This tech start-up in India is teaching people to care for family members with COVID-19

There is a power imbalance in our global healthcare system where those who care most for patients — their family members — are left out of patient healing. For marginalized families, the stakes are even more dire: In India and Bangladesh, patients have minimal opportunities and very short windows of time (on average, 2.5 minutes in India and 48 seconds in Bangladesh) to learn about life-saving preventative care, despite the best efforts of frontline health providers. This is due in part to the reality that health systems are understaffed, and healthcare workers are overburdened.

South Asia faces critical healthcare worker shortages, with, for example, an estimated need for 2.5 million healthcare staff to serve India’s population of over 1.3 billion people. Even when patients get time with their doctors, 40 - 80% of medical information provided is forgotten immediately, and almost half of what is remembered is incorrect.

As a result, patients and families often leave healthcare facilities feeling anxious, confused, and ill-equipped to care for their loved ones, leading to preventable complications, avoidable readmissions, and in some cases, death. In India, an estimated 70% of deaths in children under 5 are preventable through adopting better health practices, many of them actionable at home. Lifestyle factors and behaviors that families can adopt have significant influences on diseases such as Cardiovascular disease (CVD), that accounts for an estimated 2.6 million deaths annually in India.

At Noora Health, we have demonstrated that by recognizing the power of the most effective caregiver that any individual has - their own family - and empowering them with the right information and skills, we can radically transform patient outcomes and strengthen health systems.

The COVID-19 pandemic exacerbated challenges to health access.

The vast majority of COVID-19 cases in South Asia come from India, which has reported over 18 million cases, with around 2 million cases in the last week alone. Currently, India is in the midst of an immense second wave that has propelled it to being the country with the second highest case count, and entered into a renewed lockdown state. COVID-19 is estimated to have cost South Asia more than $2.4 billion USD, including the cost of testing ($1.9 billion USD) and overall healthcare utilization ($581 million USD).

The pandemic and subsequent lockdowns and stay-at-home orders have furthered many of the problems already plaguing the region prior to the pandemic: overstretched and understaffed health systems, poverty and unemployment, educational access and outcomes, and health access and outcomes (both physical and mental). Figure 1 below was developed by UNICEF to showcase these indirect impacts of the pandemic, specifically on maternal, child, and adolescent health outcomes.

To better understand the direct and indirect impacts of the pandemic in its early, initial stages, and thereby inform our COVID-19 strategies, Noora Health sought to learn about the perceptions community members and healthcare workers had of COVID-19, and how that influenced their health behaviours.

In light of findings from both of these surveys and the continued fluctuation of COVID-19 in the region, the need for accurate and effective digital health messaging became glaringly evident, and has been a significant component of our approach. As rates of COVID-19 infection rise, community based insights are key to informing our targeted interventions to support governments and health system partners, including currently on crucial vaccine rollout and uptake-related health education efforts.

Technology-enabled services unlocked unprecedented access to patients - in their homes.

As made evident by the COVID-19 pandemic, hospitals, nurses, and doctors simply cannot carry the enormous burden of healthcare alone.

Seeing the impact of COVID-19 on overburdened health systems and patient families throughout India and Bangladesh, we began asking ourselves this: what if we could build a system where technology helps humans focus on what matters most — caring for one another?

Through our research, we learned that technology solutions like chatbots, social media, and augmented reality can be leveraged to enhance the patient experience, empower nurses and healthcare providers with readily accessible information and tools for upskilling, and navigate some of the barriers to patient care - so long as these services are rooted in human-centred service design, remain relevant and useful to the patient’s evolving needs, and balance the scaling potential tech offers with enough human interaction to bring a human touch to these services.

India alone has 200 million WhatsApp users, with increasing usage every year. We found within the patient populations we serve that 80% of households owned at least one smartphone shared among family members. Over a year and a half (Sept 2019-March 2021), our WhatsApp services supported over 45,465 unique users in India with key health behaviour change messaging. Our team has sent over 635,000 health messages, and resolved more than 10,000 medical questions.

It was clear to us that people needed a trusted, credible, and easy to access source of information at critical moments, as they navigated staying safe and healthy during the pandemic.

In partnership with the Government of Bangladesh, Turn.io, and Praekelt.Org, we launched an interactive WhatsApp chatbot HealthAlert shortly after the onset of the pandemic, to ensure people had access to critical COVID-19 information and rapidly evolving government guidelines, reaching over 23,000 users. Health Alert covers a range of topics, from prevention and symptoms to treatment options, risks, and other services. The service also provides the government with direct insights to support their broader pandemic response.

While these tools will never be a replacement for empathy and caring human connection, they enable greater access to information and care, and meet patients wherever they are. Ultimately, we landed on a blended model that leveraged the empathy of human connection, amplified by the scale and reach of technology.

Overall, our COVID-19 response efforts have reached over 15.6 million people. Looking forward, we will continue to leverage both the power of families and technology to improve the standard of care.