HERA AI: Predictive Care Navigator

The extensive damage to the health infrastructure resulting from the 2023 Turkey-Syria earthquakes severely disrupted sexual and reproductive health services in the affected region. This had a significant impact on the estimated 4.1 million women of reproductive age and 220,000 pregnant women in the area, as it rendered many health facilities non-operational and severely limited access to essential healthcare. The lack of functioning facilities has led to increased adverse maternal and child health (MCH) and sexual and reproductive health and rights (SRHR) outcomes, especially among adolescents, young adults, and refugees, who are often the most vulnerable. Several contributing factors compound this issue for young people, especially those with multiple vulnerabilities such as being refugee women or children: physical barriers due to the destruction of healthcare facilities, mobility constraints more pronounced for specific demographics, language and cultural barriers deterring them from seeking essential care, the loss of pivotal medical records essential for care continuity, and systemic challenges including discrimination and an absence of services aligned with their unique needs in a global health context. These obstacles hinder the ability of young women to receive timely and adequate healthcare, resulting in a decline in preventive health measures and leaving them vulnerable and underserved. 

Our solution introduces an AI-powered chatbot into our existing solution HERA App via WhatsApp, designed to offer timely and personalized guidance for the immediate needs of affected populations, particularly during emergencies. Our prototype, the 'Predictive Care Navigator,' leverages the open-source LangChain framework - designed to build applications driven by large language models - to anticipate personalized healthcare needs. It operates 24/7, directing vulnerable individuals to appropriate healthcare facilities to reduce health risks and the anticipated morbidity and mortality rates. By facilitating the use of services through reminders and preventive prompts, this innovation seeks to improve access to comprehensive SRHR care, including critical services such as immunizations and prenatal consultations, thus strengthening health-seeking behaviors and informed decision-making among users.

This solution builds upon the established HERA App, an open-source mobile health platform initially launched in 2018 and was selected as one of the solvers of the MIT Solve 2023 Global Challenges, in the Health in Fragile Contexts category. The application is designed to enhance access to preventive health services for pregnant women and immunization services for children under two years of age. It includes essential features such as healthcare appointment reminders, centralized medical records storage, emergency services contact, and healthcare system navigation in multiple languages, including Arabic, Turkish, English, and Dari. Through facilitating service use, our innovation strengthens users' health-seeking behaviors and informed decision-making.

Integrating the ‘Predictive Care Navigator’ into WhatsApp eliminates the requirement for a separate app download, enhancing accessibility across demographics with varying levels of digital literacy. This approach ensures direct access to crucial health guidance without necessitating additional digital navigation skills, providing a straightforward user experience in an emergency context. The user-centric design ensures ease of interaction, ensuring easy interaction even for those with limited digital literacy. Information tailored to be culturally apt will be provided by modifying advice according to the user’s background. To safeguard cultural pertinence, the AI will undergo training that involves consultations with specialist doctors, healthcare providers, and community leaders, either from the target demographics or those trained with the experiences of at-risk groups.

In response to urgent health needs during crises, like the February 2023 Syria-Turkey earthquakes, our approach uniquely focuses on immediate, context-specific health guidance.  To meet the pressing needs of both field workers and affected populations during the acute phase of the earthquake, we've mapped active health centers in disaster zones, available at Afet Sağlık Haritası. This data is later integrated into the WhatsApp chatbot developed in partnership with Turn.IO, creating a seamless connection between ‘Afet Sağlık Haritası’ and the chatbot. Users can interact with the chatbot to instantly update the location of mobile facilities, such as clinics and pharmacies on a public map, using just a mobile phone and WhatsApp. This methodology facilitates dynamic resource distribution that adjusts to changing post-disaster circumstances. Additionally, this crucial data will be integrated into the HERA AI chatbot, further refining the optimization of resource allocation.

In regions affected by the 2023 Turkey-Syria earthquakes, our solution primarily serves pregnant women and women of reproductive age, including vulnerable refugees and asylum seekers. We place a particular focus on adolescents and young adults who are grappling with disrupted access to sexual and reproductive health services.

The Predictive Care Navigator is designed to serve as a continuous health advisor, specializing in sexual and reproductive healthcare. It directs vulnerable individuals, especially during crises, to appropriate healthcare facilities, thereby mitigating potential health risks such as unintended pregnancies, sexually transmitted infections, and complications from lack of access to prenatal and postnatal care. It seeks to augment access to comprehensive SRHR care, including immunizations and prenatal consultations, which can fortify health-seeking behaviors and enhance informed decision-making, thereby mitigating health disparities in emergency and conflict situations.

The tool offers a highly cost-effective healthcare solution, enabled by its ability to direct integration into WhatsApp, minimizing resource-intensive outreach. This 24/7 health consultancy benefits vulnerable individuals during emergencies, ensuring timely referrals and decreasing the burden on health facilities.  When scaled up, this tool could be customized for and replicated in other contexts and countries beyond our initial implementation, expanding its impact.

Dr. Aral Surmeli, the CEO of HERA, from Hatay, which was severely damaged in the 2023 earthquake that struck Syria and Turkey, highlighting our close relationship with the afflicted area.  Currently undertaking his doctorate in this field at the Johns Hopkins Center for Humanitarian Health, Dr. Surmeli's personal and academic ties strengthen our bond with the impacted communities. Following the earthquake, HERA moved immediately to safeguard preventive health services and establish itself as an essential partner in disaster response. Through collaboration with the UNHCR data team and about 30 other organizations, HERA mapped healthcare resources effectively and expedited data processing through the https://afetsaglikharitasi.org... platform. Our deep connections to the local communities—built via direct engagement and comprehension of their dynamics and needs—have uniquely positioned us to create solutions that are both culturally and contextually appropriate.

Since the first day of the disaster, our team has been on the ground, deeply involved with the affected communities and vulnerable groups. This intimate approach sets us apart; we're not remote operators but active participants in these locales. The problems we address are communicated directly from those affected, enabling us to generate solutions directly informed by the issues observed and reported to us. Each tool we have developed has emerged from the field, crafted in response to the specific needs articulated by the affected communities. By being responsive to these needs, we ensure that our design and implementation are directly influenced by the specific requirements of the communities, making our intervention relevant and poised for significant impact.

A notable portion of our field team is women, making up 80%, particularly in direct project roles. We prioritize involving women in management roles, especially those whose experiences and backgrounds mirror the communities we serve. This not only aligns with our commitment to equity but also ensures our approaches and solutions are deeply rooted in the authentic needs and perspectives of the communities.

Beyond immediate disaster response, the HERA app has been successfully implemented in various areas such as south east Turkey and Nebraska, USA, demonstrating the team's specialized expertise in addressing the needs of displaced populations in a variety of settings. With an existing user base of 9,500 downloads and 2,500 active users, HERA is not only actively used but also proven in its capacity to meaningfully engage with the community it serves during critical times.

Our solution has progressed beyond the conceptual stage and is now in the prototype phase, with a significant development being the 'Predictive Care Navigator' AI chatbot. The HERA App is already available and can be downloaded from both the Apple App Store and Google Play Store, catering to the specific needs of refugees in the U.S. (Nebraska refugee camp) and Turkey. Users can easily access various healthcare services, including appointment reminders, access to centralized medical records, and emergency services. However, it's essential to note that the 'Predictive Care Navigator' AI chatbot is currently in a training phase, fine-tuning its algorithms for optimal performance. While the chatbot exists and is operational, it has not been made open access yet. This is because the training process and data integration with afetsaglikharitasi.org, as well as eventual integration into the WhatsApp platform, are ongoing and require further refinement before public release.

HERA directly addresses the healthcare access gap for refugees by leveraging a free, easy-to-use app that simplifies health management. Unlike other platforms that are often complex and underused, HERA focuses on user-friendliness and practicality, integrating an AI-powered chatbot for real-time guidance and emergency health navigation, especially during crises. It reduces demand-side barriers to access to healthcare by centralizing medical records and providing proactive reminders, crucial for maternal and child health among refugee populations. HERA empowers refugees to take ownership of their health decisions, while also affecting behavior change when seeking health services. The HERA solution does not multiply existing health interventions but instead increases the effectiveness of existing health services by focusing on the gap between healthcare access and refugees.

The market lacks data-driven applications for refugees, a population often ignored by digital health developers. The information systems used by NGOs today are complicated and provide poor return on investment.  Addressing this, the proposed solution enhances service efficiency for refugees by simplifying data input processes and enhancing communication among healthcare providers. It mirrors successful strategies of tech giants, prioritizing value creation and efficient service sharing, but with a strong ethical stance. This approach not only improves refugees' health outcomes but also sets a new precedent for data management and collaborative efforts in the digital healthcare space, potentially influencing good practices.

Leveraging the widespread use of smartphones among refugees, the HERA app enhances healthcare service access, particularly in crisis situations. The innovation lies in a specially developed WhatsApp chatbot, created in partnership with Turn.IO. This feature eliminates traditional barriers to access by foregoing the need for account creation or system login, providing immediate connectivity to essential services. The Predictive Care Navigator is currently in the prototype phase, undergoing extensive training, and will integrate directly with WhatsApp upon completion. Our tool introduces a notably cost-effective healthcare solution, minimizing resource-intensive outreach through streamlined, targeted communication. Importantly, the technology is cross-platform and open-access, allowing for straightforward modification or replication, enhancing its potential for broad implementation and adaptability.

Over the next one and five years, HERA seeks to substantively enhance its impact, targeting specifically UN Sustainable Development Goals 3, 5, and 10, which pertain to Good Health and Well-being, Gender Equality, and Reduced Inequalities respectively. The forthcoming impact goals and metrics are designed to steer all functionalities and interventions of HERA:

Target Population Goal: The Predictive Care Navigator aims to involve 50,000 users in Turkey over the next five years, with a main goal of facilitating 15,000 displaced women's access to health services, increasing healthcare-seeking behaviors, and enhancing healthcare knowledge.

Outcome 1: Improve Timely Healthcare-Seeking Behaviors

Objective: Within a 12-month period following the Navigator's implementation, aim for a minimum 30% increase in timely healthcare-seeking behaviors among engaged participants, compared to baseline data prior to the introduction of the Navigator.

●      Output 1.1:Monitor healthcare-seeking behaviors among participants using interaction logs and user feedback, with validated statistical tools.

●      Output 1.2: Employ statistical analyses (paired t-tests, logistic regression) by year-end to confirm Navigator's impact.

●      Output 1.3: Implement continuous user feedback mechanisms and interaction tracking throughout the 12-month period to understand participants’ healthcare intentions, actions, and overall satisfaction.

Outcome 2: Enhance Healthcare Knowledge

Objective: Within 18 months, promote a 40% increase in user knowledge regarding sexual health, routine immunizations, and pregnancy care, as validated through methodical pre- and post-interaction assessments.

●      Output 2.1: From launch, employ validated surveys consistently over an 18-month period to ascertain baseline knowledge levels and monitor longitudinal changes.

●      Output 2.2: Reevaluate user knowledge at the 18-month mark to quantify improvements.

●      Output 2.3: Following the 18-month period, utilize paired t-tests to determine the statistical significance of observed knowledge gains, adhering to a p-value threshold of <0.05 to validate knowledge enhancements.

Outcome 3: Active Engagement

Objective: Within the initial 12 months, engage with a minimum of 1,000 new users in addition to the existing base of 9,500 downloads and 2,500 active users, aiming for deepened user interaction and adherence to provided health advice.

●      Output 3.1: Achieve a user base expansion by adding at least 1,000 new active users by the end-year mark post-chatbot integration

●      Output 3.2: Attain at least 80% interaction frequency with the chatbot among these engaged users through in-app analytic tools.

●      Output 3.3: Secure a minimum of 70% adherence to health advice provided by the chatbot, as measured by user follow-up.

Outcome 4: Establish Sustainable International Organizational Partnerships

Objective: By mid-2025, establish sustainable partnerships with a minimum of three renowned international organizations (e.g., WHO, UNICEF, MSF, UNHCR, IOM)

●      Output 4.1: Develop at least two long-term, active organizational-level users/relationships.

●      Output 4.2: Continuously secure funding for a stable 1.5-year financial runway.

HERA helps refugees access healthcare in their host countries by increasing the demand for healthcare and navigating the health system to save lives. Following the 2023 Turkey-Syria earthquakes, our scope broadened to include all disaster-affected women, given the impact on an estimated 4.1 million women of reproductive age and 220,000 pregnant women.

HERA's Theory of Change (ToC) is designed to leverage the "Navigator" in transforming user health behaviors and enhancing healthcare knowledge, aligning with UN Sustainable Development Goals 3, 5, and 10. The primary objective is a 30% increase in timely healthcare-seeking behaviors within one year of implementation (Outcome 1), monitored and validated through user data and rigorous statistical methods. Additionally, an 18-month goal has been set to boost healthcare knowledge by 40% (Outcome 2), assessed via regular surveys and statistical verification.

Within a year, HERA aims to attract at least 1,000 new users, focusing on deepening engagement and compliance with health advice (Outcome 3). This will be assessed through user base expansion, interaction frequency, and adherence to health recommendations, using in-app analytics. By mid-2025, HERA intends to establish sustainable partnerships with a minimum of three global organizations (Outcome 4), involving the development of long-term collaborations and consistent funding to ensure operational stability..

Here is our ToC:

Activities & Outputs:

Navigator Implementation: Implement HERA app feature for user guidance through healthcare appointments and essentials.

●      Monitor healthcare-seeking behaviors through interaction logs and feedback (Output 1.1).

●      Conduct post-implementation statistical analyses.(Output 1.2)

●      Administer continuous 12-month pre/post-interaction surveys.(Output 1.3)

Knowledge Enhancement via Navigator: Consistently offer sexual health, immunization, and pregnancy care knowledge.

●      Conduct consistent surveys to assess and track user knowledge (Output 2.1)

●      Reassess and quantify improvements in user knowledge at 18-month mark (Output 2.2).

●      Apply statistical tests to confirm knowledge enhancement (Output 2.3)

User Base Expansion and Engagement: Integrate chatbot to engage new and existing users.

●      Expand user base by 1,000 new active users post-chatbot integration (Output 3.1).

●      Achieve 80% interaction frequency with chatbot among users (Output 3.2).

●      Ensure 70% adherence to health advice provided by the chatbot (Output 3.3).

●      Utilize analytics for continuous engagement assessment (Output 3.4).

Organizational Partnership Development: Engage with international organizations to:

●      Build organizational-level relationships. (Output 4.1).

●      Secure sustainable funding sources.(Output 4.2).

Intermediate Outcomes:

Timely Healthcare-Seeking Behaviors: Minimum 30% increase in timely healthcare-seeking behaviors post-Navigator implementation.

Enhanced Healthcare Knowledge: 40% increase in user knowledge regarding key health areas within 18 months post-Navigator.

Active User Engagement: Deepened user interaction and adherence to health advice with at least 1,000 new users within a year.

Established International Partnerships: Sustainable collaborations with at least three global organizations by mid-2025

Long-Term Goal:

Amplify access to preventive health services for pregnant women and immunization for children under two globally, focusing on displaced populations, aligning with UN SDGs 3, 5, and 10.

Full time: 6, Part-time: 4, 3 board members ( in addition to the CEO), 30 contractors and volunteers

8 months for the AI powered chatbots, while the whole organization has been working on digital health tools for the last 8 years. 

Diversity and inclusivity are deeply ingrained values within our organization and we remain committed to furthering the representation of women in leadership roles. Notably, for this specific project, Dr. Neeru Narla [BK1] co-leading this project, reflecting our commitment to promoting gender balance in leadership. Dr. Narla's involvement demonstrates our focus on fostering inclusive innovation.

Women account for a sizable 80% of our direct project employees, particularly on our field work. Within our administrative board, women occupy 40% of positions, ensuring a diverse range of perspectives guide our strategic direction. This inclusive ethos is extended to our board of directors and other decision-making bodies, where women actively contribute to shaping our initiatives. Additionally, when seeking candidates for our projects, we prioritize women's involvement in management roles whose backgrounds align with the target communities we serve. Our organization is resolute in fostering an equitable environment, empowering women's leadership and management capabilities.

 [BK1]Co-lead olarak belirtmen gerekebilir !!

Our business model is primarily centered around providing critical healthcare services through a mobile application to refugees, with a focus on women and children who are often the most vulnerable in crises. This population faces a consistent, urgent need for healthcare amidst the challenges of population growth and resource decline, making the services offered by the HERA app not only essential for immediate health outcomes but also as a preventative measure to reduce long-term morbidity and mortality.

The value provided to these end users is immense, as access to continual healthcare services is crucial, often ranked alongside fundamental needs like clean water and shelter. HERA leverages a social enterprise model where the app is offered as a vital tool to healthcare providers in refugee-hosting countries. The integration of HERA into existing healthcare systems is a key part of the model, aiming to enhance the efficiency of current interventions while reducing costs. This strategic integration allows HERA to maintain its commitment to offering the app free of charge to end users, a crucial factor considering the financial constraints often faced by refugees.

While initially reliant on global health grants for funding, HERA anticipates a shift towards a more diversified funding structure over the next five years. By expanding its reach to additional refugee-hosting countries and scaling both the scope of services and the number of users, HERA expects grant-based funding to decrease from 100% to 50%. This scale-up strategy, particularly expanding the range of interventions and the targeted population, is attractive to humanitarian donors and is seen as a pathway to more sustainable funding.

HERA has previously been supported by accelerators, global health donors, research grants and social impact funds such as Google.org, Grand Challenges Canada, USAID, European Investment Bank and American Beirut University and Harvard Innovation Labs. Our team's journey has been marked by remarkable milestones and meaningful collaborations that underline our capacity to innovate and scale. With the seed funding of Grand Challenges Canada, we initiated this project, transforming an initial CAD $100k into USD$500k, demonstrating our ability to leverage resources for impactful expansion. This approval testifies to the team's professionalism, aptitude for collaboration, and the capacity to generate impact through innovation.

Furthermore, our team's achievements extend to international recognition and validation. We were honored to be selected as a finalist in the prestigious MIT Solve competition in 2023, affirming our innovative approach's potential for solving complex global challenges. Being chosen as a participant in Fast Forward's 2021 Accelerator program further highlights our commitment to pushing the boundaries of innovation and driving social impact. Additionally, our collaboration with the Turkish Ministry of Health underscores our commitment to working closely with established institutions to drive change at a systemic level.

HERA’s funding capacity increased %500 over five years.This funding growth, along with achieving 501(c)(3) status, exhibits HERA’s scalability and unparalleled ability to attract support from diverse leading expertise. However our long term sustainability goal is to work with healthcare providers to incorporate HERA to existing healthcare systems.

Our most immediate axis is the distribution of the application to populations in Turkey and expansion to new locations. With the global population of refugees on the rise, we are scaling up to take on new populations. When conflict, epidemics, and climate crises occur, new populations of refugees form. This is clearly seen in Ukraine, a country with a formable healthcare system, but the conflict of war removed the population from healthcare access. Ukraine is one of many crises where HERA can increase the efficiency of a refugee centered response.

Once we reach a critical mass (approximately 30K users) and have documented substantial  impact (number of additional vaccines, pregnancy check ups, etc.), we will begin negotiating with large healthcare providers such as MoHs in refugee hosting countries and/or UNHCR. We will offer HERA as a tool to (1) increase the effectiveness of their healthcare supply, (2) improve  maternal and child health outcomes in refugee groups, and (3) decrease health care costs. Our projected RoI of HERA (based on  similar programs’ results) is 334%. HERA will act as a consultant to the healthcare provider when implementing and integrating our HERA app into their healthcare system.