Kiran - My e-swasthsakhi

The challenge at large: Individuals in conservative communities, across genders, have poor access to information around sexual and reproductive health and rights (SRHR) The challenge becomes deeper in communities that have lower information access, having a toll on particularly vulnerable communities such as rural women, adolescent girls and LGBTQ+ populations. WHO reports that “despite progress, every two minutes, a woman dies from preventable causes related to pregnancy and childbirth, and 270 million women aged 15-49 have an unmet need for contraception. Only 57 percent of women in this age group make informed decisions about sexual relations, contraception, and reproductive health. In addition, the gender and human rights movement are stalling efforts on safe abortion care.”

The issues how we presently address it: Not for profits, including grassroots organizations like ourselves, have proven the effectiveness of deploying trained and trusted swasthswakhis (health champions) who are from these communities, to further awareness on these sensitive topics, in small groups and closed circles. However, while this model leverages the relatability of a friend, it has issues of confidentiality and bias. Individuals shy away from seeking information on issues that might be critically affecting their personal bodies, minds and life, due to lack of anonymity and fear of judgment. 

The new dimension: Expanded internet penetration through higher ownership of mobile devices, could have addressed the information gap, but data shows that, in countries like India, this has been accompanied with 30% up to 70% of total traffic from porn websites. While this demonstrates clearly that people feel anonymity and don’t fear judgement in the digital channel, it also showcases a critical risk.  The under-regulated nature of porn and the lack of linked curated medical information along with further creates unrealistic views towards SRHR and alters perception of normalcy and violence, 

Our solution address all these 3 dimensions making SRHR information and related services accessible, circumventing the challenges of confidentiality and bias in a human intervention and yet, addressing the misinformation, and context issues of a digital intervention. 

For our users in excluded communities, we want to provide an e-companion who sounds akin to our local swasthsakhi, speaks relatably and yet assures anonymity. Our tests demonstrate that this makes individuals seek more information on their personal SRHR issues. This conversational agent shall be trained only in curated medical information and blend the same with local knowledge incorporating storytelling, local context and characters. Further it shall link to telemedical support and have the ability to analyze data to identify cases that critically require intervention by human professionals. 

Our application is being built in 3 stages: 

Stage 1: Chatbot: This prototype-ready phase has a simple Whatsapp based chat where users can chat about SRHR issues and get relevant responses. Voice integration (presently in Hindi, later to be extended to other regional languages) is available and the voice sampled is that of the relatable local health-champion (swasthsakhi).

Stage 2: Services: In stage 1, analyzing a conversation, the app might be connecting a user with unanswered queries to a human agent - the local swasthsakhi who thereafter continues to provide support offline. In stage 2, we shall integrate teleconsultation and certain telediagnosis services in the application itself. The app shall also direct to offline centers for medicines and further support.  We are partnered with a medical teleconsultation provider to integrate associated consultations with doctors and counselors. We are also listing all relevant offline information in our pilot testing district, Ajmer. 

Stage 3: Hyper-contextualisation: Even in stage 1, information provided and  responses of our chatbot is contextualized to a high degree to the user query. However, we strongly believe that health information on sensitive topic is more effective towards mindset and behavioral change, when they are less ‘clinical’ and more ‘edutainment’ in nature. This means medical conversation has to be de-mystified and delivered in a style that is friendly, incorporating local references, local style of conversation, visuals with local context and characters, and relatable storytelling. We have trained our grassroots team to leverage generative AI creativity apps to customize our content significantly, with remarkably low turnaround time and costs. Stage 3 will create the opportunity to give our trained swasthsakhis to train the model to contextualize in the manner information, leveraging generative AI directly within the application. In this stage, the chatbot shall learn what to respond from curated medical information, and how to respond from customizations suggested by our trained indigenous health champions. 

Although the application could be used by anybody with information need around SRHR, our key focus is women and gender and sexual minorities (GSM) in remote marginalised communities which have recently come within internet access. 

Think of an excluded teenager who is confused about her bodily changes during puberty and has no safe space to discuss issues, both physical and mental, she is facing without the fear of being judged or shamed. Imagine this individual now chatting with ease over Whatsapp with an AI personality who addresses her anxious queries about her bodily changes, in a relatable and trustworthy manner.

This could help a woman affected by her spouse’s chronic abusive behavior understand her rights around violence, or help a closeted scared adolescent learn about the normalcy around alternate sexualities and seek out support forums. 

At a broader level, such information is likely to mitigate sexual diseases, promote healthy sexual practices including contraception, mitigate risks of fatalities during pregnancy and childbirth, aid larger acceptance of diversity in gender and sex, leading to more informed choices in sexual relations, family planning and life overall. 

The key team members for this project is a partnership between an individual with alternate sexuality (Mr. Shuvajit Payne) and a woman coming from a conservative society (Dr Monalisa Padhee. Although these individuals have had educational privilege, they both have a series of critical life incidents that make this project a personal passion. This has reflected in their life's work till now with Dr. Padhee being recognized as Acumen and Aspen Fellows for her work on SRHR awareness, and Mr. Shuvajit, being recognized within Top Global Teachers in 2020 as per Varkey Foundation list for his contribution to citizenship curriculum focusing on gender equity.

The next group of key individuals involved in the project are our community team members who are co-creators of the solution. Through our traditional awareness programs, we have already authored significant changes in agency of local women to speak up on these issues with confidence. An example will be our colleague Asha who spoke about this highly sensitive and personal aspect fearlessly  on national television (Link: Asha on Menstrual Health (Intervew with Barkha Datt, journalist). This app intends to amplify her journey at scale. 

Bindi International, (registered as Empbindi International Association), is a community oriented organization with a unique team that blends qualified professionals with individuals from disadvantaged backgrounds who have grown within the organizations with their experience. As such, our management and grassroots operations team are a balanced mix of individuals who are directly from communities that we work with. This gives us a nuanced understanding of grassroots challenges and allow us to design interventions that are human centered by design. 

In our design and implementation, we always believe in the indigenous wisdom of the community and envision the organizations role in only democratizing modern technology to foster self-sufficiency in marginalized communities. Even in this application, the role our empowered health champions are expected to play in contextualising the content the app will learn, becomes a key distinctive approach. 

Work done till now include: 

1. Training select health champions in generative AI apps to demonstrate their ability to create customized content in reduced turnaround time and lower cost

2. Testing the effectiveness of such localised content in spreading awareness in target communities

3. Development of first application prototype with technical partners from Team4Tech and Adobe. 

1. To make effective use of technology, its critical to explore different designs and integrating with platforms that extend opportunities. We believe that the Solve teams shall be able to provide the necessary critique and feedback that will enhance our model. 
2. Being a community oriented organization, we always seek support on technology as well  (both knowledge and systems). 
3. We also believe that the Solve platform is closely followed by various like minded organizations that Bindi International can partner for the future roll out of the solution. 
4. Further, although presently the prototype is being prepared for pilot in India, we believe this solution has application across the Global South and therefore would like to benefit from the Solve platforms in terms of visibility and advocacy.
5. Lastly but very importantly, we will definitely need to generate necessary financial support for incubating the solution from prototype to scale stage.

Co-designed by the community: Our present prototype is an application of existing technology for the goal of social impact, focussing on SRHR in grassroots marginalised audiences (which have recently come within the gambit of internet connectivity and mobile penetration). Our distinguishing factor here is that representatives from the community have been part of the co-creation process from the start, resulting in an effective human-centered design.

Creating demand for medical services: Secondly, our application goes beyond just conversational awareness and integrates telemedical support. Together, this is a first in areas that we operate, meaning we are creating medical behaviour information where there exists none presently. We have a ready network of health champions (swasthsakhi) who shall be promoting use of this application in their communities.

Collaborative Ecosystem: Lastly, Bindi Intertnational believes in an ecosystem approach to problem solving and as such our solutions are multistakeholder. For example, even for this solution, Bindi is partnered with Team4Tech and Adobe volunteers for technical build support and ImpactOnus Consulting for solution design inputs. In fact, if successful in pilot, Bindi has a ready network of 40+ grassroots organisation for whom this solution will be relevant. 

The vision: Every woman has access to information about her own body & health to make informed decisions. 

The mission: Our technology solution aspires to provide a large number of users, particularly vulnerable groups such as women and LGBTQ+ individuals,  personalized information and related consultation and medical services , in a relatable trusted manner, at the same time. 

Short term outputs: 

1. Drive down cost and turnaround time of SRHR awareness interventions of NGOs. 
2. Increase in number of consultations with medical professionals on SRHR
3. Increase in availing related medical services 

Medium term outcomes: Adoption of safer behavioral practices around SRHR due to higher effectiveness awareness. 

Longer term outcomes:

1. Reduction in fatalities during pregnancy and childbirth

2. Higher proportion of reporting on issues of domestic violence

3. Higher number of public ownership of alternate gender identities

4. Improved tolerance towards LGBTQ+ issues

A more comprehensive Theory of Change can be provided on request.

We will closely follow impact goals in health (SDG Goal 3) and gender equality (SDG Goal 5). Given that a component of our intervention is around awareness and information education - it falls in the realm of Quality of Education for All  (SDG Goal 4) as well. 

Within the above impact goals, the following indicators are key for us: 

GOOD HEALTH AND WELL BEING

Target

3.7

By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes

Indicators

3.7.1
Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods

3.7.2
Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group

GENDER EQUALITY

Target

5.2

Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation

Indicators

5.2.1
Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age

5.2.2
Proportion of women and girls aged 15 years and older subjected to sexual violence by persons other than an intimate partner in the previous 12 months, by age and place of occurrence

Target

5.3

Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation

Indicators

5.3.1
Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18

5.3.2
Proportion of girls and women aged 15-49 years who have undergone female genital mutilation/cutting, by age

Target

5.6

Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences

Indicators

5.6.1
Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care

The present prototype is a voice-assisted Whatsapp chatbot which leverages artificial intelligence and machine learning to respond to Hindi queries on the topic of sexual and reproductive health (SRHR). As mentioned before, in Phase 2 and 3, further functionalities around telemedicine and generative AI content creation by select users shall be added. In this way, we expect the application to deliver accurate medical information from a curated and validated database. The application will also learn ‘how to deliver such information’ in local narrative styles with relatable characters, motifs and context from the indigenous communities, from the inputs of human ‘swasthsakhis’ (health champions). 

The key team members who are responsible for the functional design of the application include: 

1. Mr. Shuvajit Payne, Strategic Advisor working as a consultant to Bindi International and principal consultant of ImpactOnus Consulting, that has provided the design intelligence for the applicartion. 
2. Dr. Monalisa Padhee, who is a full time staff and heads the Health and Education verticals. 
3. A team of 3 full time community individuals work with this team to provide continuous feedback on design and functionalities. 
4. Technical team: 3 member pro bono consultant team from Adobe volunteers who have worked with our part-time app builder.

We have had the experience of working on issues in SRHR and providing related services for a decade We have worked on creating locally contextualised content for the same goal for 4 years now and adapted to a generative-AI based workflow led by our grassroots team in early 2023. The build phase of the Whatsapp base chat solution has been there for one month. 

The team working on the present solution include people from diverse ethnicities, economic background, and individual(s) who identify as LGBTQ+. The extended organization, with a signficant representation of grassroot individuals and women in the management, has a strong policy towards DEI. 

At Bindi International, equity and inclusion are values which are implemented by creating trajectories whereby those from disadvantaged backgrounds are provided additional opportunities and support to progress in their career within and beyond the organization. The same is reflected in each of our programs where dignity and capacity of the grassroots individual is kept at the focus. 

It is worth mentioning that even our present solution aims to include the typically digitally excluded rural individuals into the data world. If implemented at scale, this has the potential to correct some of the biases that are becoming inherent in outputs of AI technology, consequent of its users profile being from similar sociocultural bracket. 

While we usually work directly with the rural population, for this solution, we will have two approaches.

Direct use of the application by individuals.

Our beneficiary here is marginalized rural individual, particularly women, girls and individuals from the LGBTQ+ community, who are most vulnerable when it comes to SRHR. Given that this is a technology solution, we are targeting communities which are remote and/or impoverished but have come within internet coverage thanks to expanding connectivity and rising mobile penetration. Usually, our beneficiaries are semi-literate or illiterate and are more comfortable with voice and/or pictoral interactions, in their local language.

Use by like minded civil society organizations in their existing projects

The application is also of relevance to the large number of civil society organizations which are already working on SRHR awareness but find it challenging to be effective in reaching out to the last mile. This can be due to the lack of available local trainers who are trustworthy and who can be minimizing personal bias and maintain confidentiality of the beneficiaries.

The need being fulfilled

Grassroots beneficiaries need their personal queries addressed around challenges related to their reproductive health, related complex matters of identity, mental health, violence and exploitation. They do not want to be bombarded with information but want curated accurate information from trusted sources. They can discuss such matters only in a safe space that is free of judgment or bias, and assures anonymity and confidentiality.

Organizations working with such beneficiaries are seeking technological innovations that shall allow effective and measurable change in awareness in a manner that is scalable.

This application addresses this need for the beneficiaries and the organisations working with them.

Although usually we work in a direct-to-beneficiary model, we will like to explore B2B engagements with other NGOs and B2G engagement by providing a tool to these insittutions for achieving their goals towards SRHR awareness and medical service adoption.

We will fund the initial cost of development and user testing from our existing grants (including MIT solve platform if successful). Our organization will be leveraging the app with 1,000+ beneficiaries in India from its own existing budgets. In fact, this is better cost optimisation, since  the cost of hosting and utilizing such a solution for large audiences is significantly less than our present spend on human resources for the same purpose. This cost saving implies that in the medium term, other NGOs will be paying to utilize this app for their awareness projects. 

However, our vision is to reach the global community through partnerships with governments. Data generated from the first two years of app usage will be utilized to advocate for the adoption of the app as a national digital public good for India. We will like to pursue similar opportunities with other governments across the Global South.