Khushi Baby Looks Ahead After a Decade of Impact in India

A group of Yale students’ novel idea of a digital pendant for infant vaccine records has become the foundation for one of India’s largest digital health platforms.

It all started when Khushi Baby co-founder Dr. Ruchit Nagar MD, MPH ’16, took the course “Appropriate Technology in the Developing World” while pursuing his MPH at the Yale School of Public Health. Taught by Joseph Zinter and Robert “Bo” Hopkins through the School of Engineering and Applied Science, the course challenged students to design solutions for real-world problems. On the first day, the students were presented with the following statistic: 1.5 million children under the age of five die each year from vaccine-preventable diseases.

Identifying data and accountability as a key gap, Nagar and his fellow students proposed a novel application of Near Field Communication (NFC) technology to serve as a decentralized health immunization record for infants in India. The students’ solution: a wearable pendant containing an infant’s health records on an NFC computer chip that could be paired with a mobile application for health care workers and would include dialect-specific vaccine reminders for families. They called their innovative enterprise Khushi Baby.

In 2014, Khushi Baby was awarded the Yale School of Public Health’s inaugural Thorne Prize for Social Innovation in Health, which included $25,000 in prize money. With the support of Indian co-founder and Chief Operating Officer Mohammed Shahnawaz, the students leveraged the award funding to begin field testing in rural Udaipur, Rajasthan. Piloting the digital intervention at the last mile revealed many challenges including health workers overloaded with paperwork, fragmented tools across different siloed health programs, and health officials that had limited visibility into actionable insights. These early insights shaped Khushi Baby’s evolution as a nonprofit digital health solutions organization.

Leveraging their public health background, the team’s first task was to study the feasibility and impact of their digital device given these newfound challenges. After promising but inconclusive results in improving vaccination rates in their first randomized controlled trial (RCT) — mentored by Nicholas Christakis at the Yale Human Nature Lab — the team spent a year redesigning the prototype to better align with national health guidelines and community needs. Their second, larger RCT, involving 3,200 mothers, demonstrated that the digital health intervention arm had a 12 percent improvement in complete infant immunization and 4 percent reduction in infant moderate acute malnutrition. Co-designing with community health workers (CHWs) and keeping a system-oriented lens has remained a guiding principle in Khushi Baby’s efforts to shape new digital health interventions and ecosystems.

From Pilot to Platform

In 2019, the Khushi Baby team approached the Government of Rajasthan’s Department of Health to scale-up their evidence-based digital platform only to receive more questions than answers. The team noted how CHWs are estimated to spend 50 million hours every month collecting data for over 800 public health indicators across 12 health programs and more than 40 health information systems. To help improve efficiency, Khushi Baby expanded beyond its initial domain of maternal and child health and began working on ways to reconfigure the public health information system.

Khushi Baby introduced the Community Health Integrated Platform (CHIP) - a single, unified platform that facilitates a digital health census, longitudinal health tracking, and data-driven service delivery. Catalyzed by a need for rapid community surveillance during COVID-19, CHIP has become one of the largest community-based digital health platforms in India. Used by over 75,000 CHWs across 48,000 villages, CHIP has tracked the health of more than 50 million people and identified over 10 million individuals with vulnerable health conditions — all at one-twentieth the cost of comparable digital health platforms in Sub-Saharan Africa.

The government of India has invested over $20 million to scale-up the CHIP platform in Rajasthan and Khushi Baby has agreements with two other large Indian states — Karnataka and Maharashtra — to continue digital health system strengthening through 2030. It has been supported by over $8 million in philanthropic investment to date.

Towards Programs and Precision Public Health

Khushi Baby is beginning to move the needle towards community impact, leveraging large amounts of public health data to transform public health programs. In Rajasthan, CHIP is utilized to:

• target and measure vaccination catch-up for over 6,700 unvaccinated infants.
• revise a TB surveillance program to target vulnerable populations, resulting in an 8-fold improvement in the symptomatic detection rate (over 390,000 presumptive cases identified this year).
• create village-level maps of multi-dimensional poverty, time-to-hospital records, climate health vulnerability, and infectious disease outbreaks.
• assess the impact of deploying a mid-level public health cadre on primary health utilization.
• complete referral care for over 500 high-risk mothers and children and over 2,000 home visits, using machine-learning and targeted strategies.

Khushi Baby continues to work in Rajasthan, where it is currently identifying opportunities to optimize health worker incentives and resource allocation across health facilities and mobile medical units. Meanwhile, Maharashtra officials are working with Khushi Baby to identify blind spots in their state-level child malnutrition tracking system and to develop an action center for the Nandurbar District, which has the state’s highest levels of maternal and infant mortality.

An Interdisciplinary Approach

Khushi Baby’s progress thus far has been supported by a multidisciplinary team and community-centered approach. Now with over 100 full-time members, Khushi Baby’s innovative technologies and initiatives span public health, public policy, engineering, and data science. The company’s deep connection to communities also stands out with more than 25 team members contributing over 250,000 work hours while working alongside community health workers. Partnerships have also been key to Khushi Baby’s iteration, scale, and sustainability.

Strong Ties to Yale and Opportunity for Yale Students

Throughout the last decade of innovation and implementation, Khushi Baby has maintained close ties to Yale. Professor Zinter and Robert Hopkins continue to serve on the organization’s advisory board. Most recently, Dr. Bhramar Mukherjee, Senior Associate Sean of Public Health Data Science and Data Equity, joined the board as well. Khushi Baby is collaborating with the Yale CarDS Lab to evaluate and democratize early cardiac disease screening to rural India with portable EKGs and state-of-the-art machine-learning models. Further connections are being fostered with the Yale India Health Network housed at the Yale Institute for Global Health (YIGH). Khushi Baby also remains an active partner with the YIGH Sustainable Health Initiative.

Over the last decade, Khushi Baby has collaborated with 17 Yale students through field visits, internships, policy research, public health and management theses, and applied data science projects.

Yale School of Public Health MPH students can receive funding for summer internships to contribute to high-impact projects at Khushi Baby and other designated sites through the YSPH Sustainable Impact in Global Health (Y-SIGH) signature internship program, Students interested in applying their skills to real-world global health implementation are encouraged to explore the options available to them through Y-SIGH. More information can be found on the Yale Student Grants Database or by contacting Anjuli Bodyk, associate director of the YSPH Global Health Concentration.

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