NuTree Bot

1.3 million Anganwadi (govt childcare centers in India) are already focused on nutrition and health, yet 40% of children in the first 1000 days are malnourished in India. 

Malnutrition in India is influenced by various factors, including inadequate access to healthcare and poor food choices, poor sanitation and hygiene practices, lack of maternal education, and suboptimal breastfeeding and complementary feeding practices. Most of this is preventable if families have access to professional, personalised nutrition care.

To bring about behaviour change in mothers, she needs to have timely, contextual, and actionable support - by a source she trusts. Each of these are adjectives are explained in the following section:

1. Timely: In the first 1000 days, the volume of knowledge varying across age-segments is diverse. For instance, the input in the first trimester of pregnancy is around ANC check up and second around IFA etc. Timely information needs to be given to each mother and family based on their needs at that point. “Dumping” information leads to disengagement and leads to an “overwhelming” feeling. The frontline worker needs to be able to give this to the family.

2. Actionable: A mother who is high risk (due to various factors) or a child who is undernourished requires different services. These interventions to be actionable so as to solve the high-risk danger faster. About 30% families fall in this category and need to be focused on most.

3. Contextual: In urban migrant slums populations, the diversity of food practices is vast. Food is extremely personal - for example, migrant families from Bihar need to be informed about equivalent/more nutritious forms of local foods like Sattu and families from Karnataka would be advised about Dosa.

4. Support: Aspects like existing belief systems, socio economic conditions, existing gender norms play a role in maternal and child care practices – thus the entire family needs to be counselled by a trusted person from within the community.

Malnutrition is not easily visible. A child is considered healthy unless told otherwise. In India, over the last 3 decades, per capita income has tripled, yet diet diversity has halved. This tells us a few things: that malnutrition is not just about access to food. It is about food choices and nutrition care. The person who cares most about the child is the family. But if the family does not know what to do if the child is malnourished, they would not be able to make changes. The only way for them to know is the community health worker (Anganwadi worker) who has several competing priorities (due to various reasons)

Given all of this, the questions we asked ourselves are: How might we provide personalised, reliable nutrition care to the families to cure or prevent malnutrition (at scale)?

When we started our research to understand how to solve this problem at scale, we realised that over 70% of women have access to a smart phone and use WhatsApp. About 50% of these women are content creators! 

Juxtapose this with the fact that in each community, if 40% of kids are malnourished, then 60% of them are healthy. What would it take for us to use existing community wisdom and have it democratically available to all community members? 

Our solution, NuTree bot, is a user-friendly WhatsApp chatbot designed to provide essential health and nutrition information directly to families, especially focusing on child and maternal health. The bot operates 24/7, accessible in four languages, and offers a convenient way for caregivers to access accurate and reliable information on immunisation schedules, child nutrition, maternal health, and overall child well-being.

NuTree bot utilises interactive WhatsApp messaging to engage users and deliver tailored information based on their inquiries. Users can ask questions about specific health topics, receive guidance on immunisation schedules, and learn about healthy recipes suitable for their families' needs. The chatbot also encourages users to share local and contextual recipes, fostering a community-driven approach to promoting nutritious eating habits.

Our upcoming AI-powered features will enhance the bot's capabilities, enabling more personalized responses and improved information discovery. By leveraging WhatsApp's widespread accessibility, NuTree bot reaches a broad audience, empowering families with the knowledge they need to make informed health decisions.

Through NuTree bot, we aim to bridge the information gap and empower caregivers with practical insights into promoting better health outcomes for themselves and their children. This solution not only provides valuable information but also fosters community engagement and knowledge-sharing among users.

Once can test out the Bot by clicking this via phone: https://api.whatsapp.com/send/?phone=919653309578&text=hi

As we’re building towards v2 of the bot, a few questions we would like to answer for ourselves are - 

• NuTree bot’s efficacy in influencing nutrition behaviour

• The level of impact that is observable through a chatbot-based model

• What else do mothers and families need - that we can facilitate through the bot? (for example: nudges and prompts to take children to government health care centres for timely vaccination etc.)

• Use AI to personalise the content more effectively 

Our solution, NuTree bot, aims to improve the lives of families with children in the critical "first 1000 days" of life, residing in low-resource settings across urban and rural India. This target population includes pregnant women and caregivers of children under two years old, who are currently underserved in terms of access to reliable health information and resources.

Challenges Faced by the Target Population:

1) Migration:The families we serve often migrate due to dependence on farming and related jobs, leading to inconsistent access to healthcare and social services. 

2) Lack of agency: Women in rural communities typically lack agency and face limited mobility, while urban poor women have slightly more freedom but still encounter barriers to accessing essential health and nutrition information.

3) Limited Access to Healthcare: While digital penetration around 70%, many families have access to shared low-cost smartphones with WhatsApp. However, they often lack awareness of their entitlements and struggle to access healthcare facilities or understand their child's nutritional status.

Impact of NuTree bot:

1) Improved Health Awareness and Agency irrespective of location: NuTree bot empowers caregivers, particularly women, by providing critical information about child nutrition and health directly on their mobile devices. Caregivers will be able to recognize signs of malnutrition (Severe Acute Malnutrition - SAM or Moderate Acute Malnutrition - MAM) and take appropriate action to seek healthcare services

2) Contextual, timely and actionable inputs: By utilizing WhatsApp, a widely accessible platform, NuTree bot delivers personalized and actionable resources to families in their preferred language, context, based on the age of the child and the status of the child.

3) Nutrition seeking behaviour: The chatbot encourages the sharing of local, healthy recipes among community members. This makes the recipes more accessible and promotes the positive deviance approach. 

Long-Term Impact:

We envision a malnutrition free India! A future where caregivers know what needs to be done to better their children's health. By improving access to nutrition care, our solution breaks the cycle of poor nutrition and improves the overall well-being of children, and families. 

Our team is uniquely positioned to design and deliver the NuTree bot solution to the target population of families with children in the critical "first 1000 days" of life in low-resource settings across India. We are representative of these communities, allowing us to tailor our solution to their specific needs and challenges.

Proximity to Communities & Community Representation: Our team members have direct personal and professional experiences within these communities. Many of our team members come from similar backgrounds, having grown up in similar settings and understanding firsthand the challenges faced by families regarding healthcare access, nutrition, and digital literacy. Our Team member, Meera* (name changed), was born and raised in a low income household, where she witnessed the impact of inadequate healthcare and nutrition services on women and children. Meera's journey of education and empowerment inspired her to join the team that is creating NuTree bot as a solution to bridge information gaps and empower caregivers like those in her own community.

The design and implementation of NuTree bot have been guided by extensive community input and participation. Before developing the chatbot, we conducted focus groups and interviews with caregivers, healthcare workers, and community leaders to understand their specific needs, preferences, and challenges related to child health and nutrition.

We collaborated with the community members throughout the design and implementation process. We prioritise local knowledge and insights, ensuring that NuTree bot reflects the cultural context and language preferences of our target users. Feedback loops are integral to our approach, allowing us to refine and improve the chatbot based on real-time community input.

In addition to our deep community connections and representative backgrounds, our team brings a diverse set of expertise to the design and delivery of the NuTree bot solution.

Nutrition Expertise: We have seasoned nutrition experts on our team who understand the intricacies of child and maternal nutrition. They ensure that the information provided through NuTree bot is evidence-based, culturally relevant, and aligned with global best practices in nutrition.

Operational Proficiency: Our team includes individuals with extensive experience in operational management, ensuring the smooth implementation and scalability of NuTree bot. We prioritize efficiency and effectiveness in every aspect of our solution deployment.

Government Strategy and Advocacy: We have team members well-versed in government strategies and public health policy. This expertise enables us to navigate regulatory frameworks, advocate for policy changes that benefit our target communities, and forge strategic partnerships with public sector stakeholders.

Technology Prowess: Our technology mentors enable us to leverage innovative digital solutions like WhatsApp chatbots effectively. 

Above all, we are driven by a shared commitment to solve this problem at scale!

Our solution, NuTree bot, is currently in the Pilot stage of development. We launched NuTree bot in March 2024 with a focus on leveraging technology to improve child and maternal health outcomes, particularly in low-resource settings across India.

Accomplishments and Testing:

1) Content Development and Flows: We have developed comprehensive content flows within NuTree bot covering critical topics such as growth monitoring, immunization schedules, benefits of breastfeeding, and good dietary practices for mothers and children. These content flows are designed to deliver actionable health information to users in an accessible and user-friendly format.

2) User Acquisition and Engagement: Within a short period since launch, NuTree bot has acquired over 1500 users, demonstrating strong initial interest and uptake within our target communities. Importantly, 92% of our users have completed the designated content flows, indicating high engagement and interest in the information provided.

3) Language Adaptability: Recognizing the diversity of languages spoken in our target communities, we have successfully implemented language options within NuTree bot. A significant majority (approximately 74%) of our users have engaged with the Hindi version of the bot, highlighting the importance of delivering content in local languages.

4) Iterative Improvement: We are actively gathering feedback from users to iterate and improve NuTree bot continuously. This feedback loop is essential for refining the user experience, enhancing the relevance of content, and addressing specific user needs and preferences.

Why Pilot Stage?

We selected the Pilot stage because we have successfully launched NuTree bot, acquired a substantial user base, and are actively iterating on our design and content based on user feedback. While our solution is gaining traction and demonstrating promising engagement metrics, we are still refining our business model and assessing scalability to reach a broader audience effectively.

Next Steps:

Moving forward, our focus is on further optimizing NuTree bot, adding flows around reminders, use AI for voice, building database of recipes, leaderboards. On the field, we are looking to expand our user base, and exploring opportunities to enhance the impact of our solution. We are committed to refining our approach based on real-world user interactions and feedback, ensuring that NuTree bot continues to empower caregivers and improve health outcomes for mothers and children in underserved communities.

We are applying to Solve because we believe it offers a unique opportunity to advance our NuTree bot solution. While funding is not our sole goal, we recognize the value of Solve's network in providing critical mentorship, innovative ideas, and access to resources that can propel our solution to the next level.

Challenges and Barriers:

1. Mentorship and Guidance: We seek mentorship from experienced professionals and domain experts who can provide strategic guidance on scaling our solution sustainably. Mentorship in areas such as technology, healthcare innovation and MEL is what we are looking for.

2. AI Integration and Optimization: Leveraging artificial intelligence (AI) more effectively within NuTree bot is a priority for us. We aim to enhance the chatbot's capabilities to deliver personalized and context-specific health information, driving user engagement and behavior change. Solve's expertise in AI and technology can help us optimize our approach and leverage cutting-edge solutions.

3. Scaling Impact: Scaling our solution to reach a larger audience of vulnerable families across India is a significant challenge. We hope to leverage Solve's network to explore partnerships, innovative distribution models, and strategies for expanding our reach while maintaining quality and relevance.

4. Impact Measurement: Accurately measuring and demonstrating the impact of NuTree bot is essential for securing further support and scaling our solution sustainably. Solve's resources and connections can assist us in refining our impact measurement methodologies, integrating data analytics, and showcasing tangible outcomes to stakeholders and potential partners.

5. Visibility and Recognition: Being part of Solve's cohort provides visibility and credibility, attracting potential supporters and investors who share our commitment to improving maternal and child health outcomes.

Solve can play a transformative role in accelerating the growth and impact of NuTree bot at this point in time in our journey. 

Our solution, NuTree bot, stands out for its innovative approach to empowering families with critical health and nutrition information while simultaneously streamlining the workload of Accredited Social Health Activists (ASHAs) and other frontline health workers. Here's what makes NuTree bot truly innovative:

1. Building Agency in Families: NuTree bot shifts the power of nutrition care access to families themselves. By providing accessible and personalized health advice via WhatsApp, caregivers gain autonomy over decision-making regarding their children's nutrition and health. This empowerment enhances engagement and encourages proactive health-seeking behaviors.

2. Reducing Workload of Frontline Workers: Our solution complements the efforts of frontline health workers, such as Anganwadi Workers (AWWs), by reducing their burden of individually educating families. NuTree bot delivers standardized, accurate, and timely information directly to caregivers, allowing frontline workers to focus on more complex cases and community outreach.

3. Government Adoption Potential: NuTree bot is designed to align seamlessly with existing government health programs and strategies. Its user-friendly interface and scalability make it an attractive tool for adoption by government agencies seeking to enhance maternal and child health outcomes at scale.

4. Contextual and Positive Deviance Content: One of the key innovations of NuTree bot is its use of contextual content and positive deviance principles. The chatbot tailors information to local contexts and cultural norms, promoting positive behaviors and practices that are already prevalent within communities. This approach fosters acceptance and adoption of healthier habits among caregivers.

5. Impact on System Change: NuTree bot has the potential to catalyze systemic change by fostering a shift in demand for better nutrition care from families. As caregivers become more informed and empowered, they are likely to advocate for improved health services and resources from the healthcare system. This increased demand can drive system efficiencies, leading to better allocation of resources and improved health outcomes for vulnerable populations.

 NuTree bot's innovative features empower families, support frontline health workers, align with government priorities, and leverage contextual content to drive behavior change. By transforming the dynamics of health education and decision-making, NuTree bot contributes to a more responsive and effective healthcare system that prioritizes the needs of underserved communities.

Our theory of change for NuTree bot outlines a clear pathway linking our activities to immediate outputs and longer-term outcomes, ultimately driving positive impact on the problem of inadequate maternal and child health outcomes, specifically addressing preventable malnutrition in low-resource communities.

Activities:

1. Development of NuTree bot: We have developed NuTree bot, a user-friendly WhatsApp chatbot that delivers essential health and nutrition information to caregivers of children in the critical "first 1000 days" of life.

2. Content Creation and Tailoring: We have curated and tailored evidence-based content within NuTree bot, focusing on growth monitoring, immunization, breastfeeding benefits, and good dietary practices, customized to local contexts and cultural norms.

Outputs:

1. Usage by Caregivers: Caregivers receive accurate and actionable health information directly on their mobile devices through NuTree bot, improving their knowledge and understanding of key health practices (#users, enagagement rate)

2. Reduced Burden on Frontline Workers: NuTree bot reduces the workload of frontline health workers, such as Anganwadi Workers (AWWs), by automating routine health education tasks and allowing them to focus on more complex cases.

Immediate Outcomes:

1. Increased Awareness and Behavior Change: Caregivers are more likely to adopt positive health behaviors, such as timely immunization, exclusive breastfeeding, and nutritious feeding practices, leading to improved child health outcomes. (All IYCF indicators) 

Longer-Term Outcomes:

1. Reduction in Malnutrition Rates: The sustained adoption of healthy practices promoted by NuTree bot contributes to a reduction in rates of stunting, wasting, and underweight among children under five in our target communities.

2. Empowerment and Advocacy: As caregivers become more informed and empowered through NuTree bot, they are likely to demand better healthcare services and resources from the healthcare system, driving systemic improvements and ensuring sustained impact beyond the direct use of the chatbot.

Evidence and Support: Our theory of change is informed by ongoing user feedback, engagement data, and qualitative insights from our target communities. We are early in our stage, but are monitoring the impact of NuTree bot, validating the logical links between our activities, outputs, and outcomes through rigorous assessment and improvement processes.

Our impact goals for NuTree bot are centered around reducing malnutrition and improving maternal and child health outcomes in low-resource communities. We measure our progress towards these goals through a combination of quantitative and qualitative indicators that reflect behavior change, empowerment of women, and enhanced support for frontline health workers.

Impact Goals:

1. Reduction of Malnutrition Rates: Our primary impact goal is to contribute to a significant reduction in malnutrition rates among children under five in our target communities. We aim to see a measurable decrease in the prevalence of stunting, wasting, and underweight indicators over time.

2. Behavior Change in Infant and Young Child Feeding (IYCF) Practices: We aim to improve caregiver knowledge and practices related to Infant and Young Child Feeding (IYCF) through NuTree bot. Specific indicators include increased rates of exclusive breastfeeding, timely initiation of complementary feeding, and improved dietary diversity among young children.

3. Agency and Support for Women: Another impact goal is to enhance the agency and support for women. Agency is defined as decision-making, mobility and self efficacy of women. 

4. Support for Frontline Health Workers: We aim to alleviate the workload of frontline health workers, leading to better support for Anganwadi Workers (AWWs) and Accredited Social Health Activists (ASHAs). We measure this impact through indicators such as reduced time spent on routine health education tasks and increased capacity to address complex health issues.

Measurement Approach:

1. Quantitative Indicators:

- Prevalence rates of wasting among children under two, measured through periodic health surveys and assessments.

- IYCF indicators like: ANC check ups, # of hospital deliveries, rate of exclusive breastfeeding, early initiation of breastfeeding, complimentary feeding, diet diversity and meal frequency  

- Self-reported changes in healthcare decision-making and agency among women, assessed through structured interviews and focus group discussions.

2. Qualitative Indicators:

- Qualitative feedback from users on behavior change and adoption of health practices, collected through user testimonials, case studies, and community feedback sessions.

- Perceptions of frontline health workers on workload reduction and improved support, gathered through structured interviews and feedback mechanisms integrated into NuTree bot.

3. Long-Term Impact:

Our goal is to achieve a measurable reduction in malnutrition rates and create sustainable improvements in maternal and child health outcomes

NuTree bot has been developed using Glific, an open source, WhatsApp based, two way communication platform that enables organisations running programmes to reach their communities.  India has the world’s largest number of WhatsApp users. This makes it possible for us to reach a very large and diverse set of users with the bot. Currently, the bot is available in four languages - Hindi, Hinglish (Hindi typed using English script), Kannada and English. The chatbot has flows for growth monitoring, immunisation, benefits of breastfeeding and what constitutes a good diet.

The bot was launched in March 2024 and was initially available only on chat, but we have since started the process of integrating voice features, making the bot accessible to those who prefer using voice notes as a method of WhatsApp communication. 

Technology features we would like to add include - 

• AI / ML integration for personalised nutritional care and guidance

• A health desk powered by algorithms that provides tailored support and care, in the language of the user’s choice, and differentiates between critical and non-critical questions raised by the participants

FMCH will set up a health desk of medical and nutrition experts, who will respond to the critical questions in a timely manner; all other questions will receive instant advice from the bot. We anticipate that a significant majority (about 80% or more) of questions to be non-critical in nature, thus allowing us to train the model to give better and more accurate responses over time.

The bot is available here - https://api.whatsapp.com/send/?phone=919653309578&text=hi (via a mobile phone, not via WhatsApp web)

The team consists of a Products Director, a part-time Product Consultant, a Senior Manager and two Product Managers. The team has a great mix of people with technology and operational experience, in and outside of FMCH. 

Work on the chatbot and the tape began in November 2023. We’re excited about the progress we’ve made so far, and are intrigued, hopeful and committed to taking the bot to over 500000 families in the next 6 months.

At FMCH, our team is predominantly women, with 90% of us being women and 70% coming from the communities we serve. This intentional diversity ensures that our team truly understands and represents the needs of the populations we support.

Moreover, within our leadership ranks, 95% of positions are held by women, including our CEO and the President of the board at FMCH. This reflects our commitment to empowering women in leadership roles and promoting gender equity within our organisation.

Our team's diversity goes beyond gender to encompass various cultural, socioeconomic, and professional backgrounds.

 We promote professional growth, encourage open communication, and ensure that everyone's voice is heard in decision-making. Our leadership has been on the field as frontline staff and moved up the ranks - we are so proud of this! It helps us make products that are rooted in community knowledge. 

Our approach combines social impact with a sustainable revenue strategy, aiming to transition from philanthropic support to government adoption for long-term scalability.

Key Customers and Beneficiaries: Our primary customers and beneficiaries are mothers and caregivers from underserved communities in low-resource settings, where access to reliable health information and services is limited.

Products and Services: We offer NuTree bot, a WhatsApp chatbot designed to deliver essential health and nutrition information directly to mothers and caregivers' mobile phones. The chatbot provides personalized content on topics such as prenatal care, breastfeeding, infant feeding practices, immunization schedules, and child growth monitoring.

How We Provide Services: Mothers and caregivers access NuTree bot by sending messages on WhatsApp, allowing for convenient and accessible communication. Mothers know about this through the government frontline workers. The government is our distribution channel. 

Impact and Revenue Strategy: In the initial pilot phase, we rely on philanthropic funding to demonstrate impact and refine our model. However, our long-term strategy is to partner with government agencies at the district level to integrate NuTree bot into existing healthcare systems.

Revenue Generation: Our revenue model aims to transition from philanthropy to government adoption:

• We collaborate with government health departments to train frontline workers (such as ASHAs and Anganwadi Workers) to distribute and promote NuTree bot among mothers in their communities.

• Government adoption involves securing contracts or agreements with health agencies for the deployment and maintenance of NuTree bot as part of their maternal and child health initiatives.

• Revenue can be generated through service contracts, licensing agreements, or cost-sharing arrangements with government partners to ensure sustainable funding and scalability.

Our plan for achieving financial sustainability at NuTree revolves around transitioning from philanthropic support to government adoption of our services, particularly through partnerships at the district level for the deployment and integration of NuTree bot into existing healthcare systems.

Revenue Strategy:

1. Government Partnerships: Our primary revenue strategy involves partnering with government health departments to integrate NuTree bot into their maternal and child health initiatives. This includes training frontline workers (such as ASHAs and Anganwadi Workers) to distribute and promote NuTree bot among mothers in their communities. We aim to secure contracts or agreements with government agencies for the deployment and maintenance of our services.

2. Service Contracts: We plan to generate revenue through service contracts with government partners, covering aspects such as technology deployment, user support, and data management related to NuTree bot. These contracts will provide sustainable funding for ongoing operations and expansion.

3.Licensing Agreements: As NuTree bot gains traction and demonstrates impact, we may explore licensing agreements with government agencies or other organizations interested in adopting our technology for similar health interventions in different regions or contexts.

Evidence of Success:

To date, our plans to fund our work through government partnerships have shown promising signs of success:

- We have over 1500 users of the Bot, with a 90% competition of flows

- During our pilot phase, all frontline workers have expressed openness to adopting NuTree bot based on positive feedback and demonstrated impact in pilot communities.

- We have successfully engaged with district level system integrating the NuTree bot into existing maternal and child health programs, showcasing interest and commitment to scaling our solution.

- We have secured initial grants and support from philanthropic organizations to develop and pilot NuTree bot, laying the groundwork for transitioning to sustainable revenue streams through government partnerships.