Dignity is a word that urogynecologist Dr. Aparna Hegde uses a lot. The pelvic floor reconstruction expert, who is on Fortune’s 2021 list of the World’s 50 Greatest Leaders, believes that every patient has to be cared for with dignity—something that’s often missing, she says, in the way patients who can’t afford to pay are treated.
It’s what motivated her to start Armman, a non-governmental organisation that partners with governments for maternal and child health programmes, in 2008 as a struggling medical student. She began with the simple idea of delivering health information to expectant and new mothers with a timed voice call on their mobile phones. Since then, Armman has reached more than 24 million women in 17 states, trained over 170,000 health workers, and partners with the Union health ministry and state governments as well as numerous non-profits.
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Dr. Hegde comes in at No. 15 on Fortune magazine’s annual list of the World’s 50 Greatest Leaders, which features New Zealand Prime Minister Jacinda Ardern at No. 1, and the mRNA pioneers, whose years of research that seemed to yield no returns was suddenly needed to create one of the most effective covid-19 vaccines, among others. Another vaccine maker in the ranking is Serum Institute’s Adar Poonawala, the only other Indian on the list apart from Dr. Hegde.
While doing her residency in Mumbai’s Sion hospital in the late 1990s, Dr. Hegde saw women die of completely preventable causes—both in urban and rural Maharashtra—simply because they hadn’t been able to see a healthcare worker in the first few months of their pregnancy, or if they had, the experience was so discomfiting that that they hadn’t gone back. “What the middle class is facing now during the pandemic—hours of waiting, lack of information, no dignity in treatment, apathy and shortages of everything, this has always been the poor’s experience of healthcare,” she says.
While that’s a statement heard often in the past few weeks, since hospital infrastructure has been overwhelmed by the second surge of covid-19, Dr. Hegde has been working to create robust referral and tertiary healthcare systems for more than a decade. “Covid has taught us the importance of primary health and referral systems. If we focus on preventive maternal and child health and put systems in place, it can be replicated easily, and will strengthen public health across the board,” she says.
Her model has been adapted to covid times as well: As the pandemic spread, Armman’s network and virtual training platform was put to use to educate women and health workers across the country about the virus and vaccination. The non-profit also launched a virtual clinic to provide antenatal and paediatric care because most hospitals were converted into covid-care centres.
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“When I had this idea in 2008, as a student in Stanford, everyone thought I was crazy—a doctor talking about scalable technology solutions,” she says, laughing. Her idea, which eventually took the name mMitra, was to make a free voice call and provide health information to women—from nutrition basics to possible health hazards—in a language and at a time of their choosing on the mobile phone, a simple device that almost every family had acquired.
“Something like gestational diabetes can be prevented from spiralling into a serious issue if the woman is able to spot the signs. But even if I entered competitions or applied for grants, the awards would go to people who had built fancy new devices, complicated solutions," she says. Armman, which is an acronym for Advancing Reduction in Morality and Morbidity of Mothers, Children and Neonates, means 'wish' in Hindi.
"Now, Armman has pioneering technology that excites everyone but back then a voice call was a boring idea. But it’s practical, cheap, can be scaled up—and it works. You need to be able to design solutions for scale in India so the 20th million woman gets the same service of the same quality that the first one did,” says Dr. Hegde. The aim is to reach 45 million women and one million health workers in the next five years.
It took five years of struggling before Dr. Hegde landed a British grant, which helped her roll out a programme in Maharashtra’s Osmanabad district. As that gained traction, more funding and partnerships came in and the programme spread across Maharashtra. In 2019, Armman partnered with the Union health ministry to manage its Kilkari programme, which was based on the same principle of voice calling. Kilkari has reached 21 million women and their children in 15 states and currently has 2.5 million active users.
“These regular messages also provide emotional support to women,” she says. “As a doctor I expected the voice messages just to inform, I didn’t expect them to empower—that was the real surprise.” With information, the women are able to stand up to patriarchal families that may dismiss their fears. “Most women sense that something is going wrong but don’t know how to speak up. With the information they get on these calls, they’re able to articulate their needs and get help,” she says.
Though she’s known to the larger world as a social entrepreneur who set up Armman, within the medical community, Dr. Hegde is an internationally renowned urogynecologist and one of the country’s few experts in pelvic floor reconstruction. “What Armman prevents, my work in urogynaecology treats,” says Dr. Hegde, who is in the process of creating a department for the superspeciality and a fellowship at Mumbai’s Cama Hospital. Her work as a doctor and a researcher informs many of the innovations and programmes that Armman rolls out. “I couldn’t do one without the other,” says Dr. Hedge, who starts her day at 4am to fit in her research work, the hours at the government Cama Hospital, fundraising for Armman, and evening private practice. “And, it may not seem like it, but I do have fun too,” she says, laughing, “but I’ve always been the kind of person who’s juggled more than one thing at a time.”