A decade flies by, and the memories of our early days at Narayana Health — the hospital in Bangalore where we started to build the Care Companion Program (CCP) — are still with us vividly every day. Moments of deep listening with nurses and patients, prototyping sessions, editing training videos, chai and idlis in the hospital canteen, late nights and early mornings in the corner of the d.school back at Stanford, and all of us energized by the potential we saw and the community we were building. 

We had a vision then, and it remains today, ten years later: To make caregivers across the world feel loved, supported, and equal partners in a patient’s healthcare journey.

From the beginning, we witnessed the power of caregivers and the immense opportunity that exists with them, especially when they are supported, respected, and equipped with the tools they need to care for their loved ones. 

We learned quickly that bringing this ambitious vision to life needs an interconnected approach — threading together different aspects into one single tapestry of care. Key questions guide this approach: What do we expect families to do differently? How are we enabling them to do so? How do we know it’s working?

With scale, evolution, and the profound admiration and awe of our teammates and the caregivers, patients, and health workers we’ve met along the way, we’re refocusing on the big picture at the doorstep of our next decade. We’re looking at four pillars to structure our work. These pillars are not exclusive but interconnected and mutually reinforcing, woven together to create a cohesive framework.

Pillar #1: Not just scaling our work, but scaling what works

We’ve set our sights on reaching 70 million caregivers across India, Bangladesh, Indonesia, and Nepal by 2027. It’s a bold, ambitious goal, and we’re committed to making it happen. As we work towards this, we’re also exploring how we can offer caregiver training and education programs in new places and settings without being limited by our capacities and resources. It’s not just about scaling our work; it’s about scaling what works best for caregivers. 

As we see caregiver training and support gain traction globally, we want to see the work and vision for it grow and evolve outside of Noora Health’s direct involvement. To get there, we’re excited to refine four different approaches in this next chapter: 

• Systems strengthening and capacity building: We want our work to be a launch pad that has a lasting impact and is used as a platform for addressing the challenges that our partners and communities face, and we’re exploring different strategies to achieve this. This builds on the decade of inroads our team has made with health workers, facilities, and government systems we partner with closely. In our newer geographies such as Nepal, we’re looking at kickstarting this by more closely co-creating with the government on everything from designing tools to monitoring impact.
• Building new partnerships: In Noora Health’s first chapter, we implemented nearly all aspects of the CCP ourselves. Covid-19 pushed us to change this and partner with local organizations deeply rooted in a particular context and who have the historical experience, expertise, and relationships to influence health outcomes — something that would take us years, if not decades, to achieve. Moving forward, we’ll continue to leverage the strengths and expertise of trusted implementation partners, extending our reach and address caregiving challenges more effectively.
• Creating a low-touch, replicable caregiver-training playbook: Our ultimate goal is to transition to a strategic and technical partner to organizations and countries interested in rolling out their own caregiver support and training programs. We’re already starting to distill our learnings and experiences into high-quality, replicable tools, processes, and frameworks that organizations and public health leaders can adapt to their own needs and contexts.
• Catalyzing collective action around caregiving: We’re advancing caregiver-centered approaches through growing government ownership at the country level — where caregiver training is increasingly embedded in public health systems and policies — while deepening engagement with global platforms like the Clinton Global Initiative, the World Health Organization, and the World Health Assembly to develop international guidelines, resolutions, and communities of practice that champion caregiving.

Pillar #2: Building a robust evidence base

In the coming years, our goal is to create a longer, more continuous roadmap to learning where evidence informs every phase across design, development, and implementation. This will allow us to iterate and improve in real-time, making our programs more responsive and effective.

We’re doing this in two ways:

• Learning by building our experimentation muscle, beyond regular monitoring. There’s a lot of prototyping and testing that happens during the program design and development process, but we want to elevate that and make it more rigorous and data-led. 

• Evaluating our work by generating more rigorous evidence across all the different condition areas, country contexts, and patient populations we’re working with. This builds on our existing evidence base of multiple peer-reviewed research studies showing the impact of the CCP on health outcomes in India — our largest area of work. We’re also conceptualizing a large-scale study across multiple locations, which will provide detailed insights that will enhance our learning.

Generating all this evidence not only supports our learning journey but is necessary in advocacy with health systems and governments to prioritize supporting family caregivers.

Pillar #3: Reimagining caregiving with tech

Since we launched our mobile phone-based service in 2019, we have seen the incredible response and impact it has had in supporting caregivers at home with timely, reinforcing messages and personalized support for their questions. Currently, our clinical team of 20 nurses handles about 10,000 incoming patient messages in eight Asian languages every day. 

To keep up with this demand and ensure we’re providing medically-accurate, contextually-informed, and empathetic responses, we’ve been exploring generative AI as a tool to improve and reimagine how we support caregivers digitally.

To build a truly personalized, proactive digital care companion, we’re envisioning and working on two AI-powered systems: 

• A highly personalized caregiving content platform that evaluates each caregiver’s family dynamics and tailors behavioral content to meet their entire range of health needs, including emotional support, making the experience more cohesive and engaging for caregivers. 
• A digital health navigator that combines AI and human expertise to respond to user queries more effectively at scale, including navigating critical cases that require specialized support.

Watch this short video about the future of Noora Health's Digital Care Companion, and how it blends tradition with technology.

While there’s a growing interest from funders, governments, and tech partners regarding the potential healthcare opportunities AI could unlock, we’re acutely aware of the challenges as well. To mitigate these, we’re making sure that we establish a responsible AI development process, using local datasets, co-creating the product with communities, and rigorously testing and iterating on it in the real world. This will allow us to enhance accuracy, equity, reliability, and empathy in AI responses and outputs.

We don’t see tech replacing the high-touch engagement we have in facilities. Instead, it complements and extends it to other health conditions, situations, and to better support caregivers and patients at home, when they need it most.

Pillar #4: Pushing the boundaries of what it means to care 

We’re continuing to build products and services that make it easier for caregivers to care, while also advocating for caregivers and the complex challenges they navigate on a daily basis.

To do this, we are investing in understanding emerging trends in the caregiving landscape and exploring how our support can evolve in response, especially in the countries we serve. For instance, India’s population aged 60 years and over is set to double to 346 million by 2050. This aging population has far-reaching impacts on the demand for care and how it is delivered — a challenge further complicated by evolving family structures that are reshaping traditional eldercare support systems. We want to make sure our programs are responsive to these societal shifts and realities.

Similarly, there are many other emerging areas globally that intersect with caregiving and deserve a closer focus, such as telehealth, mental health, AI, gender, climate change, and more. 

Our dual strategy for understanding caregiving more deeply includes:

• Building internal expertise via our in-house Caregiving Lab to understand caregiver experiences and what the future of care might look like in the geographies we work in. Another important area of focus is the care economy to understand the policies and schemes available to the caregivers we serve. Given that finances are one of the major challenges faced by caregivers, we want to see how we can build better linkages to it via our programs. 

• Partnering with experts and thought leaders who are pushing the boundaries of the theory and practice of caregiving. There are many aspects of caregiving on which we may not be the experts (and don’t need to be!). There are fantastic individuals and organizations across the globe working at the cutting edge of a range of caregiving-related issues, who we can learn from. In the coming years, we hope to keep growing this network of thought partners and contributing to larger conversations with other leaders in the space.

Now, on to the next chapter 

If you had told us ten years ago that we would be where we are today, we would have replied with a smile and a hopeful, “That’s the dream!” It’s difficult to predict exactly what the next ten years hold for Noora Health, but what we do know for sure is that we want to tackle it with the same agility, care, and more than anything — love — that has defined the last decade. 

Thank you for being on this journey with us. We couldn’t do it without you. 

We would like to thank our team and partners for stewarding and shaping the vision for our work over the last decade and into the future — you make it all possible.