Be Ready

Poor pregnancy outcomes, maternal mortality, low birth weight and Non-Communicable Diseases (NCDs) in women are our major public health challenges today. Most of these are preventable with good PCC. There is strong evidence that indicates that focusing on PCC in women of reproductive age (WRA) dramatically improves health outcomes. 

Our solution is a no cost, easily accessible web-based health risk checklist that will provide a woman and her healthcare provider with a roadmap for a successful pregnancy. This instrument can be self-administered or be administered by a frontline healthcare worker or a provider. 

Be Ready will position hundreds of millions of women on a healthy trajectory for life and will be  a game changer in maternal and baby outcomes. A healthy pregnancy signals less of an NCD burden in the future. Be Ready aims to reframe women’s health and transform the health of future generations.

Over 140 million births (an even greater number of pregnancies) happen globally every year and India alone had 25 million births in 2019. Billions of women are in the reproductive age group and Be Ready aims to leverage this phenomenal opportunity by providing a springboard for these women to get on a healthy trajectory for life and morph the health of future generations. 

Unplanned pregnancies, under and over nutrition, risky lifestyle behaviour, de-prioritizing their health and rising mental health challenges are just a few of the many impediments to women’s health. Statistics show that -

• 1/3 of all WRA globally and more than 50% in India have anaemia
• Unplanned pregnancies account for 41% of pregnancies that occur each year worldwide
• The GDM rate in India is one of the he highest in the world 
• Worldwide, there are more than 300,000 babies born with neural tube defects each year and is projected to be 4 per 1000 births in India
• Globally, there are 105,000 babies born with congenital rubella syndrome and of this 38% are in India
• An estimated 116 million babies will be born under the shadow of COVID-19 and 20 million are expected to be born in India alone

Be Ready is a PCC tool. PCC is the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. It is a web-based app that encompasses all aspects of pregnancy preparedness and walks a user through a comprehensive set of questions and provides a detailed report card of the woman’s health that will flag areas that need attention. This will allow the woman to make the necessary changes and her provider the opportunities to address and act on the risks identified. 

The 20-point checklist will address most factors influencing women’s health in their reproductive years will be the key to our solution - Anaemia, BP, Contraception, Diabetes, Environment/Hygiene, Folic acid, FGM, Heart, Health history, STIs, Mental health, Nutrition, Physical activity, Recreational drugs/alcohol, Smoking/Vaping, Thyroid, Vaccinations, Sleep, Medications and Weight. The website will include a section on more detailed information to learn more.

Be Ready is designed to be a easily accessible questionnaire hosted on a website that is mobile friendly. The tool is being designed to be universal and ubiquitous to women. Women can  self-administer the health questionnaire or have a frontline health worker administer to them. It is tool for any woman, anywhere, anytime.

Be Ready seeks to serve two distinct groups that work in tandem - WRA and frontline health workers and Ob-Gyns to easily identify and acknowledge the health risks. Be Ready acts as a risk calculator that allows a woman to make an informed choice to starting a pregnancy.

Prior to initiating the Be Ready journey, the team has conducted surveys with a number of Ob-Gyns to understand the recurrent but preventable problems occurring in pregnant women. The results indicated a need to address several issues that are easily preventable with better education, awareness and guidance. The survey also found that a number of women seeking PCC was very low. This tool will strengthen the services delivered by healthcare providers. 

Be Ready helps women in – 

• Empowering her to voluntarily choose PCC to plan a pregnancy 
• Initiating a dialogue regarding her readiness for pregnancy 
• Evaluation of her overall health and providing opportunities betterment 
• Education on the significant impact that social, environmental, occupational, behavioral, and genetic factors have on pregnancy 
• Identification of her at high risk, if any, for an adverse pregnancy outcome 

The Be Ready solution is all about maternal and new born health and is perfectly aligned with the challenge by being the  preliminary complement in maternal care services. 

Women’s health needs are marginalized due to inequitable access, affordability or being de-prioritized in the social pecking order. This and a limited voice on determining when to have a child, results in many unplanned pregnancies. One of the most glaring omissions in MCH is the unmet need for PCC. While pregnancy emergencies cannot be predicted, maternal outcomes can certainly be prevented through preparedness and that is what Be Ready aims to do. 

Be Ready is a comprehensive pre-pregnancy health risk calculator that allows women and their healthcare providers a platform to offer 360 degree approach maternal and newborn health. 

The solution also offers a concrete, tangible health report card at the end of the assessment that flags health issues that need addressing or course correction and provides an opportunity to change behaviour and lower risk. Be Ready is an evidence based, globally scalable instrument that can be a gamechanger in the world of MCH. We envision Be Ready to be validated and approved by Ob-Gyn societies and made standard of care.

It’s the first of its kind and accessible to users who are technology savvy or not. The next version of Be Ready will allow for a frontline health worker or another individual to administer the questionnaire for woman who is unable to. This is particularly relevant in the post COVID world, where technology has disrupted everyday activities including doctor’s visits. The ability to administer this questionnaire online or as part of an EMR and use this report card during a Telemedicine consult makes it convenient and location neutral. It has the potential to be a multi-language, multi-cultural global application.

Another distinctive aspect to the Be Ready solution is our reach to young women via bridal coalitions. Bridal coalitions including matrimonial websites, wedding planners, jewellery stores and wedding wardrobe shops are part of the unique wedding landscape in India. We believe it’s an excellent starting point to reach our target audience. 

The core technology that drives this PCC assessment is a questionnaire hosted on a Website that will also be mobile friendly for the woman on the move. The front end of the solution is based on the Bootstrap and HTML framework, while the backend database is MySQL. A website based platform makes Be Ready globally accessible. Be Ready will be available as an app in the next stage of enhancement when funding is available. In a world that is supremely technologically conversant, an app version of Be Ready will support quicker, easier access and improve usability. 

Be Ready, in next phase of development will harness the use of technologies such as Google AI and Tensorflow integration to support automated data analysis and intelligent report generation, Google Dialogflow for automated Chat response and we are exploring a possible migration to MongoDB to manage Big data analysis as the usage of the assessment evolves. In terms of functionality, the system will include the ability for a frontline health workers (i.e. 870,000 ASHA workers in India) to administer the questionnaire on women in rural communities where technology access or literacy is limited. Enabling and promoting the concept of PCC through technology offers tremendous value in terms of data analysis for the improvement of women’s health in general and maternal outcomes in particular - 

• Prevalence pattern of common illnesses
• Prevalence pattern on lifestyle behaviours
• Prevalence on utilization of preventive health strategies such as vaccinations, taking folic acid etc.  Health literacy impact

Be Ready is hosted on the World Wide Web as a website with mobile friendly accessibility. Usage of the internet has become ubiquitous across the globe and in countries such as India, the availability of internet through mobile data and easy availability of smartphones is affordable thus increasing its popularity and usage. According to IAMAI's (Internet and Mobile Association of India ) 'Digital in India' report, India had 504 million active Internet users, who logged onto the web at least once in the last one month, at the end of November 2019. India also made the largest leap in the world in narrowing the mobile internet gender gap with the internet being popular among Indian women as well. Over 40% of Indian women were aware of mobile internet in 2019, as compared to just 19% a year ago and 30% of women use the internet. Women using menstrual, pregnancy, parenting and fitness apps such Glow, baby centre and Fitbit has increased significantly. 

This is a tremendous boost to the use of technology in a tool such as Be Ready where a woman has information at her fingertips to learn more on planning a pregnancy. Be Ready being available on the internet provides the privacy a woman needs, whether due to cultural or social constraints, in seeking the information required. In 2019, India had more than 24.1 million births and this makes it imperative to have a solution that is easily accessible to majority of this target group. 

The unmet need for PCC in improving MCH outcomes and importance of reducing unplanned pregnancies has triggered the need for Be Ready. Simple solutions such as folic acid supplementation to reduce NTDs, iron and micro-nutrients to correct anaemia, vaccinations to prevent rubella during pregnancy and congenital rubella syndrome and modifying lifestyle behaviours such smoking or drinking alone will produce dramatic results and save lives. Many complex issues such as diabetes, heart disease, blood pressure, mental health issues or epilepsy need more nuanced care and are time intensive. Only a well-planned pregnancy will allow the luxury of time to make these women healthy and prepared. 

We have designed this tool to be used by all women everywhere throughout their reproductive years. We plan to form a multi-sector, multi-stakeholder coalition involving WRA, the community, frontline healthcare workers, professional societies, medical practitioners and NGOs to help us carry our mission forward. 

Capacity build of professional Ob-Gyn groups and frontline health workers to effect a change in perception to include PCC will be vital to our success.  The impact of this solution will be measured by the increase in the number of women seeking PCC and providers seeing a decrease in preventable health risks.

The overall benefit from the solution includes -

• Improving awareness on the existence and need for PCC as a concept 
• Low cost and the relative ease of PCC and tremendous ROI in terms of improved maternal and child outcomes
• Expanding the dialogue on what constitutes preparedness for pregnancy thus focusing on health promotion and intervention 
• Broadening, what until now, was a narrow scope to MCH by including all meaningful health contributors
• Improved health literacy levels among women, reduced unplanned pregnancies, enhanced health of women resulting in improved maternal health outcomes, 

However, the lasting and long term benefit from Be Ready will be healthier women with healthy next generations and lower incidence of NCDs. The first nine months shape the rest of our lives and pregnancy is a window to future chronic disease - Be Ready is based on these principles.

Be Ready is in a prototype stage where we are testing the solution among localized target groups. As the solution moves to a Pilot stage, we hope to reach all the WRA in Chennai in the first year. Chennai has a population of approximately 2-3 million women of reproductive age and we plan to promote the use of Be Ready amongst these women. In the subsequent years 2-5, we plan to reach women across the country, in both urban and rural areas. We plan to increase coverage in the rural areas through our 870,000 ASHA workers and Community health workers in states where ASHAs are not present. In 2019, India had more than 24.1 million births and in the post COVID world, an estimated 20 million babies are expected to be born in India. Be Ready aims to reach a majority of the women in this age group. 

Year 1 will see the launch and promotion of the Be Ready solution in Chennai and will be focused at young women in general and those on the threshold of pregnancy and motherhood in particular. We plan to accomplish this by 

• Introduce Be Ready and sensitise women about PCC encourage women through workplaces and colleges
• Partner with bridal coalitions (matrimonial sites, wedding planners, jewellery stores etc.) 
• Capacity building of frontline health workers and Ob-Gyns on Be Ready/ and use of the tool
• Initiate the building blocks to develop the 360 degree care model of Be Ready to include ‘during’ and ‘post’ pregnancy components

In Years 2-5, we hope to expand the reach of the tool to peri-urban/rural areas across the country. This will include a multi-faceted approach – 

• Develop partnerships with NGOs/ government to include ASHAs/community health workers into the PCC gamut of activity. An ASHA worker’s responsibilities today include awareness creation on health determinants such as nutrition, sanitation/hygiene,  birth preparedness, safe delivery, breast feeding, immunization, STIs, ante natal care etc.. This meshes with the concept of PCC that the Be Ready tool promotes.
• Overall enhancement of product features based on feedback including integration/ upload of report to EMRs, professional training modules and Be Ready in local vernacular
• Partnerships with professional Ob-Gyn societies such as FOGSI/ FIGO and organizations such as NHS to explore a global promotion of Be Ready Partner with our programs such as Girls inspiring Girls Initiative (GIGI) to introduce the concept of a digital health advocate

The biggest barriers to implementing the PCC concept is to make it widely available on different technology platforms to enable ease of universal access. Currently, given our limited budget, we have developed the Be Ready tool as website that is also mobile friendly. The ideal way forward for more women to readily access and use the tool will be to provide it as an app on both android and iOS platforms. Funding to develop these apps has been a challenge and we hope to secure the funding partially through this grant to help accomplish that goal. 

The Guttmacher Institute has projected that just a 10% drop in reproductive health care due to COVID-19 will equal 15 million more unplanned pregnancies and 3 million more unsafe abortions. A direct impact of this is poor pregnancy or health outcomes. A significant way to avoid unplanned pregnancies and unsafe abortions is to encourage modern methods of family planning and contraception. However, cultural or religious barriers prevent the use of contraception. We hope to use ASHAs/ Community health workers to surmount these barriers through education. 

As with all things, change is struggle. Changing the mindset of women and practice patterns of Ob-Gyns and healthcare providers to recommend PCC will be a key challenge. Be Ready is a small investment promising huge returns in health for current and future generations. Even a small change in perception will be a giant step forward for the health care community and women’s health. 

The importance of having an attractive and informative tool is critical especially in these days of information  overload. In order to develop a top-notch app, we require the support of an excellent team and funding. While we will be deeply grateful to be considered for this grant to further this technological objective, we will also explore partnerships in related areas to support the advancement of this tool. 

A partnership with ASHA/ other international organizations is vital to the successful roll-out of this tool especially in the rural areas and globally. Towards this, a dialogue has been initiated Dr Rajini Ved, Executive Director of ASHA. ASHAs have tasted success in the work they have done on maternal health and we believe that a partnership to include PCC as an initial component in the maternal health will be the first step towards  planned pregnancies. The ability to partner with ASHAs/ Community health workers will require detailed discussions with the policy makers. The roles, cultural challenges and even maternal outcomes differ vastly in states and to convince the frontline health worker as well the policy makers on the need and criticality of PCC will be time consuming but achievable given this is the first of its kind effort at this level. We hope to raise the noise level and break through the cultural barriers to achieve our goals. COVID 19 and lockdowns have transformed healthcare as we knew it and this is an added barrier that online solution may unlock. 

The team has nine members of which – 

• Full time – 1 
• Part-time/ Consultant – 2
• Contractors - 6

The DIWAS Be Ready team is perfect complement of individuals with unique expertise in different areas. The teams’ multi-disciplinary skills is our strength and a common passion and drive to improve women’s health makes us view the challenge from different angles to ensure a comprehensive but viable solution. Deep subject matter expertise, domain skills, public health and policy specialisation, creative and technological skills have blended to seamlessly to take Be ready from a concept to a product. A quick summary of skills of the team - 

• Our Team leader and primary delegate for this project, Dr Usha Sriram is a Diabetologist and Endocrinologist and also the founder of DIWAS, a not-for-profit focusing on preventions of NCDs in women. She has a long association with the E V Kalyani Hospital that specializes in maternal health care. Dr Usha currently heads the Department of Diabetology and Endocrinology at TAG VHS (Voluntary Health Services).
• Geetha Veliah is an external consultant for the DIWAS team and is public health specialist. Geetha works as an Assistant professor at the School of Public Health, SRM University.
• Haripriya Eswaran is an external consultant with over 21 years of experience across payer, provider and public health domains. She supports DIWAS in planning and design of programs.
• Bindu Menon and Padmaja Venketram are our brand managers and have helped create the design strategy for the various DIWAS initiatives including Be Ready.
• Our technology partners are Pixel studios are helping us with the development of the Be Ready application. 

Be Ready is a an initiative from DIWAS. DIWAS (rebranding from DIWWAAAS is ongoing) is a non-profit headquartered in Chennai. Our focus is on women’s health and empowerment and our programs and partnerships are in line with our goals -  

DIWAS has partnered with Voluntary Health Services(VHS) to run the ‘Sahodari’ program. Sahodaris is a comprehensive low-cost diabetes care solution for women from low resource settings. The program is designed to ensure that these women will receive completely free consultations, investigations and medications for 1 year by when they have a good understanding of diabetes and are empowered about self-management and caregiving for people with diabetes. 

DIWAS is also the health and wellness partner for Project Puthri in collaboration with AVTAR Human Capital Trust. Puthri (meaning daughter in many Indian languages) is India’s first ever developmental project that seeks to create Career Intentionality among underprivileged girl students. The program focuses on a girl from an underprivileged family, studying in Corporation or Government School, between the age group of 13 & 18 years, studying in classes 8th to 12th. The identified girls will be trained through a combination of classroom sessions, games and corporate exposure, to understand her capabilities better, prevent her from dropping-out of school, helping her build meaningful relationships and developing the necessary skills to be successful in her career.

Be Ready will deliver value to not just to young women, but will positively impact future health outcomes across a community. In the short term, Be Ready helps identify and course correct health risks before planning a pregnancy thus eliminating preventable adverse pregnancy outcomes such as preterm birth, birth defects, pregnancy losses, low birth weight etc.. Besides the clinical and emotional burden, PCC also influences the economics associated with adverse maternal outcomes for mother and baby. 

It is an opportunity to educate a woman in the reproductive age group before she becomes pregnant and improve her chances of a healthy pregnancy and healthy baby. The bridal coalition aspect will be unique to our business model as it is a great entry point to women planning a family and particularly relevant in the social construct in a country such as India. Be Ready will be launched via social media to directly target the beneficiaries in urban areas. Partnerships with professional societies of Ob-Gyns and healthcare providers to create awareness on Be Ready  are planned. 

In the long-term, NCDs such as diabetes, hypertension, heart disease and obesity can be prevented thus lowering the NCD burden of a community. A small investment in maternal health translates to big returns.  The cost of folic acid supplementation or rubella vaccination is peanuts when compared to the cost of taking care of a child with NTD or congenital rubella syndrome. The promise of a healthy baby is priceless.

Presently, Be Ready is being developed based on funding from a donor and will be launched as a free service. In its current avatar, the tool is hosted on a website and it is our vision to launch it as an app for which funding is required. We are looking at this grant as a potential source of funding to help develop the app versions of the tool and also enhance features in the tool such as inclusion of access to and training for ASHA workers, 360 degree care among others. 

As we move forward, we are evaluating the monetization of the tool through gamification and other sponsorships within ethical and legal constructs. This will support the maintenance, refining and enhancement of the Be Ready tool. We will seek partnerships with organizations in the mother and baby space as our 360 degree care becomes a part of Be Ready.

In the long term, we plan to work with policy makers in the government to include the Be Ready platform as a PCC measure within the scope of the government’s maternal health programs. We hope to achieve this through private-public partnership. 

We will be also be raising money by applying for funding from foundations such as Rockefeller, Gates, Merck for mothers, Global Fund for Women etc. 

We are eager to connect with the MIT Solve’s Health community of public health experts, technology leaders and entrepreneurs to further our ability to enhance the design, development and reach (within ethical and legal boundaries) Be Ready app. We’d seek to build a network across the globe to promote Be Ready across different communities. Most importantly, we are looking for diverse feedback and collaboration on the subject. 

Global problems need global solutions, global solutions need global partners and we look to the Solve partners and MIT faculty to refine our solution and help us leverage the huge network of the Solve family. We hope to be able to emulate prior winners who have gone on to making path breaking discoveries by defining a impactful, low-cost solution that changes the face of maternal and child health across the world. We hope that our capacity building modules will help break the resistance and change mindset of providers and influence standard of care.

We seek support through partnerships on –

• Industry networking
• Mentorship on new and efficient technologies
• Connections to professional groups across the globe on maternal and child health 
• Access and introductions to Grant organisations

We will be privileged to partner with organizations such as the Gates Foundation, Merck for Mothers, FIGO, International Federation of Gynaecology and Obstetrics, Jhpiego among others. These organizations have a track record of having delivered high quality solutions in low and middle incomes countries and leveraging their expertise and experience will serve us well. Their reach, vision, success, network and resources will aid us in making Be Ready a one of kind, dynamic solution. We believe that an organization such as FIGO will be the perfect partner and gateway for us to roll out Be Ready globally. 

Be Ready is an initiative from DIWAS, a NGO focusing on girls and women’s health. Our programs are aimed at ensuring equitable and timely access to health services for girls and women. Be Ready as a solution is targeted at women in the reproductive age group and heir influencers and mentors. The Be Ready ecosystem includes healthcare providers, frontline health workers, family, workplace and community and this platform is the ideal setting for women’s voices to be elevated and heard. As Be Ready evolves to include 360 degree care of ‘during’ and ‘post’ pregnancy support, capacity building for Ob-Gyns and frontline health workers, we also plan to use the tool focus on maternal mental health. Using role models, influencers and spokespersons to focus on the importance of not just maternal health but mental health within the maternal health spectrum will be crucial to ensuring one of our goals – happy and healthy mothers means happy, healthy children. 

Be Ready is a solution that comprehensively approaches the concept of preconception care. The challenge of preconception care being neglected is not just limited to lack of awareness amongst women but is compelling gap in the responsibilities of healthcare workers. For example, in India, community health workers/ ASHAs have a depth of responsibility around maternal health including pregnancy care, post pregnancy care and newborn care. Preconception care is missing in this vast scope of responsibility that has been critical to reducing maternal mortality in the country. 

Be Ready aims to work on capacity building of not just frontline workers but but midwives, obstetric nurses and Ob-Gyns also to change the mindset on focusing on maternal care from pregnancy alone. Frontline health workers will trained on the importance of planning a pregnancy, steps to be taken by a woman before she plans a pregnancy and training on the usage of the Be Ready solution. The solution in its next phase will include the ability for a frontline health worker to administer the questionnaire on women in the reproductive age group and use the health report to discuss health risks. The Be Ready solution will also introduce an online training for Ob-Gyns to initiate a dialogue with young women planning pregnancies or emphasising the need for preconception care for second and subsequent pregnancies. We believe that the frontline health worker and Ob-Gyn buy-in to the solution is critical and development of capacity building models for these groups is vital. 

94% of maternal mortality happens in low and lower-middle income countries and majority are preventable. Anaemia, malnutrition, rubella, low birth weight, GDM are all major public health issues and all of these health issues are preventable with simple, low-cost interventions. Be Ready is a no-cost solution that aims to build awareness around these and many other health risks and partnership with the public sector will be our USP in making this tool a standard of care in maternal and child health. 

We believe that a solution for saving lives in low and middle income countries will have to be very low cost or no cost, locally relevant, culturally appropriate and one that lends itself to partnerships with public sector. Be Ready is a solution for all women including those in the low resource settings. To bridge the gap in women from low resource settings using Be Ready, we plan to introduce a mechanism by which a frontline health worker can administer the Be Ready questionnaire on an user. Statistics show that over 20,000 babies are born with congenital rubella syndrome and this is easily preventable with immunization during childhood or adolescence. Empowering a woman with this information allows for ensure that she is vaccinated prior to planning a pregnancy and will also ensure that her children are vaccinated and protected. 

Capacity building of frontline health workers to include Be Ready in their scope of work is a critical part of the Be Ready strategy. We have initiated a dialogue with Dr Rajini Ved, Executive Director of ASHA to explore the ideal approach to expand the scope of including preconception care in the ASHA toolkit and best manner to train the workforce. A public-private partnership to rolling out Be Ready will help increase its usage and value and hopefully in time become a standard of care in government’s arsenal for maternal and child health.