shishu Newborn Kit: Democratizing Breastfeeding (in the first hour of life)

An “Integrated Ecosystem for Essential Newborn Care” educates healthcare workers to ensure all babies get their mother’s first milk.

Photo of Zubaida Bai
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I confirm that I am fully aware of the eligibility criteria, and based on its description, I am eligible to apply to the CSV Prize 2017.

  • Yes, I'm eligible

Preferred language

  • English

Organization name

ayzh

Year founded

2010

Initiative stage

  • Scaling (the solution has passed the previous stages and is growing its impact on a regional or global scale)

Annual budget in 2017 (USD)

  • $250k - $500k

Number of beneficiaries impacted so far

  • More than 100,000

Organization type

  • Social enterprise

Secondary Focus Area

  • Rural development

Headquarters location: Country

  • United States of America

Headquarters location: City

Fort Collins

Location(s) of impact

India: Chennai

Website

http://www.ayzh.com

Facebook URL

https://www.facebook.com/AYZHinc/

Twitter URL

https://twitter.com/ayzhinc

Problem: What problem is this initiative trying to address?

Newborns need their mother’s “first milk” (colostrum) for concentrated nutrition, immunity, and other critical benefits. However, many mothers are unable to initiate breastfeeding because they lack early and adequate information and support (globally, less than 40% of infants are breastfed exclusively for 6 months). Healthcare workers are crucial to helping mothers initiate in the critical first hours after birth, but often lack the tools and training needed to set up moms and babies for long-term breastfeeding success.

Solution Summary: What is the proposed solution? What do you see as its most promising aspects for creating shared value?

Our Integrated Ecosystem of Essential Newborn Care (ENC) supports mothers to understand and unleash the protective and transformative power of her first breast milk, which can prevent 22% of infant deaths in developing countries (initiation within an hour after delivery also increases success rates of exclusive breastfeeding for 6 months). The solution combines an existing product (shishu Newborn Kits) with novel training for healthcare workers. The kit contains simple tools to prevent the leading causes of infant mortality (hypothermia, infection, asphyxia); and the training gives healthcare workers the ability to adhere to best practices and deliver cutting-edge breastfeeding and nutrition science to mothers and families. ENC begins in immediately after birth in the institution and sets up for sustained success at home. Our goal is to ensure that the lifelong benefits of colostrum and high-quality ENC become a reality for all mothers and babies, regardless of facility conditions.

Impact: What is the impact of the work to date? Specify both the social and the environmental impact of your work

To date, we have impacted 600,000 mothers and babies with access to a clean and safe birth (through the sale of 300,000 kits to 300 institutions in 20 countries). We engage customers (health institutions), product users (healthcare workers) and women beneficiaries in monitoring and evaluation, which has revealed high product satisfaction along with unique opportunities to expand our product line. Beyond increasing access to essential commodities, we have used our kits to educate 5,000 healthcare workers and mothers on best practices for maternal/newborn care. Pre/post tests show increased knowledge, awareness and confidence in 60 percent of participants. Our research also shows that when healthcare workers transfer this knowledge to the mother, she is more likely to put it into practice at home. Furthermore, our model employs rural women and micro-entrepreneurs to assemble products, who report benefiting from a fair wage, increased income and a safe and empowering working environment.

Financial sustainability plan: How is this initiative financially supported? How will you ensure its financial sustainability long-term?

Supporting all of our innovations, is a market-driven model based on product sales (40-50% profit margin) transforming a field dominated by philanthropy and government subsidies. With our core manufacturing and distribution facility (based in Chennai) achieving financial sustainability, we launched two new franchise units in India with more in the works (including our first global operations hub in Kenya). To increase reach and impact, we leverage profits and strategic partnerships to support further product development and model replication. shishu Newborn Kit is already on the market with identified paths to scale for fluid implementation of proposed breastfeeding initiative.

Individual donations/gifts: 0%
Grants: 10%
Corporate contributions: 5%
Earned income: 80%
Other: 0%

Unique value proposition: What makes your initiative innovative? How does your project differ from other organizations working in the same field?

Globally, breastfeeding promotion is “trending” with efforts to normalize public practice and create supportive workplaces for nursing moms - but, little is being done to address the critical gap in the first hours after birth, prime time to establish optimal breastfeeding. Breaking away from narrow “silo” approaches (e.g. http://satthi.org focuses exclusively on HIV mothers; http://motherchildhealth.org on communication technologies), we target the “first line of defense” - colostrum and healthcare workers.

Founding story: Share a story about the "Aha!" moment that sparked the beginning of this initiative.

ayzh founder, Zubaida Bai, was on a field visit in a rural village in India, when she discovered that some midwives used a sickle – a crude blade for cutting grass – to cut the umbilical cord. Reflecting on her own experience of infection at the time of childbirth, she wondered, “If I had to suffer at one of the best facilities in India, what are the women in these villages facing?” Shortly after this “aha” moment, Zubaida launched ayzh with a simple $3 Clean Birth Kit in a Purse (called ‘janma’ which means birth), which sparked the beginning of an integrated product line that addresses the entire continuum of reproductive, maternal, newborn, child and adolescent health (RMNCH+A), built on the philosophy that the “poor are not poor in mind” and even people living on less than $2 a day will pay for products that are affordable, alleviate real challenges, and make life easier and better.

Where did you hear about the Nestlé Creating Shared Value Prize?

  • Upon recommendation from others

Program Design Clarity: We are hungry to know more about what exactly your model consists of. Succinctly list a) what main activities are you doing with your beneficiaries, b) where you carry out the activities? c) how often? d) for how many hours? e) who delivers the services? and f) any other brief details

Breaking away from common philanthropic approaches, we have a market-based model for manufacturing and distributing low-cost, high quality maternal and newborn health products, making essential commodities accessible worldwide at the “right place, right time, right price.” Leveraging our three-step “human centered” design process (Research and Innovate; Produce and Sell; Monitor and Evaluate) consists of the following activities based in southern India:

Breastfeeding Workshops (hospital-based) - Engage 1,000 healthcare workers and mothers in a series of twelve “Q&A” style workshops (1 hour long delivered by lactation experts and gynecologists), documenting specific knowledge and behavior gaps, and learning goals along the breastfeeding continuum (in tandem with distribution of shishu Newborn Kits). Leveraging data collected, we will identify key stakeholder “pain points” and develop a culturally relevant training curriculum that includes cutting-edge breastfeeding science vetted by leading lactation and nutrition experts.

Breastfeeding Curriculum (online) - Work with our ICT partner to develop content delivery mechanisms (interactive eLearning modules, practical demonstrative videos, game based learning, mobile application), as well as metrics and mechanisms for evaluating learning outcomes and user-experience. We will partner with existing customers to pilot the training curriculum with 250 healthcare workers, translating educational messages into local languages.

Focus area

  • Nutrition

We are interested in learning more about your initiative's broad impact on sustainable development. Please reply ONLY to the question(s) related to your above focus area.

Our solution aims to rethink ways to empower healthcare workers and mothers with breastfeeding science, so they are prepared to initiate as soon after birth as possible (changing the grim reality that only 43% of the world’s newborns are put to the breast within 1 hour of birth). By expanding our existing Newborn Kits with novel breastfeeding training, we integrate early breastfeeding support with simple tools to prevent the leading causes of infant mortality.

Broadly speaking, we assess impact on newborn health using the following metrics: ACCESS to essential commodities (measured by products distributed); ADHERENCE to best practices (measured by change in knowledge and behavior); and ADVOCACY around breastfeeding (measured by strategic partnerships formed that increase product reach, grassroots data collection, and knowledge sharing).

Positive product and training feedback to date in India: “We need lots more of these kits, they definitely help in maintaining hygiene and lower the risk of infection,” said a gynecologist at a large public hospital. Post childbirth, a mother reflected on the happiness and confidence the kit provided: “Mentally, I was comfortable. ‘I have everything. I am prepared.’” One trainee affirmed, “We will follow all that the training taught us and also pass on this information to the people in my community. We would like to have such trainings again.”

Furthermore, our Newborn Kit reduces medical waste through use of biodegradable packaging

Creating shared value: How does your initiative create value for different stakeholders?

Recognizing a clear business and social need to grow beyond Clean Birth Kits, we expanded our product line to address new needs and demands of existing customers, including kits for Newborn Care, Postpartum Health, and Menstrual Hygiene. As a GIIRS Rated company, we measure “shared value” in terms of our impact across our supply chain in the following categories:

CONSUMER (women of reproductive age, health workers and institutions): by targeting underserved populations with reliable access to affordable, high-quality products and training that achieves defined outcomes with satisfaction and happiness

COMMUNITY: by employing women in low-income markets; demonstrating leadership on gender equality; engaging men

ENVIRONMENT: by becoming a leader in sustainable packaging for medical products

WORKPLACE: by promoting female ownership, governance, leadership; maintaining workforce of at least 50% women; providing fair wages; implementing policies to support women and working moms

How is your initiative funded, now and over the next 5 years?

Top five funding sources to date: Grand Challenges Canada (convertible debt), Pfizer Foundation (grant), Open Road Alliance (debt), http://IDEO.org (grant), and CAMTech (grant). With a revenue model based on product sales, we maintain a 40-50% profit margin, aiming for sales to account for 80% of revenue. Our cost structure consists of COGS (64%), Sales and Marketing (4%), General Admin (12%), R&D: (7%) and EBITDA (13%), with projected USD revenues of 4,930,000 (2018) and 14,740,000 (2019). These projections are based on our ability to scale-up via new product development and geographic expansion. Prize money will support further development and reach of our shishu Newborn Kit, which is aligned with achieving our scalability and impact goals.

How do you plan to influence your field of work if you are a winner of this edition of the CSV Prize?

Using prize money to expand our Newborn Kit offering with breastfeeding training, we plan to influence the field of newborn health by generating an understanding of the stages in Essential Newborn Care through an integration of products and training. Initiation of essential newborn care in institutions is crucial to ensuring a thriving opportunity at life as the mother spends the first 48 hours at the facility. With the government of India promoting institutional deliveries to combat high mortality rates, our proposed solution not only established ENC by making it easier for the care provider to adhere to best practices and initiate breastfeeding, but it will also support knowledge transfer for mother to continue the same at home.

How will you leverage an investment from Nestle to expand the impact of your work?

Investment from Nestle presents an exciting opportunity to collaborate on increasing impact towards our commitments under the Every Newborn Action Plan, part of the United Nations Every Woman, Every Child movement. It will also be leveraged to carry on the work we initiated with http://IDEO.org, which involved prototyping value-added variations of shishu Newborn Kit, assessing demand for a breastfeeding curriculum (hence this proposal), develop environmentally responsible packaging from sugarcane bagasse, and create a marketing plan. While core operations are growing sustainably, we seek investment to scale-up across India, Africa, and Southeast Asia over the next 6 years, targeting regions with high rates of maternal and infant mortality.

Spread Strategies: Moving forward, what are the main strategies for scaling impact? What’s the projected impact for the coming years? Are you planning to expand your programme into new locations? On what assumptions do you build your scale-up plans?

To scale our proposed ENC/breastfeeding solution, we plan to partner with medical educational institutions that can offer our training curriculum to students and caregivers with accreditation, which will subsidize training and certification costs for underserved populations and more difficult-to-reach regions. We also plan to explore alternative platforms for curriculum delivery based on further research. We see ourselves as a key player in the Indian landscape contributing to the breastfeeding gaps we see in different stakeholders. Broadly speaking, we are using social franchising to scale of operations. Expanding on our original manufacturing and production facility in Chennai, we have replicated three new franchises in southern India (Andhra Pradesh, Odisha, and Karnataka) and plan to expand into northern India. We have also established our first global hub in Kenya. Our scaling plan is aligned with our long-term goal of impacting one billion women, babies and girls by 2030.

Team: What is the current composition of your team (types of roles, number of full-time vs. part-time staff, board members, etc.)? How will this team evolve as your initiative grows?

ayzh is made up of a diverse international team (20 full-time members strong), whose passion and expertise foster integrated innovation in women’s health, business and technology. Management includes: Zubaida Bai (founder and CEO); Habib Anwar (COO), Colleen Lyon (Chief of Staff), Rehana Razack (Managing Director); Priyanka Kanna (Scaling Strategy); Suchi Guar (Advocacy and Training); Sreekala Keermath (Monitoring and Evaluation); April Zhou (Procurement); and Aparna Anathakrishnan (Research). Breastfeeding Workshops will be developed and delivered with Payel Biswas (Lactation Specialist) and Dr. Rashida Sultan (Gynecologist). Online Breastfeeding Curriculum will be developed and pilot in partnership with Bodhi Health, a developer of technology based solutions for medical education.

Awards: What awards or honors has the initiative received?

MacArthur 100&Change (‘17); World Economic Forum (‘17/’13); UN Global Compact (‘16); GSBI (‘16); TED (‘16/’09); Women in the World (‘16); Nike Foundation (‘15); IDEO (‘15); Stars in Global Health (‘15); Pfizer Foundation (‘15); Duke-SEAD (‘15); Every Newborn Action Plan (‘14); INDIAFRICA (‘12), Echoing Green (‘12); World Health Care Congress (‘11)

Organizational leadership: How are you influencing your field of work in the present?

I’ve been working as an engineer/entrepreneur in women’s health for 10 years. With recent designation as a Sustainable Development Goal (SDG) Pioneer, and as the first social enterprise accepted in the Every Newborn Action Plan, my team is advancing global goals with products and partnerships across our core function areas. For example, we’ve conducted groundbreaking research with Duke-SEAD (R&D); expanded product reach in high priority regions with TOMS (business development); and employ and train women with Kuthambakkam Trust (operations). We’ve organized government roundtables to influence policy, hosted global health summits to spur collaborative innovation, and have a Gender Strategy to influence women’s empowerment in the workplace.

Should you be successful, please confirm your availability to attend the Ashoka Impact Boot camp and Creating Shared Value Prize Live Pitch Event at the World Water Forum 13-16 March 2018

  • Yes, I am available to attend the events on 13-16 March 2018

Attachments (1)

Gender Strategy_WEP.pdf

Gender equality and women's empowerment are core to ayzh. Our Gender Strategy serves as both a pledge to take action to accelerate gender parity, and a framework for guiding our path as a global brand of women’s health products for the developing world. The strategy ensures that gender equality and women’s empowerment is integrated into every aspect of our work, particularly around governance, workplace policy, poverty alleviation, and product development that benefits women, babies and girls.

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Photo of Bryan Raveen

Dear Zubaida Bai,

I just went through your application and really liked your idea. Since this competition gives points for peer review, I was wondering if it would be possible for you to evaluate our submission as I too will be doing the same for yours. As you would have noticed in the design quotient you have marks for EVALUATION which you get when you review other applications. When others review your application you get points for IDEA. To find my application you will have to Select ‘‘PHASE> Prize entry’’. On the right section of page, under the heading ‘‘FOCUS AREAS’’ click on "WATER". Go to Page 3> Click "Evaluate" on application titled "Turning the tables for Temiar tribe of Malaysia". I would also appreciate if you either applaud us or leave a comment on our page if you deem us worthy.

Thank you very much.