Hum Nari Breast Cancer Screening Program

Breast cancer cases in India are rising at higher rates than ever before and between 70-80% of the cases diagnosed have already reached stage 3 or 4 when it is much harder to treat and the chances of survival are significantly lower than an earlier diagnosis. In India there are major challenges in implementing organized breast cancer screening programs due to lack of access and awareness as well as negative cultural perception of standard screening practices. Additionally, the health care limitations caused by the global pandemic are expected to further delay breast cancer detection as women have put off routine health care visits.

Women’s health is often deprioritized in India and issues around health matters are not contextualized to empower women to take ownership over their own wellbeing. This has left a massive need for investment in healthcare infrastructure for breast cancer prevention and treatment. Currently, there are no population-based breast cancer screening programs in India. HERhealthEQ proposes to disseminate education through a culturally appropriate breast cancer screening mobile application which guides women through performing their own breast self-examination, then refers them to a local health care provider for follow-up screening utilizing a cutting-edge thermal technology device. The cost attributed to this screening, doctor visit, report, and follow-up visit is approximately 50% less than the cost of a traditional mammogram and doctor visit in India. This creates a more accessible and effective method for screening.

According to the World Health Organization (WHO), 1 in every 12 women have the risk of a breast abnormality. Indian women have only about a 50% chance of survival.  Early diagnosis is critical to decrease mortality rates. The WHO’s 2018 report on NCDs shows that 63% of deaths in India are caused by NCDs with 9% of those caused by cancer, and the highest percentage from breast cancer. NCDs, like breast cancer, rise in conjunction with globalization and urbanization, which results in a more processed diet and less physical exercise. Though India’s economy is currently expanding, if the prevalence of NCDs is not lowered, they will take a huge toll on India’s economy.  Our goal is to impact the population by speeding up the development of healthcare to be in tandem with the development of the economy. 

Based on research, a cluster randomized trial demonstrated that both simple community education programs and clinical breast cancer screening are effective in preventing death due to breast cancer. While some studies in India show that stigma prevents women from accessing the first line of care in the form of cancer screening (Nyblade), another study has found that 85% of women in rural areas were not performing self-checks for breast cancer because they had not been educated in the technique (Tripathi).

Existing resources focus on post-detection treatment which are costly for the hospitals and patients. We aim to give women agency through tools and education in performing their own breast self-exams, which frees up hospital capacity constraints from performing these routine screenings, needed now more than ever. Increasing the number of women screened can decrease the need for advanced clinical care later and alleviate some of the pressure put on the healthcare system due to depletion of medical resources caused by the COVID-19 pandemic.

The Hum Nari Breast Cancer Screening Program will ensure that women in India have the awareness, knowledge, and resources needed for early breast cancer detection and treatment through a holistic and easily accessible approach to clinical care. Our program will provide access to safe, affordable, and professional screening methods using a combination of self-checks, linkages to follow-up care, and advanced, non-invasive and non-painful thermal imaging technology developed by Niramai. 

Our intervention aims to educate women, help reduce female mortality, and improve quality of care in breast health. The change we expect to create is an overall increased awareness and attention to prevention as a tool to empower and invoke health behaviors that promote greater health equity and decrease stigma associated with accessing treatment.

We will implement and achieve concrete and measurable results at different intervention stages and through collaboration with strategic partners. With Wayu Health, we have developed a culturally appropriate free mobile phone application which will educate women and guide them through performing their breast self-examination and then will refer them directly to a provider equipped with cutting-edge, highly effective thermal screening technology manufactured by Niramai. 

Our second key deliverable will be the implementation of mobile unit diagnostics: secondary screening from a health practitioner utilizing mobile thermal imaging technology. Through a partnership with Nirimai, we have been able to secure state of the art thermal imagery equipment at a lower cost. This is an artificial intelligence led diagnostic platform and the imaging method is radiation free, non-touch, not painful and works for women of all ages. HERhealthEQ will provide these devices and equip the mobile sites, which we will scale from our pilot of two units to over 30 by the end of our initial phase of implementation.

With our partners on the ground and utilizing HERhealthEQ’s growing relationships with India-based healthcare providers and organizations, we will oversee project operations as well as providing equipment servicing.  We will work closely with Wayu Health to gather information and data from the mobile application as well as from the Niramai devices to determine our learnings and evaluations. Our partnerships will enable this continuum of care to be created, and thereby institute an enabling environment for health prevention and facilitating access to the first line of care for populations most adversely affected by global health crises.

The target population is women and those with potential risk factors for breast cancer. We are focusing on the age 30 - 65 demographic, age groups recommended by medical guidelines for routine screening for breast cancer. We strive to meet the needs of vulnerable populations through a spectrum of care that bridges the gap in proper health infrastructure and access to health facilities. Breast cancer is often diagnosed very late in low- and middle- income countries, which increases mortality rates. We want to ensure early detection and early diagnosis to promote healthier outcomes. 

During our pilot program, women in the urban and semi-urban areas in Northern India will benefit from education and screening for breast cancer.  Our program will ensure that women from all backgrounds and age groups have equal access to affordable professional breast cancer screening.  Since we focus on preventative care, we seek widespread awareness and screening, rather than targeting specific groups of women.  Although some are more susceptible, the main risk factor for breast cancer is simply being a woman.  With that in mind, we hope to spread our message of education and care with the help of our strategic implementation partners. We seek to reprioritize and position women's health care as "whole family care."  When we invest in women's health it also improves economic and educational outcomes for the community, and enhances overall quality of life for women and their families.

HERhealthEQ is launching this project with specific expertise and nurtured connections in the medical device supply network from our previous projects and our connections in the medical field. As Medical Device and Healthcare executives in both the for-profit and nonprofit industries, our team is uniquely positioned to revolutionize how hospitals and clinics in developing countries are connected with and trained to use high quality medical equipment.

Some examples of our past programs illuminate the impact we make on communities across the globe by building and maintaining effective relationships with key partners, community health workers and the communities we are serving. 

Our Hum Nari partners each have extensive experience in India: our collaborators are an integral part of success. Our tech partner Wayu Health, an Indian health technology company, has developed a culturally appropriate Android mobile app which guides women through performing their own breast self-examination, and then refers them to a local health provider for follow-up when needed.  Since Wayu is local, we can be confident that the technology they have developed is applicable and accessible to women in rural areas.  The app allows women to safely and easily understand how to perform a breast self-exam, reaching a much wider cross-section of women than ever before in India, and connecting them to appropriate care professionals.

HERhealthEQ seeks partnership and funding from MIT Solve to ensure that we can move forward with our mission and provide access to equipment to dramatically improve women's lives and have a ripple effect on communities and regions. If a woman does not have agency of her own health, she can not be empowered in any other factor of her life. Solve funding would give us the opportunity to fund approximately 25% of the equipment costs towards the breast cancer screening program, contributing to its success.  For this program, we are using state of the art thermal imaging technology, which is revolutionary in breast cancer for its accuracy and non-invasive qualities, but even at a reduced price the cost of 30 units of equipment is $433,000. We intend to provide equipment that can be used throughout the pilot program and beyond and that is most effective for the population to be served in India. However, this requires a sufficient investment. An investment from MIT Solve will bring us one step closer to realizing the next stage of this program. However, perhaps more importantly, partnership with Solve will enable HERhealthEQ to connect with the organizations, people, companies, and thought leaders who could further propel our work and our vision. Additionally, we believe the mentorship of incredible individuals can better prepare our organization for the significant growth we are planning.  We have an easily adaptable and scalable solution to a significant world issue, but we need to be supported (not just financially) with the best people around us to achieve these goals. Industry leaders, thought leaders, peers and change-makers associated with MIT Solve are those people who can help us overcome our current barriers to growth.

Hum Nari is the only project with the goal of providing the whole cycle of breast cancer treatment in India. Our role is to provide the equipment, set up, training, and monitoring needed to make this program highly effective and easily replicable.

While the approaches of organizations in India provide temporary “screening camps,” we focus on partnering long-term with clinics and hospitals who have the facilities to use the Niramai screening devices.  Health care professionals at these sites will have access to the Humari app allowing them to view a patient's history and medical records once an abnormality is detected creating a more efficient, scalable solution to the problem. 

Working in partnership with local organizations Wayu Health and Jhpiego International gives local, firsthand perspective on project implementation. HERhealthEQ’s relationship with medical device manufacturers gives us access to the Niramai screening devices which would otherwise be unattainable.  

We have developed an innovative, culturally appropriate breast cancer screening mobile phone application which guides women through performing their own breast self-examination, and then refers them to a local health provider for follow up when needed. The continuum of care is enhanced through our extensive network of health clinics, providing appropriately trained care providers as the conduit through which women can seek further consultation and support. This is both a creative and an innovative solution in that it provides direct educational techniques and follow-up care to women who would be otherwise without basic healthcare services. HERhealthEQ is the critical element of this in-person care as we will equip local providers for clinical screening using our network of medical device companies. We will offer state of the art Niramai thermal imaging equipment at a reduced cost, creating a complete care network that can be scaled across India. Our value add is in connecting on-the-ground medical providers with the appropriate equipment and devices they need to effectively provide holistic support. This will ensure that more women will have a chance of early breast cancer detection and successful treatment outcomes through increasing awareness and access to affordable professional breast cancer screening.

Our goal is to ensure that more women in India have improved breast health awareness and access to affordable professional breast cancer screening, resulting in successful treatment outcomes. The mobile phone application will guide women through a breast self-exam. The app will connect women to local screening units for follow up care. Each of these diagnostic screening units will utilize community health workers and will have the capacity to screen over 100 women per unit per month, for a total of, at minimum, 36,000 women per year.

Through replication of scale and distribution of medical equipment in more countries, within 5 years we plan to have dispersed over 200 pieces of equipment and to have positively impacted the health and lives of over 1 million women in low and middle income countries.  To achieve this, in addition to capital, we need to continue building strategic partnerships with medical device manufacturers, partner organizations and governments, and innovative entrepreneurs. In order to scale and achieve impact goals (and financial goals), we also need robust technology that can track our equipment and can create an interface between the patients in low- and middle-income countries and the need for screening, diagnostic, or treatment equipment.

We will measure the project’s overall impact using different indicators at various intervention stages. 

Upon completion of intervention stage 1, the launch of the Wayu Health app for self-exams/ education, we aim that 10,000 women will gain an awareness and a basic education in breast self-exams. We will be able to measure the impact of this stage by the number of women who have downloaded and logged onto Wayu mobile application, the number of women who perform self-exam and the number of women who can answer basic questions about the disease and how to perform a self-exam. 

By intervention stage 2, the implementation of the first two sites of diagnostic screening units, we aim for a total of 10,400 women to be impacted by our program. We will measure the impact at this initial screening and treatment stage by the number of women screened through the Niramai thermal imaging technology and the percent utilization of the medical equipment provided as well as the usership of the Wayu health application. 

Stages 3 and 4 will see our project scaled and replicated to be eventually operating over 30 diagnostic screening devices. We will measure the expanded impact of the project at this stage by these same metrics as above, including; the number of women screened through the Niramai technology, the percent utilization of the medical equipment and the intake of women per clinic. 

Furthermore, we will measure the impact of the Hum Nari Breast Cancer Screening program based on the number of referrals made for further treatment and the percentage of cancers detected based on the total number of women screened.

HERhealthEQ’s theory of change and strategic framework is guided by our mission of improving the health outcomes of women by providing easily accessible and affordable quality care through medical device equipment. After two years of conducted research, we have developed this plan using the most advanced breast cancer screening technology available in India paired with an Indian-based health application company, both of which are culturally appropriate and highly-trusted. The immediate problem our solution is addressing is the rising diagnosis of late-stage breast cancer in Indian women, which is resulting in an increase of preventable death in women. The reason, as proven in above cited research, is due to a lack of early screening access and an increase in the prevalence of NCDs (including breast cancer) due to rapid modernization of Indian culture. Our theory of change can be simplified below:

Inputs/Activities: HERhealthEQ introduces the Wayu mobile application to the market and, in partnership with pre-identified doctors and clinics, provides the Niramai thermal breast screening devices to local facilities. HERhealthEQ trains the technicians and doctors on proper use of the equipment as well as the backend of the Wayu mobile application, which links patients to the clinics and to the Niramai screening devices. The mobile application and the accessibility of the screenings are promoted by our partner doctors and through targeted marketing campaigns.

Outputs: Women download the mobile application and learn how to perform self-exams. At least half of those women then go on to schedule an in-person screening with a linked Niramai device at a local clinic. Those women are then promptly screened and given an instant report. Women who are flagged as high-risk through the screening (approximately 4-5%) will then be referred on to a follow-up appointment to complete diagnosis. 

Short-Term Outcomes: Women are empowered to perform self-exams through the gained knowledge from the mobile application. Women feel more confident and secure in making an appointment to be screened with a Niramai thermal screening device because they understand the importance of screenings and have been properly informed through HERhealthEQ sponsored educational campaigns in partnership with Wayu and our doctor partners.

Long-Term Outcomes: The breast cancer mortality rate is significantly lowered. Women are being screened regularly and diagnosis are at earlier stages of cancer development, meaning there are more treatment options and the overall health outcomes have significantly improved.

Through a partnership with Nirimai, we have been able to secure state of the art thermal screening equipment at a lower cost. This is an artificial intelligence led diagnostic platform and the imaging method is radiation free, non-touch, not painful and works for women of all ages. HERhealthEQ will provide these devices and equip our partner clinics, which we will scale from two units to over 30 by the end of the pilot program. 

Among our staff and partners, we actively invite and value all voices into program design and implementation. We promote community engagement via regular surveys and feedback forms, strategizing to particularly encourage minorities, the elderly, and disabled to make their needs heard. We hold our staff accountable to connect community feedback to strategic decision-making processes. 

Race, caste, and religious discrimination remain prevalent in India despite efforts to the contrary. We will work to actively reach those in marginalized segments of society by being inclusive in our language, promotion methods, and aware of different cultural or religious needs for staff. Women of all socioeconomic backgrounds are at risk for breast cancer, so removing barriers to access through low cost and culturally sensitive screening is one of our main objectives. Providing free screenings to those who need it will be a goal of the program.

HERhealthEQ is a hybrid model.  We are a 501c3 revenue generating non-profit, with a for-profit "arm" that enables the investment of impact investor capital.  It is a quasi-equity model that allows us to perform all our work as a non-profit while having the ability to scale using impact capital.

HERhealthEQ is revenue generating through two preferred avenues: sale of equipment and lease of equipment. Service, installation, and training is provided as well, in collaboration with our partners, which have an already established network and infrastructure in the region we are working in.  HERhealthEQ also creates revenue-generating programs with trusted partners, sharing in the revenue generated from the profits of the program, including the Hum Nari Program. 

HERhealthEQ is able to charge below traditional distributor prices because we obtain the equipment either at no-cost (through a donation of equipment) or at an at-cost price, utilizing our nonprofit status and ability to assist the company we purchase from by creating exposure, goodwill, and PR.

HERHealthEQ is able to partner with organizations who are looking to further their mission, with entrepreneurs looking to grow their businesses, and with public or public healthcare centers to strengthen their healthcare capacity and directly benefit the communities we serve. 

HERhealthEQ ensures the sustainability of this project primarily by utilizing a revenue generating social enterprise model. Through a very low cost to each beneficiary (~$4 per scan), the program will be able to sustain itself in the long term. This creates sustainability for HERhealthEQ’s operations and allows the replication and scale of programs as well as staff expansion.  We are fundraising through grants and individual donations for the launch, but will be self-sustaining after the initial costs.  Secondly, we have the opportunity to partner with local companies, eliminating the need to transition to local partners to ensure the project can succeed. Their local intel sustains the project after the equipment is donated and the programs are put in place.  

We have identified numerous further streams of revenue which we continue to seek out and secure to ensure the financial sustainability of our organization. These include: 

• Obtaining revenue through the sale and/or lease of the equipment we provide

• Obtaining revenue through revenue-share programs with partner organizations 

• Grants

• Corporate donations in support of specific programs

• Corporate donations in support of the overall organization

• Corporate equipment donations

• Partnership with other NGOs who have funding to deploy to programs

• Individual donations through virtual/on-line and (when able) in person fundraising events

• Impact investments

• Strategic networking for high-net worth individuals to donate/support

• Board contributions 

In the near future we expect to have more financial support from corporations, impact investment capital, and in the next 3-5 years will be sustained through the revenue generated by the sale and/ or lease of the equipment we provide. 

The largest grant that HERhealthEQ has received in the past was for $50,000, received from a private foundation. These funds were allocated to our own project development, which at the time were focused on cervical cancer detection. We have also received grants from corporations, totalling approximately $20,000, which have been used to increase our organizational sustainability and further our mission. 

We have recently moved from a traditional non profit organization structure, to a revenue-generating non profit organization. Meaning, we aim to receive revenue from this solution. The amount of revenue is fairly insignificant as we launch our pilot program as described above. The importance of revenue-generation for our organization is so that we can continue to scale this program to ultimately reach more women.