Barakat Bundle

Every year 4 million infants die and 300 thousand women die from causes related to pregnancy and childbirth, with a large fraction concentrated in South Asia. 80% of these deaths are preventable through existing interventions around time of birth and yet the world has not figured out how to distribute these interventions in a way that eliminates these preventable deaths. Barakat Bundle aims to solve this problem by creating life-saving care and education Bundles to ensure safe childbirth and first year of life for mothers and newborns in need in South Asia. Each Bundle consists of: 1) Evidence-based low-cost, high-impact essential solutions and technologies targeting major causes of maternal and infant mortality in South Asia; 2) Pictorial low-literacy health education for families; and 3) Patented safe-sleep bamboo Giving Cradle to incentivize and create demand. We expect 74% reduction in maternal and infant mortality in the communities where it is distributed.

Every year over 4 million infants die and almost 300 thousand women die from causes related to pregnancy and childbirth, with a large fraction concentrated in South Asia. The major causes of infant mortality include prematurity, infections, and birth asphyxia, while major causes of maternal mortality include hemorrhage and infection. These causes are well-understood and can be managed via proven and affordable public health solutions and technologies. Known, feasible, evidence-based interventions such as thermal care and clean delivery kits can prevent more than 80% of these deaths when provided in an integrated, demand-inducing, and cost-effective way. However, these barriers to care persist due to: (1) lack of integration between programs addressing different disease burdens, (2) inappropriate education accompanying health interventions; and most importantly (3) overlooking how to create demand for health interventions from mothers. Most interventions have an exclusive focus on ‘needs’ of the target population which do not address ‘wants.’ ‘Wants’ are equally important to increase demand, motivate utilization, and thus create impact, particularly with regards to healthcare.

Barakat Bundle aims to solve this problem by creating life-saving care and education Bundles to ensure safe childbirth for mothers and newborns in need in South Asia and to support them during the first year of the child’s life. Each Bundle consists of the following: 

1. Evidence-based, low-cost, high-impact essential solutions and technologies such as a sterile blade, cord clamp, chlorhexidine, thermometer, hand soap, baby oil, warm clothes, and more targeting major causes of maternal and infant mortality in South Asia as well as desirable goods to incentivize and create demand
2. Pictorial low-literacy health education calendar to teach families what is in the Bundle as well as other healthy topics like handwashing, breastfeeding, danger signs, etc.
3. Patented safe-sleep bamboo rocking Giving Cradle created and manufactured by Barakat Bundle with built-in mosquito net and sensory toy to reduce likelihood of suffocation. 

Furthermore, each Bundle acts as an incentive to motivate facility delivery because receipt of a Bundle is conditional on a mother giving birth in a health center to ensure skilled birth attendance on the most dangerous day for mother and baby.

Barakat Bundles support rural communities’ newborns and mothers in South Asia who cannot afford care, cannot access health centers, or do not have sufficient information to provide simple care at home. Communities are meaningfully integrated into the planning, implementation, and evaluation of the project in 3 ways: 

1. During the planning process, Barakat Bundle used human-centered design and gathered feedback from over 100 mothers, fathers, and healthcare workers in rural India
2. With regards to implementation, using the common ‘drop from the sky’ approach will not be effective, i.e. we cannot just ship Bundles and expect to see a significant change. Thus, Bundles are distributed directly to local health centers with training curriculums that health workers can adapt based on their knowledge of the communities they serve
3. For evaluation, our project involves leadership from local research institutions. 

Based on research around interventions included in Bundles, we expect to reduce infant and maternal mortality by 74% in communities where distributed. We expect additional indirect impacts from more empowered, educated, and equipped families, health workers, and health facilities. Barakat Bundle can be a comprehensive, integrated, and demand-driven delivery model for these interventions to improve maternal and child health across South Asia.

Barakat Bundle addresses infant and maternal mortality in South Asia. Our solution expands access to low-cost, high-impact solutions and technologies to mothers and newborns in need by addressing barriers-to-care through a groundbreaking delivery model. Furthermore, Barakat Bundles expands access to facility delivery because receipt of a bundle is conditional on mothers giving birth in a health center. The patented safe-sleep bamboo Giving Cradle with built-in mosquito net acts as a strong incentive for families. We created and manufactured the Giving Cradle because families told us it is a key motivating factor for them to give birth in a health center.

There are 3 key reasons why Barakat Bundle is innovative and different than existing interventions:

1. Comprehensive: Unlike other interventions which focus on singular issues, Barakat Bundle understands that this is not a one-dimensional challenge. As such, Barakat Bundle addresses multiple causes of mortality and barriers to care, builds educational capacity among health workers, improves quality of care provided by health centers, and empowers mothers to champion care for themselves and their newborns. It is only by addressing both demand and supply side aspects of the challenge in a multidimensional way that we can expect to make significant improvements.
2. Integrated: Unlike other interventions which often operate in silos or parallel to the existing health system, Barakat Bundle works in sync with the existing health system and other mission-aligned actors. By collaborating and building on existing efforts being made by the government and other NGOs, we can amplify each other’s’ efforts to reduce preventable maternal and child mortality more effectively and efficiently.
3. Human-Centered Design: Unlike other interventions which are often designed without input from the target population, Barakat Bundle was developed with input from over 100 mothers, fathers, and healthcare workers in rural India. Why did we do it? We believe that creating Barakat Bundle with the people whom it is intended to serve means that it is more likely to be accepted, more likely to be understood, more likely to be used correctly, and thus more impactful at eliminating preventable infant and maternal mortality than other existing interventions. 

1. By offering families items that they need and want to take care of themselves and their newborns with a condition that to receive it they must give birth in a health center, we are motivating health seeking behavior on the most dangerous day for mother and baby.
2. By providing families with education in addition to items while also training local health workers, we are empowering communities to provide stronger home-based care to their families and motivating proactive, preventive health behaviors rather than reactive, emergency health responses. 

Barakat Bundle uses manufacturing technology through 2 key inclusions in the Bundle.

1. Each Barakat Bundle includes a curated compilation of existing evidence-based solutions and technologies such as sterile blade, cord clamp, chlorhexidine, thermometer, hand soap, baby oil, warm clothes, and more targeting major causes of maternal and infant mortality in South Asia with desirable goods to incentivize and create demand.
2. Our patented safe-sleep bamboo rocking Giving Cradle with built-in mosquito net and sensory toy to reduce likelihood of suffocation is created and manufactured by Barakat Bundle. Further details on specific items and their evidence-based health impact are included in the table below. Note that items in pink are considered to be demand items that drive demand for the Bundle.

Known, feasible, evidence-based interventions such as thermal care and clean delivery kits can prevent more than 80% of infant deaths (Bhutta 2014) but this can only be achieved if the interventions are welcomed and used appropriately by target populations. Demand is a critically important factor in motivating and empowering families to adapt healthy behaviors and is often overlooked in current public interventions (Banerjee 2012). Barakat Bundle’s items, specifically the patented safe-sleep bamboo rocking Giving Cradle has been shown to generate demand needed. We have completed two product development pilots in India, where we interviewed mothers, fathers, and healthcare workers, tested our distribution model, and used the process of human-centered design to curate appropriate medical items and create our safe-sleep cradle. Our pilots have shown that parents want to use our Bundles. 73% of mothers we interviewed stated that they desired the items in the Bundle. When provided with the Bundles, mothers also used the items; for example, 95% used the soap and an average of 80% of mothers used all items according to follow-up visits.

We create Barakat Bundles that incentivize expectant mothers to deliver in a health center and receive their own bundle containing evidence-based solutions and technologies that support healthier infants and mothers in South Asia. The image below outlines the mechanisms by which Barakat Bundle will create social value within South Asian societies. The most direct impact of the program will target infants and mothers. Beyond this however, families will benefit from reduced loss of life, more informed parents, improved happiness, and greater earning potential.

We have completed our two product development pilots where we interviewed more than 100 mothers, fathers, and healthcare workers. and finalized our supply chain. In the next year we will serve 400 families in Madhya Pradesh, India. In five years, we aim to serve over 5,000 of families.

In the next year our goal is to launch our first large scale distribution pilot in Madhya Pradesh, India. Our proposed pilot involves distributing 400 Barakat Bundles over a 3-month period to families. With this pilot we can work with local health systems to help 400 newborns have a safe birth and a healthy first year of life. Going forward, in the next five years we plan to increase the scale of distribution within India while reducing the cost of Bundles through economies of scale. All distributions are conducted with non-profit Indian community partners and include ongoing evaluation points to allow for iteration and improvement. We also plan to transition from a grant-based funding model to a sustainable revenue generating business model through sales of our patented Giving Cradle in North America.

In the next year, we are well positioned to conduct our distribution of 400 Bundles but may have to scale up or down depending on if we can close our final USD 10,000 funding gap. In the next five years, however, we are facing an opportunity/challenge with regards to our sustainable funding model. Our goal is to sell our patented Giving Cradle in North America to fund our non-profit distribution of full Barakat Bundles (i.e. including Giving Cradle) in South Asia. We face barriers with regards to market entry in North America and capacity to manage North American sales while maintaining focus on our core non-profit work of distributing Barakat Bundles. We are specifically concerned how much financing and effort to put towards marketing in North America which can ultimately help fund Barakat Bundle sustainably in the long run but may have short term unintended consequences; and yet without it may limit our sustainable business model’s chance for success.

To address the financial barriers for the upcoming year, we are actively looking for funding to fill the gap. To address the market barriers for our sustainable business model over the next five years, we have generated connections with parenting and women’s networks as well as social media mom-influencers. We are also exploring wholesale platforms to minimize our cost per customer. Last year, we launched sales of our Giving Calendar and Giving Kites sensory toy in North America to familiarize ourselves with North American marketing and operations and to generate a consumer base so that the launch of the Giving Cradle builds on the foundation we have built. We are looking for support in marketing with a specific focus on consumer goods for parents (preferably cradle). Note that all sales of Giving Calendar, Giving Kites, and Giving Cradle in North America are used to subsidize our non-profit work in South Asia.

We currently have 4 part-time staff and 3 contractors.

As an all-female team focusing on solutions for mothers and their children, we are passionate and personally vested in our product. This drive provides our team with unique insight and passion. We have invested our time, energy, and resources without taking salary to bring our vision to reality. In addition, our team represents diverse backgrounds with significant public health, operational, business and research experience. All of our team has lived and worked in South Asia, with a special focus on India, and have strong personal and professional networks throughout South Asia. In addition, we recognize gaps in our skill set and have worked with others (Agenda28 for design assistance, Indian Institute for Public Health for on-the-ground research support) so we can focus on our core competencies. We have been able to leverage resources from our domestic networks including the Harvard Innovation Lab, MassChallenge, Brigham and Women's Hospital, and Halycon Incubator among others to create a strong network of mentors and board members.

For our upcoming distribution pilot in India we are currently working with Johnson & Johnson and ayzh as corporate partners, Aarogyam Knowledge to Action Society as our NGO distribution partner, and Indian Institute of Public Health as local research evaluators. 

Our current business model is a grant-based funding model that allows us to provide Barakat Bundles to non-profit partner organizations in India. We provide them with Bundles and training manuals for their community health workers which help connect families to the health system for childbirth, alleviate pressure on the health system through empowered home care, strengthen education and care provided by community health workers, and ultimately support them in serving a healthier community with each new baby that is born. We are looking to pivot the funding element of our model to a sustainable revenue generating business model through cross-subsidization with North America. We have launched our Giving Cradle brand in North America and our goal is to create a hybrid organization where Giving Cradle licenses the patent from Barakat Bundle and Barakat Bundle owns a portion of Giving Cradle so that the two businesses are mutually beneficial. 100% of sales from Giving Cradle will support Barakat Bundle. This means that as Giving Cradle grows, Barakat Bundle can help more families in need. This new business model will add a business to consumer side to our work in North America. We anticipate families in North America will be interested in purchasing the Giving Cradle because it exceeds all safety requirements, is eco-friendly, and with each purchase they help a family in need in India receive the exact same Giving Cradle and more through the partnership with Barakat Bundle.

As mentioned in the previous answer, we are currently shifting our financial strategy from grant funding as a standard non-profit to revenue generation with the addition of our North American Giving Cradle brand. We expect to continue to solicit grants and donations and we actively try to prioritize focus on recurring grants and donations to minimize our cost to obtain each dollar each year. However, our goal is to be primarily funded by our revenue generation. We also plan to minimize costs and add impact by eventually shifting our supply chain to India so that we can provide economic impact to people in bamboo farming and manufacturing, fabric sewing, printing, and other industries.

We are applying to Solve because we are looking for a supportive community that can help us advance our efforts as we pivot from a grant-funded model to a revenue-generating model. This is a sink or swim moment for Barakat Bundle and the mentorship and strategic advice that Solve and MIT’s networks can provide will be critical in increasing our likelihood of success. We also hope to be able to share our experience in human centered design, non-profit operations and partnership development, product development (including passing regulatory safety testing and obtaining a patent) as well as international sourcing and manufacturing. Being part of this community would be incredibly meaningful to our organization, to us as individuals, and ultimately to the mothers and children that we serve.

We are looking for strategic partners who can:

1. Help us reduce our costs and take advantage of economies of scale as we increase manufacturing and distribution of Barakat Bundle.
2. Provide strategic advice as we adjust our business model from grant-funded to revenue-generating and from exclusively B2B in India to the addition of B2C in North America
3. Advise on marketing, media, and exposure for Giving Cradle in North America to kickstart our sustainable funding model. 

We are also open to partners who can ‘see what we do not see’ based on their experience and can provide advice that can open our eyes to other opportunities or pitfalls that may lie ahead.

The behavior change technology that drives Barakat Bundle, i.e. using demand items to drive health seeking behavior, is very much inspired by MIT professors Abhijit Banergee and Esther Duflo. Their book, Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty was essential to our investment in human centered design to develop Barakat Bundle. An opportunity to share our work with them and get their feedback as we constantly iterate and evolve would be unparalleled. 

We would also love the opportunity to work with the MIT D-Lab to further develop the organizational design of our bundle, i.e. is there a way we can organize or present the items and information in the Bundle to further motivate and incentivize greater use? 

Finally, we are very much inspired by the behavior change story of Lucky Iron Fish and would love to learn more from CareMother and Neopenda. We are always open to learning from and sharing with other mission-aligned organizations because it often leads to unexpected opportunities for partnership and/or key takeaways that allow us to build off each others’ learnings or missteps along the way. We would specifically love to include Lucky Iron Fish as an item in our Barakat Bundle.

The world doesn’t need exciting new technology to reduce maternal and infant mortality, it just needs to figure out how to better use the technology we already have to create more impact. 80% of maternal and infant deaths are preventable and we already have the tools to solve them. Barakat Bundle qualifies for the Innovation for Women Prize because we have compiled a curated and comprehensive collection of existing evidence-based solutions and technologies such as sterile blade, cord clamp, chlorhexidine, thermometer, hand soap, baby oil, warm clothes, and more targeting major causes of maternal and infant mortality in South Asia with desirable goods to incentivize and create demand. The key desirable good is our patented safe-sleep bamboo rocking Giving Cradle with built-in mosquito net and sensory toy. However, to receive this full Bundle, mothers must give birth in a health center. This piece of the puzzle is our behavior change technology - by offering families items that they need and want to take care of themselves and their newborns with a condition that to receive it they must give birth in a health center, we are motivating health seeking behavior on the most dangerous day for mother and baby. 

Barakat Bundle would use the Innovation for Women Prize to scale up distribution of our comprehensive collection of existing evidence-based solutions and technologies across India to empower more mothers to provide better care for themselves and their newborns.

India has a vast network of community health workers known as ASHAs who are responsible for health promotion and education, specifically involving prenatal care, motivating childbirth at a facility delivery, and postnatal care. However, they are not always equipped or empowered to provide necessary public health interventions, specifically for maternal and child health. We found ASHAs face many barriers, including:

1. Lack of access to medical items.
2. Lack of appropriate health education materials for low-literacy families.
3. Limited strategies to create demand from mothers for health interventions. 

To develop Barakat Bundle, we sat down with over 100 mothers, fathers, and ASHAs to develop the final Barakat Bundle that:

1. Ensures mothers and ASHAs have access to simple medical items to provide care.
2. Empowers ASHAs to provide appropriate health education.
3. Facilitates ASHAs in encouraging health seeking behavior with a demand-generating cradle incentive. Barakat Bundle builds on the existing health system infrastructure in India to empower mothers and ASHAs to reduce preventable infant and maternal mortality in South Asia. 

Our team will use the Health Workforce Innovation Prize to invest in further developing our training materials for ASHAs, to provide sample Bundles for local communities that ASHAs can use for training purposes, and to scale up Barakat Bundle’s distribution in more communities across India.

Unlike other interventions which often operate in silos or parallel to the existing health system, Barakat Bundle works in sync with the existing health system and other mission-aligned actors. For example, Barakat Bundle leverages the existing community health worker network in India to deliver health education around the Bundle which builds their knowledge and capacity while also strengthening community trust in the existing health system. Unlike other interventions which are often designed without input from the target population, Barakat Bundle was developed with input from over 100 mothers, fathers, and healthcare workers in rural India. We believe that creating Barakat Bundle with the people whom it is intended to serve means that it is more likely to be accepted, more likely to be understood, more likely to be used correctly, and thus more impactful at eliminating preventable infant and maternal mortality than other existing interventions.

India is a diverse country with different needs across different communities - our goal is to create Barakat Bundle in a way that supports maternal and child health across the country while also delivering it in a way that affords health workers the opportunity to adapt it to their local health practices. We would use the Bill & Melinda Gates Foundation Funded Award to scale up distribution of Barakat Bundle across communities in India to empower families to obtain better care as well as the health system and health care workers to be able to provide better care.