Vaccines.. It's All We Can Think Of

Today is a historic day – the first set of Britons are set to receive the COVID19 vaccine made by Pfizer and BioNTech. For a pandemic that began earlier this year that has so far killed 1.5 million worldwide, disrupted global economic growth and upended life, there was little hope that a vaccine would be successfully made available by this year. But against all odds, and due to the relentless efforts of scientists, the world can finally start seeing an end to this disease.

Meanwhile, back in India, millions of infants had to forego their regular vaccines this year due to the fears of COVID19. Dipstick surveys revealed that nearly 5 million children alone could have missed out on their vaccinations in March – these are alarming numbers for a country that has had historically low immunisation rates. Child immunisation is a critical public health intervention that reduces infant and child mortality significantly. Owing to massive implementation costs and limited awareness in rural areas, nearly 47% of India’s poorest remain unimmunised.

Ruchit Nagar, a medical student at Harvard Medical School and Mohammed Shahnawaz, a doctoral candidate at the Indian Institute of Health Management Research, Jaipur – got connected through peers and shared their concerns over the ground realities contributing to low infant immunisation and poor maternal health in India.

“Maternal and child health remains an area of concern in Rajasthan, where 40 out of every 1,000 children die before the age of 1 and where 420,000 pregnant women are considered high risk for delivery every year. Beyond health metrics, paper-based and digitally siloed data collection mechanisms to date have left an incomplete picture, with less than half of expected infant and maternal deaths reported in the first place. Strengthening digital health solutions to be more accountable particularly for those at the last mile has therefore become our calling,” said Nagar.

Nagar, who was at Yale University in 2014, developed a medical wearable called Khushi Baby along with classmates that went on to win the Yale Thorne Prize for Social Innovation in Health and $25,000 in seed funding. By the time Nagar met Shahnawaz, the product was well on its way to becoming a full-fledged venture in Udaipur, Rajasthan with the support of NGO Seva Mandir. Khushi Baby has developed wearables that can monitor the health of babies and pregnant women.

40,000 Mothers and Infants Tracked… And Counting

Since 2017, Khushi Baby has tracked 40,000 beneficiaries (mothers and infants) with the support of 150 Auxiliary Nurse Midwives (ANMs). This maternal and child health platform consists of a mobile application for the community health workers, a digital health card (powered by Near Field Communication technology) for the beneficiaries, and a dashboard and automated community engagement platform for health officials. In village-based health camps where connectivity is absent, health workers can review medical history, give informed care, and update the medical record by a simple tap of their smartphone with the beneficiary's health card. This card not only stores the medical history but can also store the biometric template of the beneficiary to facilitate offline authentication and beneficiary ownership over their biometric record. Beyond the health card, the system is notable for dialect-specific, automated voice call reminders.

In a 2-year, 3200-mother randomized controlled trial, the Khushi Baby intervention improved health behaviour outcomes of full infant immunization by a factor of 1.66 and decreased malnutrition rates by a factor of 0.26.

Recently, in partnership with Google AI and researchers from Singapore Management University, Khushi Baby is developing the first community health worker diligence model - a machine learning solution to quantify the trustworthiness of a health worker's given data. This data quality score is being applied to appropriately incentivize health worker diligence and to filter data before passing it for AI models to predict downstream health and health behaviour outcomes, revealed Nagar.

At RAISE 2020 held in October 2020, Milind Tambe, Director for Google’s AI For Social Good and Harvard professor for Computer Science, spoke at length about Google’s AI for Good research efforts with Nagar on the panel as well.

Timely Help During COVID19

Beyond their maternal and child health platform, the Khushi Baby team adapted a version of the platform to help the Rajasthan Department of Health respond to the COVID-19 outbreak. This platform used by 58,000 health workers (including ASHAs, ANMs, and medical officers) facilitated door-to-door screening, referral, and follow-up care for COVID-19 and other primary care concerns. Between July to October, over 1.2 Cr beneficiaries across Rajasthan were screened via this platform, which will be extended moving forward to longitudinally track community health, including the forthcoming delivery of COVID-19 vaccines to the population at large

A Trusted Partner For Rajasthan Govt's Community Health Management

This year, Khushi Baby entered into a 3-year legal partnership with the Department of Medical, Health and Family Welfare in Rajasthan as The Nodal Technical Service Provider. The Khushi Baby health platform has received financial sanction from the MoHFW under the National Health Mission's Innovation head for scale-up, with a budget of 17.55 Cr for the current financial year. Nagar believes there is tremendous potential in wearable technologies to monitor pregnant women, newborns and ones with low birth weight – and governments need to scale up such technologies. 

Khushi Baby's longitudinal platform for tracking maternal and child health is actively looking to incorporate IoT devices, including wearables, to ensure more streamlined collection of vital parameters. With such higher quality data, the ability to predict adverse maternal and child health outcomes would only improve, leading to timely intervention.