In his junior year, Ruchit took the course 'Appropriate Technology for the Developing World' - taught by Professors Joseph Zinter and Robert Hopkins at the Yale Center for Engineering Innovation and Design. The objective of the course was to develop innovations to address the world's immunization gap. Ruchit and his team focused on the area of data and accountability, specifically for creation of a digital vaccine record. The first breakthrough came from realizing that Near Field Communication tags could be used to store compressed vaccine records in an offline, battery-free form factor. These digital health records could be viewed and updated by simply scanning the tag with a compatible Android device.
Ruchit and team won the inaugural Yale Thorne Prize for Social Innovation, which provided seed funding to field test the initial Khushi Baby system.
The team was fortunate to find an implementation partner in Seva Mandir, a leading NGO in Rajasthan, providing maternal and child health services to last-mile communities unreached by the government's health system. Ruchit reached out to 40 professors from local universities and was lucky to be connected with then PhD student from IIHMR Japur and now COO, Md. Shahnawaz. Soon the team recognized that the black thread (kaala dhaaga), worn by beneficaires to ward off evil eye (buri nazar), could be used to house the digital medical record - tying tradition with technology. With the support of 300 backers on Kickstarter, the Johns Hopkins Future Health Systems Grant,the UNICEF and ARM Wearables for Good Challenge Award, the team spent 2015 conducting extensive field scoping of 96 villages in Udaipur followed by a 200-mother randomized controlled trial to evaluate the impact of early intervention on timely infant immunization.
The early efforts lead to a connection with the District government of Udaipur and funding for a 2-year, 3200-mother randomized controlled trial by the International Initiative for Impact Evaluation. At this juncture, Khushi Baby was able to support its first batch of full-time members and established its Udaipur headquarters as a Section 8 non-profit in India. In the next months, while Ruchit was at Yale pursuing his MPH, the team of four (Shahnawaz, Vijendra, Pawan, Hamid) oversaw a baseline coverage evaluation study of over 5,000 mothers across 600 villages, managing a a 40-member team of surveyors along the way. Meanwhile, the mobile application was redesigned to adhere to National Health Mission guidelines and satisfy the requirements of the users, Auxiliary Nurse Midwives providing maternal and child health services.
In 2017, after a year of co-designing the platform with health workers, Khushi Baby launched the intervention with the government - a tablet application for health workers, the Khushi Baby necklace for beneficiaries, a dashboard for health workers, and a dedicated field team for hands-on support - in the form of the region's largest randomized controlled trial. The platform also evolved to include automated voice call reminders, an offline biometric authentication mechanism, WhatsApp groups for health worker follow-up, high-risk algorithms, all while being simultaneously evaluated.
Khushi Baby delved into design thinking during 2018, which was filled with empathy maps and faciliated discussions with mothers and nurses. We were also fortunate to receive cornerstone grants from GAVI and by winning the Johnson and Johnson GenH challenge. By the end of 2018, and some 10,000 surveys later, the results of the trial showed that mothers randomized to areas with he Khushi Baby intervention were 1.66 times more likely to have their infants fully immunized by 12 months and 0.26 times less likely to have their child suffer from moderate acute malnutriton. These results were found in spite of significant financial, technical, operational, and political challenges.
In 2019, our platform continued to function in a sustained manner in Udaipur. At the tail end of the year, with promising imapct results, Khushi Baby approached the Government of Rajasthan's Department of Medical Health and Family Welfare. Khushi Baby's system was vetted against incumbent platforms and ultimately tapped by the Health Secretary as the base for the State's Nirogi Rajasthan Platform for comprehensive community health tracking. Our first project with the Department of Health involved establishing 12 IT-enabled clinics for primary care services, including maternal and child health, in urban slum areas.
In 2020, the Khushi Baby team grew to a full-time team of 40 members, signed a three-year contract as the Nodal Technical Support Partner to the Department of Health, received funding for our innovation from the Central Ministry of Health and Family Welfare of 2.4M USD, and scaled an adaptation of the platform for the COVID-19 response to empower 50,000 health workers to reach 12M residents across Rajasthan. Our COVID-19 response also included a state-wide whatsapp chatbot, social media and policy support for the Department of Health, and PPE donations for healthworkers and policemen.
Upon reflection, our true success has not been from reaching scale. The success has been in the journey to get here. We take pride in staying rooted in rural Udaipur for over 3 years, working hands-on with hundreds of frontline nurses, and helping facilitate hundreds of life-saving referrals for malnourished children identified through our platform. We take pride in having ownership over end-to-end design, development, and deployment of culturally appropriate, digital health systems. This too has been accomplished by building from the ground up, with evidence, and on the most frugal of budgets.
Looking ahead, we are excited to help build integrated digital health systems with the Department of Health, implementing AI models to track health worker diligence and predict maternal and child health risks, and automating mechanisms to encourage and document follow-up with those in most need - to monitor and motivate community health, to the last mile.
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