Part III: Why we should invest more in nonpregnant, underserved women

Today is the third of our three-part series on why we believe that investments in women’s health should be more inclusive. We'll profile Gayathri, our newest community health worker.

Gayathri experienced something she never had before when she joined Tulalens. 

“(Taking part in the service) meant that I’d be doing something for myself whereas usually everything I do revolves around taking care of others.” 

Her family has been incredibly supportive of her, which certainly helped her and her family adopt iron-rich foods into their diet. She lives with her two kids, her husband and mother-in-law. But, it wasn’t all easy.

Initially she didn’t realize the importance of what we were doing. Her husband is at work during breakfast and lunch so she found it easier to buy pre-made food at local shops that had no nutritional value than to cook iron-rich foods. When we found she wasn’t adopting any iron-rich ingredients over several weeks, we experimented by pairing her up with another customer and by having them keep each other motivated to achieve weekly goals. If they both achieved the goal, we promised them an incentive. The other customer didn’t achieve her nutrition goal, but Gayathri did, and has continued to do so for months after this. She was moved by the fact that we were actively thinking about ways to motivate her and that we didn’t give up on her. Once she started incorporating the iron-rich ingredients in her diet, she realized that it was easy to do. 

Gayathri and one her kids in front of her home                              in Chennai. 

Gayathri and one her kids in front of her home                              in Chennai. 

Gayathri always aspired to become a nurse, but was pressured into getting married and having children like many young women in urban slums. She’ll now be able to carry out her dream in a different form by becoming our first full-time paid community health worker. 

Women like Gayathri find the symptoms from iron-deficiency anemia to be a major and daily pain point. However, it is hard for them to prioritize eating iron-rich foods when they have to worry about walking 100m to use the toilet, walking to the water pump several times a day to ensure they have water, cooking on an open-fire kerosene stove and ensuring that rats don’t enter their house and bite their children in the evenings. 

Gayathri has taught us the benefits of being more experimental. As we sign up additional customers, we’ll try pairing women together and gamifying the process to keep women and their families engaged and healthy. 

Part II: Why we should invest more in nonpregnant, underserved women

Today is the second of a three-part series on why we believe that investments in women’s health should be more inclusive. To illustrate this we’ll profile our customer, Deivarani.

Deivarani, her husband and two children live in a 120 square foot home that has no toilet or shower. When Tulalens first began working with her, she was slow to adopt the recommendations we made. Over time, we learned about the hurdles she faces and how to help her overcome them.  

Deivarani is a homemaker. Her daughter is the primary breadwinner in the family. Her husband is a plumber and an alcoholic. He comes home drunk and picks a fight with his wife almost every day. In order to avoid conflicts with him, she ignores his comments. Over time though, he started using our service as a reason to pick fights with her, and our community health worker. 

Above illustrates a typical interaction between our customers and our community health workers, who we equip with tablets to collect and share health information. 

Above illustrates a typical interaction between our customers and our community health workers, who we equip with tablets to collect and share health information. 

Many women in India are taught that they must adjust regardless of their husband’s behaviors, so it's unlikely Deivarani will ever leave her husband. An old Tamil saying sums up this practice well. “Kallanalum kanavan, pullanalum purushan” meaning ‘A husband is a husband, even if his heart is as hard as stone or as ever-changing like a blade of grass.’ 

However, Deivarani sees deep value in our service, so we want to find workarounds to invest in her. Ideally, we’d like to educate her husband on the benefits of our service, but have found it impossible to engage him. Instead, our community health worker has now customized the service, and doesn’t come to her house when her husband is there. Instead, she goes at a time when she can spend time with Deivarani and support her to live a healthier life. Deivarani's become one of our best performing customers, and her daughters have also adopted iron-rich ingredients. 

Interested in hearing more about the lives of our customers, and why it’s so imperative to invest in women’s health more inclusively? Join us again next Wednesday. 

Part I: Why we should invest more in nonpregnant, underserved women

Today is the first of a three-part series on why we believe that investments in women’s health should be more inclusive.   

Nagavalli, our customer, works as a domestic helper at 9 homes every day. During her only window of free time, she cleans the house, spends time with her children and cooks them dinner. Her conviction that her two sons and daughter, aged 14, 10 and 8, can lead better lives than her overrides the hopelessness that she could easily succumb to.

“I want my kids to study well and not end up in a job like me. That’s all I want and nothing else.”

Pictured above is Nagavalli, our customer, in her home in Dhideer Nagar, one of Chennai's slum areas. 

Pictured above is Nagavalli, our customer, in her home in Dhideer Nagar, one of Chennai's slum areas. 

Her husband is a painter, who sometimes has work. He spends most of his income on alcohol, and gives Nagavalli the leftovers. This money can barely buy her a cup of coffee, she says. She wants to be independent of him, so she works to pay for their food, school tuition for her children and all other household expenses.    

Nagavalli, similar to millions of other low-income women globally, is overburdened with responsibility, is often treated poorly by her husband and family, and has no support network to care for her own health.

Two key pieces of evidence support this notion.

First, trends in foreign aid show us that investment in women’s health outside of the critical period in which they’re pregnant is limited. Foreign aid related to women’s health has mostly been channeled into decreasing maternal mortality and into HIV prevention and treatment over the past several years, and thankfully rates of maternal mortality and HIV incidence have decreased drastically. A recent Lancet article suggests that we should expand our health investments to include women during other parts of their life.

Second, more women and girls suffer and die from disease in emerging markets as compared to developed countries. 3.9 million girls are missing in emerging markets, .9 million of these girls are in India, and .3 million are across South Asia in part because of deep-rooted gender discrimination. 30% of these deaths occur between 15 - 49, yet deaths and disease associated with pregnancy, childbirth and postpartum represent a decreasing fraction of the burden of disease for women.

The question we should now be asking ourselves is this: how can we work with women to improve their health and live more prosperous lives during other parts of their lifecycle?

Tulalens aims to fill this serious void in investment by developing a suite of services for and with women 18 to 40 inclusive of women without children, women with children and pregnant women. By providing healthcare to women inclusively, we aim to shift the thinking of every layer of society from family members to investors to acknowledge women’s important role as productive members of society. 

Through human-centered design, we’ve found that iron-deficiency anemia is one of the most prevalent pain points our customers face. Our first service addresses this condition. Iron-deficiency anemia can lead to severe headaches, tiredness, repeated infections, adverse birth outcomes for pregnant women and in it’s worst form, maternal deaths. More than 55% of women in India have iron-deficiency anemia, and this percentage may be higher among poorer women. Official statistics are not disaggregated by income level. In fact, the Indian government came under spotlight last year in attempts to hide the severity of the problem.

To put the power back into women's hands, we’re equipping them with the tools, support and information they need. We help women track their iron, and recommend and sell iron-rich ingredients customized to individual households' taste preferences, budgets and time constraints.

How does the service benefit our customers? This is what Nagavalli had to say.

“Before I joined Tulalens, I would often be so dizzy and experience headaches. I would clean the wash basin (at the homes I work at) and would get so dizzy I thought I’d fall over and hit my head. I was scared to tell my employers because I knew they’d say I wasn’t doing a good job and just replace me. Since becoming a part of Tulalens, I no longer feel this way. I feel like I have the energy to work in two more houses! I no longer feel scared, and I feel good about making healthy food that I previously didn’t know about for me and my children.”

Women such as Nagavalli are willing to invest in their own health, but they need support. Tulalens serves as the instrument to catalyze their investments.  

Do you want to learn more? Check back next Wednesday for part two of our three-part series. 

 

Where Technology Has Failed India’s Poorest Women, We’re Building Trust

By Priya Iyer 

For the past few months, our team has been visiting customers face-to-face, including a 33-year-old woman living in the slums of Chennai, India.

We’ve visited her every day in temperatures easily soaring above 100 degrees. (The locals call this peak summer season ‘agni natchathiram,’ the season of fire.) We’ve visited her in the pouring rain, when the alleys in front of her home have begun to flood. And we’ve visited her despite her mild scoldings — she’s as worried about our health, when we’re outdoors in this extreme weather, as we are about hers. It’s all worth it, though, because we’ve finally gained her trust.

Building trust, not technology, is the most challenging aspect of our work at Tulalens, the social enterprise I founded. The women we work with have been failed by markets and the government. They live off of less than $2.50 per person per day in their household. They have rarely if ever been asked for feedback on a product or service in their life. Without the foundation of trust, we found that equipping millions of women with the crucial health information they needed through technology would be impossible.

Understanding Our Customers

This realization didn’t come easily. When we started out more than a year ago, we attempted to bring women living in urban slums Yelp for healthcare. When we first launched, I carried the misconception that technology would help us quickly reach millions of women. By December of last year, we’d reached 1,000 customers. However, it was becoming apparent that we weren’t adding measurable value to their lives. I turned to social enterprises that were specifically working with the poor in emerging markets, and who were having a measurable and scalable impact. I saw a pattern — each of them had incorporated human-centered design (hcd) into their work early on and regularly. After reading more about AyzhMedic MobileNoora Health and others, I reached out to design thinking experts, and we found a generous volunteer through MIT D-Lab’s IDDS network (I lived in Boston at the time) to guide us. I flew to India, and used hcd as a tool to learn why our Yelp for healthcare system wasn’t working. Gathering customer feedback in this market segment is particularly challenging. Women are not accustomed to voicing their opinions, and most people are treated as passive recipients of services, so we had to be creative. We used +Acumen’s courses,ideo.org’s hcd resources, and the power of brainstorming. We created everything from card sorts that helped women prioritize the most important aspects of prenatal care to in-depth interviews. This taught us that government clinics had quotas to fulfill and would dictate where women went to healthcare depending on the area they lived in. Husbands and mother-in-laws also made decisions for women. In this often patriarchal society, it was common for women to have minimal autonomy around decision making and resource allocation. Households generally had one mobile phone, and husbands would usually hold onto that phone. This made women hard to reach and we had to find work arounds. Women talked to their neighbors, but rarely talked to people in other communities. Their sources of information were limited, and the information they took in on health was often inaccurate. Some of the barriers we faced were so complex that we couldn’t overcome them after lots and lots of iteration. I came to the conclusion that we could: 1) Quit; 2) Pivot. I chose #2. It was April. We had runway until July, at the time.

The Turnaround

I returned to India again, and we began determining what key problems affect women on a daily basis using hcd. We held a health camp to understand what problems women faced in their everyday health and asked women to develop collages demonstrating what health meant to them.

By beginning here, we learned about the headaches women suffer, the weakness and fatigue they feel, and how often they get sick. These setbacks make it hard for them to work outside the home and bring in extra money for their families, to care for their family and attend to the housework. Importantly, they told us these were problems in their lives that if changed could bring about drastic improvements for them.

We decided to track their diets to better understand what was going on. That’s when we discovered that the women we work with are eating 3 mg of iron on average per day. The recommended daily value is 18mg. Many are living on a diet that is made up mostly of rice, and surviving on about 600 calories a day.

Our customers had directed us to a major problem they face, but what could be done to help them? We began talking to local shopkeepers and found something surprising: Iron-rich foods are affordable and accessible to many of these women. But a knowledge gap exists. Many are not aware of the consequences of iron-deficiency anemia nor are they informed about what to eat to get the adequate amount of these iron- and calorie-dense foods.

More than 55% of women in India suffer from iron-deficiency anemia. This leads to a 30% decline in productivity due to headaches, weakness, susceptibility to infection, and to lifelong setbacks in cognitive development and stunting for the children of pregnant women.

We’re addressing this problem by recommending iron-rich ingredients that women can incorporate into their diets. We’re working with them to customize this intake to their household’s taste preferences, budget and time constraints, and by tracking and providing women with daily feedback on their iron intake. So far, we’ve been able to more than double our customers’ iron intake. We’re in the process of rapidly prototyping our service to continue to improve upon our impact. Women have also told us how empowering it is for them to be able to eat healthy, and cook healthy foods for their families. They’ve shown their commitment to their health by paying a small fee for our service.

Women certainly schooled us when we were on the wrong path, and we’ve now incorporated these learnings into our work. Our next step is to evaluate our prototype. Only after this is complete, will we start to build the technology, an app that our community advocates will use.

Our takeaways

  • Know your customer and let your customer know you: Spend as much time as possible where your customers are. When you’re straddling two countries this can be challenging. Early on, I was reluctant to spend as much time as I needed in Chennai for a long list of reasons. We ended up building something that women didn’t find useful. If I really wanted Tulalens to impact the lives of women, which I did, I realized I had to face the tradeoffs. I now spend weeks away from my partner, and know I’ll spend hours outside in the extreme weather. But, we are more convinced than ever that we are addressing a truly critical problem in the lives and under-served women, that they need the service we’re providing, and that they trust us to provide it.
  • Build trust, then tech: The technology that social enterprises build is often simple compared to the trust we have to build. I promise, I’m not saying this from a misguided perspective. I’ve worked with developers and have been learning how to code. Our example and many others I’ve seen show that investing the time to build trust first pays off.
  • Human-centered design: The resources I shared are some of our favorite hcd tools. Using hcd helped us focus on women’s needs, find creative ways to gather feedback, and come up with several out-of-the-box ideas that led to testable assumptions.
  • Test ALL of your assumptions: Break your idea up into components and ensure each component undergoes the litmus test of reality. I’d highly recommend Lean Startup for Social Change as your guide. We also use a few of the tabs in this Lean Dashboard to keep track of everything we’ve tested and learned. If you’re interested, download “Template: Lean Dashboard.”
  • Charge your users: Charge users early on. The women we work with make between $.60 to $2.50 per person per day. We were hesitant to charge them initially because we were worried about their capacity to pay. However, we dove in and tried. Charging women a minimal fee easily helps us gauge if they find utility in the service. It’s been an amazing tool that shows their willingness to invest in their health and keeps us on track. In the long run, it will help us cover all of our operational costs.

 

 

What We're Reading

We’re all in this together, right?

With that in mind, we try to keep up on what is going on out in the world of philanthropy, non-profits, healthcare, tech, development, startups...the list goes on!

There's so much to be learned from these different communities and the organizations, thinkers, and doers that are part of them. Reading about the work going on in these spaces fortifies and expands our perspective. It prompts us to have more thoughtful conversations about the work we do.

Take a look at what we are reading this week:

  • There’s been a lot of speculation around how Mark Zuckerberg and Priscilla Chan should give away their $45 billion. This piece ties in suggestions with broader trends in the philanthropic space.
  • This recent piece that came out in the Lancet encourages us to rethink maternal and child health, and suggests that we broaden our focus.

What are you reading?

Compiled by Priya Iyer and Kathleen Pointer

Q&A: Ranjeet Vidwans

By: Kathleen Pointer

Tulalens Board Member Ranjeet Vidwans.

Tulalens Board Member Ranjeet Vidwans.

Ranjeet Vidwans will readily admit he’s not quite the same as the rest of the Tulalens board. He doesn’t come from a background working with nonprofits and development. 

But that’s his strength. He complements the expertise of the other members with his knowledge of startups and for-profit tech companies.

Ranjeet, who was born in India but moved to the U.S. when he was “not quite 10,” studied computer science at Rutgers University. He’s since worked in the tech startup world, and for some larger companies, too.

He lives with his wife and two children in Cranford, New Jersey.  

Want to get to know Ranjeet a bit better? Check out our conversation about what he’d do on his perfect day (although he points out this fantasy day has never actually happened), what book is on his iPad and why he’s so passionate about Tulalens.

What are you reading these days?

I absolutely love to read. I devour books. My interest varies — I like history, historical fiction, horror, business and self-improvement.

Right now, I’m reading Concrete Blonde. It’s total airport fiction but that  literally happens to be what’s on my iPad right now.

Also, The 4-Hour Work Week. There are a couple of books I like to reread every year and that’s one of them.

What is your favorite part about living where you live?

I love that it’s close to family. It’s close to both my parents and my mother-in-law. My wife’s two sisters also live very close to us in New Jersey. It allows our kids to grow up with their cousins and grandparents.

There’s a good school system. It has all the things you look for in terms of places to raise a family.

What would you do on your perfect day off?

I’d let my wife sleep in and have morning time with the kids. We’d have brunch. It’s our favorite meal.

I’d read for an hour or two. Take a nap...I love naps even though I hardly ever get to take them. Then catch a hockey game and follow it up with a nice cocktail and a big steak dinner.

I’ve never had a day like that in my life but that’s why we’re moving forward!

What might someone be surprised to know about you?

People who knew me when I was younger might be surprised that I’m an early-riser and have a good work ethic.

People who know me now might be surprised that I was a straight-A student (...it went off the rails pretty quickly.)

What’s a hidden talent?

I’m freakishly good at trivia.

Are you an early bird or a night owl?

Early is when I typically like to work, and night is when I typically read and binge watch bad TV.

I’m perpetually short on sleep.

What do you do for Tulalens?

I’m on the board. I haven’t been on quite a year yet. It was late summer when I joined. My involvement is not an ongoing operational role. I work with Priya and Erin to set and plan towards fundraising objectives. I work on medium and long term planning. How are we going to fundraise to meet our objectives — things of that nature.

How did you get involved with Tulalens?

Anita Datar and I were college friends. We met the first week of undergrad and were friends ever since. She told me about it when she and Priya were still kicking the idea around. I was aware of what she was doing because she called to pick my brain about fundraising and tech startups and it went from there.

What was your first impression of the organization?

My first thoughts were that it was a very, very cool idea. It’s something important because it’s focused on helping the folks that never get any attention from the start-up community. It’s a really unique confluence of a couple of things.

There are loads of funding efforts going into creating and deploying services, but it’s important to connect the people that need those services with services that already exist. There is tons of inefficiency. It’s solving an important problem in a unique way.

Why did you want to be part of this organization?

I’ve done a lot of tech startups, but I have no experience on the development side of things or with NGOs.

Erin and Priya and Anita all had experience on that side and they wanted to apply startup principles to a not-for-profit. I felt I could complement what they already brought to the table with for-profit startup experience.

What about Tulalens inspires you?

It’s an ability to apply concepts and principles that have heretofore been applied to solving “first world” problems so to speak. The concept has been effective, so we’re applying it to a population that has been grotesquely underserved, historically.

It is being much more efficient for the people that need the service, and it helps them make the choice that’s best for them.

What would you tell someone who is thinking about donating or getting involved with Tulalens?

Tulalens is a great place for you to invest your time or make a contribution...

...if generally you are interested in applying modern technology to help assist the underprivileged in any way, shape, or form.

...if generally you care about child care, neonatal care, parental care, women’s issues and children’s issues particularly as it relates to healthcare and the crucial stages right before, during, and after birth.

...if generally you are interested in the South Asian subcontinent geographically since that’s our immediate area of care.

...if generally you fit any one or more of that criteria talk to us about what Tulalens is doing and how we can help you get involved.

 

Ranjeet's interview with Kathleen has been edited for length and clarity.

The Rise of Indian Philanthropy

By Priya Iyer

Imagine that you're an engineer tasked with improving the efficiency of a 'roti' (flat bread) maker from 100 rotis an hour to 40,000 rotis an hour. Thousands of under-nourished children are depending on you. Akshaya Patra Foundation, an organization that addresses malnutrition in school children, faced this very issue. As Emily Rosenbaum, CEO of the foundation, explained at a recent TiE Boston event, this is one of several challenges Akshaya Patra had to overcome to scale. The organization began as a religious mission to feed 1500 hungry children in Bangalore, India. They’ve now scaled to reach 1.4 million children in schools across 10 states.

Experts believe that changes in the Indian philanthropic landscape will soon help more and more promising organizations such as Akshaya Patra reach scale in the future. There is so much enthusiasm around these changes that the Bridgespan Group, Stanford Social Innovation Review and Dasra launched “Impact India,” a magazine for philanthropists and social innovators interested in India. After working in India for about 15 years, Jeff Bradach, Bridgespan Co-Founder, pointed out three specific trends he's witnessed:

 

1) Giving while living: Wealthy people are starting to give while they’re alive, so they can be involved in their wealth distribution.  Azim Premji, Wipro chairman, is one of several examples of this new form of philanthropy. He started the Azim Premji Foundation to help children receive quality universal education. 

2) Evidence-based giving: A widespread distrust of NGOs due to corruption has existed amongst Indians and Indian diaspora for years. As a reaction to this distrust, donors such as Corporate Social Responsibility (CSR) arms and foundations such as the Deshpande Foundation are engaging with enterprises based on impact metrics, a concept that was previously unheard of.  There’s also been a rise in sites such as Dasra, Global Giving and Give India that provide credibility to impactful NGOs.  

3) Experimental philanthropy: Some philanthropists in India are moving away from traditional philanthropy models. The Omidyar Network is a good example of experimental philanthropy. Their structure in and of itself proves unique. As an investment firm rather than a foundation, they can invest in both for-profit and nonprofit organizations that are for-impact.

After hearing all of this, I’m left with two questions. The Indian philanthropy landscape has now become more open to investing to scale social enterprises. First, what are projected trends in the growth of the seed funding market for social enterprises in India? If individuals and organizations are not willing to take on the risk of funding social impact organizations at the seed stage, a pipeline of innovative organizations that are ready to scale won’t exist. Second, some larger organizations such as Pratham are creating U.S. arms so they can tap into the immense funding opportunities abroad. We know from a recent "Impact India" article that if Indian diaspora gave at the same rate as people in the U.S., and gave 40% of their contributions to India, $1.2 billion would flow from Indian diaspora to Indian causes. How will more organizations better tap into this latent opportunity?

Thanks to Kathleen Pointer for editing this piece. 

 

 

    

 

 

Q&A: Saumya Joshi

Saumya Joshi, Tulalens Advisor 

By: Kathleen Pointer

Saumya Joshi works in academia, but she’s not just drawn to what’s happening inside the classroom. 

“I work a lot with the students and the industry and academia, so it’s quite an interesting mix,” she said. 

Saumya, an Associate Director at the Indian School of Business, one of the top 30 in the world, curates and develops programs and expands their outreach.

Her portfolio includes applied learning activities, practicum courses, life consulting assignments and pro bono work.

In other words, she helps students  take concepts taught in the classroom, and apply them in the world — something Tulalens founder Priya Iyer was drawn to when they met. 

“I immediately knew I wanted to work with Saumya after our first meeting because I could tell she was an incredibly good problem solver, she had the ability to ask probing questions and the humility to listen," Priya said. "Her diverse experiences at ISB, the private sector and her previous volunteer work with women in slum areas led her to become a huge value add to Tulalens very quickly.” 

She previously worked in the private sector as a Supervising Analyst at Ernst and Young and an Associate Research Analyst at Deloitte.

Saumya, now an advisor for Tulalens, helps to make sure ideas work as well on the ground as they do in a brainstorming session.

Saumya Joshi, a Tulalens advisor and an Indian School of Business Associate Director.

 

What do you like most about where you live?

The thing I love the most about Hyderabad is it has a very temperate climate. It does get really warm, but it is very manageable unlike other parts of India. It doesn’t ever get really cold. 

I use the same the wardrobe throughout the year — I buy a lot of dresses.

The topography, too — Hyderabad is in the southern part of India. It is very rocky and it has a lot of lakes. There are natural rock formations all around and it’s gorgeous. It’s very rustic, very natural. I love that. 

What would you do on your perfect day off?

I would read a book. I would make myself a nice cup of tea, read a book in my bed, and not get out of it all day.

Do you have any hidden talents?

I can sing. I used to be part of my school’s rock band. They were very bad, but I was also part of the choir and they were really good. 

I can also play hockey! I used to be the university center forward. But I busted my knees and gave up hockey. I’m super tiny, so people are surprised that I used to play hockey and hold that stick, but it’s true! 

How did you learn about Tulalens?

I heard about it from the ex-dean of my school. Over a year back he wrote to me about Priya. She wanted to connect to ISB regarding some help and he asked if I could I meet her. 

At the time, I didn’t know a lot about Tulalens. I did a quick Google search to see about the venture. I went for my meeting with Priya one fine day, and just looking at her enthusiasm — we hit it off super well!

How are you involved with Tulalens?

Most of my work with Tulalens is with Priya.  We have good rapport and we get along really well. Her energy is infectious!

We usually end up talking one to two times a month. If there is any sense of a roadblock, we discuss it. I’m focused on business development, and helping her with forging partnerships in India. I advise on marketing, expansion ideas, and where we would want Tulalens to be down the line.

Why do you think Tulalens’ work is important?

  1. The demographic we’re helping — they are the bottom of the pyramid, the most neglected section of people simply because they don’t have the capacity to pay a lot.
  2. The issue that Tulalens is trying to solve or sort out — it is a very interesting way of looking at healthcare service in India.

Everyone else is looking at providing the service. Tulalens is looking at what is available and how can we make people more aware of the services. And then, it’s generating a feedback loop that will help improve the services.

Information is power. A lot of us are very tech savvy and have everything at our fingertips and knowing is a huge power, but we don’t realize a lot of people in the world don’t have that access. They need someone to help be the bridge.

What about Tulalens inspires you? 

It’s a mammoth task what we’re undertaking. It’s not an easy space to be in, but we’re all doing it because we believe in it.

And all of these young and really qualified people in the U.S. are trying to sort out a problem across the world. They could be doing something more profitable, but they're not.

It gives me a lot of hope.

Human-Centered Design: Here's what we learned.

By Priya Iyer

This year, human-centered design has become a big part of our work. Check out some of our tips and insights based on our learnings so far in the post below. 

Why human-centered design?

In September 2015, we won our first innovation challenge, which allowed us to launch a pilot in Chennai, India. Previously, we were operating on the generosity of a few people, and conducting piecemeal work in Hyderabad due to financial insecurity.

As a very early-stage social enterprise, innovation challenge grants are key to survival. Yet, the two questions we get asked most frequently when we apply to innovation challenges are, one, how we'll scale and, two, how we'll become sustainable. Yes, these are incredibly important questions, but in asking them investors often brush over the more immediate question of if a solid model is already in place. The reality is that it takes months of testing and refining (and testing and refining, and testing and refining!) to get there. This is certainly true in places where markets and the government function, and an even more daunting reality in the places we work, where markets and the government have failed people. If you're forced to scale too early, you often end up scaling something that doesn't work well.

We've tried to remain cognizant of this reality in our own work. Since September, we've reached more than 400 women across three slum areas. We then conducted a brief impact survey, and realized many aspects of our model could be improved upon to better meet the needs of the people we serve. This is why we've decided to incorporate the process of human-centered design into our work.

(Many of you may have heard this term, but if you want a better understanding of it, specifically in this context, check out this article from the Stanford Social Innovation Review.)

 

Here's how we're incorporating human-centered design into our work:

(Each organization might go about the how differently, but this is what has worked for us. I'd encourage organizations to start this process as early on as possible.)

Step 1: Find the right expertise for your team. When we started incorporating HCD into our work, we were familiar with the concepts, but had never gone through the process. Luckily, we found a talented design volunteer through MIT's International Development Innovation Network (IDIN). She uses these principles in her work in the private sector (designing power tools) and in an emerging market context (designing health programs in rural India.) Incorporating her expertise has benefited us tremendously.

Step 2: Train yourself and your team. Initially we used the ideo.org field guide as a road map to train our team in India. This worked as a temporary solution, but we want to do more. Encouraging people to truly exercise an open mind, and to dig into their curiosity can be challenging, particularly when cultural norms dictate otherwise. Recently, ideo.org came out with a facilitator's guide. We're going to use this to continue training our team, so they can build off of the concepts they're already using.

Step 3: Define and prioritize your challenges. Although these will change as you begin implementing your work, ideo.org's HCD field guide, and +Acumen's course of HCD are good tools to help you get started.

We set out to work through two design challenges:

  1. What information on health clinics do women prioritize when deciding where to seek prenatal care? 
  2. How do we ensure we remain relevant to women? In other words, how do we ensure women engage with our platform on an ongoing basis?

Step 4: Quickly determine how you'll work through these challenges and implement. There are several tools that can help you work through your design challenge(s) not limited to focus groups, games, and card sorts during individual interviews. The resources above get into these in depth.

To address our first design challenge, we developed individual interview guides, and cards with pictures of different aspects of the health clinic such as a female doctor and a sonogram machine. Women ordered the cards based on what they felt was most important, and told us why. This was a highly effective way for us to learn more about their needs.

For the second design challenge, we used a series of general focus groups and in-depth individual interviews. Once we started seeing emerging themes around lack of information on nutrition, lack of information on tablets and vaccines at the clinic, and fears around delivery, we began asking questions that probed more deeply into these areas.

Step 5: Expand your team to continue the process. We sprinted through this process in less than a month. Our learnings were so poignant that we've decided to incorporate this into our everyday to continuously refine our service. Think you'd be good at helping us out with this? Or do you know someone who would be? We're hiring a Design Fellow in Chennai.

(Do you think human-centered design could work for your organization? If yes, we hope this helped! Feel free to share your thoughts or questions: priya@tulalens.org.)

Kathleen Pointer read and edited drafts of this post. 

Q&A: Uday Varma

Q&A: Uday Varma, Tulalens Customer Relations Manager

By Kathleen Pointer and Priya Iyer

Uday Varma is a Customer Relations Manager for Tulalens in Chennai, India.

Uday Varma is a Customer Relations Manager for Tulalens in Chennai, India.

Uday Varma comes from a family of problem-solvers, making his position as the Tulalens customer relations manager a natural fit. 

If one person has a problem, everyone else tries to help solve that problem," he said. "My family is very supportive." He has two brothers, a sister, a brother-in-law, and his parents, and enjoys making meals with them.

Uday, who is based in Chennai, India, is responsible for a range of tasks for Tulalens, not limited to training our India team and planning next steps. Previously, Uday supervised a baseline survey at Abdul Latif Jameel Poverty Action Lab for the Tamil Nadu Skills Development project. He holds an MCA in Engineering from Anna University and a BCA from the University of Madras.

What do you like about where you live?

I love my city -- Chennai -- very much because it is a land of people from many different states in India and of different religions. Many of my friends are Christians, and many of them are Muslims. Nobody looks at what caste or religion you are. They’ll come together to help you in times of need. To give you an example, during the flooding in December, a mosque flooded. Members of a Hindu temple said they’d convert their space into a mosque (so people would have a place to pray). When I hear these things, I’m proud to be from Chennai.

What would you do on an ideal day?

I’d go to the temple with my family. I’d spend time with my family and friends. We’d make some delicious dishes like on New Year’s Day, when we made biryani. In the evening, I’d tutor poor children in my area, like I usually do. The children are 15-16 years and I tutor them in all subjects except Tamil. I’ve been doing this for eight years.

What do you wish more people knew about you?

Everyone thinks I’m very quiet when they first meet me. Once I know you, I’m very, very outspoken and very friendly.

What are three words that describe you?

Hard worker. Simple. Dedicated.

What’s a hidden talent?

I’m an average student. I didn’t study much during my school days. Once I started tutoring, I realized I was good at teaching students and that I should study more. I got a master’s degree in engineering. Another hidden talent - when a situation arises I handle it with an open mind.

Who is someone you admire?

Mahendra Singh Dhoni — he’s the current captain of the Indian cricket team. His story is very inspiring. He’s also portrayed as very simple and very open.

Uday conducts a focus group with the husbands of pregnant women in Kasimedu, Chennai.

Uday conducts a focus group with the husbands of pregnant women in Kasimedu, Chennai.

What do you do for Tulalens?

I train our customer relation agent to survey women and share information with them, and sometimes I collect and share information. I double check all of our data, collect data from the hospitals that women are attending, map out slum areas and decide what areas we should go to next. I also identify the important people in each area and explain Tulalens to them. Some people feel happy when I talk to them, and others don’t want to help us. Sometimes people speak rudely because they don’t understand what we’re doing, so I patiently talk to them.

What was your initial impression of the organization?

I thought Tulalens was a very good service. I’d worked with J-PAL (Abdul Latif Jameel Poverty Action Lab) before, and wanted to continue to do something useful for under-served people. As a man, I was a bit nervous that pregnant women wouldn’t respond well to me, though.

How do you feel about working with us?

I really feel happy because I like helping people. At first, I wondered how people would react if we gave them this kind of information. Then, I realized it makes people happy. I also like it because I have the freedom to decide what areas we work in.

What do the people you work with say about Tulalens?

People always say it is good to know information on health clinics because they do not know about it currently. People always feel happy knowing information on prenatal care.

What do you hope the future holds for Tulalens?

I hope Tulalens will be a well-known social enterprise organization throughout the world.

Kathleen and Priya edited Uday's responses for length and clarity.

The Genesis of Tulalens

2014

October: Priya Iyer left her job to found Tulalens in Hyderabad, India, and put her savings into launching the work. 

November: We reached 114 pregnant women across 3 slum areas in Hyderabad. Our first advisor - Vandana Sharma - helped us structure the pilot.

December: We raised $2,200 through an Indiegogo campaign thanks to the support of friends and family, particularly two large contributions from Vidhya Iyer and Durga Paruchuri

2015

January: Tulalens officially became a non-profit with 501(c)(3) status

March: Two board members - Anita Datar and Erin Stock - and two advisors - Saumya Joshi and Vik Paruchuri - joined our team. 

April: We reached 500 more women, and quickly realize that we should focus our efforts on pregnant women before we expand services to women receiving other reproductive health services. 

June: We received our first two individual donations and corporate matching gifts from Durga Paruchuri and Vin Paruchuri, and their companies Genentech and Noble Energy respectively totaling $6,000.

July: The Tulalens board held our first fundraiser in Washington DC. 

August: We won $32,000 in Palladium's Make It Possible Initiative

September: We launched our work in Chennai, India, hired two full-time team members - Uday Varma and Lakshmi Muthukumar, and a board member - Ranjeet Vidwans - joined our team. 

November: We developed real-time analytics software with DataKind allowing us to get information back to women more quickly, and Kathleen Pointer, a marketing and communications expert, joined our team of volunteers. 

December: We reached 400 women in Chennai in total despite severe flooding, and Laura Lighty, an expert in human-centered design, joined our team of volunteers. 

Q&A: Erin Stock

We're all about open information at Tulalens, and we're hoping to foster that spirit in all areas of our organization. One way we're doing this is by launching a monthly Q&A feature here on our blog. In this series, you'll get to know the people in the Tulalens community. First up, an interview with board chairwoman, Erin Stock.

Q&A: Erin Stock, Tulalens Board Chairwoman

By: Kathleen Pointer

Erin Stock is the Tulalens founding board chairwoman.

Erin Stock is the Tulalens founding board chairwoman.

Erin met the organization’s Founder & CEO, Priya, in tenth grade statistics class at Blue Valley Northwest High School in Overland Park, Kansas. (The two were fast friends!)

After high school, she earned a journalism degree at Northwestern University, and went on to report on immigration for The Birmingham News in Alabama and on humanitarian crises out of Bangkok for IRIN.

I think (coming from a journalism background) really shapes the way I think and the way I solve problems,” she said.

She has a master’s degree from the University of Arkansas Clinton School of Public Service, and lived abroad in Jakarta and Bangkok while in school.

One of the perks of her time at the Clinton School was a private lecture for students given by the former president.

Aside from Tulalens, Erin works as a communications consultant for clients who include a financial inclusion think tank housed at the World Bank, as well as a journalism nonprofit that is pioneering a new form of conflict reporting.

Want to know more about Erin? Check out our conversation below. She tells us about what she does (ideally) in her down time, her favorite things about the city she calls home, and why she’s so passionate about Tulalens.

What are you reading these days?

I’m reading this book called Geeks Bearing Gifts: Imaging New Futures for News by Jeff Jarvis. He’s the director of the Tow-Knight Center for Entrepreneurial Journalism at the CUNY Graduate School of Journalism, and is a thought leader in the media space.

I’m a regular reader of the Washington Post — I love my local paper! I also like NPR’s Goats and Soda. They have compelling stories about things that matter.

What is your favorite part about living where you live?

If I had to say one thing, I would say how walkable and pedestrian-friendly Washington D.C. is. There is so much to do and see without even spending any money.

What would you do on your perfect day off?

My perfect day off starts with a really nice rest so that I could wake up at sunrise and make myself some coffee and read. I’d get my paper and also consume some news on my phone.

Then, I’d go for a long bike ride through Rock Creek Park — ideally, my fiancée would be with me for that. Once we got back, lounging by the pool would be lovely.

I’d also love to eat out. There’s this Thai restaurant (Thai X-ing) in D.C. that’s heaven. Your plate is never empty and it feels like you’re having dinner in someone’s home.

What might someone be surprised to know about you?

I had my first job bagging groceries when I was 14, and when I was interviewing for the job the manager asked me what I wanted to be when I grew up. I told him in all seriousness that I wanted to be the first woman president of the United States. It’s funny that I once seriously aspired not only to be the president, but to be the first woman president.

What’s a hidden talent?

I’m a scuba diver - from Kansas. I got certified in high school. There are these shops where you get your training, and you do pool dives. You have to do an inaugural dive in an actual body of water and my family all did it together, so we went on a trip to the Caribbean.

Are you a early bird or a night owl?

I’m definitely a morning person. The world is built for us, I realize that, and it’s not fair.

What do you do for Tulalens?

I’m responsible for coordinating our board meetings, and I help with decisions around strategic direction, fundraising, and communications. I find, at least at this stage, that we’re a highly engaged and active board.

Erin presents at Tualens' first fundraiser in Washington, D.C. (July 2015)

Erin presents at Tualens' first fundraiser in Washington, D.C. (July 2015)

How did you get involved with Tulalens?

I first met Priya in tenth grade statistics class. We were two kindred spirits, and we quickly became very close — best friends. Since then we went off to school and lived abroad, but in 2012,  we happened to land in in DC at the same time. As Priya started to think about starting a social enterprise, I heard her ideas and her thought process evolve. I was there when she took the plunge, quit her job, and made Tulalens her focus.

What was your first impression of the organization?

Initially, Tulalens was Priya to me. I know her so well and we go so far back. I had a great deal of respect for what she was doing. As I became more involved and I learned more about the work, I’ve come to see it is much bigger than her.

It’s rare to be involved with something that has such a direct impact on people. It’s a gift to get to work with Tulalens.

When did you know you wanted to be part of this organization?

Immediately.

Early last year Priya reached out and asked if I would be interested in joining the board. I was so honored that she asked me, but she told me to take some time to think about it because it was a big commitment. I made myself not give her an answer on the call even though I knew what I would say. I confirmed it just hours later.

What about Tulalens inspires you?

Having been a journalist, I’ve always really valued the power of information and storytelling. I’ve seen it transform communities for the better. At its core, Tulalens is about putting power through information into the hands of people who are some of the most marginalized in the world. It’s not through someone else’s information but through their own, and that’s what I found so novel and inspiring about the work. It’s harnessing the power of crowdsourced information to help people improve their lives and improve their communities.

If you want to use information for good, this is the most important space you could be working in.

What would you tell someone who is thinking about donating or getting involved with Tulalens?

Tulalens is innovative and cutting-edge not just in terms of the service we’re offering and the model, but also in the way we work and how we’re approaching the problem.

What is going to make us have a real, sustainable impact is that we’re honestly assessing what’s working and what’s not and we’re changing course as needed. We are committed to putting the customer at the center of what we do.

Erin’s conversation with Kathleen has been edited for length and clarity.

Remembering Anita

By Priya Iyer 

Anita Datar, a mother, daughter, sister, and a close friend and founding board member of the Tulalens team was killed in the Bamako, Mali terrorist attacks on Nov. 20. After the news was made public, dozens of reporters contacted us to talk about her involvement with our organization. Trying to encapsulate everything she was to us while we were in shock was impossible. When we were ready to talk, the news cycle was over. That's why this week, the week of Anita’s birthday, I want to take a moment to explain how Anita shaped me and Tulalens.

I met Anita when I was working at Futures Group (now Palladium), an international development consulting firm. I was immediately drawn to her smarts, warmth and quirky sense of humor. When I found out that she'd be the team lead on a health economics project I was working on in Guyana, I was ecstatic. During our first trip to Guyana, we braved bumpy boat rides, shared meals together, and discovered many parallels in our lives including our views on international development, our upbringing as children of immigrant parents, a love for books, and a lesser known goofy side.  

On this project, my role was to focus on the data collection and analysis. Early on, I mentioned to Anita that I became paralyzed with fear when I spoke in public. As an introvert, I was convinced I’d never be able to overcome this.  Anita, a fellow introvert, shared with me that she'd once been the same way. When I watched Anita speak in public she was so eloquent that it was difficult to believe this was ever true. She told me that after ten years of intention and practice, she'd accomplished what she thought was impossible. She inspired me to do the same. By sharing her previous vulnerability, she broke down barriers between us. On top of that, Anita found opportunities for me to speak in public including within the project we were working on. Each time I spoke, she gave me honest feedback until I learned to manage my fear. She helped me find confidence in myself that I was previously incapable of seeing.

I knew that she was a go-to mentor at our office, but didn't realize the depth and reach of her impact until her memorial this past weekend. I'm still baffled by how she had time to guide so many of us. It was this same attitude that she brought to her most important role as a mother, and to her role as a global health expert. She felt and enacted the idea that when you equipped people with resources, rather than controlled them, they would find ways to improve their own lives.  

When I structured Tulalens this year as a non-profit, I initially sought advice on how to find board members. Some people advised me to seek out high-profile board members simply because of their status. This seemed inauthentic. I thought through my network and immediately realized I wanted to ask Anita. She believed in Tulalens and in me. She was honest and insightful when it came to examining the work we were doing and advising on how to improve it.  All of this coupled with her deep belief in our mission, which was so obvious when she pitched our work,  made her a truly remarkable board member. But it’s limiting to call her a board member because of the depth of her commitment to our work. She was willing to do whatever it took to support Tulalens.

To share one of many examples, she reached out to all her friends and family members to help us win our first innovation challenge. She emailed and called me almost every day during those two weeks to give me status updates or keep my spirits up with a joke. Right before we'd won, I was about to run out of all of my savings and Tulalens had very little money left in the bank account. Anita knew how important winning the challenge was to us, and did everything in her power to make sure our work continued.   

I move between sadness, anger and disbelief because Anita is gone. I recognize, though, that I can't allow my pain to create negativity. Instead, I hope that each of you who didn't get to meet Anita is fortunate enough to find someone as rare as her in your own life. I hope that each of us who knew Anita will channel the many qualities we admired in her to make the world a bit more beautiful.  We at Tulalens will certainly be doing so.


Thanks to Kathleen Pointer for reading a draft of this blog.

Looking at the World Through a Balanced Lens

By Priya Iyer

Our partner, Everyday Ambassador, originally published a modified version of this post. 

I come from a family of pioneers. Similar to the American pioneer, my family moved west, but from India to Kansas.

My sister and I were born and raised in Kansas, and we lived with my maternal grandparents and parents, unlike the nuclear families in our neighborhood. Although we were one of the few immigrant families, I was oblivious to the ways we were different until I started school. Kids mocked the color of my skin and the ‘bindi1 I wore, a relic of the lives my parents had left behind. One family at our school even left copies of the Bible on our driveway in the hopes of converting us. As an extremely shy and introverted child, I internalized this treatment and began to view myself as “an other.” My feelings of being ostracized evolved into an empathy, and then a drive to uncover the potential of marginalized communities.

I followed this drive to find my career path, despite strong protests from my parents. They thought I should choose a career that offered economic stability. This singular focus is what allowed them to create opportunity for us in America. However, their hard work gave me the luxury of choice. I eventually pursued my own interest, a career in global health.

My career first took me to Guyana where I ran a national health program at the Ministry of Health. I often spent hours talking to people in remote communities to understand how they lived and interacted with health services. In one community, I learned that pregnant women with complications were being sent on hours-long boat rides to the nearest hospital while in excruciating pain. Ministry of Health officials hadn’t interacted with some of these communities to improve services for years, yet money was readily available. Several aid agencies worked with the Ministry, but rampant corruption and bureaucracy prevented this money from reaching its intended beneficiaries. Under-served communities seemed to be an invisible factor in the equation of aid. They were being treated as the “other” with no say in shaping their own lives.

Time and travel taught me that this did not have to be the status quo. I decided to take action, and Tulalens was born.

Tulalens, in a nutshell, is a Yelp for health clinics in under-served communities. If organizations such as Yelp and Amazon successfully crowdsource information on restaurants and clothing for upper- and middle-income communities, we wondered why we couldn’t do the same for critical services in low-income communities.

Our ultimate aim is for communities to be part of a solution that helps them make informed choices on where to seek health care. Our focus is currently pregnant women living in urban slum areas in Chennai, a city in my ancestral state in India. So far, we’ve reached 900 women. 80% of these women were aware of only one health clinic in their community, and none of these women had information on the quality of clinics in their community. They often returned to clinics where they received poor care.

One young woman we spoke to told us that a security guard at the health clinic took her infant from her. He forced her to pay a bribe–her entire life savings–in order to get her baby back. Despite this, she returned to the same clinic for care because she didn’t have information on the location or quality of other clinics in her area. I was appreciative of her courage to tell strangers her story. She didn’t want our pity. She wanted a solution, and we were able to provide that.

This solution is the crowdsourced information we share with women on the overall quality – infrastructure, access and provider quality – of the clinics in their communities so they can seek care at better clinics in the future. Within a month, 20% of women who used our service have switched to a higher quality health clinic, 41% have advocated for better services at their current health clinic, and 92% have discussed the information with their husbands.

We have no roadmap on how to build Tulalens. Instead, we’ve built and will build based on listening and experimentation. We use our values as our compass. 

 

1 A ‘bindi’ is a red dot worn on the forehead of women in South Asia. It can have many meanings ranging from decorative to religious.