Avegen – Tackling Maternal Mortality in India using Technology
India has one of the highest maternal mortality rates in the world - Together for Her wants to change this with a new databased platform.
Mothers can evaluate visited hospitals according to their “Quality of Care” – using nine WHO-based indicators. These ratings are freely accessible to (expectant) mothers who are looking for contact points and want to find out more about their health in general. The hospital ratings are also evaluated after registration on the website, which has so far shown a significant increase in their “Quality of Care”. Besides, Together for Her offers bundled services to pregnant women to help them monitor prenatal health, which can be offered more cost-effectively due to the website’s economies of scale.
We spoke to Anne Reijns and Dr. Sumiti Saharan, Directors of Together for Her, a program that is initiated by Healthtech startup Avegen, about their challenges, their learnings and what they want to achieve with their maternal healthcare program.
If you had to describe yourself in three words, what would you say?
Sumiti: I am a nerd for data and a problem solver.
Anne: I love tackling complexity and am passionate about female healthcare.
When we look at Avegen and maternal health care, what was the initial idea, and how did you start building Together for Her?
Sumiti: The initial trigger to start building Avegen, came from a very personal experience from our CEO, who is a doctor. One of his good friends was suffering from diabetes and an infected smoker’s leg. In the end, his leg was amputated. People who are in such complex health conditions need more support to be able to make the right choices. The current health system has somehow failed this person to do so. This became the genesis of Avegen.
Anne: It is really about preventable health outcomes. Take maternal healthcare for example. It is crazy, because most deaths are preventable, and they are often connected to either quality care, not having enough support nor the right information or access to the right treatment.
That combination is where Avegen started and our maternal-health program Together for Her is coming from. In India, maternal healthcare is one of the biggest problems. If you are able to change behaviors and direct towards the doctor, you can actually prevent anemia, or pre-term delivery, which has a huge effect on maternal mortality.
Avegen and maternal health-care topics started to form the idea that it is possible, we just need to do something with it, and the digital solution is the only way to do that if you want to make it scalable.
You had the idea, but that is all theory. What were the first steps when you started building the business around it?
Anne: It’s two folded. Due to market differences between the UK and India, our steps were slightly different. In the UK we started looking into the provider’s side because if you want to get to a patient, you need to go through health insurance and the healthcare provider.
On the one side we want to make healthcare more personalized, so people have more access to doctors. But there is a resource problem, there are only so many nurses and an increasing number of people with health issues as they are living longer.
We started building a workflow management tool that really supports the nurses in a specific healthcare area to improve equality of care, reduce their workflow, make sure that they can personalize the care, know where the patients are and make sure they don’t drop out, which is one of the main reasons for a bad treatment. That’s where we started in the UK and after that, we added to the patient’s side because as soon, we had access to the provider, the step to the patient was easier.
Sumiti: In India, we actually turned it around. In order to get access to the doctor, you need to get to the patient. We started with a quality of care platform, which was funded by a grant. We thought that, if we can take feedback from the patients, we can improve the quality of care at the hospitals, get access to those and convince them that they need to be more patient-focused. We started with the quality of healthcare platform that we now have in 1,000 hospitals in India, with 35,000 reviews at the moment.
What has been the biggest challenge so far?
Anne: Healthcare in India is farther behind than in the UK. Our biggest idealistic social focus is on trying to make the biggest impact there.
However, the market is not ready to pay for software solutions. So how do you support a healthcare system if you can’t find a willing payor? In addition, we’ve been trying different ways, with different business models. Figuring out who the payor is has been extremely hard. The way we do it now is saying that it is grant-based funding because it is a social impact story and we fund it with the business that we have in Europe.
What are some special moments that you will always remember?
Sumiti: When you work in healthcare, there are so many, it is one of the gratifying bits. I will start with the numbers first. When we started with cardiac rehab I remember, that we put ourselves on the pedestal test how this pattern of change works.
We tried it at Buckinghamshire and we looked at what the outcomes are like. We saw that with the implementation of our technology we had a 51% reduction in the number of people who had to get re-admitted after having a cardiac event for a second stroke. It is a number but is so powerful because you’ve impacted lives.
And the workload from nurses has reduced. Furthermore, on hospital-level, the costs of care have reduced by 32%. We had the technology and just by implementing it, we created a dramatic change in how healthcare is working on both terms.
Personally, that gets reinforced when mothers reach out to you in India. They write to you and tell you about their pains and problems. You are able to give them advice and tell them if they need to see a doctor.
Anne: For me, there were two big moments. The numbers are very powerful as Sumiti mentioned. However, the biggest realization for me – coming from Europe and living in India – was when I was at one conference. It was a very privileged setting, and I was going around saying what I did and why we do what we do. And a woman was standing next to me saying: “Let me tell them why your work is important.” And this woman told her horrible story of losing one of her children because of poor quality of care and poor decision making because her doctor was not aware of what her prior medical history was.
Hearing someone else tell your story, that makes it very real, it stuck with me for days even though I am in the business, but hearing the personal story makes you think – this is why you do it. These moments make it worth it.
Why is it important to build healthcare solutions focusing on women?
Anne: Healthcare is traditionally built for white middle-aged men. Only since 1996 are women a mandatory part of clinical trials. You can see this on the examples of cardiac rehabilitation or heart attacks. More men get a heart attack, but as a woman, you have a higher risk of dying from it, which is only explainable by gender bias in healthcare.
Sumiti: The signs of a heart attack for women are completely different from a man. Dizziness is a sign of a heart attack for women but not for men. There are so many heart attacks being undiagnosed because women feel lightheaded and at that moment all the information that is being circulated does not tell her this could be a sign for a heart attack. As a woman, even if you do go to a doctor, you have a 50% higher chance of being misdiagnosed after a heart attack.
Anne: Many types of diseases don’t get the attention they should. Very few care about maternal health or infertility because it is a women’s problem. And that is so extremely infuriating that we still have to fight for basic things such as healthcare. Especially in India or developing countries where a husband considers it as preventive care, and thus a woman does not get an ultrasound.
Sumiti: People forget that delivery and pregnancy, in general, is one of the riskiest things a woman would go through. And it is an experience that spans through nine months of pregnancy and the aftercare impacts the woman’s and the baby’s life. To not have fair support around it does not make sense. It is not about creating a healthcare system that is exclusively for women. It is about creating a healthcare system that is equally beneficial for all people.
Where will Avegen be in five years?
Anne: What we want to achieve in the next five years is that we want to have improved lives of more than ten million individuals in Europe and urban India thereby setting ourselves up to become a global digital healthcare provider.
Sumiti: We want to take complex health journeys that currently don’t have the needed support and really address them. That is why we picked to begin with HIV, cardiac health and maternal health. And we are also looking into certain types of cancer that require an extreme amount of support.
What are the next steps?
Anne: We are very busy proving the clinical effectiveness in India with our study, which is not just looking into outcomes, but it is a proper clinical effectiveness study that has not often been done in digital areas.
Secondly, we are strengthening our current disease areas, which is very exciting, and we are definitely growing our customer base now massively. These things are the key focuses for 2020 and then we will see further.