Guddi Bajis: High-Quality Affordable Medicines for All

We are tackling the following four (4) problems:

[1] Lack of Accessibility: While 2/3rds of the Pakistani population lives in rural areas, the majority of health infrastructure and health human resources exist in major urban centers, with the result that rural villagers and peri-urban slum dwellers need to commute into city centers to access quality, primary care.

[2] Lack of Affordability: The Pakistani government spends just 0.8% of its GDP on healthcare (most tertiary-care focused) with the consequence that over 90% of healthcare expenditures in Pakistan are incurred out-of-pocket. The recently introduced National Health Insurance Program (Sehat Sahulat Program) provides inpatient, catastrophic care coverage at both public and private sector hospitals but does not cover outpatient (OPD), pharmacy benefits and care for chronic disease (e.g. Non-Communicable Diseases (NCDs).

[3] Lack of Quality: over 50% of prescription medicines available in rural areas are counterfeit and dispensed by unqualified personnel who lack formal pharmacy training and do not have a pharmacy license.

[4] Fragmentation of HealthCare: Even in urban centers, outpatient primary and secondary care continues to be delivered in a highly fragmented, ad hoc and discontinuous manner across different health systems which leads to duplication of tests, unnecessary procedures and late detection of chronic disease with multiple comorbidities, etc. The customer journey is far from delightful. 

Increased Accessibility: doctHERs is a digital health platform that matches the underutilized capacity of female doctors (who otherwise would be excluded from the workforce) to the unmet need of health consumers via frontline health worker (FHW)-assisted technology. We recruit, equip and train female frontline workers (nurses, midwives, etc) including a large cohort of community health workers who are affectionately referred to as ‘Guddi Bajis’ in their colloquial language. These trusted intermediaries can perform sophisticated diagnostic and interventional procedures (e.g. antenatal care using handheld Ultrasound) through AI-enabled telemedicine in real-time under the clinical supervision of remotely located female doctors. 

Increased Affordability: Corporations (MNCs) co-finance our digital health & wellbeing plans as part of market-based supplier quality control, retail incentive, workforce retention or customer loyalty programs. Over 50,000 annual subscribers are actively enrolled in these programs by MNCs including Unilever, Ali Baba (Daraz), Friesland, Mondelez, Bazaar and Reckitt.

Improved Quality: doctHERs procures medicines directly from ethical pharmaceutical manufacturers (it is licensed as a pharmaceutical distributor, wholesaler and retailer in Pakistan).  These medicines are delivered by logistics partners to last-mile rural distributors called ‘Guddoo Bhais’ (Good Brothers) who liaise with village-based Guddi Bajis and prvide them access to FMCGs, health/hygiene supplies and OTC and prescription medicines. As the entire supply chain is overseen by doctHERs, we are able to guarantee the authenticity and quality of the medicines.

Continuity-of-Care:  Guddi Baji FHWs help to curate and coordinate care from prevention to palliation - spanning across all care venues and levels (home, primary care, secondary care, tertiary care, etc). This carefully curated patient-customer journey helps to ensure that patients are not subjected to unnecessary or duplicate tests/procedures which is a common scenario when patients shift from one health system to another.

Rural Villagers and Urban-Slum dwellers across emerging markets with household incomes of less than $3/day.  

By providing low-income rural villagers with free video-consultations with licensed female healthcare providers (these costs are covered from within the distributor margin of the pharmacy medicines), Guddi Bajis are able to create significant value for their communities, earning them trust, respect and profit at the same time. 

The doctHERs’ team is an eclectic mix of doctors, nurses, pharmacists, social entrepreneurs, design thinkers, anthropologists, research, advocacy and policy academics, financial ‘quants’ and ‘techies’. This cross-functional, multi-disciplinary, blended experience enables doctHERs to deliver ‘integrated innovation’ - social, financial and technological, in collaboration with both the public, development and private sectors.  

In collaboration with Unilever (and co-financed via an $800,000 investment by  UKAID via the Transform project), doctHERs impacted more than 2.7 Million rural villagers via 109 tech-enabled Guddi Bajis across 16 districts of Sindh, KPK and Punjab, Pakistan. This 30 month project implemented between 2019 and 2021  has given us tremendous insight into the unmet needs of the target population (both articulated needs and observed needs) as well as what a viable, sustainable business model would look like at scale and the pivotal role that last-mile retailers-cum-frontline health workers such as Guddi Bajis can play in this regard. 

To exchange learnings and insights and explore potential synergies with other SOLVERs and prospective Corporate Partners.

What is innovative about the Guddi Baji Telepharmacy solution is that it combines the exponential power of technology with the irreplaceable potency of human empathy. We train, equip and deploy ‘trusted human intermediaries’ -  Guddi Bajis from among the large pool of available frontline health workers - predominantly women who have previously served as lady health workers (LHWs), midwives or paramedics). These women serve as life-saving conduits, linking their communities to a global network of licensed female healthcare providers (HCPs such as therapists, nutritionists, doctors, pharmacists, etc.).  

Another aspect of our solution that is often recognized to be very innovative is the reintegration of women into the workforce. We use technology to match the under-utilized capacity of female HCPs to the unmet needs of previously underserved health-seekers. By doing so, we aim to bring ~50,000+ licensed HCPs back into the global health workforce. 

1 Year:

1) Growth: Year 1 is about expanding the Guddi Baji Telepharmacy service in 8 districts across Pakistan and growing it to a target population of 500,000 lives whose care is coordinated by ~500 Guddi Bajis (also Women of Color) so that the model can be fully ‘pressure-tested’ prior to a full-scale commercial launch.

2) Engagement: doctHERs will enlist and engage a community of  ~500 Guddi Bajis (also Women of Color). This engagement will entail (i) interactive sessions on various topics (ii) self-defense classes

3) Product and technology: The proprietary technology that undergirds the doctHERs platform already exists. An intuitive customer-friendly, User Interface (UI) will need to be developed by a front end developer with an API that can link interoperably to other data systems. 

4) Platform: A platform that digitally matches Supply (of Guddi Bajis) and demand (for Care) will be piloted in Year 1   

5 Years:

1) Financial: Boost financial literacy and independence among frontline female health workers (i.e., female nurses, midwives and community health promoters);
2) Health: Decrease the morbidity and mortality of mothers and their children;
3) Work Culture: Create an inclusive employment culture for women health providers to thrive.

Our 3-5 year vision is to enable this model to scale in Pakistan 100x fold (i.e. to 50 Million Lives) regardless of whether this amplification is implemented by doctHERs or by other companies. Our measure of success will be to ensure that no beneficiary in our target population  is deprived of access to high quality Care Coordination.  

In an effort to promote good health and well-being, economic growth, and reduced inequalities (SDGs 3, 8, 10) the following KPIs are applied to measure impact goals: -

FINANCIAL: Percentage change in income of frontline health workers (female nurses, midwives, community health promoters)

HEALTH OUTCOMES: Percentage change in maternal, neonatal and under-5 child mortality and morbidity rate

SOCIAL MEASURE: Proportion of female healthcare providers reintegrated into the health workforce and provided with inclusive employment

We believe that the smart deployment of ‘Guddi Bajis’- Frontline Female Health Workers (input) paired with 4G powered tablets (input) into the community will generate life-saving/mental health/nutritional/pharmaceutical services (outputs), with high accessibility to rural villagers and urban-slum residents (also outputs). These services will generate (i) improved quality of life outcomes for neonates/children/mothers (outcomes), ii) increase financial freedom of the frontline female health workers (also outcomes); this will ultimately increase the quality of life and overall health of young mothers and their children (impact), and society with cultivating a culture of financial independence among female health workers (impact).

Our digital care platform sits on top of robust data architecture, designed and developed on top of  AWS. The platform has APIs with software linked to handheld, digital diagnostic devices (e.g. handheld ultrasound) as well as APIs to EHR, patient-facing payment portals, etc. 

We extensively use WhatsApp for non-HIPAA related information exchange with our customer-beneficiaries. 

We have an inclusive hire policy that ensures at least 10% of the workforce comprises people with special needs. In addition, our company was co-founded by a woman and is predominantly managed and serviced by women. From service providers to customers and employers, doctHERs strives for diversity, equity and inclusion. 

Our main business model is B2B2C – Business to Business to Consumer in which we provide consumers with access to essential health services/products via distributor and/or retailer intermediaries (including last-mile retailers such as ‘Guddi Bajis,’ or ‘Care Coordinators’ in the present context. For every $USD we receive from sponsors, 40% goes to the healthcare provider (e.g. doctor/pharmacist), 20% goes to the care coordinator, 20% covers our operating expenses, yielding a 20% net surplus that is re-invested to organically scale our impact. We have 3 main distribution channels/revenue streams:

1. Corporate value chain model co-financed by large corporations (this targets blue collar workers (suppliers, producers, SME retailers) who are formally or informally linked to corporate value chains 

2. Industrial SMART clinic model - nurse-assisted telemedicine clinics that are installed inside ports and factories, focusing on industrial workers 

3. Female Community Health Worker (CHW)-Centered Model; this is the ‘Guddi Baji’ or ‘Care Coordinator’ model that focuses on low-resource communities - in collaboration with public, development and philanthropic sectors The Care Coordinator B2B2C model enables an ecosystem-based approach that promotes asset protection and women’s empowerment/entrepreneurship in addition to improving health outputs/outcomes.

doctHERs has two core business models:

Corporate Model (for-profit): focuses on delivery of care to populations linked to corporate value chains (suppliers, distributors, retailers, etc). These populations can be urban or rural (or both). 

Public Sector (Not-for-Profit): doctHERs collaborates with corporate foundations, development agencies, government departments, etc to deliver non-commercial services to beneficiaries enrolled in subsidized health schemes (e.g. PPIF).   

By 2025, doctHERs aims to scale its corporate model such that the venture becomes completely independent of grants to finance any aspect of its core operations or R&D. Approximately 50% of our core operations and R&D budget is currently covered via R&D innovation grants and award activities. Any grants/awards we receive beyond 2025 can then be channeled to amplify the impact of our public sector work as part of our own corporate citizenship.

We have previously raised a total of $3.5 Million in funding ( via a combination of equity, debt and grants) and are now in the midst of raising a $12 Million round which will enable us to scale our work in the developing world while also launching a variant of our model in the US. This investment will enable us to build high-quality, engagement teams on the ground in Pakistan and the US.

In addition to the above, doctHERs has won over $2 Million in awards/grants including some of the following:

1. 2017 - MIT SOLVE (women and technology category) – 2017 - doctHERs

2. 2017 – McKinsey Geneva Forum for Health Award (for CoFounder Dr. Asher Hasan)

3. 2019 – MIT Tiger Challenge Award ($500,000) – doctHERs

4. 2020-21 – Transform (UKAID, Unilever) - $800,000 - doctHERs

5. 2020 – Million Lives Club selection (by Grand Challenges Canada, UKAID, etc.) – doctHERs