Smart and Sensitized Rural Communities

Meet Samina. She is a 19 yr old female living in a small village of district Jhang, Punjab, Pakistan.  Samina has been battling with Post-Traumatic Stress Disorder(PTSD) since she was married 3 years ago to a 44 year old man. 

Nearly all of the public health resources in Samina’s village have been diverted to tackle COVID-19. Without a social safety net and without access to a counselor or public health provider, Samina is unsure of how to cope with both PTSD.

It is in this challenging context that we have deployed tech-enabled, female frontline  health workers (‘Guddi-Bajis’ or ‘Good ‘elder sisters’). Samina met a Guddi-Baji at a local ‘muhalla’ meeting of women. The GB immediately connected Samina to a mental health counselor via telemedicine.

Samina is just one of 50 million+ women in Pakistan and 600 million+ globally who can be healed from their trauma post COVID-19. 

In Pakistan, ethnic traditions, cultural norms and communal practices play a vital role in women's mental health and wellbeing. COVID-19 has exacerbated already-patriarchal attitudes towards women, including restrictions in mobility and autonomy inflicting major psychological damage. 

COVID-19 mandated social distancing has an estimated 20 million women and girls deprived of access to education, health and/or socio-economic opportunities. In this pandemic environment, the inability to achieve full self-realisation (Maslow’s hierarchy) has major adverse psychological impact. Incidents of domestic violence and GBV have increased during COVID-19 with over 125 women in Tharparkar (a beneficiary population we now work in) reported to have commuted suicide between March 2020 and March 2021.  

COVID-19 has also accentuated the already higher prevalence rate of mental disorders in historically marginalised, minority communities.  Province wise prevalence is Sindh 16%, Punjab 8%, Baluchistan 40%, Khyber-Pakhtunkhwa 5%. COVID-19 has also intensified economic disparity & problems with security and safety, all of which are manifested in higher rates of mental health issues.  

 Our Solution

1.           Sensitize communities on specific health and hygiene messaging covering different therapeutic areas such as SHRH, osteoporosis, infectious diseases, neurological diseases, mental health and wellness, hypertension, breast cancer awareness, MNCH, menstrual hygiene management, etc.

2.           Link communities to a global network of qualified healthcare providers via female frontline health worker-assisted telemedicine and telepharmacy

3.           Accelerate access to our qualified and remotely located doctors, psychologists, mental health specialists and other Healthcare providers.

4.           Improve e-counseling for better outcomes by providing the enrolled communities with the convenient access to high-quality, tech-enabled, quality healthcare and authentic medicines under the supervision of registered and licensed female community pharmacists virtually engaged to effectively conduct follow-ups with the diagnosed patients.

5.           Develop a Coordinated Clinical Pathway - refer rural villagers to RHCs, THQs, and DHQs (Secondary and tertiary public healthcare delivery venues)

Over 80% of rural communities in Pakistan (~160 million lives) lack access to affordable, quality healthcare. The debilitating effects of illness and disease have led to loss of productivity, social isolation and/or exclusion and a downward socioeconomic spiral for rural, hard-to-reach families that can keep them trapped in poverty and psychological disturbances. The major contributing factors to the lack of access to quality healthcare in rural areas include:

·        exclusion of over 50,000 qualified female healthcare professionals from the Pakistani health workforce and

·        lack of skilled, technology-enabled frontline health workers in rural village communities

In order to better understand our target population, we have conducted UX design thinking studies in which we have immersed ourselves in the target population.  Through observation, rapid prototyping and iteration, we have created continuous feedback loops with our beneficiaries. These loops connect our frontline health workers, customer service reps and patient care coordinators (PCCs) who channel this daily, weekly, and monthly input to our product design team (both via WhatsApp as well as our telemedicine platform), leading to rapid iterative product cycles, in line with our philosophy of continuous improvement (‘kaizen’). We track customer (beneficiary) satisfaction via Net Promoter Scores (NPS), with the most recent score being 86, a 11-point increase over the previous 12 months.

In alignment with the 2030 SUSTAINABLE DEVELOPMENT GOALS (SDGs), our solution addresses the following unmet needs of the target population:

·       SDG 1 (No Poverty): by improving the economic status of low-income frontline health workers, last-mile, small business retailers (Guddi Bajis) and their households.

·       SDG 3 (Good Health): by providing rural populations with tech-enabled access to high-quality, qualified female doctors, licensed, female pharmacists and authentic, unadulterated, quality-assured pharmaceutical medicines, healthcare supplies and personal hygiene products.

·       SDG 5 (Gender Equality): by reintegrating women who have been excluded from the workforce (remotely-located, urban-based, female doctors, licensed female pharmacists)

·       SDG 8 (Good Jobs & Economic Growth): by providing underemployed, rural, community- centered, female frontline health workers with decent jobs and income-generating opportunities

·       SDG 10 (Reduced Inequalities): by providing rural populations (including ‘Guddi Baji’ last-mile retailers and last-mile distributors) with access to better income-generating opportunities, thereby reducing income disparities between rural and urban populations.

·       SDG 17 (Partnership for the Goals): by fostering collaboration between multinational corporations (such as Unilever), an award-winning social enterprise (doctHERs), a public-sector agency (Poverty Alleviation & Social Security) and academia (MIT and Insead).

COVID-19 has exposed the glaring inequities that exist in the Pakistani healthcare system but also highlighted opportunities for women to Rise Above and take a much more active role in the health and wellbeing of their nation. 

doctHERs is a gender-inclusive, digital health venture that uses technology to match the underutilised capacity of female healthcare providers (HCPs including doctors, pharmacists, therapists, etc) while promoting the socio-economic inclusion of women in the workforce via multi-sectoral partnerships.

 Over 100 Guddi Bajis have been deployed in 8 districts across KPK, Sind and Punjab, impacting over 2.3 Million women and children since 2019. 

The following conclusions or proof-of-concepts (PoCs) were established by doctHERs:

1.   Female Frontline health worker (FFHW)-assisted telemedicine is a technologically feasible way to deliver quality healthcare to remote, rural communities.

2.   Rural Villagers are not independently able to afford a price point (PKR 250 per consultation) that would sustain a FFHW-assisted telemedicine-based, business model, independent of corporate or public-sector subsidy.

3.   The proposed revenue share per consultation for a Guddi Baji (PKR 50) is insufficient to meet the living needs of a Guddi Baji as a single revenue source. This means that the FHW (Guddi Baji) needs to generate additional revenue streams via an ‘ecosystem’ approach. 

4.   Guddi Bajis (GBs) were able to augment their income by an average of PKR 1500 per month, via a tech-enabled primary healthcare delivery model. This represents a ~25% increase in their monthly income which is significant but not sufficient. 

5.   The Guddi Baji (GB) rural, sustainable living models provide an ideal platform for promoting the inclusive employment of female healthcare providers.

Our intervention up-skilled, equipped and deployed 150+ technology-enabled, frontline female health workers (FHWs) in rural villages of Punjab (16 districts) and Sind (2 districts) in 2019 where they sensitized over 1 Million women on specific, at-risk diseases and connected over 38,000 women and children in need of quality healthcare to a nationwide network of female doctors via HD video-consultation. Over 200 female doctors and healthcare providers were reintegrated into the Pakistani health workforce by doctHERs, thereby promoting gender-equality as well as the creation of decent work and economic growth opportunities. 

Our goal for MIT Solver is to extend & scale the Guddi Baji project to 700 GBs in one year and amplify this to 3000 GBs across Pakistan in next five years. Through this, we are hoping to be able to connect 3 Million rural women to our network of remotely located HCPs. This continuity of care model will enable a more coordinated care approach to healthcare. The service will offer access to quality health and mental wellness in the fragile and untapped rural communities of Pakistan.

Tech-enabled Service Delivery and Remote Patient Monitoring via Innovative Visual Technology Coupled to the Community-Based, Trusted Intermediaries:

Our 500 FHWs already live in the target villages we plan to enroll in this project. Suspected patients will be identified with in the mental health and wellness support program, whereas our FHWs will conduct door-to-door screening and counselling sessions. We plan to screen at least 25,000 villagers as part of this proof-of-concept phase but in terms of transitioning to scale, we already have the capacity to screen many more lives at the discretion of the Public Mental Health Reach Program (e.g. these 500 target villages have a population of ~1.5 Million lives and (via various NGO partners) we have access to over 6000 FHWs, reaching 30 Million lives).

From an M&E perspective, we have created continuous feedback loops with our beneficiaries via our frontline health workers, phone-accessible customer service agents and nurse, patient care coordinators (PCCs) who channel this daily, weekly and monthly input to our service delivery design team (both via WhatsApp as well as our telemedicine & telepharmacy platforms), leading to rapid iterative service cycles, in line with our philosophy of continuous improvement (‘kaizen’). We monitor and  track end-user (beneficiary) satisfaction via Net Promoter Scores (NPS), with the most recent score being 86, a 11-point increase over the previous 12 months.

Full-Time Staff: 60

Part-Time Staff: 145

• Dr. Asher Hasan (Founder): https://www.linkedin.com/in/as...
• Sabeen Fatima Haque (Co-Founder, doctHERs); https://www.vitalvoices.org/pe...
• Nadia Bukhari: Lead, Global Gender Equity - International Pharmaceutical Federation (FIP); https://www.linkedin.com/in/na...
• Khaqan Sikander (CEO): https://www.linkedin.com/in/kh...
• Adnan Mustafa (Head, BD): https://www.linkedin.com/in/ad...
• Dr. Subia Rauf (Head, Integrated Health Systems): https://www.linkedin.com/in/dr...
• Dr. Aqsa Fahad (Head, Clinical Operations): https://www.linkedin.com/in/dr...
• Dr. Maryam Siddique (e-Pharmacy Supply Chain Innovation): https://www.linkedin.com/in/ma...
• Dr. Sobia Javed (ePharmacy Supply Chain Management): https://www.linkedin.com/in/dr...
• Dr. Arzu Moosvi: (Pharmacy Liaison, USA): https://www.linkedin.com/in/ar...
• Sarah Khan:  Systems Design & Digital Transformation: https://www.linkedin.com/in/sa...
• Nazia Bilal: Research, Advocacy & Policy: https://www.linkedin.com/in/na...
• Maheen Dhanani: UX/Health Systems Designer: https://www.linkedin.com/in/ma...

doctHERs and it's co-owned implementing partner (Naya Jeevan) is a multidisciplinary group of doctors, pharmacists, therapists, supply chain optimisers, digital transformers, design thinkers, MBAs and public health scientists who have successfully scaled Naya Jeevan to profitability and sustainability over a duration of 8 years. 

Since 2012, Naya Jeevan has been working to provide health & wellness services to workers (and their families) in corporate value chains (smallholder farmers, distributors, retailers, etc) which extend from factory to field. 

Applying the principles of customer centred design thinking, the Naya Jeevan team immersed itself in the Senior Guddi Baji environment to better understand the unmet needs of the resident villagers.  One of the key pieces of insight it gleaned is that these villagers need reliable, uninterrupted access to essential medicines/supplies and that one of the reasons this has not happened in the past is because there was an insufficient business case for an MNC to finance a  last-mile distribution  system in isolation.  By serving as a tech-enabled, last-mile aggregator, Naya Jeevan has made it far more cost-effective for MNCs to share a common, last-mile distribution system. 

doctHERs is a gender-inclusive, digital health venture that uses technology to provide access to quality healthcare while promoting the socio-economic inclusion of women in the workforce via multi-sectoral partnerships. 

Inputs (digital supply chain integration, essential Health, Nutrition and Wellness (HNW) products, Gudda Bhai LMDs) are combined to perform 

Activities (e.g. last-mile distribution of essential Health, Nutrition and Wellness products to a large village-based network of women last-mile retailers). These activities generate Outputs (e.g. tech-enabled sales of essential HNW products and services in rural villages) that yield tangible Tangible goals (e.g. a % decrease in the incidence rate of malnutrition in children under 5) that achieve the ultimate Impact we are seeking (i.e. to increase the resilience and systemic capacity of rural villagers and their ability to rapidly bounce back from environmental shocks such as COVID-19 pandemics.