Save Mother Save Earth

In India the prevalence rate of Gestational Diabetes Mellitus (GDM) is estimated to be 10% to 14.3%which is much higher in comparison to the western countries. The incidence of GDM has increased to 20% over the last decade, meaning 1 in every 5 pregnant women is likely to acquire diabetes during pregnancy in India. 11.69% women in West Bengal, especially in fragile rural areas, suffered from gestational diabetes. iKure's maternal healthcare interventions in India have witnessed pregnant women having limited access to diagnostic kits in rural sub-centers due to a continued shortage of testing kits causing a delay in diagnosing Diabetes which leads to fatal outcomes, lifelong disabilities among newborn children, or even deaths in the incidence of uncontrolled diabetes. GDM is a clinical entity associated with raised maternal morbidity which contributes to the high (Maternal Mortality Rate) MMR of 109 per 100000 live births in West Bengal. Sundarbans the world’s largest delta faces devastating cyclones, swelling sea levels, and diminishing habitat is at the forefront of the climate crisis. 50% of the population lives below the poverty level. iKure is working in the Sundarbans through its transformative, inclusive, and disruptive approach toward ensuring continuity of maternal care at the grassroots.  

Accessibility to healthcare in the context of Sundarbans (our area of intervention) is a challenge. According to a 2016 study, the impoverished Sundarbans lack choices in healthcare. The publicly funded facilities are non-functional or non-existent and the available diagnostic kits for Diabetes remain inaccessible. This gap remains leading to an increasing diabetic burden in this region. It was observed in a study in 2010, among the people living in Sundarbans aged between 15-59, women disproportionately have a higher burden of disease in comparison to men. 

Diagnostic methods available hamper the screening of GDM in the fragile rural set up. Some of the tests like HbA1c are expensive and are unavailable in the rural setup. Random blood glucose is more affordable and convenient as it requires no fasting, it is not recommended as a single diagnostic test unless classic symptoms of diabetes are present. Fasting blood glucose requires fasting which is difficult in the outpatient setting areas. 

On-time screening and awareness amongst Pregnant women (PWs) in the rural community save mothers and child for almost 70% of the Diabetic cases are preventable and do not require medicines. 

Diagnosis of GDM is an important public health issue because GDM increases the risk of congenital malformation by 25 folds. Babies born to mothers with untreated gestational diabetes are typically at an increased risk of developing problems such as large size for gestational age (which may lead to delivery complications), low blood sugar and jaundice. GDM causes pregnancy induced hypertension and polyhydramnios. Women  with  GDM  are  more  prone  to develop diabetes  mellitus  in  future.

iKure a population health management organization aims for transformative gestational diabetic management of pregnant women in Sundarbans using a paper-based diagnostic kit powered through smartphones or any relevant Android devices to detect Diabetes aiding in on-time diagnosis, treatment and management. 

A simple, affordable (INR 5/ test), rapid (within 5 -10 minutes) and highly accurate quantitative paper-based sensor, integrated with smartphone application, has been developed for on-spot detection of hemoglobin and plasma glucose concentration using approximately 10µl of finger-pricked blood. Addressing this burden, especially in the rural and semi-urban setup will improve global economic and health security promoting health equity and achieving the Sustainable Development Goals (SDGs). One Health is an integrated and unifying approach that aims to achieve better public health outcomes.

This test kit has the advantage of saving the long-distance travel time, wait time in health centers as well as expenses. Preliminary validation studies inside and outside laboratory ambiance reveal a successful deployment of the test procedure in rural settings where no infrastructural facilities for diagnostics are available. On-field deployment has further proven the test-kits to be extremely user friendly and usable by minimally trained frontline workers for catering the needs of the under-served.

The solution will serve the vulnerable rural pregnant women in Sundarbans, India. 4.5 million population living in 54 Islands of Sundarbans amongst the total of 102 islands lives in extreme conditions with no doctors, hospitals and clinics. Presently, iKure would like to kick start with two of the most endangered islands of the Sundarban Delta, Kumirmari and Satjelia then gradually spread across other islands. Sundarbans is acclaimed by UNESCO for its ecological richness being the largest delta in the world created by the confluence of Ganga, Brahmaputra and Meghna but unfortunately it is a very difficult place to inhabit. Approximately 50% of the entire population of Sunderbans live below the poverty level.Women here often suffer from irregular menstrual cycles, vaginal infections, recurring UTI and miscarriages. According to a study in 2010, it was observed that women in Sundarbans disproportionately have a higher burden of disease in comparison to men.

Public health utilization for pregnant women in the region are pre-determined by socio-economic status, gender, class and caste. For example, a woman's reproductive age determines whether she could access a doctor or not, with older women at a disadvantage. Also, given long distances from major hospitals for remote women residents, their chances of seeing a certified doctor is very limited. Seeking antenatal care for these pregnant women is further influenced by Caste, cultural norms and prejudice and superstition. Access and utilization of antenatal care varies in size and context and the pandemic has made the situation worse in the region. 

Program Goals:

iKure expects to meet the following quantifiable goals on successful completion of this Program:

1. Benefit the pregnant women across Sundarban District with improved health outcomes over a period of 18 months. 

2. Empower the frontline health workers ASHA Workers, iCHAs and ANM.

• iKure will leverage Community Health Workers (CHWs) with the aim to provide screening, monitoring and escalation of Pregnant Women (PWs) at risk supported through sustainable primary healthcare model, technology innovation, and community engagement. The program will work with ASHA workers, ANMs with iKure's community health workers. The engagement of health workers will be strengthened by evidence based risk assessment for targeted counselling, follow up, and routine check-ups. The referral and doctor consultations will be facilitated through primary health centres, sub health centres through telemedicine platforms.  

• Recruitment, training and mobilization of community health workers will be done by iKure for different handholding of their designated roles in performing household visits, community mobilization and facilitating teleconsultation.

• iKure will build an effective community engagement strategy through various digital and face-to-face communication. It will disseminate IEC/BCC messages both through face-to-face interaction and through mobile phones of the participants. WHIMS platform can send automated nudges to inform and educate the users. By installing WHIMS patient application on their mobile, one can receive SOS alerts for telemedicine consultations, home visit or even reminding medications.
  

Sujay Santra, is the Founder & CEO of iKure Techsoft Pvt. Ltd. He has worked for IBM and Oracle for over 12 years before founding iKure in 2010 in Kolkata, India. To date, iKure has impacted 26 million people across 10 states in India and offers technology solutions in MENA Countries, Sub-Saharan Africa, and South-East Asia. Sujay received an Ashoka Fellowship from the President of India, Shri Pranab Mukherjee, in 2016 and was conferred with the '100 Most Impactful Healthcare Leader Award' by the World Health & Wellness Congress in 2018. He has been part of global platforms as a speaker, including for the World Economic Forum, United Nations, MIT Solve, and many more. With a Masters degree in Computer Application (MCA), he attended the Executive Programme in General Management (EPGM) from the Massachusetts Institute of Technology (MIT) in the USA, which introduces students to the latest in MIT thought leadership on innovation, strategy, decision-making, and leadership. Sujay is a member of the National Core Committee of Information Technology(IT) & Information Technology Enabled Services (ITES) of the Confederation of Indian Industry (CII) and a member of the subcommittee on  ‘Digital Skilling’, contributing to the formulation of government health policies.

Golden Frankly is AVP Innovation & Strategy at iKure Techsoft Pvt. Ltd. He comes with over 15 years of experience in Program Management and has enabled impact with 50+ non-profits. He has worked with leading international and national organizations such as ORBIS International, Sankara Eye Care Institutions and Bhoruka Charitable Trust and has travelled extensively in India to follow his passion to connect with people who live at the bottom of the pyramid. Golden graduated from the prestigious Tata Institute of Social Sciences Mumbai with a Masters in Social Work. Golden advocates the marketing and sales aspects of iKure ensuring that operations have an adequate budget for experimentation while achieving business revenue and profit. He also participates in product development activities. 

Tirumala Santra Mandal, PhD, is an Associate Vice President (AVP of Research and Communication) at iKure Techsoft Pvt. Ltd. With a doctorate degree in Corporate Communications from the  Indian Institute of Technology (IIT) Kharagpur, she has worked in diverse fields of communications such as lie detection, communicative English and multimedia communication with the Defence Research and Development Organisation (DRDO) & IIT Kharagpur. Tirumala leads the research team at iKure and contributes immensely towards research intervention, data management, & research publications. She actively supports and contributes in strategic corporate communication at iKure and handles and monitors PR releases. Tirumala supports iKure in different areas from technology to HR to operations with data insights and data governance to drive organizational goals. She has worked in maternal health programe, Diabetic management, nutrition management, Diabetic Retinopathy. She has authored multiple publications in research and communication for various peer-reviewed journals, as well as actively participates in global networking forum.

Barnali Banerjee, is working as a Research Analyst at iKure Techsoft Pvt. Ltd. She has an experience of over 22 years in public health, clinical research, health and safety data management and analysis. She is a Masters in Computer Application and has authored 11 publications in national and international journals. Barnali supports iKure in research analysis, interpretation, data visualization using R, SPSS and Python. She performs writing and reviewing SAS code to create outcome measures, restructure data files, perform data-cleaning operations, Data masking, and perform various forms of statistical and data analysis.

iKure has touched 20.69 million population across 9 states in India, successfully treating 3 million people across more than 6400 villages. 

This opportunity will help us get access to the wealth of knowledge. Connecting and collaborating with partners and experts who share our vision and mission would help us overcome the hurdles that we face.  Mit Solve would be a recognisable platform with access to a network of experts and mentors, local hubs and funding. With Solve we could make a larger societal impact and improve the quality of life in the fragile context worldwide. 

We hope that Solve to support us access financial and technical resources which would help us get a better reach to the underserved communities under one platform and amplify our impact.  

The traditional approach for GD involves regular visits to healthcare providers and frequent blood sugar monitoring. The solution can significantly improve the management of GD by providing real-time monitoring of Blood sugar levels and offering support for the patients through health workers that can monitor more closely, provide timely interventions and prevent serious health complications such as pre-eclampsia, preterm birth, and large-for-gestational-age babies. The solution will improve the health outcomes of both the mother and babies with the potential to save lives with positive climatic impact. 

In terms of market change, the solutions can create newer opportunities for healthcare providers, manufacturers, and developers to deliver more efficient and effective care potentially reducing costs and improving patient satisfaction. It will encourage more no of women to seek care for gestational diabetes with greater accessibility, affordability and convenience over traditional care models.  

1. Benefit ~ 10,000 pregnant women across Sundarban District with improved health  outcomes over a period of 18 months and 30,000 over a period of 3 years.

2. Empower ~ 400 frontline health workers (ASHA Workers) & ~ 100 ANMs

• iKure will leverage CHWs with the aim to provide screening, monitoring and escalation of PWs at risk supported through sustainable primary healthcare model, technology innovation, and community engagement. The programe will work with ASHA workers, ANMs with community health workers. The engagement of health workers will be strengthened by evidence based risk assessment for targeted counselling, follow up, and routine check-ups. The referral and doctor consultations will be facilitated through primary health centres, sub health centres through telemedicine platform.
• iKure will build effective community engagement strategy through various digital and face-to-face communication. It will disseminate IEC/BCC messages both through face-to-face interaction and through mobile phones of the participants. WHIMS platform can send automated nudges to inform and educate the users. By installing WHIMS patient app on their mobile, one can receive SOS alert for telemedicine consultations, home visit or even reminding medications. 

Early Detection and Management of Gestational Diabetes.

Increased accessibility and affordability to diagnostic care. 

Improved health outcomes of mothers and children with reduced MMR and IMR.

Improved livelihood and grassroots women empowerment. 

Problem: Diagnosis of GDM is an important public health issue because GDM increases the risk of congenital malformation by 25 folds. Babies born to mothers with untreated gestational diabetes are typically at an increased risk of developing problems such as large size for gestational age (which may lead to delivery complications), low blood sugar and jaundice. GDM causes pregnancy-induced hypertension and polyhydramnios. Women with  GDM  are more prone to develop diabetes mellitus.

Intervention: The  integrated population health management platform with a 360-degree mechanism  will register each patient with a unique patient identity and capture different vitals including screening GD to help identify and categorize pregnant women (PWs) in different risk stratification model. This allows CHWs to make an informed decision, triage PWs and refer them to Gynecologist through a teleconsultation.

Inputs: A unique, transformative,  affordable (INR 5/ test), rapid (within 5 -10 minutes) and highly accurate quantitative paper-based sensor, integrated with a smartphone application, which has been developed for on-spot detection of hemoglobin and plasma glucose concentration using approximately 10µl of finger pricked blood. 

Output: Increased patient engagement, real-time monitoring of blood glucose levels, tracking of high risk PWs and support for vulnerable population.   

Outcomes: 

Early Detection and Management of Gestational Diabetes.

Increased accessibility and affordability to diagnostic care. 

Improved health outcomes of mothers and children with reduced MMR and IMR.

Improved livelihood and grassroots women empowerment. 

Impact:  Reduced MMR, IMR and life long disability of the vulnerable population with reduced carbon footprint in the Sundarbans.

A unique, transformative,  affordable (INR 5/ test), rapid (within 5 -10 minutes) and highly accurate quantitative paper-based sensor, integrated with a smartphone application, which has been developed for on-spot detection of hemoglobin and plasma glucose concentration using approximately 10µl of finger pricked blood. The device will be integrated with a population health management platform with a 360-degree mechanism  will register each patient with a unique patient identity and capture different vitals including screening GD to help identify and categorize pregnant women (PWs) in different risk stratification model. This allows CHWs to make an informed decision, triage PWs and refer them to Gynecologist through a teleconsultation. The integrated model with improve maternal and child health, reduced healthcare costs and potentially save lives.    

Our diverse leadership team comprises of Sujay Santra, the Founder & CEO who is skilled in Information Technology but shares his knowledge in every department of iKure, Tirumala Santra Mandal, PhD, is an Associate Vice President (AVP of Research and Communication) with a doctorate degree in Corporate Communications from the  Indian Institute of Technology (IIT) Kharagpur leads the Research and Communication department, Golden Frankly is AVP Innovation & Strategy has 15 years of experience in Program Management and has enabled impact with 50+ non-profits, Barnali Banerjee, is working as a Research Analyst who supports iKure in research analysis, interpretation, data visualization using R, SPSS and Python.  Our team is made up of trained Community health workers, Statisticians, Technology experts, operational managers, Doctors, researchers  who have immense expertise working in different geographic locations across India. The team has immense experience working with field team members, international institutes, and different State Governments of India. Our core members guide all the employees and align them with the soul vision of iKure i.e., to bring Access to Affordable and Accessible Healthcare to 50 Million Population by 2025 and create Zero Mortality in Primary Healthcare. 

iKure is a population health management company that meets primary healthcare and prevention needs through a unique combination of health outreach initiative, skills development and technology intervention. iKure focuses on addressing the primary health care needs across all settings – rural, semi-urban and urban areas. iKure has impacted 20.69 M population, treated 3 M people, touched 6, 200 villages across 10 states in India. The social venture also offers technology solutions in MENA countries, Sub-Saharan Africa and South-East Asia.

• The programe will aim to build sustainable and healthier communities by empowering grassroot community members frontline health workers to serve the PWs in their community.  

• The programe will lay a strong foundation for a robust supply chain system, which will be both community-responsive and inclusive. 

• The initiative will facilitate CHWs to earn incentive based on early registration of PWs,  enabling the pathology tests, teleconsultation as and when needed and and providing the necessary nutritional supplements.  

• The initiative will have the potential to engage with local NGOs to make the future programmes more successful and contribute to better health, economic empowerment, peace and harmony in the region.  

Leveraging the methodical livelihood generation schemes offered by iKure, iKure has empowered cadre of Community health workers that earn livelihood beyond stipend period.  The CHWs will promote the early registration of the PWs, spreading the awareness on gestational diabetes and telemedicine services through mobile based supply chain applications and make them accessible in hard-to-reach communities.The initiative helps them income of 5000 to 10,000INR per month.  We envisage creating a collaborative approach to build self-sustainability of the CHWs to act as Entrepreneurs through various supply chain products to serve three sections of the community; women community members to develop capacity and skills to earn livelihood locally, village community members to benefit from enhanced ANC coverage facilitated through primary healthcare delivery and local vendors through supply chain products. The intervention will bring new frontiers at the frontline, bringing awareness, advocacy and actions at primary care level in bringing sustained impact in health and socio-economic outcomes of the vulnerable pregnant women in the region.