Digital General Practitioner (GP) Model

The dire lack of access to quality healthcare in Bangladesh, particularly in rural areas, where the Universal Health Coverage (UHC) Index stands at a mere 52%. Over half of the population faces limited healthcare access, resulting in numerous adverse health outcomes. In Bangladesh alone, approximately 572,600 deaths, accounting for 67% of total deaths, are attributed to NCDs. NCDs are a significant contributor to premature deaths, responsible for 22% of such occurrences. NCDs pose a significant threat, with 71% of the population having NCD risk factors, 28% dealing with hypertension. The prevalence of diabetes in Bangladesh is alarming, with 8.4 million adults affected in 2019, a number expected to nearly double to 15.0 million by 2045. Additionally, mental health issues are widespread, with a treatment gap of 91%, and only 1.10 mental health workers per 100,000 population. The Maternal (MMR) & Infant (IMR) Mortality Rate  is alarmingly high with maternal 7,660 (123 per 100,000 live births) preventable deaths annually & infant  mortality 24 per thousand live births rates in Bangladesh are among the highest globally. Compounding this issue is the fact that more than half of births occur at home without the assistance of skilled birth attendants pressing need to promote institutional deliveries. MMR & IMR remains a significant concern, with a substantial portion of healthcare expenses being out-of-pocket, amounting to 74%. The scale of the problem is substantial, with millions of individuals affected locally. Furthermore, there is a severe shortage of healthcare professionals, with a doctor-to-nurse ratio of 1:0.4, and only 25% serving rural areas where 60% of total population  are living. This disparity amplifies lack of healthcare access, higher costs particularly impacting rural households, where catastrophic healthcare expenditure affects 26% of households. Several factors contribute to these challenges, including the lack of a structured referral system, limited awareness, and low literacy rates in rural areas, hindering preventive and primary healthcare efforts. The absence of adequate healthcare infrastructure, particularly in remote areas, exacerbates the problem, leaving many underserved and vulnerable populations without essential services.

Our solution, the Digital General Practitioner (GP) Model, is a revolutionary approach to healthcare delivery designed to make healthcare accessible, affordable, and equitable for all, particularly focusing on underserved rural communities in Bangladesh. At its core, the model leverages technology, trained frontline healthcare workers, and a well-structured referral system to provide comprehensive healthcare services directly to people's doorsteps. The model works by deploying Health Workers (HWs) to conduct household visits in rural communities. Offering a wide array of services, from preventive care to primary care, the model bridges healthcare gaps through household visits by trained health workers, ensuring 20 daily visits to remote areas. These health workers are equipped with Smart health kits (Point of Care Diagnostics, POCD) that utilize Internet of Things (IoT) and Artificial intelligence (AI) technology for health education, screening, risk assesment and refferals. During the visits, health workers provide a range of primary & preventive healthcare services, including essential preventive check-ups like, screening of diabetes, hypertention, nutrition, Breast cancer, Eye, Growth Monitoring; maternal care and health & well-being counseling. 

The visits by health workers are tracked using GPS technology for monitoring and ensuring coverage. Patient data security is ensured through Face ID recognition, maintaining confidentiality and privacy. The Model operates on a structured referral system, where health visitors identify health concerns and refer patients to community clinics or GP centers for further assessment and treatment. These community clinics, staffed by Community Healthcare Providers (CHC), provide essential health checkups & counseling and dispense medications. Furthermore, 24x7 telemedicine services enhance accessibility. Additionally, our Generative AI-powered co-pilot aids HWs in delivering personalized health education and awareness. For more comprehensive care, patients requiring in-person consultations are referred to General Practitioners (GPs) at GP centers. GP centers offer a wide range of primary healthcare services, including doctor consultations,  treatment, medication, prescription services, lab & diagnostic tests and delivery facilities. The services span primary care, If specialized care is needed, patients are further referred to secondary or tertiary-level healthcare facilities staffed by specialists. To ensure continuity of care, patients are eventually referred back to GPs for follow-up and ongoing support. To enhance accessibility and affordability, the GP Model incorporates a digital payment system integrated into the health visitor app. This system simplifies the payment process for healthcare services and medications, making it more convenient for patients and improving financial transparency within the healthcare ecosystem. Our solution has already been successfully implemented, and we aim to collaborate with the government to extend its reach, particularly to underserved communities, including tribal populations. By aligning with government efforts and leveraging 4IR technologies such as AI, we seek to create a more comprehensive healthcare ecosystem, providing access to quality healthcare for all at an affordable price point, equivalent to the cost of a cup of coffee.

The model serves to directly and meaningfully improve the lives of underserved rural populations in Bangladesh by providing accessible, affordable, quality & comprehensive healthcare services at their doorsteps. By addressing their healthcare needs through innovative digital solutions the model aims to empower individuals and families to lead healthier and more productive lives. The model introduces a transformative approach to healthcare delivery, prioritizing accessibility and inclusivity for underserved regions in Bangladesh while advancing the cause of UHC. Designed to cater to the rural populace, this innovative model begins with HW who conduct doorstep visits, leveraging technology to provide tech-enabled health services. Through the integration of IoT and AI, these HWs assess health risks, offer health education, and refer patients to the appropriate level of care. The model ensures a seamless continuum of care by directing risky patients to the closest Community Clinic for further assessments, and onward referrals to the Union Sub-Center and secondary/tertiary care centers as needed. This comprehensive approach addresses a spectrum of healthcare needs, encompassing Health Education, Social and Behavior Change Communication (SBCC), Non-Communicable Diseases (NCDs), Common Communicable Diseases (CD), Nutrition, Family Planning, Pediatrics, Maternal Health services such as antenatal and postnatal care, Adolescent Health, Mental Health, Geriatric Care, and Preventive Care, including Health Screening for conditions such as Autism, Breast Cancer, Alzheimer's Disease, Parkinson's Disease, and Eye Care. All these services are aligned with the guidelines outlined by the World Health Organization (WHO). The model places particular emphasis on key components for NCD screening and maternal services, addressing conditions such as Hypertension, Diabetes, Obesity, and Malnutrition, while also implementing a tracking system for pregnant mothers. From preventive care to Non-Communicable Disease (NCD) screening and maternal services, thereby bridging healthcare gaps in remote areas. A robust referral system for advanced care, ensuring uninterrupted healthcare access.  Furthermore, 24x7 telemedicine services enhance accessibility, while smart IoT devices aid in monitoring health metrics, ensuring timely interventions and improved health outcomes.

The target population for this solution encompasses individuals and families residing in rural areas, particularly those who face barriers to accessing quality healthcare services due to geographical remoteness and socioeconomic factors. Currently underserved, these communities often lack access to regular healthcare check-ups, diagnostic tests, and specialist consultations, leading to undiagnosed and untreated health conditions. The Digital GP model addresses these needs by bringing healthcare directly to their doorsteps through trained Health Workers, thereby eliminating the need for long travels and reducing financial burdens associated with seeking healthcare services.

By engaging with the government and fostering public-private partnerships, the model aims to expand its reach to a broader customer base, including policymakers, healthcare providers, and other stakeholders committed to improving healthcare delivery in rural areas. The successful pilot deployment in Nayanagar Union of Melandaha Upazila in Jamalpur demonstrated the feasibility and effectiveness of the model, with a notable response rate and subscription uptake among rural communities. With partnerships such as with PKSF, the model has shown its acceptance and scalability across multiple locations, affirming its positive impact and acceptance within rural communities.

CMED Health's core team is a dynamic assembly of experts, each contributing a wealth of experience and skills in their respective roles. Together, this core team encompasses a diverse range of skills and experiences. They are united in their commitment to leveraging technology and innovation to improve healthcare accessibility and the quality of life for underserved populations. Their combined expertise is a driving force behind CMED Health's mission to make a positive impact on healthcare in Bangladesh.

Prof. Khondaker A. Mamun, PhD - Team Leader and AI/ML Expert: Prof. Mamun leads the team with over 18 years of experience in government and non-government projects. His expertise spans ICT, Digital Health, Health Management Information Systems, and Education. He's a visionary in 4IR technologies like AI, Big Data, and IoT in healthcare. Prof. Mamun has been influential in international discussions through his involvement in the WHO/ITU Focus Group on AI for Health (FG-AI4H) and has played a pivotal role in developing the Digital Health Strategy for the Ministry of Health and Family Welfare in Bangladesh. He holds a patent for the innovative Digital Health Inclusion Model.

Dr. Farhana Sarker - AI/ML Expert: Dr. Sarker brings her extensive experience in healthcare and technology to the team. She excels in strategy planning, project design, and management, with a focus on health and medical information systems analysis and software development. Her expertise extends to data privacy, security, interoperability, and quality assurance, with proficiency in machine learning and Genetive AI Models. Dr. Sarker is dedicated to pushing the boundaries of healthcare and technology.

Moinul Haque Chowdhury - Project Manager & AI/ML Expert: Moinul serves as the Project Manager and AI/ML Expert, with over 14 years of experience. His capabilities include health and medical information system analysis, software design, development, quality assurance, data privacy, security, and interoperability. He has been instrumental in designing innovative models such as the Integrated Digital Healthcare Platform (IDHP) and the Enriched Sastho Digital Health Intervention Model.

Ashraf Dawood - Operation Lead: Ashraf brings over 25 years of expertise in Operations and distribution management, particularly in the telecom industry and Mobile Financial Services. His career includes heading Sales and distribution functions in the pharmaceutical industry. Ashraf currently serves as the Chief Operating Officer at CMED Health Ltd. His experience spans grassroots execution to formulating long-term strategies. 

Dr. Marzia Zaman, as Head of Medical Services, drives strategic healthcare initiatives, leveraging over 12 years of public health expertise. Specializing in digital health solutions, she focuses on innovative AI technologies to improve adolescent health outcomes. With an MBBS from Chittagong Medical College and an MPH from North South University, she champions initiatives like the Bangladesh Anti-Microbial Resistance Response Alliance. Dr. Zaman's contributions encompass sexual health, mental health, tuberculosis control, and nutrition, enhancing healthcare delivery through inclusive datasets and groundbreaking AI engines

Our innovation has reached significant milestones, serving a total of 58,954 individuals across Nayanagar Union in Melandaha Upazila (Jamalpur district) and Pabna. Through strategic partnerships with organizations like PKSF, our Primary Healthcare (PHC) model has been successfully piloted across 65 locations in Bangladesh, demonstrating its feasibility and garnering positive user feedback. The integration of IoT-enabled medical device-based health screening and the "SuSastho" platform has facilitated access to healthcare services via Android, iOS, or web platforms. This approach prioritizes knowledge dissemination and leverages Generative AI for clinically vetted responses, validated through consultative workshops and clinical validation processes. In Nayanagar Union, our Proof of Concept (PoC) deployment engaged 12,746 rural individuals, achieving a notable 60.55% response rate and confirming the model's feasibility through subscription payments of 100 Bangladesh Taka monthly. Publications stemming from these initiatives underscore our commitment to rigorous testing and continuous improvement, ensuring the effectiveness of our innovation in addressing healthcare challenges. Additionally, our study revealed valuable insights into the prevalence of Non-Communicable Diseases (NCDs) within the study population, highlighting the importance of early detection and intervention. Through our partnership with PKSF, we have expanded our reach to serve a total of 1,726,109 individuals in 2023 across various union areas, further emphasizing the scalability and impact of our innovation in addressing healthcare disparities.

We are interested in this challenge because we deeply care about our country’s healthcare paradigm. We want to improve the existing healthcare delivery system. Our work started in 2015 from thorough research on healthcare delivery challenges in rural Bangladesh and identified the key issues. CMED Health was born from that research to solve these issues, and this model is one of the final solutions that we’ve developed. This challenge presents a unique opportunity for us to work together with the key stakeholder of healthcare in Bangladesh, the Government and develop a proof of concept for a public-private partnership. We want to showcase to everyone that this model is functional and can help people to access healthcare services, ease the payment process and control fraudulent activities. This model offers a profound opportunity to instigate a transformative impact on the healthcare ecosystem of Bangladesh utilizing IoT-enabled, AI-driven, cloud-based 4IR technology. Our motivation stems from a critical need to shift the prevailing focus in the healthcare landscape, which predominantly centers on secondary and tertiary care. Bangladesh, like many regions, has seen an overemphasis on curative measures rather than preventive and primary healthcare. We are passionate about reshaping this ecosystem by establishing a robust and effective referral chain, thus redefining healthcare priorities. 

At the heart of our interest lies a vision to foster a healthcare environment where preventive and primary care is as prioritized as public health interventions. We recognize that a well-structured and efficient healthcare referral system is pivotal in achieving this shift. By establishing such a system, we aim to align with the larger goals of the public health systems in Asia and the Pacific, particularly in the pursuit of universal health coverage and the enhancement of healthcare access and affordability. 

The implications of our work extend beyond the realm of healthcare. A healthier population is intrinsically linked to increased productivity and economic growth. By participating in this challenge, we anticipate a direct and positive impact on the well-being of communities and, indeed, the entire nation. Our endeavors are inherently aligned with the global SDGs, particularly Goal 3: Good Health and Well-being. 

By taking on this challenge, we see an opportunity to showcase our expertise in healthcare, and digital technologies, all harnessed for the betterment of society. It is a platform to reaffirm our commitment to leveraging technology for the greater social good, underscoring our dedication to creating a healthier, more equitable future for all.

The Digital GP model is a transformative approach to healthcare service delivery, ensuring inclusivity, accountability, efficiency, quality, timeliness, safety, and affordability across the entire spectrum of healthcare while harnessing cutting-edge technology and collaborative partnership with government to create a healthier and more accessible future for all. This model brings healthcare to the citizen's doorstep and ensures preventive, promotive & primary care and referral for secondary and tertiary care. This tech-enabled end-to-end approach guarantees that individuals receive healthcare services that are accountable, transparent, timely and affordable. This complete healthcare continuum is an innovative step towards achieving holistic health coverage, ensuring patients receive the right care at the right time. 

The model has been meticulously crafted to optimize the delivery of healthcare services, achieving an exceptional level of efficiency with a minimal workforce. By effectively leveraging IoT-enabled, AI-driven, cloud-based technology, including telemedicine, we optimize the use of healthcare professionals, expanding their reach and impact across a wider population. This innovative approach is essential in addressing the shortage of healthcare professionals in rural areas. 

The model integrates text-based and IoT-enabled medical device-based health screening to assess health risks, identify high-risk individuals, and ensure access through the "SuSastho'' platform on Android, iOS, or the web. All versions of “Susatho.AI”,  Bangla Medical GPT-based solution cater to the dissemination of knowledge about mental health and provide vetted responses using Generative AI. Altogether this initiative targets to drive equitable AI practices and ethical considerations in delivering sexual, reproductive, and mental  health services while ensuring privacy and security of user data by following best practices for data protection and compliance with local and international regulations. This innovation has undergone rigorous validation and performance evaluation through consultative workshops, with an ongoing ethical approval process from the Bangladesh Medical Research Council (BMRC)

Adiitionally, Our incorporation of a digital payment system revolutionizes the financial aspect of healthcare. It overcomes barriers to affordability by simplifying the payment process and enhancing financial inclusion for all. This digital payment solution is integral in making healthcare services more accessible and affordable. 

When serving the population, we prioritize patient data security with Face ID recognition, assuring that patient information is protected and safe against fraudulent activities. Our services are HIPAA compliant. This innovation directly addresses the challenge of Fraud Detection, safeguarding patient data and privacy. 

The model incorporates government and facilitates public and private partnerships, fostering a collaborative approach towards healthcare delivery. This partnership-driven strategy creates a pathway for effective national healthcare service delivery, solving the challenge of access to government health entitlement. By availing govt. health schemes at doorstep, we’re improving access to care for all. This referral chain from doorstep to community clinic to Union Sub Center to Upazila Health complex will reduce the patient overflow at higher level of health facilities, ensure access to care and significantly reduce out of pocket expenditure. A successful pilot will showcase the ideal healthcare delivery model for the rural people of Bangladesh.

Our solution aims to revolutionize healthcare delivery by leveraging patient-centered care principles, Continuous Quality Improvement (CQI), and cutting-edge 4IR technologies such as AI and IoT, building upon the existing Susastho platform. By strategically collaborating with government agencies, private healthcare providers, and other stakeholders, we create a comprehensive support system. Through activities like implementing a robust digital infrastructure, establishing seamless referral pathways, and providing doorstep services, we anticipate several outcomes. In the short term, we foresee achieving digital health inclusion and equitable, accessible, affordable, and quality service delivery with a focus on preventive and primary care. In the mid-term, we expect to establish an efficient referral system, enhance health education, expand facilities offering emergency obstetric and neonatal care (EmON), and ensure the delivery of in-patient care and essential medical supplies. Looking towards long-term outcomes, we envision advanced public health, reduced C-section rates, decreased out-of-pocket expenses, widespread adoption of health protection and insurance, significant annual healthcare expenditure decrease, slowed annual patient growth, improved health access for rural communities, resilient public health systems, and ultimately, a transformed and sustainable healthcare system contributing to Universal Health Coverage (UHC). This comprehensive approach aligns activities with immediate outputs and longer-term outcomes, aiming to address the root causes of healthcare disparities and improve overall health outcomes for our target population.

Our impact goal is centered on ensuring equitable access to affordable, high-quality healthcare for all individuals, with a specific focus on enhancing maternal and child health, and combating non-communicable diseases (NCDs) in rural communities. We are dedicated to improving healthcare access and outcomes by adopting inclusive approaches that cater to the unique needs and preferences of rural women. Our overarching objective is to transform rural healthcare in Bangladesh, particularly targeting underserved populations, including women and families at the bottom of the pyramid. To achieve this, we are committed to reducing maternal and infant mortality rates, improving overall health outcomes, and stimulating economic growth by empowering local communities through health entrepreneurship. Over the course of five years, we aim to train ~50,000+ health workers and create health accounts for ~170 million individual, ensuring that healthcare services are accessible to all. Through our digital platform, Susastho, we conduct regular health risk assessments, provide timely interventions, and facilitate seamless referrals to advanced care, including 24x7 telemedicine services. By prioritizing maternal and reproductive health, we are actively working to address healthcare access, with the ultimate goal of reducing maternal and infant mortality rates. Our steadfast commitment to doorstep service delivery ensures convenience and accessibility for rural communities, which we measure through the uptake of services and user satisfaction levels. Through continuous monitoring and evaluation of these efforts, we strive to achieve tangible improvements in the lives of rural communities, ensuring that no individual is left behind in accessing essential healthcare services.

The model demonstrates its novelty through population-based studies, responsiveness to emerging health crises, and practical implementation in rural settings. The lack of proper healthcare facilities, resource constraints, and a non-functional referral system hinder Bangladesh’s healthcare system offering comprehensive primary and preventive healthcare (PPH) services. To address these issues, cloud-based medical system framework (CMED) created the proposed model for the rural people of Bangladesh with a digital health account and structured referral mechanism. The proposed model aimed at delivering comprehensive preventive and primary healthcare services. The successful pilot project, which served 12,746 individuals across diverse demographics, demonstrates the model's efficacy in addressing healthcare gaps and providing valuable socio-demographic and healthcare-related data for improved health outcomes. Another study involving 1,341,589 individuals, employs community health workers trained under the "Enriched Sastho" program for data collection, ensuring robust data quality. The identification of stroke prevalence (1.07 per 1,000 people) and its association with risk factors, particularly the higher prevalence in males, provides novel insights, substantiating the scientific validity of the study and emphasizing the imperative for targeted early prevention strategies, particularly in managing hypertension and diabetes, to address stroke risks effectively in rural communities. CMED Health has partnered with Palli Karma-Sahayak Foundation (PKSF) to pilot this model where trained health workers went door to door, provided preventive and primary healthcare service focused on NCD, assessed health risks and connected patients to doctors when needed. The pilot was conducted in one union where 31,868 people received monthly doorstep digital healthcare service for 6 months. The outcome of the pilot demonstrates the benefits of the data-driven digital platform to increase the effectiveness of primary healthcare service delivery by establishing health records, structured referral systems, risk assessment for early intervention, and enhancing equity in rural areas. About 99.5% of the respondents exhibited satisfaction when asked about the acceptance of CMED digital health services. The respondents also expect a continuation of the CMED digital health services in the future.

The provided publication links substantiate the scientific and technological validity of the proposed innovation. This support is derived from evidence-based research, real-world data, and adherence to established healthcare protocols and standards:

CMED: Cloud-based medical system framework for rural health monitoring in developing countries

Digital health inclusion towards achieving universal health coverage for Bangladesh utilizing general practitioner model

Prevalence and Risk Factors of Stroke in Rural Bangladesh: A Population-Based Study on 1.3 million people

Factors associated with low medication adherence in patients with Type 2 diabetes mellitus attending a tertiary hospital in Bangladesh

Digital Health Inclusion to Achieve Universal Health Coverage in the Era of 4th Industrial Revolution

Implementation of a Digital Healthcare Service Model for Ensuring Preventive and Primary Health Care in Rural Bangladesh

Feasibility of Digital Health Services for Educating the Community People Regarding Lifestyle Modification Combating Noncommunicable Diseases

Management Team: We have 4 full-time members overseeing project management, accounts & finance, clinic & service management, and ICT management.

Operation Team: Our team includes 2 full-time members responsible for customer support and continuous quality improvement.

Technology Team: We have a diverse technology team consisting of 1 DevOps engineer, 2 backend developers, 1 frontend developer, 2 app developers, and 2 software quality assurance (SQA) professionals.

Clinic Staffs: Our clinical team includes a clinic in-charge, 2 full-time doctors, 1 pathologist, 1 clinic assistant, 9 health workers, 1 nurse, and 1 MLSS.

In total, we have 28 full-time staff members.

6 Years

CMED Health is committed to fostering diversity, equity, and inclusion within its team to ensure a welcoming and inclusive environment for all members. Our leadership team reflects a diverse range of backgrounds, expertise, and perspectives, contributing to the richness of our organizational culture. We actively promote diversity by recruiting team members from different socio-economic backgrounds, genders, ethnicities, and cultural identities. Additionally, we prioritize minimizing barriers to opportunity for staff by providing equal access to professional development, training, and advancement opportunities. Our team's goals for becoming more diverse, equitable, and inclusive include implementing policies and practices that promote fairness, respect, and belonging for all team members. We have taken actions such as conducting bias training, establishing mentorship programs, and creating affinity groups to support underrepresented staff. Furthermore, we regularly review our recruitment and retention practices to ensure they are inclusive and equitable. By fostering a diverse and inclusive team, we believe we can better serve our target population and drive innovation in healthcare solutions that address the diverse needs of our communities.

The Digital GP model employs an inclusive, adaptable, and scalable approach to healthcare delivery, with a primary focus on underserved rural regions in Bangladesh, all while advancing the cause of Universal Health Coverage (UHC). Our key customers and beneficiaries are both individuals and families residing in these rural areas. Through a subscription-based pricing model, we ensure sustainability and cost-effectiveness, making our services accessible to a wide and diverse customer base, regardless of demographic factors. Our Health Workers (HW) serve as the frontline providers, visiting households to deliver tech-enabled health services directly at their doorsteps. Leveraging IoT and AI technologies, these HWs assess health risks, provide health education, and refer patients to the appropriate level of care. Additionally, our Generative AI-powered co-pilot aids HWs in delivering personalized health education and awareness. The model offers a comprehensive range of services, including preventive care, Non-Communicable Disease (NCD) screening, maternal services, and more, bridging healthcare gaps in remote areas. To ensure uninterrupted healthcare, we have established a robust referral system for advanced care, including 24x7 telemedicine services and GP centers equipped with doctor consultations, lab tests, and delivery facilities. Digital solutions such as mobile apps and web platforms streamline data and payments, facilitating easy access to healthcare services. Our target customers want and need these services to address their healthcare needs conveniently and affordably, without the barriers of distance or cost. By collaborating with the government and fostering public-private partnerships, we aim to expand our reach and impact, ultimately contributing to an enhanced healthcare ecosystem in rural areas of Bangladesh.

Our business model centers on a subscription-based pricing approach, charging households a nominal monthly fee of BDT 200/$2 for access to our comprehensive range of healthcare services through the Digital GP model. This model ensures sustainability and cost-effectiveness for families in rural Bangladesh, generating non-grant revenues while appealing to a broad customer base, irrespective of demographic factors. By achieving operational break-even in 2021, we have demonstrated our ability to balance financial sustainability with our commitment to community welfare. Our focus on robust growth is evidenced by the significant increases in active unions, service-obtaining families, active clinics, subscribers, and telemedicine service obtainers. To further solidify our financial sustainability, we project target revenues of $194,943.56 in 2024 and $1,689,745.00 in 2025, extending through 2026, reflecting our commitment to fiscal responsibility and sustainable growth. While we aim for financial sustainability through revenue generation, we recognize the importance of grant funding to execute plans focused on community welfare over ROI. Therefore, we seek grant funding to revitalize health facilities and upskill manpower in two to three union centers. Additionally, our plan for long-term financial sustainability includes collaboration with the government and the establishment of public-private partnerships. For example, our upcoming pilot project in Araihazar Upazila, Narayanganj District, will serve as a demonstration of our model's effectiveness in partnership with the government. This collaboration not only highlights the role of public-private partnerships in addressing healthcare challenges but also provides opportunities for revenue generation through service contracts with governments. Overall, our evidence of financial sustainability includes achieving operational break-even, steady revenue growth, and strategic partnerships aimed at diversifying revenue streams while maintaining our commitment to providing accessible and affordable healthcare services to rural communities in Bangladesh.