Our motivation stems from the fact that over 1.5 million children worldwide continue to die from vaccine-preventable diseases every year and a third of these children are in India alone. At the same time, for every 100,000 live births in Rajasthan, 244 mothers are dying from pregnancy or birth-related complications. Despite this daunting reality, it is clear that families and health workers on the ground put an astonishing amount of time and effort into providing access to care, especially to children, to the best of their abilities. The mother of Khushboo, a child in rural Udaipur, travels hours by boat and walks an additional 45 minutes to get her child immunized. Health workers often travel 1.5 hours on bike, over difficult terrain, to get to the vaccination camp. Even if both mother and health worker manage to get to the camp on time to receive care, the interface to record and monitor their healthcare encounter is outdated, cumbersome and error-prone. With the amount of effort that is put into receiving care, the least we can do is to make sure that the care received is of high quality and is tracked in the most efficient and correct way possible. This is what we at Khushi Baby aim to fix, and this is why we wake up every single day to innovate for global health.

What it does

The Khushi Baby (KB) system is a digital passport that integrates wearable tech, mobile health, and cloud computing. The necklace itself serves as a culturally relevant symbol of good health, as the black thread is thought to protect the child from nazar, or evil eye. Here’s how it works:

First, a digital pendant is given to patients. Health workers operate a mobile app, and scan the pendant to both read and write data without mobile connectivity. Using our app, mothers' pre-natal care check-ups can be recorded and health workers will be alerted of any potential pregnancy risks in order to refer the mother to a higher care facility. Infant vaccinations are also subsequently tracked to ensure full routine immunization through the first year of life. Later, this data is synced to a cloud-based dashboard, allowing health administrators to generate reports and manage stock with real-time, granular data. The KB system also connects back to the community through educational voice call reminders in the local dialect.

How we built it

Khushi Baby started as a class project at the Yale Center for Innovation Engineering and Design (CEID). We built a demo prototype, received seed funding through the Thorne Prize for Social Innovation in Health, and brought the KB system from the classroom to the field. We spoke with hundreds of mothers to come up with our form factor: the culturally-significant black thread necklace. After working with Seva Mandir, a well-established NGO in Udaipur, Rajasthan, we had an immunization-ready app and dashboard. We recently went back to the drawing board and rebuilt our system from the ground up to not only cover child immunization, but also maternal healthcare monitoring. After extensive paper prototyping, field testing, trainings, and nearly a year of development on our revamped system, "KB 2.0" has been launched. We've also been fortunate to bring in new partners from UNICEF, Gavi, Safran-Morpho, MobiSoft Infotech who have helped us tremendously along the way.

Challenges we ran into

As a group of public health students, we initially struggled with how to turn what was essentially a research project into a sustainable social enterprise. We have also faced challenges as we rebuilt our system, specifically with regard to delays in the product cycle and funding barriers. Our most significant challenges revolve around effective stakeholder engagement, ANM (auxilliary nurse midwife) culture and infrastructure, as well as funding difficulties at the district government level.

Accomplishments that we're proud of

We are very proud to have launched our new app for maternal and child health in Udaipur, slated to reach thousands of mothers and children by next year. We are grateful to have been supported and recognized by UNICEF, Gavi, National Digital India, the NFC Forum, ISIF Asia and more. For a more detailed description of our awards and honors, refer to our 2016 annual report.

What we learned

Implementation and stakeholder engagement is not easy, and does not happen overnight. The biggest hurdle in building an information system is overcoming the attitudes and habits of the current culture and shortcuts taken therein. We have learned that it is essential to apply a local lens to everything that we do and to work intimately with the community, in order to ensure that our system is well adapted and optimally tailored to the people that we serve.

What's next for Khushi Baby

We have just launched our second randomized controlled trial using our new app for maternal and child health within the Udaipur district government context. With one foot planted firmly in Udaipur, the other is moving toward national level scale-up in India. There are high level talks already underway at the state and central government level; with the help of UNICEF Innovation and Gavi, we hope to make improvements upon the existing national electronic system and deploy at a national scale. With this important next step, we hope to expand our social impact while ensuring that our system is profitable and sustainable. Another major improvement we hope to make to our app is to apply big data analysis strategies to link non-obvious patterns in antenatal care to birth and PNC outcomes.

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