HealthQo | AI-powered emotional wellness

20% of the world’s psychiatrically ill reside in South Asia. 

Due to COVID-19, healthcare experts predict a proliferation of mental illnesses, especially in developing countries. Migrant workers and daily wage laborers across South Asia have lost their primary source of income, putting them at higher risk for serious mental illnesses. 

HealthQo is an AI powered SMS-based mental health service that monitors an individuals’ mental health without any reliance on the internet - to mitigate the mental health effects of COVID-19 on individuals from marginalized communities. A person’s responses to a set of questions are analysed to determine whether they are at risk and require outreach from medical personnel.

HealthQo is a simple, scalable, and cost-effective solution that can provide at risk communities with an accessible solution. It can effectively restrain the long-term ripple effects of the COVID-19 pandemic. HealthQo’s services will be needed in a counterfactual scenario without COVID-19 too. 

There is a significant proportion of people who are already suffering from mental health issues in South Asia, and millions more risk falling into this bracket. Before COVID-19, 20% of India’s population was predicted to be afflicted by mental illnesses by the end of 2020 and 24 million people in Pakistan required psychiatric assistance. However, the resources made available to address these problems are lacking - Pakistan only has 1 mental health professional for 526,000 people while India has 1 for every 750,000.

Moreover, the majority of South Asia’s urban population is employed in the unorganised sector - they fully rely on daily wages. The sudden and expanding loss of work will only aggravate mental health problems in this demographic due to persisting emotional stress. 

There is also the issue of the stigma that surrounds mental health. Many people in South Asia do not want it to be known that they are experiencing mental health issues or are seeking assistance from a mental health professional. 

And thus, we believe that there is a dire and urgent need for a solution that will target this population group in a way that allows them to seek mental health privately, effectively and economically. 

We gather anonymous user data (mobile numbers, demographic region, gender, occupation) from primary healthcare centers, regional institutions and district departments. We then correlate this data with places that comprise a high density of migrant workers, unemployed people and socio-economically disadvantaged communities. Once the data passes through these filters, we send out an SMS using our AI chatbot and ask ten questions in the local language. Based on the responses to these questions, we use an internal scoring metric to rank an individual’s emotional state. If a person crosses a certain threshold state, the chatbot asks them if they wish to speak with someone telephonically or be enrolled in a weekly follow up.

In case a person chooses to speak with a professional, our dashboard raises an alert, which our NGO partners have access to. This way, a person’s needs are taken care of in a timely manner.

In case of a high volume of calls or influx of at-risk respondents, or if a country has deficient infrastructure and cannot handle telephonic calls, we ask if we may reach out to a respondent on a weekly basis via SMS, and even monitor their emotional state using IVR (automated calling).

Our target population is underserved communities in South Asia - the base of the pyramid marginalised communities; who reside in refugee camps and rural villages - migrant workers and daily wage earners. Especially with regard to the COVID-19 pandemic, most of the solutions require access to a smartphone or the internet - both of which are far too optimistic assumptions in developing countries. In South Asia alone, 67% of the population does not have access to the internet. We’re looking to find a solution to help address these people.

As countries go on lockdown, the lives of people living in rural villages and refugee camps have been drastically affected. Loss of livelihood, reduced social interaction, limited access to resources and information - all have a compounding impact on the mental health of communities. 

We conducted extensive surveys to understand the problems people face. We found that most of our respondents feel that a text-based or telephonic interaction can help them find their way. The questions we ask through the AI chatbot are tailored to the situation in the local community and also take into account cultural cues in order to facilitate a genuine conversation.

Not only is deteriorating mental health one of the ripple effects of the pandemic, mental health issues also have a long-lasting weakening impact on one’s immune system, making communities susceptible to infections and diseases. There are significant links between mental illnesses and viral and communicable diseases. Mental health issues also result in other challenges relating to food, healthcare, housing, and behavioural issues such as substance abuse - which places people at greater risk of contracting and spreading infectious diseases. People who suffer from mental health issues will be at high risk, either during this pandemic or the next. 

HealthQo’s AI-powered chatbot requires absolutely zero reliance on the internet or even a fancy smartphone. It is a solution that utilizes regular feature phones connected to a network operator. We do not require a ground-based force - our impact is solely limited by the data that we can gather and the cloud space we use to process people’s answers. It’s simple, effective, and has the potential to help abolish a looming stigma.

We’re one of the first team’s to develop a solution that incorporates artificial intelligence, machine learning, mental health - all aimed at the last mile. Not only do we represent a product innovation, but also a process innovation as this solution has the potential to lower the burden on the healthcare ecosystem of developing countries, while building happier and resilient communities.

Our team has taken the ‘lean’ approach - where we devise a simple solution relying on multiple inputs from experienced healthcare personnel, practitioners and frontline centers. Another aspect that separates us from other mental health programs is that we are trying to tackle the solution bottom up - we hope to eventually eradicate the stigma behind mental health and not just seek a temporary solution to the pandemic’s impact.

HealthQo will revolutionize the way artificial intelligence and machine learning are used for increasing access to mental healthcare. The backend system consists of Amazon Web Services and Twilio. Amazon Web Services stores the data and the algorithms that process a person’s responses to our messages, while Twilio is a data management system designed specifically for large-scale SMS systems. 

We also use a custom dashboard to flag alerts and convey critical information to our partners (NGOs, local healthcare departments, stakeholders, etc.). All of these facilities are made available through the cloud in order to ensure ease in scalability and uninterrupted access. 

The questionnaire that we use works in tandem with a custom scoring metric to determine whether a person requires further help. Although this is not a ‘technology’ per se, it does form the core functionality of HealthQo’s system. This questionnaire has been validated by psychologists and mental health practitioners in India, Hong Kong and the United States. We wanted to come up with a robust system wherein the inputs do not need to change from region to region. We then implement this using our web-based tools.

In general, automated chatbots are ubiquitous and are used in a variety of settings from customer service portals to online shopping support. Specifically for health related applications, questionnaires have been used to evaluate the emotional health of a patient. HealthQo simply combines these two approaches in a way that access to mental health professionals is possible to even the most isolated communities - as long as they have a mobile phone.

Behind the scenes, we use Amazon Web Services’ cloud servers to store responses to the questions and then evaluate a score on the basis of a weightage metric. Text messages are also sent automatically by our backend servers.

HealthQo is a zero to one solution through which we hope to tackle the underlying cause of stress and other mental illnesses in developing countries - more focused towards marginalized communities such as refugee camps, rural villages and slum dwellings. In low-resource settings, communities do not have the bandwidth to look out for each others’ emotional wellbeing, outreach to professional care is out of the question, and people try to ensure that the community does not get to know about their ‘disorder’. 

From the system’s side of the problem, developing countries simply do not have the resources to cater to hundreds of millions of people; even if we go on a mass recruitment drive of professionals, we’ll have hundreds of thousands of people to every one mental health professional. A ground based in-person solution is thus out of the question. In order to overcome this obstacle, we’re using artificial intelligence and machine learning in conjunction with a set of robust questions that can help us understand a person’s emotional state. 

Following a certain weightage criteria approved by mental health professionals, we identify whether a person is at risk and connect them to a two week IVR program or an NGO. 

Through our pilot, we have realized that most people need someone to talk to - either virtually or telephonically, and HealthQo does just this. We hope to induce some form of behavioral change amongst our target communities and make people more open to accepting the prevalence of mental illnesses and taking active steps in order to deal with them in a positive way.

HealthQo is currently being piloted in twenty districts in South India, covering a user base of 46,000 people most of whom are migrant workers. We will also be conducting an operational pilot in collaboration with ‘Karuna’ in Nepal in order to understand the impact of socioeconomic and cultural differences on people’s responses to the questions. By the end of 2021, HealthQo will have expanded pan-India, Nepal, Bangladesh and Pakistan, and we project that our system will serve more than 2 million people. In five years, we hope to remove the stigma behind mental health in South Asia, and work with state and district level health departments and NGOs. These partnerships, commensurate with a continuous improvement of the technology will improve the quality of mental health care to over 300 million people by 2024.

The COVID-19 pandemic has led to loss of livelihoods all around the globe - although the ramifications are especially severe in marginalized communities in South Asia. Take the case of India. The world's largest migrant labor force - amounting to almost 152 million people - has lost their source of income amid the stay-at-home orders and has little or no access to primary healthcare facilities. We project that till the end of 2021, we will be working with marginalized communities and dealing with the ramifications of the ongoing pandemic. 

In general, we want to eradicate the stigma of mental health in developing countries. A simple and discrete solution that only uses SMS-based intervention is an ideal place to start. Furthermore, we wish to create a network of mental health professionals, departments and NGOs and make emotional wellbeing a top priority in developing countries. We also envision our solution to constitute the largest healthcare-related data collection activity in history! With real-time monitoring of people’s emotional wellbeing, districts, states and countries can create ecosystems wherein people are happy, content and are looked out for.

Some of the common sentiments experienced in the South Asian communities facing mental illness include: feeling shameful, isolated, fearful of impacting their social image. Therefore, here is a huge misunderstanding about mental illnesses, including the causes of mental health issues and appropriate medical attention that is available. The percentage of individuals facing such problems in South Asian countries is significantly high with nearly 20% in India, 17% in Bangladesh and upto 24 million people in Pakistan requiring psychiatric assistance. The need for education is imperative to curb preventable consequences while ensuring such issues are tackled. 

Another cause for concern is the lack of adequate infrastructure to meet the need of an extensive  population. The average expenditure across the region is only 5.4% of the GDP and most were below the world average. The resources allocated to mental health are also significantly lacking. For example, Pakistan only has 0.19 psychiatrists per 100,000 people - the lowest in the world. 

Deficient funding will also limit our operations as we would not be able to expand and continue deployment into the South Asian regions without the financial support.

HealthQo has the potential to create the largest healthcare-related database. Therefore, with large sets of data, limitations in achieving efficient data management and analysis on a timely manner can be predicted. Moreover, mental health is a private and sensitive topic, so we need to be vigilant while handling the data and establish a secure database to ensure privacy of our users.

Personalizing the treatment process and making it more discrete - Sending messages to individual phones eliminates the needs for users to reach out to organizations, especially if they are unsure about how to seek help and the need for help. We aim to translate the messages in regional languages prevalent in the target communities to enable a comfortable user experience. 

Using the extended support network of NGOs and primary healthcare centers - If a user is deemed as in need for more intervention, our dashboard will send the necessary information to partner organizations, allowing them to reach out to the users. This ensures necessary support is given to vulnerable groups which may normally not be possible until a person individually seeks professional help. 

Partnering with social enterprises, incubators and local governments - Currently the mental health system in South Asian countries is not adequate to meet the extensive need. By collaborating with such organizations, we want to bring forward a conversation about mental health in a way that motivates government bodies to use our anonymous user data to better direct healthcare policies or programs. 

Using AWS’s integrated security facilities - AWS employs a host of measures for data protection and privacy.

Core solution team

Dhruv Suri (Part-time): Visiting researcher at the Massachusetts Institute of Technology D-Lab

Ayushi Bharati (Full-time): Biotechnology graduate from Hong Kong University of Science and Technology (HKUST)

Hinna Hussain (Full-time): Economics graduate from HKUST

Anika Tahsin Ahmed (Part-time): Biotechnology major at HKUST

Godson D’Silva (Part-time developer): senior data scientist at HERE technologies

Affiliated Advisors

Syed Ali Hussain: Assistant Professor, Walter Cronkite School of Journalism and Mass Communication, Arizona State University

Shrish Bhattari: Organizational Development Consultant, Viamo

Prabhat Singh: Frontline Healthcare Specialist

Eva Chen: Associate Professor, Division of Social Science, HKUST

Our team is well positioned to execute HealthQo’s services and mission. Our core team is made up of 4 individuals who have accumulated varying experiences and skills. Dhruv’s work, as a visiting researcher at MID D-Lab, focuses on designing low-cost technologies for rural agricultural cooperatives in Africa. He also has two years experience working in the frontline healthcare sector with a focus on rural communities and migrant workers. Ayushi is a Biotechnology graduate (with a minor in social science) from the Hong Kong University of Science and Technology (HKUST). She has experience working on marketing and outreach campaigns which will help HealthQo scale rapidly. Hinna is an Economics graduate and her current final research paper explores how technology can be used as a tool with Behavioural Economics to guide policies. She has also spent a year, previously, working in the mental health field in a therapy centre and as a research assistant. Anika is a final year Biotechnology major at HKUST. She is a leader at Student Innovation Global Health Technology (HKUST) where she has led numerous research groups to develop products in healthcare. She is also the logistics team co-head and marketing team lead at the Hult Prize Foundation - a global social venture challenge that focuses on pressing social issues.  

We are actively collaborating with specialists whose expertise include data science, public communication campaigns, and psychology. This is to ensure every point in our design and operational process is optimal in achieving our mission.

Our current partners include: MIT Hong Kong Innovation Node, MITD-Lab, Kasturba Medical College Manipal, India, SIGHT, Mitram Foundation, India and thirty other NGOs specializing in mental health and aids for low income citizens. To name a few:

• MIT Hong Kong Innovation Node

  • Has focused on accelerating the path from idea to impact to help strengthen the region’s innovation ecosystem. The node is providing us with access to their workspaces for three months as well as monetary support for prototyping.

• MIT D-Lab

  • Works with people around the world to develop and advance collaborative approaches and practical solutions to global poverty challenges.

• Kasturba Medical College Manipal, Karnatika, India

  • The college is among the top private medical schools in India and is approved by the Medical Council of India. 

• SIGHT, HKUST

  • Aim to empower students to use innovative health technology for implementation in developing regions around the world. Through the ‘Scholar’ program, SIGHT is providing us with prototyping support and access to a network of professionals with social entrepreneurship backgrounds. 

• Mitram Foundation, Karnatika, India

  • Mitram is a suicide prevention helpline offering emotional support to individuals going through crisis. They are extending their expertise in guiding questions for different populations while also serving as our intervention partner. There will be no exchange of data from either parties.

HealthQo’s value proposition is simple - we’re dedicated to ensuring ubiquitous access to mental healthcare to everyone regardless of race, socioeconomic status or ethnographic background. 

Our target customers are people residing in marginalized and low income communities across South Asia. By targeting these communities via an SMS based mental health questionnaire, HealthQo provides access to aid even in the absence of smartphones or the internet. 

In addition to the inadequacy of resources in developing countries, mental health is often considered a huge stigma and taboo, further preventing people from reaching out to professionals who can help people find their way. By personalizing the pathway to emotional wellbeing through simple messages sent directly to individuals, HealthQo provides communities easy access to such services. We’re also doing away with the need to physically reach out to people while adhering to social distancing norms. By reaching out directly to people, communities and nations, HealthQo has the potential to become the largest mental health anonymous data collection exercise targeting otherwise inaccessible areas and providing extensive insight into people’s behaviour at the last-mile. 

Through our pilot that is currently underway, we’re extremely excited to see people respond to the questions and potentially improve their emotional state impacted by the COVID-19 pandemic. Most of the people we deem ‘at-risk’ through the platform are from migrant communities - which we previously identified to be greatly affected due to loss of income, lack of resources and limited access to information.

There are two key financial criteria to our mission: (1) that the emotional assistance always be provided free of charge to the people, and (2) that we have a financially sustainable organization by year three of operation. 

Grants: for our initial round of funding, we’re looking to raise capital through grants facilitated by local governments and foundations such as the Draper Richards Kaplan Foundation and Mercatus Center. Many local initiatives in developing countries - AID India, Give2Asia, etc. are specifically focused on funding projects and initiatives aimed at the base of the pyramid population including marginalized communities and refugees. Progressively, HealthQo will have a reduced dependence on grants, from 90% in our first year of operations to less than 20% by year three.

Partnership Revenue: HealthQo will partner with national and state-level mental health initiatives and NGOs geared towards providing mental health support to everyone. Particularly in the advent of the current and future pandemics, we look to offer HealthQo as a service in partnership with district, state and national health departments. 

Anonymous Data Sales: By year five, HealthQo will have reached 300 million people across Asia, and will have impacted the lives of millions more globally. Using the lessons learned and data accumulated in the process, we will be in a position to continuously inform policymakers and health professionals with robust data. Healthcare practitioners who otherwise need to rely on outdated data and statistics will be able to effectively inform their decision making through almost real-time insights. 

The current infrastructure of mental health services in developing countries does not provide support to rural or marginalised communities since the majority of mental healthcare centers are located in urban areas. Therefore, we believe we can improve the infrastructure by establishing a global mental health monitoring service with maximum outreach capacity in those communities. Therefore, to achieve our global expansion plan of covering 2 million users in 4 countries by 2021, we need financial and strategic support from Solve to establish significant market penetration. 

The financial resources will be utilised to support the expansion and identify the need of a region-specific deployment strategy – deployment time to receive high response and numbers of questions asked for maximum engagement. Upon establishment of a systematic deployment structure, we will exponentially grow our user-base and positively impact the mental health state of people.

With continuous expansion, we can potentially gain access to 2 million user data, and with large mental health focused data, privacy concerns become more prominent.  Hence, efficient data analysis and management will be crucial to facilitate effective interventions. To achieve the following, we plan to seek technical expertise from data analysts and data privacy experts who are part of the established network of Solve and MIT. Their expertise will increase our process to develop a secure and efficient data management infrastructure, which we will utilise to provide possible intervention to improve mental health of communities.

With our partnership with Solve, we want to increase market penetration to create maximum positive impact. To achieve it, we require the support from Solve to secure media exposure in rural and marginalised communities. Moreover,  the health sector is a continuously evolving market due to unpredictability in disease outbreak and high interrelation between mental and physical health. Therefore,  we want to take advantage of the business and entrepreneurship training provided by Solve to equip ourselves with knowledge to cope with the changes of the market.

To increase efficiency of HealthQo, we are planning to seek partnerships with experts in data analysis or psychological studies. Therefore, we want to collaborate with Rich Fletcher, a MIT faculty member whose research focus is on “utilizing a variety of mobile technologies and wearable sensors for use in behavior monitoring as well as psychological and behavioral interventions”. By collaborating with him we want to identify a severity threshold based on the user-data collected by HealthQo. This will support the establishment of an algorithm, deciding on the need for further intervention. 

Moreover, the pandemic together with the deficient infrastructure of mental healthcare have exacerbated the mental health issue in many developing countries. Therefore, immediate intervention is required. To achieve that we will seek partnership with telecommunication companies, like Vodafone.  Vodafone has a mobile market share of 28% in India, and with access to their customer-base we can penetrate the Indian market with more stability and at a higher rate to make an immediate impact.

To attain higher user-engagement among communities, we plan to seek partnerships with community-based organizations, especially UN Women. Since many marginalised communities in developing countries neglect the mental health of women, therefore, by utilising their established network we can increase our outreach among the female demographic. Moreover, by supporting our service, UN Women can improve the gender gap observed in terms of mental health services provided to women, and thus, can result in a mutually beneficial partnership.

It is projected that the negative economic and psychological effect of COVID-19 will be observed in the coming years. Therefore, to alleviate the pre-existing mental health issues exacerbated by the pandemic,  we plan to utilize the prize amount to expand our outreach in the most neglected and vulnerable communities in 4 developing countries by 2021.  We will be one step closer in meeting the UN's Sustainable Development goal of good health by providing the following functions:

• Regular monitoring of the mental health state of individuals to alleviate the burden on limited resources allocated to mental health sectors in developing countries and better manage resources based on the data.
• Insight on the severity of the issue from the data being collected which can increase the push to improve mental healthcare services in developing countries.
• Connect medical experts to people in need of mental healthcare service, which is achieved by utilising our systematic algorithm system. Current infrastructure of mental healthcare services are provided to people who seek them so by proactively reaching out to people in need we can improve health security of communities and lower suicide rates.
• Visual maps of mental health status of communities formulated through data analysis can allow health experts to predict trends and strategies early prevention methods to better equip the mental health departments, thus, increasing efficiency of the service.

We plan to utilize the prize amount to improve our service and meet two additional Sustainable Development Goals (SDGs): gender equality and sustainable development.

As mentioned that once our service is deployed, it has the potential to be the largest data collection system in the health sector. With the prize amount, we seek to engineer a system capable of analyzing and storing large sets of data. Therefore, the data can provide insight and motivate health and government organizations to rebuild the healthcare infrastructure according to the needs and severity of mental health issues at hand. Moreover, the insight provided can encourage researchers to indulge in research about mental health disorders. Such a system could serve as a key factor in establishing sustainable healthcare infrastructures in developing nations and working towards meeting the 9th SDG of sustainable development.

Mental health disorders are generally stigmatized in developing countries, additionally, in rural and marginalized communities, mental health disorders in females are more neglected and negatively viewed. Moreover, the existing healthcare infrastructure is less accessible to females – the majority of mental-health hospitals are located in urban areas and females from those communities are less likely to travel long distances for medical care. Therefore, by utilising the data collected from HealthQo, we will use the prize amount to identify mental healthcare professionals or related organizations based on rural areas that need more interventions to connect them with nearby services. Moreover, we plan to invest in community-based outreach to gain trust from the female demographic and proactively reach out to them. By minimizing the gender inequality faced by females in terms of having access to mental healthcare services, and empowering girls and women by improving their mental health, we can contribute to the 5th SDG of gender equality.