Digital solutions: maternal & newborn healthcare workforce

This solution seeks to advance the way that primary health care performance improvement happens in low- and middle-income countries. 

Across the world, healthcare workforces have become increasingly overburdened. Innovative, locally-led solutions are urgently needed to balance the opportunity for frontline health workers to participate in performance improvement efforts, with their primary responsibility as care providers. 

Equalize Health ECHO tele-mentoring clinics are designed to respond to clinicians’ needs in low and middle income countries. Overburdened healthcare workers have significantly increased their demand for specialized training, mentoring, and peer to peer connection, so that together, they can improve patient outcomes and better respond to patient needs during the pandemic.  

We have a particular focus on maternal and newborn health, as we identify the greatest training needs of healthcare workers that will translate to the greatest impact on patients’ lives. 

As we respond to the direct impacts of the pandemic, we also cannot allow progress in maternal and newborn health to regress. Studies already indicate that in the face of the pandemic, maternal and newborn health has worsened. 

These funds will be vital in prioritizing the urgent need to provide safe, accessible, and equitable maternal and newborn care with the strategic response to this pandemic and future health crises. [Lancet 2021]

We have experienced exponential demand for our tele-mentoring clinics and expect this trend to continue as new strains of COVID-19 present new issues and impact new populations. 

Pre-pandemic, we trained 31 healthcare workers over two, 12-session tele-mentoring clinics. Over the following 24 months, this number has grown to 3,000+ healthcare professionals with 90 sessions completed. We aim to keep pace with this demand, working with local healthcare workers and professional medical associations to develop curricula that support the current needs and conditions of local contexts. 

We will offer our ECHO tele-mentoring with the overall goal to strengthen healthcare systems to manage the current crisis and be better prepared for the next one.

Equalize Health is seeking philanthropic support for newborn and maternal health- focused telementoring to: 

1) Balance 5000+ healthcare workers' opportunity of performance improvement efforts with their responsibility of primary care providers; 

2) Provide actionable insights to healthcare providers, funders, and innovators to optimize adoption of latest, relevant technologies; 

3) Share measurement and data of improved knowledge, attitude, and practice of healthcare workers in overburdened settings. 

This locally-driven, collaborative virtual training program places healthcare workers at the center of building stronger healthcare systems. To improve the care of East Africa’s most vulnerable patient populations - mothers and newborn babies - this program responds to the most urgent professional needs of these healthcare workers. 

By leveraging local expertise across the region and our extensive experience in India, we can quickly meet the needs within the healthcare workforce, thus strengthening East African healthcare systems for the future. In particular, this funding will:

• Identify: Better understand and prioritize the knowledge gaps and training needs of East African healthcare workers hardest hit by the pandemic

• Connect: Digitally connect the healthcare workforce with one another and local experts on critical topics  in caring for sick newborns and at-risk pregnant mothers

• Scale: Quickly, responsively, and sustainably support and strengthen the knowledge, confidence, and practice of more than 8,500 healthcare workers across East Africa in the next three years

Equalize Health’s East Africa telementoring program builds off the success and learnings of the telementoring programs we implemented in India over the last three years. 

This experience and our strong and growing network in East Africa allows us to rapidly scale impact to healthcare workers, patients, and health systems where maternal and newborn mortality rates are highest.

Each year, more than 2 million newborn babies die within their first month of life.  Annually, more than 300,000 mothers die in childbirth. The majority of these deaths are preventable. But, instead of making progress we are moving backward.

Maternal and newborn health rates have worsened during the pandemic. We directly address the leading causes of maternal and newborn deaths, Postpartum Hemorrhage (PPH),  Respiratory Distress Syndrome (RDS), and overburdened healthcare workers by equipping doctors and nurses with the medical innovations and resources they need: 

1. Our Blood Loss Monitoring Device will provide early detection of postpartum hemorrhage after childbirth and accelerate time to treatment for mothers in South Asia and Sub-Saharan Africa (42% of the world’s deaths due to PPH occur in Nigeria and India alone). 

2. FlowLite, nCPAP (neonatal continuous positive air pressure) will ensure high-quality newborn RDS treatment is within most countries' capacity to implement and save more newborn babies' lives.

3. Tele-mentoring clinical sessions will equip overburdened clinicians with peer support, knowledge, confidence, and practice to increase quality care to patients. 

Our impact-driven approach identifies the greatest needs in the most underserved communities. We then design and deliver world-class, affordable technology that will save lives.

The common assumption is that we could all access medical technology if it was more affordable.  Yet, the solution is not as simple as this. There are power outages, overburdened staff, unreliable maintenance, shortages of supplies, and more. To mitigate all barriers, we design with and for everyone involved in the healthcare process. We address the problem with the following: 

• Project Described in this Proposal - Strengthening Healthcare Workforce & Ecosystem:  Global partnerships with governments, medical associations, medtech companies help design products that established brands are eager to put their name on. Clinical telementoring sessions promote peer-to-peer learning, so that overburdened clinicians have the capacity to best use the technology available to them. We focus on correct and continued usage, not just sales. 

• Research: Local research analysts work with clinicians to identify the biggest gaps in health care where innovation can do the most good.

• Human-Centered Design: We partner with local innovators, to design locally-driven medical products.  

• Scaling via the market: Instead of using a donation-based model, we scale our world-class, affordable medical solutions via the market. This encourages for-profit companies to compete with our prices, bringing down costs while maintaining quality. The result is greater choice for purchasers and better care for patients

At Equalize Health, we are “user obsessed”. We work alongside the many people who use and interact with our products (patients, families, doctors, nurses, midwives, repair people, purchasing decision makers, distributors, and more). Under-served and marginalized groups and those who serve them provide critical insights for problem identification, device design, distribution and support. Our idea addresses and builds on the needs of under-served communities in three ways:

1. We have a deep understanding of local needs: Our locally-based teams work with local healthcare workers and governments to understand problems: Is the problem of recognizing when a woman is bleeding to death after childbirth local only to public hospitals in Botswana? How is blood loss estimated in different regions? What potential solutions are already being used?

2. We source the best community-led innovations and engage local experts: We prioritize the perspectives of patients and healthcare workers when developing solutions. For example, we sourced solutions for postpartum hemorrhage (PPH) detection and treatment from Dr. Hofmeyr, a South African OB-Gynecologist in Botswana. We solicited feedback from doctors, midwives, and nurses in different geographies, and we then adapted the concept to develop a suite of products that will address PPH in Asia, Africa, and the Americas. 

3. We choose commercial pathways that will keep us accountable for improving patient health outcomes on a global scale. For example, we ask local hospital administrators - responsible for purchasing decisions: What are the most trust-worthy brands in your hospital? Who responds to your servicing requests most promptly? This holds us accountable to healthcare workers: if they don’t like the product, they will not purchase it nor use it. Our goal is to develop technologies that not only save lives, but that doctors and nurses love.

In addition to this approach, as a team we bring lived experience in global health from across Africa, Asia, Europe, and the Americas. Our leadership is driven by deeply personal connections in the communities we serve. 

Most recently and vividly, our India team suffered greatly with the April 2021 COVID wave. Our tele-mentoring global lead drove 5h to secure oxygen for her husband who was struggling to breathe in the backseat. Through phone chains, finding supplies, and moving across the country to care for vulnerable family members, they supported loved ones, neighbors, and communities. And still, we lost family members who couldn’t access treatment in time.  Despite these personal struggles, our team remained committed to supporting healthcare workers, as we worked together to continue quality care for mothers and newborns. (slide 29)

Even prior to COVID, we were all deeply aware of the tragic consequences of a lack of access to quality healthcare. Among our team, we include mothers who suffered life-threatening postpartum hemorrhage, the loss of a premature newborn child, and children who are thankfully now thriving today because of access to phototherapy for jaundice. Our leadership team speaks passionately about our work, as they know children with cerebral palsy from untreated jaundice, lost family members to preventable diseases, and been faced with impossible decisions. We know that these situations were preventable. Today we are grateful to be part of a team that is inspired and committed to creating equitable health. 

Support and expertise from this Challenge will help in the following key ways: 

• Technical & Financial: Expansion of our tele-mentoring clinics to areas of high-need such as East Africa, West Africa and South Asia. 

• Technical: Build capacity of our user intelligence “UQ” teams working alongside healthcare workers and patients to identify the largest health gaps and best solutions for patients living in the toughest circumstances

Equalize Health creates medical technology for everyone.  We believe in the power of user-centered design and innovation, yet we recognize that for real change to happen, we can’t  stop at the number of medical devices designed, launched, and sold. 

Our innovative tele-mentoring program partners with the healthcare sector in India and East Africa to enable broader positive impacts from others, and scale local expertise across the country. Technology will never be fully utilized if the healthcare system itself is overwhelmed.  Our innovation design process focuses on leveraging the best concepts across the globe, and partnering with local healthcare professionals all along the value chain, to improve the health of people living in the toughest circumstances.  Nurses, doctors, specialists, and biomedical engineers need the knowledge and confidence to put technology and patient care skills into practice.  

This proposal therefore leverages local healthcare expertise and the internationally recognized Project ECHO model to be a catalyst for rapid response to healthcare workers’ training needs and preparation for future health crises.  As a not-for-profit medical technology company, Equalize Health has achieved locally-driven impact at scale,  at a rate that has not been seen in healthcare worker capacity building, and at a time when the healthcare workforce is most challenged.  The following innovative approaches led to this success:  

• We provide digital training support in local languages to increase participation across all healthcare workers, including doctors, nurses, specialists and more. 

• We quickly respond to locally-identified needs and facilitate tele-mentoring sessions that connect the network to specialists across India. 

• We provide training sessions for India’s healthcare workers that address both the direct and indirect impacts of COVID-19 on patients and the healthcare system. We recognize the outsized impact and multiplier effect of focusing our efforts on COVID-19 treatment and the health of mothers and newborns.  

Equalize Health has rapidly become one of the leading maternal and newborn health focused ECHO implementers in India.  We are the partner of choice for medical colleges, associations, and professional organizations seeking to support their healthcare workers and improve patient health outcomes in their regions. Our partners include: Government of Chhattisgarh, UNICEF, Indian Academy of Pediatrics, National Neonatal Forum, Kangaroo Mother Care, Association of Medical Engineers Kenya, Medical Colleges, and Medical Associations. 

2023: 

10 clinics focused on:

• Neonatal care including respiratory support, hyperbilirubinemia diagnosis

• Maternal care including postpartum hemorrhage diagnostics and treatment

• Biomedical engineering including forecasting demand for spare parts

1,000 unique learners

Kenya: National Union of Biomedical Engineers in Kenya (NUBEK), Kiambu County; Ethiopia: Ethiopian Neonatal Network; Tanzania: Paediatric Association of Tanzania; Uganda: Uganda Pediatric Association, Association of Obstetricians and Gynecologists of Uganda (AOGU)

2028: 

8M Patients Reached 

10,000 unique learners (nurses, doctors, healthcare workers, biomedical engineers) with improved knowledge, attitude, and practice

7 countries 

--maternal mortality rates 

--newborn mortality rates

-- number of unique learners participation 

-- number of patients treated by participants within 6 months of telementoring clinics

--increase in knowledge, attitude, and practice 

--gender, location, role 

--topics, needs, technology training needs, and user insights from research teams across India and East Africa 

Theory of Change: 

Our nimble, hyper-localized telementoring clinics became highly sought-after during the pandemic, especially as new strains of COVID-19 presented challenges impacting younger populations. Equalize Health has rapidly become one of the leading maternal and newborn health-focused tele-mentoring implementers in India, and, with promising pilots underway in Kenya, we plan to replicate this program’s success across East Africa. 

In India, we are now the partner of choice for medical colleges, associations, and professional organizations seeking to support their healthcare workers and improve patient health outcomes within their regions. Our partners include: Government of Chhattisgarh, UNICEF, Indian Academy of Pediatrics, National Neonatal Forum, Kangaroo Mother Care Foundation, Himalayan Institute of Medical Sciences, Nursing College, All India Institute of Medical Sciences (AIIMS Delhi), MGM Medical College (Indore), and more!

In 2021 in response to clinicians' and healthcare workers’ needs, we launched two telementoring clinics in Kenya that address the leading causes of newborn and maternal mortality:

• Strengthening Obstetrics and Gynecology Care for Maternal Teams: In partnership with Kenya Obstetrical Gynecological Society (KOGS) and led by Dr. Simon Kigondu, Chairman of KOGS Central Branch, this clinic trains maternal care teams including OB-GYNs, midwives, nurses, and clinical officers to strengthen the knowledge, teamwork, and communication of maternal delivery teams in order to better manage complex pregnancies and and improve delivery safety. Participants engage in case-based learning and receive continuing education points for their participation. 185 unique learners participated in this clinic.

• Improving Critical Care Device Maintenance and Servicing: In collaboration with Kenya’s Association of Medical Engineers (AMEK) led by Eng. Milicent Alooh, Secretary General AMEK, this clinic focuses on strengthening maintenance, servicing and disinfection of critical care devices, for biomedical engineers across the Kenyan healthcare system. Biomedical engineering is a vital, yet neglected discipline in healthcare systems, particularly in Sub-Saharan Africa where many medical devices are donated without training and servicing support. Our clinic is focused on empowering biomedical engineers with the knowledge, skills, and resources to enable hospitals and hospital equipment to constantly be ready to serve patients and save lives. 80 unique learners participated in the pilot clinic.

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User- Centered Design Medical Device Technology 

Our innovative use of technology enables healthcare workers, including nurses, biomedical engineers and more, to engage with local experts and participate in ongoing communities of practice in a safe, language appropriate environment. This encourages insights from all sectors of the healthcare workforce to contribute to both identifying needs, training programs, and the design of medical solutions. 

We partner with counties, medical associations, non-governmental and aid organizations (UNICEF) and local governments to collect and track health data.  

We are committed to building partnerships with local experts, researchers, healthcare workers, and networks who share our vision of ending preventable maternal and newborn deaths and meeting SDG 3 by 2030. 

Currently, we partner with the following third party evaluators and national and local governments: 

Ethiopia Neonatal Network, Ethiopia 

Government of Makueni County, Kenya

Kenya Obstetrical and Gynaecological Society

State of Chhattisgarh, India 

UNICEF, USA 

Ugandan Pediatrics Association, Uganda 

University of California, San Diego, USA: EH is partnering with UCSD to conduct a study with Makueni County on healthcare worker performance improvements as a direct result of the telementoring program outlined in this proposal. 

Vermont Oxford Network: EH is partnered with the Vermont Oxford Network and the Ethiopian Neonatal Network as part of their Quality Improvement (QI) work in Ethiopian hospitals for neonatal care. In implementing this QI program, VON has set up data collection to track patient demographics, conditions, and outcomes and then uses that data to address health care gaps, many of them primary in nature. This will result in the implementation of a tool like the Downe Score or an OSCE for strengthening learning around nurses' provision of neonatal CPAP.

Link to Gender Equality Statement: https://a.storyblok.com/f/9558...

We are a global team of designers, engineers, medical professionals and business minds based in India, Kenya, and USA.  Collectively, we have 85+ years of global health experience, have launched over 62 global health innovations to market, and speak 16 languages. 

Staff and leadership: 

• 100% Clinical Advisors and Innovation Leads/Partners based in-country

• 57% of the board & advisors based in, with lived experience or with roots from the populations we serve

• 64% Senior team based in, with lived experience, or with roots from the populations we serve

• 65% of team are based in, with lived experience, or with roots from the populations we serve

• Largest team is based in Delhi with 10 staff members

Equalize Health is a non profit medical technology company.  The majority of our revenue is philanthropic funds from individuals, institutional donors, and public funders.  

Our medical products are sold on the market, and all profits go towards research and development of other high-impact products in our product development pipeline.  

The telementoring program described in this proposal is offered free of charge to the healthcare workforce and associations involved. This model is designed to ensure that our program can reach under resourced healthcare settings at that cost is not a barrier. This also increases accessibility to leveraging the latest technologies, and increasing knowledge, practice, and attitude where it is most needed.  This program has been supported by several key global health funders, including CRI Foundation, Vitol Foundation, and Schmidt Futures. 

As we launch more products on to the market, we expect to see our revenue model further diversify to 50% earned revenue and 50% in philanthropic funding.  Currently, philanthropic funds account for ~99% of our revenue).  We have also recently launched a $15M Catalytic Fund for Maternal and Newborn Health to secure funding for product development, user research, and scaling of existing medical solutions, to help reach SDG 3.1 & 3.2 by 2030 (reduce maternal and newborn mortality). To date, we have raised $3M of the $15M.  We have significant multi-million, unrestricted, and long term funders including Mulago Foundation, Elevate Prize Foundation, Noorda Foundation. 

The Bill and Melinda Gates Foundation currently supports Equalize Health's Pregnancy DeRisk Stratification Initiative. 

Examples of Key Funding Received in Last 3 Years: 

Bill and Melinda Gates Foundation - $1M (nCPAP product development) 

Noorda Foundation - $1.5M Catalytic Fund

CRI Foundation - $1M Catalytic Fund

MIT Elevate Prize Foundation - $300,000 Recognition of Leadership in Sector 

Mulago Foundation  - Catalytic Fund 

New Opportunities Foundation

DRK Foundation Alumni, Life You Can Save grantee and portfolio member