'Guddi Bajis': a gender-inclusive, digital workforce

The exclusion of women in the workforce in both developing countries and mature markets has resulted in not only a massive loss of human potential but also loss of human life - especially in developing countries such as Pakistan where over 140 million people continue to lack access to quality, affordable healthcare.

The 'Guddi Baji' last-mile, Micro-retailer Value-creation Program (MVP) provides frontline health workers with: (i) technology inputs (software/hardware), (ii) training (app-enabled, inventory management, business skills, entrepreneurship bootcamp) and (iii) income-generating assets (inventory such as fast-moving consumer goods, health supplies and products and digital financial services). 

This MVP impacts SDGS 1 (poverty alleviation), 3 (health), 5 (gender equality), 8 (dignified work), 10 (reduced inequalities) and 17 (public-private partnerships).

The exclusion of women in the workforce in both developing countries and mature markets has resulted in not only a massive loss of human potential but also loss of human life - especially in developing countries such as Pakistan where over 140 million people continue to lack access to quality, affordable healthcare.

In Pakistan, the good news is that the government has trained over 100,000 female Frontline Health Workers (FHWs). The bad news is that over 80,000 of these workers are unemployed or underemployed and both physically and technologically disconnected from the mainstream health system. 

Reasons for exclusion of FHWs include: (i) lack of consumer awareness around the availability of point-of-care (PoC) diagnostics in rural communities, (ii) lack of demand in the public sector for the skills of FHWs in the absence of qualified doctors and (iii) rigid public health systems that prohibit FHWs from working part-time or flexi-time.  

Our target population consists of over 3 million low-income lives across 3000+ villages in 36 districts of Punjab and Sind (low-income = income less than $3/day).

When designing our model, we immersed ourselves in the target population we are serving so we could observe their natural behaviour. As a result we have a more nuanced understanding of their actual needs (in addition to the needs they verbally expressed). We rapid prototyped our model to deliver different types of frontline health interventions with or without remotely connected doctors. The model which received the most positive feedback and which we continue to iterate on is the nurse-assisted video-consultation model. We also have created tight customer feedback loops that feed directly into our service design.

Female Health Workers (FHWs), nurses and community midwives are recruited, equipped and trained on ICT hardware/software (tablets, broadband connectivity and point-of-care (POC) diagnostic tools such as handheld ultrasound) and then deployed in a rural, hub-and-spoke model. 

The digital health & wellness hubs are operated by female retailers (Guddi Bajis) with inventory supplied by Unilever and major pharmaceutical companies via a social business model. The spokes consist of a group of 4-6 female FHWs who cover a cluster of between 6-8 villages and prioritise end-user cases based on guidance provided by AI-inputs and predictive analytics. 

All FHWs are trained on Basic Life Support (BLS) and Advanced Life Support (ALS) and can escort acute patients/trauma victims in ambulances/ambulettes to the nearest tertiary care center while delivering life-saving interventions at point-of-care or during transport to the trauma center, guided by remotely located Emergency Room (ER) physicians and trauma surgeons.

The technologies we apply include the following: (i) HD video-consultation linked to a digital health platform; (ii) AI & big data-enabled Predictive Analytics to help our FHWs prioritize the geographies and cases they cover in the field and (iii) Point-of-Care digital diagnostics (e.g. handheld Ultrasound, ECG, fetal heart monitoring, etc)

The Guddi Baji last-mile retailer project is unique in that it: leverages technology, (ii) up-skills frontline health workers and (iii) involves a large-scale public-private collaboration between Unilever, doctHERs (a 2017 MIT SOLVE winner) and the Punjab provincial government.

We  recruit, capacitate, and equip frontline health-workers (midwives, etc) with laptops, tablets and smartphones. These trusted intermediaries are essential to our model as they help to build trust with health consumers in a culture which values interpersonal human interaction (as opposed to virtual). By leveraging technology, we are able to amplify access to quality healthcare to remote rural and urban slum populations alike.

We believe that the re-integration of women into the workforce (output) by leveraging technology (an input) will yield increased economic empowerment for women (outcome) which will ultimately lead to increased returns for both society and participating corporate/business partners (Impact). This theory of change is based on compelling evidence cited by Dalberg (1) and the Cherie Blair Foundation (2) which reports that "female sales agents had superior customer service skills and processed customer queries more quickly than men" 

1. Dalberg: "The business Case for Women's Economic Empowerment"; 2014

2. Cherie Blair Foundation: “Women Entrepreneurs in Mobile Retail Channels”; 2011 

We are currently serving over 1 million lives in 16 districts of Punjab and 2 districts of Sind. Our current beneficiaries include 22,000 low-income (income less than  $3/day) workers who are linked to corporate value chains and work in factories where it is relatively easy to deploy up-skilled, tech-enabled female frontline health workers (FHWs). 

By the end of 2020, we expect to be serving over 2 million lives across 36 districts of Punjab & Sind. 

By the end of 2025, we we expect to be serving over 25 million lives across  South Asia (Pakistan, India, Bangladesh), i.e. '25 by 25'

Our goals over the next 12 months are to:

(i) positively impact the health & socioeconomic outcomes of 2 million+ women and children in our target population in 3000 rural villages across Punjab in which Unilever is currently delivering their 'Mera Sona Gaon' community activation projects; 

(ii) deliver over 500 life-saving interventions at point of care and

(iii) demonstrate the technological and clinical feasibility of this program at a scale of 200 Guddi Bajis deployed at the frontlines via this model

Our goal over the next 5 years is to:

(i) positively impact the health & socioeconomic outcomes of 30 million+ women and children in our target population across South Asia, N. America, ASEAN, MENA and Sub-Saharan African regions. 

Barriers over the next 5 years include:

(i) Access to Retainable, Human Talent: remains a major challenge for social enterprises

(ii) Access to Growth Capital: we currently operate in a frontier market (Pakistan) where the human need for our services is great but where it is very challenging to raise growth capital.

(i) Access to Retainable, Human Talent: We plan to recruit (and retain) intrinsically motivated talent that is curious, compassionate, courageous and keen to make a scalable impact. 

(ii) Access to Growth Capital: we will replicate our model across other geographies and enlist American and European impact investors who are seeking unusual returns. 

Market Failure 1 (supply-side): Over 15,000 licensed female doctors in the US are transitionally excluded from the US health workforce at any given time due to childcare or parental care responsibilities. In addition, there are thousands of international medical graduates (IMGs) who are trained as medical doctors but not licensed to practice medicine in the US. 

Market Failure 2 (demand-side): Over 25 million Americans (and another 11 million undocumented workers) lack access to affordable, high-quality healthcare because they are ineligible for government health programs (Medicaid or Medicare). 

Our Solution for the US: We will capacitate and equip IMGs to serve as frontline health workers (FHWs). They can be deployed in factories, retail clinics, community centres and corporate offices where they can connect underserved, uninsured health-seekers to a nationwide network of remotely located, (female) doctors via HD video-consultation/telemedicine. 

30+ full-time staff; 90 full-time contract staff

We are a diverse team of cross-sectoral experts - with over 60 cumulative years of experience in the following industries: pharmaceuticals, healthcare, finance, online education, AI technology, big data science, design thinking, gender-inclusion and women's entrepreneurship. 

Over the past 5 years, we have taken our social business (doctHERs) to scale and profitability in Pakistan. We are now embarking on a major scale-up/amplification of the frontline health worker initiative to enable us to further amplify our impact across South Asia and North America.

Our current partners include:

• Philips (handheld ultrasound)
• Miller Center for Social Entrepreneurship - accelerator
• Innovations in Healthcare - peer innovator network
• Corporate Customers: Unilever, Reckitt Benckiser, Telenor, ClickMedix, Accenture, Roche, 
• United Nations Development Programme (UNDP)
• UNICEF
• UN Women
• Funders: Pfizer, Grand Challenges Canada, Development Innovation Ventures, Philips, Unilever, UKDFID, Gray Matters Capital, 

Our core business model is very straightforward: we charge corporate employers/sponsors a subscription fee for a monthly digital health & wellness plan of ~$5/person/month. Our COS (Cost of Sales) is $2.50/person/month, yielding a gross surplus of 50%. After deducting SGA (sales, general & administrative) operating expenses, we are able to generate a net profit margin at the unit economic level of ~15%-20%. 

Corporations are willing to pay this amount both to mitigate against reputational risk (worker HSE regulations) as well as to incent their value chains ( distributors, retailers, etc) to perform better - our path to scale. 

We have 3 major revenue streams identified for 2020:

• Earned Income via SMART telemedicine clinics: $250,000 projected for 2020
• Health Service Delivery Contracts for Corporate Value Chains (suppliers, distributors, retailers, etc)  - $1.5 Million projected for 2020
• Growth Capital - Series A - $2.5 Million (close by July 2020)

ServiceNow can help us overcome the following barriers:

(i) access to human capital development: by enabling customised employee workflows that help to boost employee productivity and morale  while delighting customers.

(ii) Digital Workflow Integration: your ServiceNow platform can help to integrate discrete workflows across multifunctional workforce groups (e.g. healthcare providers who are also last-mile retailers) 

• Management Consulting Firms (Accenture, BCG, McKinsey)
• Digital Health Innovation companies (Google, HP, McKesson, etc)
• Software Integration Companies