Noora Health

Intention is often touted as an essential starting point for big visions but sometimes incredible things happen one small step at a time. Edith Elliott and Shahed Alam – now Noora Health Co-CEOs - were given a course assignment to improve healthcare at a hospital in India. Edith was in the global health policy area and Shahed was studying medicine at the time. Neither of them had any inclination to create an NGO but they had a powerful idea: no-one cares more for a patient in the health care system than their family members, and all those people were a major, underutilized resource that could extend the umbrella of the care significantly, if they were trained and supported to be truly effective.

Edith and Shahed traveled to India, along with two others involved in the project, to investigate further and speak with a specific hospital about how they might put the idea into action. Together with the hospital’s staff, they began experimenting to see what worked. As Edith describes it, “we just started trying different approaches for engaging families. When something stuck, we’d build on it and get more ideas from the caregivers about better ways to support them.”

The model extends care beyond community health services; families are not taking on roles held by the health system, they’re being trained to do their own part more effectively, with support from the professionals. “There are some great advantages to families as part of the care umbrella,” says Edith. “They’re very proximate so it takes no time for someone to show up. They already help with care, naturally. And they notice changes in another family member more readily because they know them well.”

Initially, Shahed and Edith intended to simply create a model the hospital could take over and run on its own. Self-sustaining systems were therefore baked into the program from the start. But in the process, they accumulated some very good data and the hospital asked them to expand to other facilities in its network. “That’s when we thought, maybe we’re on to something,” says Shahed. “The snowball started rolling and we progressed one hospital at a time, beginning with that first network, to create a scalable program.” And they formalized the creation of Noora Health 

As their impact statistics and anecdotal success evidence grew, so did their reach. Fast. The program is now being deployed with 11,500 facility partners in India, Bangladesh, and into Indonesia, training health care workers – 20,000 so far - to become trainers in turn for the caregivers. 14 million caregivers have now been trained, representing 9 million patients.

With each new health facility and geography they enter, the process starts with selecting existing healthcare professionals to become Noora trainers. The local or national government takes the lead on nominating people, usually nurses. There is no financial incentive for trainers but they do acquire extra skills when they become part of the Noora training team. “The HCWs are instrumental in the program design for their community, because they know it from the inside,” says Shahed. “Not just what ailments are most prevalent, but right down to how people should be dressed in the training materials, what food should be featured, what are the long-held beliefs about illness and health in that place.”

Beyond being part of program development, the trainers are taught soft skills for more effective teaching and presentation. “We see the HCWs taking ownership of the program as they gain confidence with experience,” says Shahed. “What they’re teaching becomes more dynamic and alive.”

Warning signs for major medical conditions are a big part of the education, so people at risk can seek intervention before ending up with a catastrophic issue. Initially, Noora’s focus was in cardiology because that was the specialty of the first hospital and it requires a lot of aftercare once the patient is sent home. But half the people in a district hospital are there to have a baby, so Noora upped their programs in maternal and infant health. Increasingly, scope also includes general medical and non-communicable diseases. Priority conditions are determined facility by facility. “Wherever the medical burden is highest and there’s an opportunity for families to have a major impact on outcomes, that’s where we focus,” says Shahed.

Noora extends support further through a mobile phone platform with reminders about care practices and educational resources. Even in situations where a family has no running water, at least one member is likely to have a cell phone. The Noora HCWs work with the families to ensure the key care-givers have access to the app and understand how to use it.

With millions of proof points behind them and more on the way, Noora has demonstrated this to be a highly impactful, low cost care solution. It costs far less to train caregivers than to treat an avoidable medical incident or re-admit patients from post-surgery complications. 71% decrease in cardiac complications and a 56% decrease in newborn readmissions are just two of their impressive results.

Noora has recently been the recipient of a TED Audacious grant, a collaborative in which The Patchwork Collective participated. “Our funding has almost entirely been unrestricted,” says Edith, “which has been critical for creativity and innovation. With the Audacious infusion we have a launch pad to reach an unbelievable number of people, but also to promote the policy work and creation of best practices and tools, so any system or facility, anywhere in the world, could make this work. You need unrestricted capital to make this kind of thing happen.

Their Audacious-based goal is to reach 70 million people, but it’s not the numbers that are motivating them every day. “When we go into a ward and sit down with patients and family members, and they say ‘thank you for listening, I feel so much better in being able to help my father or sister this way’, that’s what drives us”, says Edith. “This work is about connection, love and compassion.”

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