Using Tech to Reintegrate Women into an Agile Workforce

Over 50,000 licensed female healthcare providers (HCPs) are excluded from the Pakistani workforce. doctHERs reintegrates these women by using a digital health platform to connect remotely-located female doctors (who work from home) to health consumers in need via trusted intermediaries such as tablet-equipped nurse/midwife-assisted video-consultation.

doctHERs reintegrates female healthcare providers (HCPs) who have been excluded from the workforce by using a digital health platform that connects remotely-located female doctors (who work from home) to health consumers in need via trusted intermediaries such as tablet-equipped nurse/midwife-assisted video-consultation (telemedicine).

doctHERs uses the power of technology and the potency of the human touch to transcend sociocultural barriers that discourage women from participating in the workforce. By creating a more agile workforce on the supply side, doctHERs is able to match the underutilized capacity of female doctors ('doctHERs') to the unmet needs of millions of underserved Pakistanis including those in corporate value chains (smallholder suppliers, distributors, retailers, micro-retailers, including their spouse, children and parents).

Lower-middle income frontline health workers (community health promoters, nurses and midwives) are recruited, trained and equipped with technology - hardware, software and wifi/broadband connectivity. They are then deployed in corporate offices, factories, retail clinics and ambulances where they are able to connect health consumers (especially female workers who otherwise have highly restricted access to women's health) to remotely located female doctors. These trusted intermediaries are trained to conduct sophisticated diagnostic and interventional  procedures under the supervision and guidance of a remotely located (home-based) female doctor.

doctHERs pathway to scale is  through collaboration with large distribution and co-financing corporate partners.  In collaboration with Unilever, GSK & Reckitt Benckiser, doctHERs has provided over 25000 paid video-consultations to low-income workers in corporate value chains including 6000 consultations that have focused on educating low-middle income women on breast cancer, self-examination and mammography.

By 2030, doctHERs will impact over 200 million lives across 5 continents in partnership with iconic, multinational corporations while reintegrating 50,000 women into the workforce - enabling them to achieve their full socioeconomic potential.  

The exclusion of women in the workforce in both developing countries and mature markets has resulted in not only a massive loss of human potential but also loss of human life - especially in countries (including the US) where millions of people continue to lack access to quality, affordable healthcare.

In Pakistan, the good news is that 60% of medical school graduates are women. The bad news is that 3 out every 4 of these graduates are not participating in the workforce - largely due to sociocultural barriers that prevent them from achieving their professional aspirations with their family responsibilities. 

We believe that the re-integration of women into the workforce (output) by leveraging 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 

The impact of our solution is as follows:

Supply Side:

(i)  Number of women who are reintegrated into workforce as a result of tech-enabled model

(ii) % change in licensed female doctors who are actively participating in health workforce (comparing endline at 24 months to baseline)

Demand Side:

% change in income of tech-enabled, female frontline healthworkers (nurses, etc)

% change in maternal, neonatal and under-5 child mortality & morbidity (M&M)

Monthly (anonymized) data obtained from digital payment partner (Telenor) to measure income deposited in mobile bank account - compare endline (24 months to baseline) - % change in income of frontline health workers (female nurses, midwives, community health promoters)

(i) Direct - monthly recruitment and reintegration of HCPs into doctHERs network over 24 months

(ii) Indirect - obtain monthly recruitment data from healthcare-oriented headhunters to assess industrial 'ripple effect' over 24 months - Number of female HealthCare Providers (HCPs) reintegrated into health workforce and provided with inclusive employment

Obtain monthly M&M data from participating health systems (hospitals, clinics, labs) that our health plan members have access - compare incidence data in month 1 (first 30 days) versus to endline (24 months) and interim trends - % change in maternal, neonatal and under-5 child mortality & morbidity (M&M)

doctHERs is unique in that it uses a digital health platform to match the underutilized capacity of female doctors (who would otherwise be excluded from the workforce) to the unmet needs of health consumers in emerging markets. We  recruit, capacitate, and equip frontline health-workers (nurses, etc) with laptops, tablets and smartphones. These trusted intermediaries are pivotal to our model as they help to engender trust with health consumers in a culture which prefers interpersonal human interaction (as opposed to virtual). By leveraging technology, we are able to expand access to quality healthcare to remote rural populations alike.  

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

Our solution is deployed across 4 venues: (i) corporate offices, (ii) factories (iii) retail clinics and (iv) ambulances. In each of these venues, we deploy a trained, smart-phone/tablet equipped female frontline health worker (nurse, midwife, EMT) who connects beneficiaries to remotely located female doctors ('doctHERs') who are working from home. 

The cost of our monthly tech-fueled, digital health & wellness plan (which comes with unlimited visits) is $5/month and is usually paid by the corporate sponsor/employer on behalf of their value-chain workers (distributors, retailers, etc) and (contracted) employees.

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. 

Some of the mitigatable risk factors that could impede the success of our solution include:

(i) Connectivity Risk:  broadband connectivity varies tremendously with geography - we use multiple ISPs and wifi, DSL & cable to mitigate this risk. 

(ii) Regulatory Risk: the federal government has not issued any specific guidelines around telemedicine - as a pioneer in this area, we are initiating dialogue with them to craft these guidelines.

(iii) Country Risk: The unmet need (and opportunity) for women’s empowerment and gender inclusion is the greatest in this par of the world. We fully and knowingly embrace this risk.

https://2016.mitinclusiveinnovation.com/#winners

https://sharedvalue.org/groups/docthers-connecting-women-improving-health-transforming-lives

https://techcrunch.com/2016/08/11/how-digital-has-redefined-go-to-market-strategy/

Although we've done it before - i.e. piloted and scaled Naya Jeevan, an "HMO for the marginalized" to profitability in Pakistan (over 300,000 health plan members enrolled over the past 7 years) -  where Solve can really help doctHERs is by fast-tracking our path to global replication through collaborations/partnerships with other like-minded entrepreneurs who may be interested in replicating/adapting  this model in their  emerging market of choice (or even the US where this model can be applied).

Perhaps there's a Moore's-like 'law of exponential replication' waiting to be discovered in the tech-enabled social enterprise arena?

Our current partners include the following:

Acceleration/Mentorship: GE Healthymagination & Miller Center for Social Entrepreneurship

Peer Exchange: Innovations in Healthcare (Duke University, McKinsey, WEF)

Corporate Partners: Unilever, Reckitt, Telenor

Development Partners: UNDP, UNICEF, 

Tech Partners: Cloudclinik, MyZindagi.pk, Augmentcare

(i) Sehat Kahani

(ii) Aman Foundation

(iii) Procheck