'Pehchaan': Self-Service Digital IDs

The exclusion of women in the formal workforce in developing countries in the MENASA region has resulted in not only a massive loss of human potential but also significant loss of economic growth - especially in emerging markets such as Pakistan, where over 40 million women continue to lack access to a legal identity.

The 'Pehchaan' ('recognition') Digital Identity program provides residents of last-mile rural villages and urban slums with access to a legal, digital identity at Point-of-Service (PoS) using female frontline digital ID agents (who cross-function as health workers and last-mile retailers). These frontline women are equipped with 4G-wifi enabled tablets, preloaded with  software authorised by the government data and regulatory agency to process digital ID cards linked to the national database.  

This digital ID program impacts  SDG 3 (health), SDG 5 (gender equality), SDG 8 (dignified work), SDG 10 (reduced inequalities) and SDG 17 (public-private partnerships).

The exclusion of women from the formal workforce (due to a lack of legal identity) has resulted in a massive loss of human potential, especially in developing countries such as Pakistan where over 70 million women remain excluded due to a lack of legal identity. 

In Pakistan, the good news is that the government has trained over 100,000 female Frontline Health Workers (FHWs) who have the potential to be trained as digital ID agents and deployed across rural villages in Pakistan where they can provide millions of rural women with access to a legal identity. The bad news is that over 80,000 of these workers are unemployed or underemployed and both physically and technologically disconnected from the mainstream, public or private IT and digital health systems. 

Reasons for exclusion of FHWs include: (i) lack of demand in the public sector for the skills of FHWs in the absence of qualified doctors and (iii) rigid public health systems that prohibit FHWs from working part-time or flexi-time. 

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

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

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

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

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The Pehchaan last-mile digital ID solution is unique in that it: brings technology that was previously only available in large city centres to the frontlines  (ii) up-skills female frontline health workers as digital ID agents and provides them with inclusive, dignified employment in a manner that creates multiple value streams for the target population and (iii) has the potential to be transformed into a large-scale, public-private collaboration between Unilever, doctHERs (a 2017 & 2019 MIT SOLVE winner) and NADRA, the National Database & Regulatory Authority (NADRA) of the Pakistani government (the current Chairman of NADRA, Usman Mobin is also an MIT alumnus).

We  recruit, capacitate, and equip female frontline health-workers (cross-trained as digital ID processing agents) with laptops, tablets and smartphones. These trusted intermediaries are essential to our model as they: (i) help to build trust with end-users, (ii)  enforce appropriate social distancing in the age of COVID-19, in a culture which prefers interpersonal human interaction over virtual and (iii) keep the hardware they use for biometric scanning sanitised and disinfected. By leveraging technology, these FHWs are able to amplify access to both digital identities as well as quality healthcare to remote rural and urban slum populations alike.

In 2019 we served over 1 million lives in 16 districts of Punjab and 2 districts of Sind. Our current beneficiaries include 22,000 low-income (income less than  $3/day) workers who are linked to corporate value chains and work in factories where it is relatively easy to deploy up-skilled, tech-enabled female frontline health workers (FHWs). 

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

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

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

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

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

Our AI-enabled telemedicine platform has the ability to integrate seamlessly with NADRA's digital identification platform and software via an API. Similarly, the NADRA platform offers integration with several financial service providers, enabling digital payments using the cNIC SMART card. The cNIC SMART card has a SIM chip which can be used to store relevant medical history, prescription data, etc thus enabling the cNIC to function as a health e-passport. This will create significant incentive for residents to upgrade from the conventional card to the SMART card.  

Our digital ID POS solution uses the same technology and platform as the NADRA system, but merges the enrolment process into a single application which is operated by a single frontline worker (digital ID agent) at Point-of-Service (POS). Accordingly, it provides a more user-friendly consumer experience (CX) for end-users, saving them time, energy and significant real and opportunity costs in travelling from their rural villages to large towns/centres. 

Our platform uses HL7 architecture, is HIPAA compliant and uses open APIs to integrate with other systems.

We utilise a store and forward option in which the enrolment application is filled offline and then uploaded when connectivity is better. By using a literate, frontline intermediary (digital ID agent), we are able to overcome challenges with end-user literacy and numeracy levels.

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

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

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

Our goals over the next 12 months are to:

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

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

(iii) demonstrate the technological and clinical feasibility of this model at a scale of 200 digital ID agents deployed at the frontlines via this model

Our goal over the next 5 years is to:

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

Barriers over the next 5 years include:

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

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

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

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

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

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

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

Our current partners include:

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

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

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

We have 3 major revenue streams identified for 2020:

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

2017: 

• Gray Matters Capital: $90,000 (convertible debt)
• Naya Jeevan: $100,000 (short-term loan/debt)
• Earned Income: $65,000

2018:

• Gray Matters Capital: $90,000 (convertible debt)
• Naya Jeevan: $100,000 (short-term loan/debt)
• Earned Income: $125,000

2019:

• Unilever (Transform Program Ph 1): $400,000 (service delivery contract)
• GSMA/DFID (via Naya Jeevan): $150,000 (service delivery contract)
• Earned Income: $345,000
• Tommy Hilfiger: $92,000 (award- winner TH Social Innovation Challenge)

2020:

• Gray Matters Capital: $120,000 (convertible debt)
• Unilever (Transform Program Ph 2): $400,000 (service delivery contract)
• Earned Income: $675,000
• Punjab Population Innovation Fund: $125,000 (service delivery contract)
• Tiger IT Foundation: $500,000 (equity + debt)

We are currently raising $1.5 Million in innovation grant money to help amplify the impact of our Pehchaan digital ID agent/frontline health worker project from 1 Million lives to 5 Million lives at a cost/per life of ~$0.30 per life. 

Personnel: $300,000

Equipment: $100,000 (Capital expenditures)

Program-Related Costs: $1,200,000

SGA: $200,000

Total: $1.8 Million

Having participated in several SOLVE challenges in the past, we find that the ecosystem network effect that SOLVE has created is phenomenal. Each contest has a unique group of invested stakeholders who we get exposed to. 

The Mission Billion Challenges will give us an opportunity to work with innovators at the World Bank who are focused on using a customer-centred approach to amplifying digital identity solutions.   

To help diversify our revenue base, we are building small teams in the US and Europe (UK and Continental) who can liaise directly with potential bilateral and multilateral partners  at the HeadQuarters level. 

We are always looking for like-minded partners with innovative products/services or approaches that can be integrated with the 'market basket' that our female frontline health workers offer to their last-mile rural communities. 

Business Development: Large MNCs with extensive supply chains and distribution systems such as Coca~Cola, Nestle, Pepsi, etc. We can provide our digital identity solution to tens of thousands of workers in their supply chains. 

Product - Innovation & Integration: We are very open to integrating new services and products into our frontline health worker 'value chain', e.g. we have integrated Philips' Lumify handheld ultrasound device into our FHW-assisted telemedicine model.

Impact Finance: Impact funds (corporate, development sector, etc) can invest in doctHERs and help us to globalise our impact across South Asia, the ASEAN region and Sub-Saharan Africa