Digital Embrace: Empowering Women with WONDER

• Marginalized and exploited teens and young mothers
• High Maternal mortality
• Poor Quality of care provided
• High Neonatal Mortality:

• Young girls in Africa continue to bear the burden of teenage pregnancies, associated mortalities, lack of access to essential health education regarding HIV/AIDS, STIs, medications, and contraception. Exploitation, rape, and poverty account for the numerous teenage pregnancies.
• The adolescent girls and young women go through significant amount of sexual violence. Though there are some organizations that give shelters to these girls, it is not easy to access these (SGBV) shelters from where they can receive psychosocial support.
• Three out of 10 teenage girls become pregnant before they reach 20 years of age and over 300,000 babies born in Uganda are born by adolescents aged 15-19 years. Teenagers in rural areas are more likely to start childbearing than girls in urban areas.
• Restrictive governmental policies in addition to the lack of sex education and other reproductive health rights, and services make it even harder for young girls to navigate through the system.
• There is a dire need to create awareness, opportunities, and access for these girls to get appropriate information about their sexual health rights so that they can make informed health choices. This access alone can significantly address the problems of unplanned pregnancies, pregnancy related complications and unsafe abortions that account for high maternal mortality and morbidity.

In the year 2020, out of the 13 countries with the highest maternal mortality rates around the world, 12 are located in sub-Saharan Africa. Highest being in South Sudan, followed by Chad and Sierra Leone.

• Causes of deaths
• Poor antenatal care
• Teenage pregnancies
• Acute shortage of healthcare workers.
• The increase in institutional births in recent years has not been matched by quality health services. Multiple studies have clearly demonstrated the knowledge gap of providers especially in the low resource’s countries contributing to maternal deaths
• Each year between 50 000 to 100 000 women worldwide is affected by obstetric fistula which is directly linked to “obstructed labor and poor quality of care.

The causes can be summarized by the 3 delays:  seeking, reaching, and receiving care and most of those are preventable

Most of the medical complications resulting in maternal death and harm could be identified during ANC care.  Yet, most SSA countries have low ANC coverage.

Adolescent pregnancy is associated with high risk of maternal and neonatal complications, death, adverse childhood experiences, emotional, physical, or sexual abuse; intimate partner violence; living with someone who has substance abuse or mental illness or is involved in criminal activity.

• Sub-Saharan Africa has the highest neonatal mortality rate in the world, 27/1000 live births accounting for 43% of global newborn deaths. Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at or immediately after birth and in the first days of life.
• Infectious diseases, pneumonia, diarrhea, and malaria is the leading cause of under-five deaths.

• The digital solution, WONDER (Women’s, Obstetrical, Neonatal, Death, Evaluation and Reduction) empowers women to take control of their own health. It has a comprehensive smart electronic health record system that supports multiple modules of patient centered mobile applications.

• Platform is based on early identification and an alert system that forewarns the user and the providers of impending problems resulting in appropriate and timely interventions.   “Nurse in the purse”, the well women application gives all necessary educational contents on common health issues, STIs, monitor their cycles, mental health, and contraception. Leading questions elicit information that helps an internal algorithm to identify as reassuring or need consultation from her health provider.  Telehealth button connects her with a designated health provider who can be a mental health counselor or an OBGYN provider depending on the need.
• Obstetric care is based on digitized “Maternal, Early Obstetric Warning score” and “Newborn Early Warning Score” systems.  An alert system based on critical clinical information, important lab results and VS. When abnormal values are entered, an internal algorithm would create alerts that require immediate intervention by an obstetrician. It also offers Clinical Decision Support tools, clinical guidelines, and telehealth for immediate consultation with skilled obstetricians. With these guidelines, alert system, and secure telehealth, community health workers and non-obstetric doctors and nurses in the rural areas can provide up to date maternal and newborn care with confidence.
• A tertiary care center with Obstetrician and consultants would function as electronic birthing center (eBC), and monitors multiple peripheral centers, provide consultations and/or guide to stabilize sick patients and organize transport.

Benefits of WONDER

• Patient centered free remote patient monitoring system from Teen to menopause.
• The well women application that targets women of all ages, focuses on Teens regarding their sexual health, STIs, HIV/AIDS-to be added) and contraception. It also has a specific module for depression based on clinical practice guidelines.
• Special applications for informed mothers for self-monitoring of pregnancy.  Low-level providers can monitor multiple patients and still be connected with Obstetricians without delay.
• Wonder Application designed for antenatal and postnatal care by low-level providers.
• Newborn application designed for Community health workers to give home based newborn care.
• All applications are connected to Wonder electronic health records with clinical decision support tools for providers.
• Cloud based, safe, secure, economical, scalable, with multilingual capacity and inter-operability.
• Proven, easy application, works in tandem with existing health systems without the need for additional infrastructure.
• Proven with 3 projects covering antenatal, Intrapartum to postpartum & newborn care in India (~220,000 patients) functioning in parallel with the existing Government system of care & without the need for building additional infrastructure in two districts in Bihar India. 

• Recognition and Awards:

Received the highest award from the Green Electronic Council of the USA as a catalyzing Impact on scale for the Maternal Mortality Prevention Project conducted in collaboration with HP Inc.

Selected as semifinalist for the prestigious SKOCH Award (Highest Civilian award in India) for excellence in technology and applications.

Our solution is targeted to serve young girls and mothers and infants. 

• Africa has the highest birth rate among adolescent girls globally. Poverty, sexual and gender-based violence, and poor health outcomes, combined with lack of access to education, results in girls to unwanted pregnancies. Measures that empower girls, combined with easy access to healthcare can play a critical role in preventing teenage pregnancies.
• Girls ages 15-24 remain at substantial risk of acquiring HIV in Sub-Saharan Africa.
• Sub-Saharan Africa still has the highest rate of maternal deaths in the world.
• 2.3 million infants died within a month of birth in 2021. (UNICEF)
• The tools to prevent maternal and newborn deaths exist, but their distribution is unequal.
• There are significant regional differences in skills, resources, infrastructure, quality of care provided to pregnant women, mothers, and infants. Women in rural and hard to reach areas suffer the most. 
• More women are dying because of poor quality of maternal care rather than lack of maternal care.
• The specific maternal health needs of young people, migrants, people with disability, and other vulnerable groups also remain unmet.
• In at least five countries, more than 10 per cent of all maternal deaths are estimated to be AIDS-related
• Lack of readiness and functionality of primary health delivery systems are major contributors to poor effective coverage and poor quality-of-care of maternal health services. 
• Studies show that 2·15% of neglected obstructed labor would result in a vaginal fistula, yielding a prevalence of 1·88 cases per 1000 women aged 15–44 years in sub-Saharan Africa.

Our Solution WONDER:

• We have a comprehensive evidence based digital solution that is patient centered, administered by low-level providers but still closely connected to specialists through an alert system, and telehealth.
• A free well women mobile app, “Nurse in the purse”, is sensitive to the needs of the very young girls and females.
• Have the tools to train self-help women, and community health workers to function as mental health counselors.
• Maternal and newborn care programs are based on maternal and newborn early warning signs.
• Award winning Wonder App is designed for low-level trained community health volunteers to provide antenatal care with the backup of skilled providers.  This has been proven by implementation in 2 states, ~ 230,000 women and 4000 newborns and is still ongoing in India.
• Network of well-known physicians in Kenya who have agreed to work with WONDER and coordinate care to young girls and teen mothers:
  • Dr Juliana Otieno Pediatrician, Uzima University, Kisumu
  • Dr Paul Mitei, HOD, Obstetrics and Gynecology, Jaramogi Oginga Odinga Teaching and Referral hospital.
  • Jane Atieno Owuor, County Reproductive Health Coordinator...Kisumu
  • Mr. Salim from the Inuka Cultural center
• Also, it can work with the existing health systems, without the need for building large new infrastructures, and develop an inclusive and respectful quality of care. 
• WONDER programs have the interoperability to work with the existing health systems, without the need for building large new infrastructures, simple, economical, and scalable.

• Dr. Vinita Saini, our local Team Lead in Kenya is a Pediatrician representing Wonder4Health in Africa.
•  She bridges the gap between expert healthcare intervention and grassroots understanding. 
• She works with the Inuka Cultural Center, in the heart of Nairobi’s Kibera community.  Inuka provides a haven for healing, skill development, and rejuvenation providing hope for many in Kibera. 57% of its staff come from the Kibera family, having cultivated trust over 15 years.
•  As one of Africa's largest informal settlements, it mirrors the resilience of its inhabitants.
• Dr. Vinita would be the liaison between WONDER and the team of doctors in the Tertiary care center in Kisumu, Kenya.
  • Dr Juliana Otieno Pediatrician, Uzima University, Kisumu,
  • Dr Paul Mitei, HOD, Obstetrics and Gynecology, Jaramogi Oginga Odinga Teaching and Referral hospital. University of Neirobi,
  • Mr. Salim from Inuka Cultural center
  • We can create secure links and connect them with the various specialists at the University without the need for third-party involvement.
  • All of these can be coordinated through the help of Ms. Jane Atieno Owuor, County Reproductive Health Coordinator, Kisumu.
• Collaborative Outreach: Inuka’s enduring ties with local stakeholders, from educators to community leaders, provide a conduit for collaborative solution crafting.
• Listening to the Ground:  Regular interactions with Kibera families ensure our approach remains grounded, evolving as per their feedback and insights.
• TEPG – A Proven Model: The Empowerment Program for Girls (TEPG) at Inuka has already been a transformative force in Kibera, making it an ideal platform for the 'Nurse in the Purse' program. TEPG's alignment with our mission acts as a strong foundation for SRHR solution integration.
• Upholding Community Aspirations: Involving community leaders, faith based organizations, youth, and parents in our solution-formulation ensures that our actions echo the community's voices and visions. 

Engaging the Community in Solution Development:

Will create a digital network of Care delivery:

With our experience of developing a network of care delivery model, we will develop an up-to-date care model in Kenya.

The young girls will have a mobile of their own or the Nurse in the purse application can link the girls with their mother’s mobile so that they can be in direct communications with the community health worker (CHW). They will be counseled on the mobile applications and the available services. When entered, an abnormal input will give an alert by the internal algorithm, and a telehealth feature can directly take them to the skilled provide or will have the option to call their “own” CHW based on their rapport, prior communication, and comfort level and then to the doctor.

CHWs will be given a WONDER Kit with biometric devices and a computer system with the WONDER applications.                            

Community Level centers     >     Secondary level Hospitals   >   Tertiary Care Hospital (Electronic Birthing Center)

In summary, our alliance, bridging Dr. Vinita’s, exposure to Kisumu’s Health system, and Inuka Cultural Centre's trust and TEPG's transformative framework, promises not just solutions but meaningful, lasting change for the young women of Africa. 

250,000 mothers and children

800 users

Two states in India have implemented WONDER and continue to use our applications

We understand that no one solution can address all the problems that has been identified in the care of women and children.  I have cared for women for > 35 years and worked at the inner city of Chicago as well as in affluent neighborhoods. This experience has given me an opportunity to understand the problems of women in depth. Having been the head of maternal and neonatal mortality and near miss review committee and educational committees for over 25 years has given me unique abilities to understand the problems and how to rectify them by educating the provider thereby closing the loop. Also, I have worked with three different electronic health record systems. This helped me to understand the problems and the dire need for and importance of documentation and how the user experience determines the success of the program. Hence, I have tried to address the negatives of EHR from my experience and added the clinical decisions to support and help physicians in acute emergencies.  Rather than a mundane work of documentation, the EHR is interactive with clinical support and guidelines from various societies but still gives the physicians the independence and discretion to use their clinical acumen in treating their patients.

Our solution also addresses the following problems:

Our mobile applications help women to empower themselves and stay connected to their providers

Avoids the 3 major delays contributing to maternal deaths

Can provide up-to-date care using low and mid-level providers

Address the problem of lack of skilled providers. One skilled provider can manage multiple institutions with Wonder EHR and our model of electronic birthing center. (modelled after the successful electronic ICUs). This electronic birthing center can be housed anywhere in the world and can still watch and serve smaller institutions situated in remote and hard to reach areas.

Take antenatal care and newborn care to patient’s home with positive results

All the data collected could pave the way to develop AI models that can further improve the care of women and children.

Overall, a woman in remote corners of the world can receive up-to-date care which would be the same as a women’s care in affluent part of the world.

WONDER is a cloud based cutting edge technology solution that works in parallel with the existing model of care, without adding additional cost of building new infrastructure but still is Simple, cost effective, secure and scalable.

I feel all of the above makes this WONDER truly an innovative one.

Goal for the next year: 

WIN the MIT Solve grant! That will help us to Improve the development, application, implementation and maximize its functions. Get all the feedback from the fields, the users, coordinators, and experts from this program and in the field to make WONDER a truly unique and powerful model to help improve the care of young girls, women, and all the mothers at large.  

Expand the implementation in 5 states in India as well as at least a couple of countries in sub–Saharan Africa that has the highest MMR and NMR in the world.

Hope to expand the program to benefit the African American, and Native American population in the US where the MMR has been steadily increasing over the past few years.

Goal for the next 5 years:

Since WONDER platform is based on vital criteria and critical clinical information and an alert system, it can be applied to any specialty. We hope to expand the development to cover children under 5 and eventually up to age 18.

We plan to use the large sets  of data and develop AI predictive models which will help to further improve patient meaningful outcomes.

We hope to expand the WONDER program in several low resources countries especially in Sub-Saharan Africa with very high maternal and neonatal deaths and demonstrate success by reducing the Maternal & Neonatal Mortality rates (MMR & NMR)  by 40-50%, a goal that can help meet the SDG targets.

The above success will be an asset to expand our program to the US which is one of the developed nations with increasing MMR.

Currently we are working with UNICEF. We hope to develop partnership with other organizations like WHO, World Bank  and  other doner agencies to implement the program across multiple states and countries.

Our experience through the prior applications have shown the ability of the program to successfully reduce the MMR by 50%. This was achieved by using young girls with computer skills who were taught to use the electronic health record system and also trained to check vital signs every four hours and record them in the system. When there was a red alert, they printed the order sets and treatment guidelines and placed them on the patient’s chart and alerted the nursing staff about the red alert. This was of immense help to the two nurses who had to take care of ~40-50 patients in labor at any given time. If treatment was not given, the red alert continued until the values reached a comfortable zone. This helped to avoid problems falling through the cracks and unattended.

We were able to reduce the in-hospital eclampsia by 91%.  

Even in an institution with limited providers and resources, we demonstrated the timely intervention i.e., from identification to initiation of treatment within 1 hour in 95% of cases. The target by ACOG and RCOG is 30-60 minutes and is not met by all institutions yet even in high resources countries.

Though the buy-in by the doctors was difficult at the beginning, within the next few months, they understood the value of the program and were very impressed by the help they received in managing their patients. Seeing how helpful it was to look at the dashboard and see the sickest patient who needed their care first, felt comfortable to instruct their nurses to follow the Wonder protocols in their absence to manage any acute obstetric emergencies.  

While majority of neonatal deaths occur within the first 28 days, WONDER newborn program administered by self help women with basic education has not lost even one child during the past one year. This outcome made the self-help women feel empowered and gave them the feeling of ownership and they feel proud that they are the front-line providers and they alone have created such a huge impact on the outcome of these children. 

Full time 4

Contractual: 6

About 10 years

Leadership Commitment: WONDER Leadership has a clear commitment to diversity, equity, and inclusivity. This commitment is reflected in organizational values, policies, and actions.

Diverse Hiring and Promotion, we actively seek diversity in our workforce, from entry-level positions to leadership roles. Implement fair and unbiased hiring and promotion processes that focus on skills.

We foster an inclusive workplace culture where all employees feel valued, respected, and empowered to contribute their unique perspectives. We encourage open door and open communication policy and provide training on inclusivity.

Equitable Compensation: Ensure that employees are paid fairly and equitably for their roles, regardless of their gender, race, or other personal attributes.

WONDER has a diverse team that can offer varied perspectives and experiences. 

We ensure that our products, services, and facilities are accessible to individuals with disabilities. This includes accessible digital content and physical accommodations.
We provide ongoing education and training on diversity, equity, and inclusivity to all employees. This helps to increase awareness and reduce bias.

WONDER engages with the communities it serves to better understand their needs and perspectives.

WONDER develops and implements its policies that support diversity and equity, including anti-discrimination policies and flexible work arrangements.

WONDER promotes diversity in leadership roles

Continuous Improvement: Diversity, equity, and inclusivity efforts is an ongoing and continuously evaluated and improved.

WONDER hold leaders and employees accountable for their commitment to diversity and inclusivity through performance evaluations and feedback.

Incorporating diversity, equity, and inclusivity into our work is a comprehensive and ongoing effort that involves every aspect of our organization.

WONDER has been enabling technology transformation for Women's Health, Newborn Care and Child Nutrition in India for the last 6 years.  We have and continue to deliver meaningful technologies at our core activities: Patient services, Care delivery that has helped our consumers in public health leverage technology adaptation to manage their patients effectively. Wonder Healthcare Solutions is committed to bringing emerging medical advances to women's health and child nutrition around the world by leveraging technology. We provide easy access and links to various clinical guidelines. This makes the clinician's and users experience of using WONDER more meaningful and efficient. 

Some of the key focuses of WONDER are listed below:                                    Maternal Mortality Rate                                                                      Woman's Wellness and Reproductive Health                                                    Infant Mortality Rate Under 5 mortality Rate                                                  Full Vaccination Coverage                                                                  Children's Nutritional status (children age below 5 years who are underweight Anemia among children, girls and young women                                              Underweight women with BMI below normal                                                Life expectancy at birth                                                                              Still birth and recurrent pregnancy losses                                                        Female feticide 

Products/Services: 

WONDER App                                                                                                WONDER EHR                                                                                          Nurse in the Purse                                                                                          WONDER Mom's application                                                                            WONDER New Born Application 

Revenue Streams: 

Licensing/Subscription fees for healthcare providers to access the platform and data analytics. 

Impact: Improved access to healthcare, especially for those in remote areas. Enhanced patient outcomes through remote monitoring and early intervention. Reduction in healthcare costs through preventative care and reduced hospital readmissions. 

Key Activities: Software development and maintenance. Patient engagement and support for using the technology. 

Key Partnerships: Collaboration with healthcare providers and facilities. Integration with electronic health record (EHR) systems. Integration with insurers and payers 

Cost Structure: Costs associated with software development and maintenance. Marketing and sales expenses. Support and customer service costs. 

Metrics and KPIs: Number of healthcare providers using the platform. Patient adoption and engagement. Reduction in hospital readmission rates. Financial metrics related to revenue and profitability. This business model leverages healthcare technology to provide value by improving access to care, enhancing patient outcomes, and reducing healthcare costs. It's focused on technology, partnerships, and user engagement to achieve positive impact and generate revenue in the healthcare sector.

Diversify Revenue Streams:

We plan to do the following 1. Selling Products or Services: We continuously explore opportunities to create and sell products or services that align with our mission. 2. Service Contracts to Governments: We provide service and manpower contracts with government/public institutions to provide specialized services or expertise. 3. Investment Capital: We are in the process of raising investment capital from impact investors/ venture philanthropists who share our vision. 3. Grants: Continue to apply for and secure grants from government agencies, private foundations, and international organizations that align with our mission and initiatives. 

1. To scale our operations. 

2. Financial Sustainability Planning: 

   Budgeting: Develop a comprehensive budget that includes all income and       expenses. Ensure that your budget is realistic and that it accounts for both     short-term and long-term needs.

   Financial Reserves: Build and maintain financial reserves for emergencies     or unexpected challenges.

   Sustainability Metrics: We set clear metrics to measure our progress             toward financial sustainability. We monitor key performance indicators           (KPIs) related to revenue, expenses, and sustainability goals.

   Efficiency and Cost Reduction: Continuously evaluate our operations for       efficiency and cost reduction opportunities.

    Transparency: We maintain transparency in our financial reporting and          outcomes. We clearly communicate how donations and funding are used        to  make an impact. Donor Engagement: We continuously cultivate strong      relationships with donors, showing appreciation for their contributions            and involving them in our mission and work.

4. Impact Measurement and Reporting: 

      Impact Metrics: We clearly define the social or environmental impact            we seek to achieve and establish metrics to measure progress and                  outcomes. Demonstrating impact can attract and retain donors. 

5. Adaptive Approach: 

      Flexibility: We are prepared to adapt our funding model as                            circumstances change. Diversification and a willingness to explore new          revenue streams are key to long-term sustainability. 

6. Legal and Tax Considerations: 

     Maintain tax status: We maintain our tax status by complying with all           legal requirements and regulations related to your organizational                   structure. 

7. Evaluation and Adjustment: 

8. Regular Assessment: W regularly assess the performance of each revenue stream and funding source. We adjust our strategy based on what works and what doesn't.

9. Long-term Vision: Make WONDER a Model program to provide a cutting edge platform to provide healthcare that is blind to the race, socioeconomic status and geographic location.

10. Plan for the Future: Our long-term goals are a clear vision for the financial sustainability of our organization. This will help guide our strategic decisions and growth. Financial sustainability is an ongoing effort that requires strategic planning, adaptability, and a commitment to fulfilling our mission. By diversifying revenue streams, engaging with donors and partners, and maintaining transparency, our organization will become financially sustainable while making a lasting and meaningful impact on global  maternal and child care.