

1. We look to empower health officials at the state and district levels with actionable analytics and tools to deliver community awareness at scale (via automated engagement mechanisms)

2. We look to empower 70,000 health workers on the frontlines, working in villages and underserved communities, by providing a mobile application which facilitates advanced planning, point of care decision making, continuous education, and financial planning. 

3. We look to empower over 2 million families going through the spectrum of maternal and child health care by providing timely awareness content in the local dialect and by creating an accountable system that increases their likelihood of receiving essential primary health services.

Currently: 9000+ health workers, 75,000+ mothers and children

Next year: 20-50K health workers, 250K+ mothers and children

Five years: 1M health workers, 25M mothers and children

Next Year:

Successfully complete India’s first state-wide digital health census in the State of Rajasthan, already underway for active surveillance of vulnerable groups during the COVID-19 pandemic.

Identify hundreds of thousands of otherwise left-out groups and vulnerable populations in the State of Rajasthan and track them longitudinally for their reproductive maternal neonatal and child health

Next 5 Years:

Digitally empower India’s largest community health workforce of 1M ASHAs to deliver informed care and receive structured continuing education through their smartphone. Rajasthan’s successful model can easily be replicated to other states that share common national vertical health programs.

Smartphone ownership by the ASHA varies from 20-70% depending on geography. First, ASHAs will need to locally procure phones. The government is still working to see if budgetary allowance can be provided for this effort.

Second, tens of thousands of ASHAs will need to be trained on not just the mobile health application, but on how to operate a smartphone in the first place. Our team, which leads master trainings (training of trainer’s model), will be limited in its ability to be present at block and sector level trainings – due to the scope and travel limitations with COVID-19.

We have designed the application to work on budget smartphones which can be locally procured. The government is planning to add a 2000 INR incentive for ASHAs to help them procure the phone. The mobile application will also help the ASHAs better capture their work and should generate more earnings in the long run.

Trainings have been adapted to ensure virtual VC participation at the district, block and sector levels. Standard operating guides, user manuals and shareable WhatsApp videos have been developed for offline and asynchronous training on the platform. With the strong leadership of the Health Secretary, support of the state’s administrative and training machinery, we will use a training of trainers model to overcome barriers.

Department of Medical, Health, and Family Welfare - nodal technical support partner

Department of Information Technology & Communication - hosting, security, application performance monitoring, voice messaging services

JHPIEGO - integration of their labor monitoring platform into our longitudinal community platform for tracking reproductive maternal neonatal and child health

IDEMIA - integration of their contactless fingerprint biometric technology for offline authentication of health care interactions

JPAL, Harvard Medical School - impact evaluation on effect of our platform on maternal and child health indicators in the post COVID-19 setting

We are a non-profit in a 3-year, legal agreement with the Department of Medical, Health, and Family Welfare (DMHFW), for the Government of Rajasthan. Our contract ensures the DMHFW owns the solutions we build and implement. The DMHFW does not pay us for our services, but recognizes us explicitly as its Nodal Technical Service Partner for its flagship integrated health platform, Nirogi Rajasthan. Accordingly we use our affiliation to raise funds from donors and funders to support our internal operating costs, while we scale impact through IT-enabling the government's vast public health delivery system.

Over the last 5 years we have raised 1.45M USD with 92K USD awarded funds still due, including 224K USD in the last year. Our biggest funders have included GAVI, Johnson and Johnson, and 3ie (the International Initiative for Impact Evaluation).

We primarily raise funds from a combination of grants and partnerships with established funders. A small proportion of our funding comes through individual donors as well. 

Our path to financial sustainability comes from continued and scaled delivery of our innovative platforms for demonstrable impact in the maternal and child health space, which leads to follow-on funding. Our R&D expands access to new grant and research based funding as well. Right now, we are in the process of raising a 1.5M ticket from private organizations to trigger 100% matching from the Bill and Melinda Gates Foundation, as a GAVI Infuse Pacesetter.

Over the last 5 years we have raised 1.45M USD with 92K USD awarded funds still due, including 224K USD in the last year. Our biggest funders have included GAVI, Johnson and Johnson, and 3ie (the International Initiative for Impact Evaluation).

We are seeking to raise 340K in grant funding to cover our operating expenses through the end of 2021. If we raise over 1.5M from partners, we will activate 100% matching funding, which would immediately propel us to set up offices in multiple states who have also expressed interest in our platform and accelerate our scale-up.

Our estimated expenses are 250K USD for this financial year.

Khushi Baby is at an inflection point in our journey. After 5 years of working at the grassroots level, generating high-quality evidence, refining our solution, and completing a year of advocacy at the state level, we now have this 3-year window to scale-up our platform, as the nodal technical support partner to the Department of Medical, Health, and Family Welfare, Rajasthan. In turn, we hope to secure our funding runway through 2021, so that our 40-member full-time team can focus on successfully scaling our solution with the Department of Health. We also seek guidance from those who have gone through this before, on how we can prepare our organization for this next chapter of scale. Elevate's multi-year funding and programmatic support will help our Khushi Baby mature into an organization that can deliver both scalable and sustainable public health impact.

BMGF- funding and technical support, at scale, and in India

Rockefeller Foundation - strong alignment on use of digital platforms for precision public health

Smartphone manufacturers - to help with large-scale government procurement for female community health workers who will become first time smartphone users