The Future of Women-centered Healthcare

Pro Mujer’s Ami Cuidado is a healthcare platform connecting a network of physical clinics, digital health tools and community healthcare workers (CHWs) to improve access to affordable, high-quality healthcare for low-income women in Mexico. This model will establish three levels of interconnected physical clinics each equipping CHWs with digital tools to provide personalized treatment plans to women and refer them to physical centers. These clinic types includes: 1) Premium (large) clinics; 2) Convenient (medium) clinics; and 3) Rural (Mobile) clinics. Our goal is to reach a total of 1 million patients in the first year. 

 Ami Cuidado addresses the disproportionate barriers women face to accessing affordable, quality healthcare by providing women-centered services including sexual and reproductive care, preventative NCD and COVID-19 consultations and gender-based violence prevention. 

In Latin America, 1/3 of the population have limited access to affordable high-quality healthcare, especially for low-income women and their families. Furthermore, 54% of women had no effective access to critical health services, with estimates that 2.5 million families are pushed to poverty each year due to health costs. Additionally, women are disproportionally affected and report having an unmet need for critical sexual reproductive and family planning care. With an existing fragmented health system, continuous rise of non-communicable diseases and a pandemic emergency of COVID-19 underway, the need for women-centered healthcare services are greater than ever. 

Although research shows that gender-sensitive care yields improved outcomes, women-centered health remains largely absent in the region. Based on our 30-year history successfully providing over 9 million health interventions to underserved women in the region, Pro Mujer developed a social health enterprise called Ami Cuidado, an innovative women-centered design approach to primary healthcare. This multichannel healthcare platform is the future of women’s healthcare in the region providing affordable, high-quality services to both prevent and tailor treatment via three delivery channels: physical clinics, digital tools and community healthcare worker (CHW) outreach. 

Ami Cuidado is a healthcare platform connecting physical clinics, along with a CHW network and digital tools in Pachuga, Hildalgo Mexico. This platform model is a system of interconnected clinics by way of digital services, including four main features:  

1. Education: A virtual library including animated videos, infographics and articles on prominent health concerns for women in the community, including COVID-19 and NCD prevention information. 

2. Telehealth Services: Patients can subscribe to a membership to Ami Cuidado featuring the ability to schedule appointments online, review personal health data and coordinate video/phone chats for urgent needs with physicians and nurses. 

3. Community Health Workers & Digital Tools: Local women are trained on critical health and pandemic information to provide patient consultations, which includes a digital training on Pro Mujer’s patient data collection tool. Once patient information is input into the app, risk-level for COVID-19 and/or NCDs is determined by app calculations, allowing CHWs to inform and work closely with physicians and nurses to refer patients for further consultation. 

4. Chatbot Contact Center: A 24/7 A.I. chatbot to answer health concerns, with the option to connect with a physician or nurse if needed. 

Our solution targets women at high-risk of incurring in catastrophic healthcare expenses, especially those with NCDs and detected acute conditions; our clients in Mexico are low-income women who’ve become microentrepreneurs out of necessity, working mostly in the informal sector. 62% have levels equal to or less than secondary school and 90% of them are between 20 and 59 years old, 82% are overweight, of whom 45% are obese, 9% suffer from hypertension and 19% are pre-diabetic or diabetic. After scaling to the countries where we operate within Latin America, we plan to impact the lives of 2 million women by 2025. 

Further, the platform targets women and their families irrespective to their association to Pro Mujer. With Ami Cuidado, PM aims to become the primary healthcare provider of women and their families in Mexico and Latin America. Strengthening primary healthcare removing barriers of access, allowing women in low-income communities to resolve most of their healthcare needs, and their families’, in a one-stop clinic, making a massive impact on poor communities that lack quality healthcare. 

Nearly 60MM people could fall into extreme poverty due to health expenses for COVID-19. In a region where 1/3 of the population does not have access to healthcare, Ami Cuidado makes preventative healthcare services accessible to the most vulnerable population of women. Our solution is a hybrid of in-person and digital services focusing on individual health needs, and providing affordable COVID-19 testing, diagnostics and physician consultations. Our digital platform collects patient data to help improve prevention healthcare, while CHWs raise awareness on pandemic and health information locally.

Social enterprises focused on health are in a nascent phase across the region, with some highly specialized models appearing, such as Clínicas del Azucar (Diabetes care), Salauno (Ophthalmology) and Reina Madre (Obstetric care) in Mexico. These are potential referral partners for Pro Mujer’s patients to get specialized care, and represent examples of successful elements that PM aims to emulate. However, a women-centered primary care model, with both digital and physical clinic components, is scarce in the region, representing an opportunity for Pro Mujer to design unique healthcare experiences for women and build a high-demand and differentiated business model.    

We anticipate that our innovation will lead to better health results, and improved patient satisfaction and engagement. In turn, an improved health status will enable women to grow their business, increase productivity, work or seek educational opportunities and thereby reduce their economic vulnerability.  

Ami Cuidado platform is a set of systems and processes that all connect to offer a single online portal for patients to access all their healthcare needs. This online portal gathers information from consultations and services which are delivered through physical clinics, digital tools and community health worker outreach. Our physical clinics will have a woman-centered design that offers a safe and stigma-free environment that directly meets the health needs of women, while the online portal hosts digital health services such as health-risk questionnaires, virtual consultations and chat-bots. The CWH network will reach patients who require follow-up at home, either because the physical clinic is not accessible for them or they are in need of assistance to access the online platform.The clinical history of patients will be digitally captured via data collection apps and tools by physicians, nurses and CHWs, these tools then feature an embedded algorithm that determines patient risk-levels and the need for prompt follow-up treatment. 

For instance, CHWs will use a mobile app especially designed to gather patient information, identify those at high-risk for NCDs and COVID-19, and refer patients to physical clinics if necessary, as well as provide health information and evaluate patients improvements. The platform is simultaneously connected with diagnostics devices and services, building a robust patient registry, and tracking clients over time to ensure continuous health monitoring and management.

According to multiple health research institutions, digital health services, or telehealth, is ideally suited to meet the demands of patient care while at the same time reducing virus transmission, stretching human and technical resources, and protecting patients and healthcare workers. AI technologies improve the efficiency and accuracy of healthcare operations. For example, machine learning and artificial intelligence algorithms allow diagnosing and customizing patient care and follow-up plans to get better results. It is possible to achieve this by utilizing the software, different algorithms and modern computer hardware. Rugged tablet computers with application-focused features are an effective tool for data collection and real-time communications for all the healthcare workers who are battling against the COVID-19 on the front line helping to check the diagnosis and update patient information in real time. Additionally, public health authorities are advising patients to see their doctors remotely if they suspect they have symptoms of COVID-19, or need medical help for many other reasons. It reduces the chance of people getting infected by the virus if they can stay home. 

In a research study, tele-heath services were evaluated for the distant surveillance of patients with chronic disease, such as NCDs. AI methods were applied to the management and surveillance of the condition. A risk-stratification algorithm allowed for the early identification of patients at high risk of critical health conditions by way of telehealth measurement data recorded from patients, successfully treating those patients and preventing extreme complications to occur.

Problem. Latin American low-income women face barriers to access adequate health services; thus, limiting their ability to effectively treat and prevent critical health conditions. 

Activities: In Education: our platform offers direct healthcare education and trainings to women via clinics, CHW and digital tools with a focus on prevention in targeted NCDs (Diabetes, Hypertension, Obesity, Cervical Cancer and Breast Cancer) COVID-19, GBV and mental health. Basic health information is available through digital tools, such as patient portals and the chatbot contact center; 

Access: Basic healthcare services, referrals and counseling through CHWs, and physical clinics; while digital tools also provide basic services, referrals and counseling such as patient online portals and use of digital patient support (i.e., via WhatsApp). The goal is to identify patients with high needs at an early stage by modeling and predicting risk factors for key conditions. With a network of physical clinics and health specialists, our platform refers high-risk patients to get the adequate support they need to gain treatment and prevent health complications.

Prevention: Our platform features frontline health staff training on detecting and referring patients exhibiting risk factors for NCDs, COVID-19, GBV, sexual and reproductive health concerns and mental health issues. Trained frontline healthworkers, nurses and physicians, will then train and oversee CHWs to provide relevant and critical health education to women throughout the community.

Outputs: Increase in percentage of women showing interest and seeking better health, increase the number of patients receiving health service by Pro Mujer and partners, increase in the number of patients in follow-up treatment with NCDs, increase the number of women at reproductive age receiving family planning services, increase in referrals to low-cost, high-quality primary care. Increase in early detections of NCDs, including breast and cervical cancer.

Long term impact: Timely high-quality cancer detection; Increase in self-care knowledge through innovative and transformative channels; Positive compliance of NDCs treatment plans; Empowered and healthy women able to reach their full potential. 

In 30 years, Pro Mujer has provided over 9 million health interventions throughout Latin America. Ami Cuidado is part of Pro Mujer’s long-term healthcare strategy to provide health education; preventative healthcare; and access to high-quality, low-cost healthcare services to women throughout Latin America. Based on this plan, we aim to expand services to improve the lives of at least two million low-income women and their families in Latin America by 2025.  

This model will establish its first physical clinic “cluster”, along with a CHW network and digital tools, in Pachuca, Hidalgo, Mexico. The plan is to establish 25 clinics in Mexico in 5 years, with a system of interconnected clinics: a) Premium clinics: large, high-value service centers featuring a pharmacy, specialists and labs; b) Convenient clinics: medium size clinics with limited services, but ability to refer patients to Premium clinics; and, c) Rural clinics, or mobile clinics: reaching remote regions. We will reach 500,000 patients via clinics and another 500,000 patients via digital tools for a total of 1 million patients reached in the first year. In year 2, Ami Cuidado will expand to Nicaragua, and scale to Argentina by year 3. In Bolivia, this model is currently being implemented with our partner, “InnovaSalud”, a social enterprise with 42 clinics already established throughout the country. By 2025, we plan to have a digital platform with health resources for more than 2 million women and 100 clinics across Mexico, Nicaragua and Bolivia. 

In the next 5 – 10 years, Ami Cuidado facilities, equipped with in-house frontline health staff, digital tools and CHWs, will expand to 100 clinics throughout Mexico, Nicaragua, Argentina and Bolivia as a financially sustainable health enterprise. The goal is to reach approximately 13,000 patients per year in each clinic with expected channels for generating nearly $600K in self-sustaining revenue annually. By These revenue streams are as follows: (1) membership subscription fees (2) walk-in clinical services and (3) pharmacy sales. On average, membership sales will represent more than 70% of total revenue for each clinic, with anticipation of those sales to cover operational costs. This long-term sustainability vision features a compelling business case for impact investors, while also partnering with local governments to scale effectively and reach wider populations, while private investors support the overall model development. 

1) Clients do not seek care, follow referrals or adhere to treatment. Our data shows, 68% of women report not accessing care due to fear, confusion or lack of information, and 28% due to logistic barriers 

2) In México, there is an excessive offer of low-cost clinics (CAFs, pharmacies with a doctor), but these often lack quality doctors, do not prioritize patient outcomes, and overprescribe to raise profits.   

3) Unexpected withdrawal of funding or temporarily closing parts of operations due to unforeseen circumstances (ie. COVID-19). 

1) Clients do not seek care, follow referrals or adhere to treatment. Our data shows, 68% of women report not accessing care due to fear, confusion or lack of information, and 28% due to logistic barriers. 

• CHWs will sensitize, build trust, engage individuals, assuage fear and provide personalized information on diagnosis/treatment, reaching centers, & logistics to remove barriers. 

• Weekly CHW-client check-ups & follow-up schedules will ensure treatment adherence.  

• Quant/qualitative results will be reported to Pro Mujer’s team for mitigation analysis. 

2) In México, there is an excessive offer of low-cost clinics (CAFs, pharmacies with a doctor), but these often lack quality doctors, do not prioritize patient outcomes, and overprescribe to raise profits.  

• To mitigate, we will leverage our trusted name and CHW outreach to help women find and utilize our health centers. As more clients use services, the high quality of affordable care will positively differentiate our offering and exponentially grow service reach. 

3) Unexpected withdrawal of funding or temporarily closing parts of operations due to unforeseen circumstances (ie. COVID-19). 

• To mitigate this, we will leverage a mix of revenue sources embedded in the proposed project, and our sustainable operations model.  

• PM financial services have a history of achieving sustainability and profitability, experience on which we will rely as this project progresses. 

• PM will leverage stimulus package loans and offerings by the US government and local authorities to compensate for suspended services due to COVID-19. 

Abelardo Vidaurreta, Global Health Medical Manager: Leading the design and management, implementation and scale of PM’s healthcare platform.  

Fernanda Diaz, Global Health Programs Coordinator: With a specialization in program design and execution, will develop and establish the CHW model.  

Marcos Lavandera, Global Health Innovation & Technology Coordinator: A MEL specialist, leading the data strategy for data-driven decision making.  

Janet Gutierrez, Mexico Director of Health: She is a general surgeon and currently pursuing a Masters in Health Management, will be leading the operation of the clinics. 

Pro Mujer (PM) is a leading women’s development organization in Latin America with a mission to empower underserved women by providing access to finance, education and healthcare services. In 1990, PM began disbursing small loans to support women’s micro-enterprises. In 1998, PM introduced basic healthcare services, along with loans, addressing the most prevalent non-communicable diseases (NCDs). In our 30-year history, PM disbursed $3 billion micro-loans and provided over 9 million health interventions to 250,000 low-income women annually. Today, our goal is to build an accessible healthcare platform, Ami Cuidado, to become the largest health enterprise for women in the region. 

In 2019 alone, Pro Mujer provided over 446,000 health interventions for the five most common NCDs for women in the region as example:  

• 37,000 blood glucose tests, identifying 2,000 cases of elevated blood sugar.  

• 79,000 blood pressure measurements, identifying 3,000 cases of high blood pressure.  

• 18,000 Pap smears, identifying 1,050 cases of abnormal cervical cells.  

• 28,000 clinical breast examinations, identifying over 352 breast abnormalities. 

• 72,000 BMI measurements, identifying 47,000 cases of high BMI. 

PM is the leading implementer with strong partnerships for the development, delivery and evaluation of our proposed innovation.  

Strategic Partnerships: 

• Network for Specialized Care: PM is forging partnerships with local external providers to refer patients to specialized treatment through a network of providers across the country. 

• CHW Experts: PM will partner with CHW experts, including the Maya Health Alliance, to design our CHW model, and with Hesperian Health Guides, to adapt training apps and materials for CHW training and development. 

• Digital Health Tools Providers: In partnership with organizations such as MuralMed, and with support from Microsoft, PM is developing digital tools, including apps for frontline healthcare workers and patients, and a robust end-to-end digital health management system. 

• Research Institutions: In order to have an independent and unbiased perspective on our impact, PM is partnering with academic and research institutions, such as the Centro de Investigación y Docencia Económicas (CIDE) in Mexico, to conduct research on behavioral change and health outcomes. 

Ami Cuidado's business model will facilitate education, prevention and access to high quality and low-cost health care services. 

Ami’s main revenue streams will consist of: (1) membership sales; (2) one-time services, such as, consults, evaluations, lab tests and wellness sessions; (3) pharmacy sales; and (4) telemedicine consultations.  

Our membership model will offer the base of the pyramid access to annual and holistic health services, including basic and mental health consults general evaluations, ultrasounds, vaginal tests, pap smears, hypertension and diabetes tests, lab tests, unique wellness sessions. On the other hand, our digital clinic will offer telemedicine consults, an educational health and wellness blog and a chatbot contact center to address any need at any time.  

Our CHW network, which will consist of 1,200-trained workers focused on increasing detection of health risk and adherence to treatments on rural areas across Latin America. We estimate that 60% of Ami’s members will enroll through a CHW.  

By year 5, Ami will operate 17 clinic clusters, which will consist of a premium clinic and two smaller community clinics. Our premium clinic will operate with 4-doctors and 3-nurses and will have the capacity to attend more than 12,000 per year. Our smaller clinics will operate with 1-doctor and 1-nurse and will have the capacity to attend more than 3,000 patients per year. The costs related to the clinic operations include the medical and administrative staff salaries; the clinics rent, maintenance and services; our initial pharmacy inventory; and the disposable equipment. 

On a clinic cluster basis, we estimate that each cluster will have a positive operating income by its 2nd year of operations and that it will reach its peak operating efficiency state four years after it starts operating. Each clinic cluster will have an average revenue of 1.7 Million USD at its peak state and an operating income of 300K USD. Hence, we estimate that each cluster will have a 15%-18% operating margin by its year of operation.  

As mentioned, by year 5, Ami will operate 17 clinic clusters, reaching +$30 Million USD revenues and +$5M of operating income. Ami’s expansion plan across Latin America is designed to reach annual break even by year 4.  

To ensure financial sustainably, we will focus on capturing both investments and grants to fund operations and innovations. Equity contributions and debt funding will be leveraged to drive our expansion plan and cover each clinic cluster’s infrastructure and pre-breakeven operational costs. We estimate we will need 2 Million USD of equity funding and 3.4 Million debt funding during the first 3-4 years to expand. On the other side, grants will be focused on driving technological innovation and increasing access to low income population through our digital channel, our CHW health care workers network and cross subsidies. 

In Latin America, low-income women face disproportionate barriers to affordable, quality healthcare. These include stigmas around sexual and reproductive care, higher rates of NCDs, and widespread gender-based violence. Although research shows that gender-sensitive care yields improved outcomes, women-centered health remains largely absent in the region. For over three decades, Pro Mujer has provided women-centric and community-oriented health, finance, and education services to low-income women and their families across Latin America. We have impacted over 2 million women with 9 million health interventions, including cancer screenings, disease management and family care. Pro Mujer in a pivotal moment to advance gender equality in the region. By 2025, we plan to have: 1) A digital platform with health resources for more than 2 million women; 2) 100 clinics across Mexico, Nicaragua and Bolivia, leveraging Pro Mujer’s already existing network of clinics and partners; and 3) A broad Community Healthcare Worker system to provide tailored care and referrals at the community level. MIT Solve Challenge is critical to making this vision a reality and we therefore invite you to join us in transforming healthcare for all women in Latin America. 

Pro Mujer (PM) is a leading women’s development organization in Latin America with a mission to empower underserved women by providing access to finance, education and healthcare services. In 1990, PM began disbursing small loans to support women’s micro-enterprises. In 1998, PM introduced basic healthcare services, along with loans, addressing the most prevalent non-communicable diseases (NCDs). In our 30-year history, PM disbursed $3 billion micro-loans and provided over 9 million health interventions to 250,000 low-income women annually. Today, our goal is to build an accessible healthcare platform, Ami Cuidado, to become the largest health enterprise for women in the region.

Pro Mujer’s solution is inspired by the daily challenges of the brave and resilient women of Latin America, and the transformational community impact created when women are given opportunities to empower themselves and have control over their health. In working with nearly 250,000 women each year in six different countries in LatAm, Pro Mujer recognizes the significant, sustainable community development in children’s education, safety and overall economic prosperity when women are valued and given tools to thrive. Our health social enterprise solution, Ami Cuidado, is designed for women by women, intentionally structured as a safe, supportive space to address women’s health needs while fostering trust and collaboration within their communities. Like MIT Solve, advocating for progressive socio-economic and sustainable systems that serve underprivileged persons globally, Pro Mujer is driving progress towards greater access to affordable, quality healthcare systems tailored to low-income women to create a world where all women can thrive.