Divya Kamerkar shares her journey co-founding Pinky Promise, an app that provides accurate, instant and high-quality reproductive healthcare information and services to Indian women.
In India, there are nearly 360 million women of reproductive age - 8% of those women are concentrated in the big cities like Delhi and Bombay, while 92% are concentrated in smaller cities and rural areas. At the same time there are only 70,000 trained gynecologists in India, of which 50,000 are located in the big cities with only 20,000 outside. This has caused a huge mismatch between the demand for reproductive healthcare services and the supply thereof. There’s also a financial component to the problem as women in India experience a lot of social issues that affect their financial ability.
In general, women have poor behaviors when it comes to their own health and taking care of themselves - they are more focused on taking care of their family members. Divya highlights that it’s very common for mothers, sisters and elder women caregivers to go about their jobs and lives with chronic back aches, headaches and other health issues. But when it comes to their children, significant others or other people, these same women are the first people to take them to a healthcare facility. What ends up happening is there’s a very high rate of out-of-pocket expenditure caused by the high expenditure women incur in terms of their healthcare issues due to the lack of preventative care.
In India, talking about reproductive healthcare is taboo. There’s an awkwardness and silence associated with a women’s menstrual cycle, urinary tract infections and other reproductive health issues. Before Divya and Rahul co-founded Pinky Promise, they surveyed women to understand the issues around reproductive health. What they found when they surveyed 300 women was that 70% of women between the ages of 18 and 32, whether they were located in the big cities, smaller cities or rural areas, did not go to a clinic when they had reproductive healthcare issues.
But at the same time, India has a very high availability of mobile internet with the cheapest 4G internet rates in the world and affordable smartphones flooding the market. And so because of this, women actually take to the internet in high volumes to research their reproductive healthcare symptoms, trying to find a source of care.
That’s where Pinky Promise comes in. Instead of you Googling your symptoms and finding 500 different sources telling you that you could have anything from HIV to cancer, or suggesting that it's a genetic problem. Pinky Promise built an integrated healthcare platform that covers different reproductive healthcare issues and walks you all the way from a symptom to an exact understanding of what that symptom means. Their symptom checker is built and verified by gynecologists. Pinky Promise uses the same medical protocols doctors use to deliver diagnoses in order to deliver an accurate symptom assessment.
Pinky Promise has a retainership with a number of gynecologists who are registered on their system. Once you’ve answered a few questions about your medical history and the symptoms you’re experiencing their software populates a suggested diagnosis with a set of tests. All of this information is then shared with a gynecologist who can then make their own diagnosis using the information provided. Should the gynecologist change the recommended diagnosis the system learns from it.
The cost of one consultation is Rs. 50 (60 cents) because the marginal cost of each consultation run on the Pinky Promise platform is almost zero. They are able to capture a hundred percent of the funnel.
With the Pinky Promise platform a gynecologist is able to see around 30 people on average compared to telemedicine and other platforms that are only able to see an average of 2 people per hour. These platforms reach a problem when they try to scale.
In addition to the platform, Pinky Promise also provides lab testing for blood and urine samples. They collect blood samples from patients’ doorsteps within 24 hours across 97 zip codes around India thanks to their partnership with Metropolis Healthcare, one of the best multinational pathology centers in India. Pinky Promise also has a community support chatroom where women can anonymously talk to other women about issues like their period or sexual wellness. They’ve built a period tracker and the team is working on adding sleep and step tracking, which will enable their diagnosis system to have a preventative approach. The ability to receive data off of customers' apps will help Pinky Promise to detect and predict issues earlier, which will reduce the amount of hospitalization incidents and out of pocket expenditure.
Divya did her undergrad in the U.S. thinking she was going to become a doctor. She comes from a family of doctors and was diagnosed with a condition called polycystic ovaries when she was only 16. She started to do her own research around women's health and found that there was hardly any information available and women’s health issues were often ignored.
She often heard gynecologists say once you get married, your polycystic ovaries will go away, which is not true at all. At 16 she wanted to find a way to solve it. She completed her undergraduate degree at Yale.
During her second year, she took a class that changed everything for her on global health led by the former director of the World Bank for South and Southeast Asia. It was there where she decided that she’s more interested in businesses and systems-level approaches to healthcare.
After graduation, Divya worked in government for the establishment of public healthcare facilities in Delhi and across India. She then went on to work for a consultancy, The Bridgespan Group, focused on their healthcare vertical across India, sub-Saharan Africa, and Southeast Asia. She learned a lot about the hospital infrastructure, insurance and existing digital healthcare players. Divya completed her MBA at Wharton Business School, where she was able to build out Pinky Promise.
Divya and her co-founder came up with the idea for Pinky Promise, while she was pursuing an MBA at Wharton Business School. Divya ended up pitching at different competitions while she was at Business School, and won $22,500 from a Swiss organization called the Jacobs Family Foundation.
At that point, they had built out the entire chatbot for the symptom checker. Divya and her co-founder, Rahul, used to take turns day and night, imitating a chatbot on Facebook because they wanted to make sure that the diagnostic script and the algorithms are actually working.
They used to copy-paste the entire algorithm for more than 400 women and keep improving it to make sure that the answers to the questions and the options they provided made sense. They were actually solving issues by answering questions and that's how they started building the app.
In March 2022, Divya and her team received an investment of $126,000. They launched a paid service in November 2022 and reached a total of 350 completed consultations by January 2023.
Divya and her team are in the process of launching chronic care plans for other health issues like fertility, polycystic ovaries, which are more subscription based and recurrent revenue based. They are also looking into handheld devices and self-testing kits which would end up solving for the lack of diagnostics in smaller areas. Divya shares that they are taking a data-driven approach to learn from and better serve their customers every day.
Divya shares that their customer base is varied, spread over tier two and smaller cities. This is as a result of two things, the fact that their offering is in English and due to the lack of healthcare infrastructure in smaller areas.
The privacy, convenience and quality that Pinky Promise is able to provide is something that even affluent women require and can’t typically access. A significant proportion of their customers are from lower socioeconomic groups who come to their app because of the affordability factor. A lot of users stumble upon their app through their online acquisition channels and end up using it.
Pinky Promise has launched a Hindi and Marathi version of their app and plan to be available in 26 languages this year.
In India, the health insurance penetration is extremely low, which is different from the rest of the developed world. Only around 3.2% of the total Indian population is covered by some sort of meaningful health insurance. In the developed world, companies focus on early detection and preventative healthcare to reduce expenses and improve employee well-being. They typically partner with insurance companies to provide a bundled offering. Indian companies don’t typically do this as a majority of healthcare expenditure is out of pocket.
Pinky Promise is a B2C business and doesn’t currently partner with businesses to expand their reach. They do however partner with external providers to offer facilities like pathology services.
The Indian Government is focused on providing universal health coverage or a form of national insurance to people who fall below the poverty line. Pinky Promise aspires to partner with the Government in the future to provide health care services to women who are covered by government insurance.
Divya and her team wanted to build a product that could scale and capture a significant market. Initially, they focused on nailing the product and building their capabilities to solve patients’ reproductive healthcare issues. They built a comprehensive map of different symptoms, medical conditions, related treatments, pathology tests and linked them to one another. They then validated their product by launching revenue-generating features in December 2022 and served 3,000 active users in January 2023. They were also able to facilitate 194 consultations with gynecologists that month at a price point of Rs. 50 (60 cents). Pinky Promise has now served a total of 100,000 women whilst staying lean as a team.
The Pinky Promise team started off wanting to build an AI-driven diagnosis for reproductive health issues. However, they soon realized that the majority of artificial intelligence and machine learning models are not good enough to deliver an entirely AI-driven diagnosis. So instead they developed an intelligent protocol-based approach to deliver what a customer may think is a fully automated AI-driven diagnosis.
Although her co-founder Rahul wanted to focus on the diagnostic element only, Divya’s experience in highly active and engaged chat rooms for pregnant women led them to consider community-based features for their app. They tested chat groups in WhatApp focused on specific reproductive health issues such as polycystic ovaries, pregnancy concerns etc. They saw excellent engagement that led them to add chat rooms to their app, where now 2,000 messages are exchanged daily and drives conversion.
Finally, they were thinking in a framework-driven approach where they would start with content, build community and then monetize with commerce on the app. However, they realized that mastering the commerce element requires additional capabilities and that they would stretch themselves too thin. Hence, they decided to focus on the diagnostic elements and add a Rs. 50 gynecologist consultation to improve patient outcomes. They expect that as they scale they’ll add a commerce element with customized product-based recommendations for an improved patient experience.
ChatGPT or even Bard are fantastic tools that you could plug in as APIs into your app to provide a superior user experience. However, ChatGPT is not well equipped to perform searches.
The Pinky Promise chat code is constrained because the team realized that when people type their symptoms out in a free flow it’s literally all over the place. They’ll talk about their relationship problems, healthcare issues and include random snippets of medical history. Engines such as ChatGPT that need to try and understand intent are just totally thrown off. Hence, they decided to constrain the chat options to improve the quality of diagnosis. ChatGPT APIs will now enable them to provide a more natural experience to their users with their symptom checker.
Divya believes that their communication with patients is key to success. Despite having limited resources and a small team, they value and provide individualized feedback. WhatsApp is instrumental in India, allowing for efficient communication and the use of template messages. As soon as patients book a consultation or receive a prescription, they immediately message the doctors who are able to assist them in real-time on WhatsApp.
They are also testing more in-app-based messaging and feedback mechanisms through APIs to enable for scale. This will enable them to route communications to doctors and their support team when needed.
The team also looks at all the qualitative feedback that's come in from Freshdesk as a ticket and follows up with individual calls when needed.
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