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Shifra: Sexual and reproductive health web-app for refugee and migrant communities

Shifra aims to increase the sexual and reproductive health literacy of refugees and migrants everywhere.

Photo of Rebeccah Bartlett

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What problem does the idea help to solve and how does your solution work? (2,000 characters maximum)

The Problem: There is a lack of access to quality, respectful sexual and reproductive health (SRH) across the globe. On top of that, when communities experience a sudden or continued refugee or migrant crisis, there is additional pressure placed on existing health services and the health burden is amplified. Without access to SRH services, people on the move don’t have access to contraception, have poor access to prenatal health care and safe birthing practices, are exposed to sex trafficking, and have an increased risk of sexual assault. This endangers both the lives and livelihoods of women, girls and people who identify across the LGBTQI+ spectrum. Humanitarian response, while well intentioned, often doesn’t address users’ actual needs. The Solution: Shifra is a digital health tool partnering with users in 3 ways: It is a process of authentic community co-design that builds employment pathways for the communities involved in the replication and scale of Shifra internationally. The evidence based, trauma informed digital health content improves the SRH health literacy of these communities and the bridges health needs and safe services in new locations. It also addresses needs that often go unsaid, such as information about mental health and sexual assault. Shifra uses anonymous user data to demonstrate people on the move’s specific needs, compel health systems to better meet the needs of the most underserved and disadvantaged communities, and save costs and reduce resource wastage at the same time. Using our diverse skills and networks, we are redesigning the way health in conflict is approached to one in which the refugee is able to assess her own health needs and work with experts to determine the best way to access services. Most importantly, Shifra is redrawing the existing power structures within the humanitarian landscape so that the beneficiaries are the primary decision-makers in their journey to health, safety, and dignified independence.

Geography of focus (500 characters)

Shifra is headquartered in Australia but we are committed to improving access to SRH for people on the move globally. Shifra is available for Arabic, English and (shortly) Dari speakers. We are in discussion to partner with other communities on the move to increase their access to SRH services. So far, we have explored partnerships with asylum seekers travelling through Central America, refugees in France and LGBTQI+ refugees in Kenya.

Building Bridges: What bridge does your idea build between people on the move and neighbors towards a shared future of stability and promise? (500 characters)

Shifra meets users where they are, supporting them to access health information with privacy and dignity, and then connects them to health services that are local and trusted. At a minimum, people on the move who have access to SRH are able to plan and space their families, facilitating their integration into host communities and setting them up for education and economic success. This access to quality SRH contributes to the long-term economic development of entire communities.

What human need is your idea solving for? (1,000 characters)

Supporting women and girls’ access to comprehensive SRH services saves lives and increases their chances of achieving higher education, longer-term employment benefitting entire communities through shared information and education. For women and girls to be given this chance, they need to be recognised by those who direct health policy and funding and provide associated services within their new communities. Sexual and reproductive health is a fundamental human right. Addressing these needs positively impacts the right to earn an education; the right to find stable and meaningful employment; the right to provide a safe and secure upbringing for one’s children; and the right to participate in the community that surrounds us as dignified human beings worthy of respect and recognition.

What will be different within the community of focus as a result of implementing your idea? (1,000 characters)

Shifra has been designed to be scaled up in multiple ways demonstrating transferability and broadening the app’s potential to reach beyond the SRH setting. Specifically, Shifra can be expanded to cover other health care and social welfare services and extended to cover other low resource settings regardless of the level of emergency or crisis. We feel strongly that for girls to count, they need to be counted. Anonymous data, sourced from the app’s utilisation habits and search histories demonstrate what users are searching for, where and how often. This helps us map need and improve community-based service provision, thereby reducing inefficiencies and resource wastage. Shifra is focused on developing relationships with partners who are committed to ensuring women, girls and LGBTQI+ people, in particular, are able to access comprehensive SRH services. We support in-country capacity by working with local refugee coders, app developers, designers and health educators and professionals.

What is the inspiration behind your idea? (1,000 characters)

In 2015, founder, Beccah, watched the news as thousands of refugees drowned trying to escape to Europe from war-torn Syria & read the following story in the Associated Press: "When a boat carrying over 500 refugees capsized near the Italian island of Lampedusa in October 2013, one of the victims was an Eritrean woman who drowned while she was giving birth to a baby boy. Days later, when Italian coast guard divers pulled their corpses from the water, they were still attached by the umbilical cord." Pregnant women weren’t just giving birth on these boats & in this water. They were also dying in the process. As a nurse-midwife with a growing understanding of the power of mHealth in low resource settings, Beccah started piecing together ideas for a solution that may help those who survive to find quality, respectful and culturally sensitive SRH information once they made it to safety. Shifra has been designed for the millions of displaced people waiting for their chance to be recognised

Describe the dynamics of the community in which the idea is to be implemented. (1,000 characters)

In 2017, Shifra undertook community-based participatory research focused on self-identified health barriers for Arabic-speaking women from refugee backgrounds in Australia. 28 women participated in group surveys and 10 women engaged in Photovoice and GIS go-alongs to explore healthcare barriers identified in surveys. This empathy-building exercise also explored acceptability, desirability & feasibility of mHealth solutions within this community to improve access to primary healthcare services. Women reported limited awareness, utilisation of primary health services & low accessibility of health information, yet phone ownership and health info searches online indicate mHealth solutions are feasible and acceptable. We continue to work in similar ways with every new language or cultural community we are developing Shifra for. We prioritise community co-design and capacity development in all budgets, including in our plans for a Spanish language pilot program in Central America.

How does your idea leverage and empower community strengths and assets to help create an environment for success? (1,000 characters)

Shifra engages local health professionals, who are aligned to our mission, to work with us, validate our information and improve access to local reputable health services. We also support health providers to offer more culturally appropriate and respectful care. Shifra was co-designed and piloted with multiple Arabic-speaking migrants and refugee communities in Melbourne, Australia. Shifra is affecting meaningful service and policy change and helping to reduce resource wastage by listening to, learning from and working with the local communities most affected by inaccessible and chronically underfunded health services. We know that genuinely including and co-designing health solutions with users ensures higher utilisation rates, viability and sustainability of the partnership and the solution. More importantly, communities that are listened to and engaged, particularly those who experience systemic disadvantage, experience greater improvements in both health and health behaviour.

What other partners or stakeholders will work alongside you in implementing the idea, if any? (1,000 characters)

Shifra has developed an extensive network of end-users, research institutions, local partners, healthcare providers and international NGOs. To implement the community champions program in Australia, we will draw on our existing relationships with bicultural health workers, community advocates, health professionals, sexual and reproductive health services, LGBTQI+ community networks and health centres, and legal centres working directly with asylum seekers/refugees. To replicate in Central America, we will work with bicultural health workers, community advocates, health professionals, sexual and reproductive health services, LGBTQI+ community networks and health centres, legal centres working directly with asylum seekers/refugees, Rotary International, Techfugees, Monash University (MCHRI, MADA, MBS) and the University of North Carolina.

What part of the displacement journey is your solution addressing

  • Being on the move, crossing borders, and/or temporarily settled

Tell us how you'd describe the type of innovation you are proposing

  • Technology-enabled: Existing approach is more effective or scalable with the addition of technology

Idea Proposal Stage

  • Pilot: We have started to implement the idea as a whole with a first set of real users. The feasibility of an innovation is tested in a small-scale and real world application (i.e. 3-15% of the target population)

Group or Organization Name

Shifra

Tell us more about your group or organization [or lived experience as a displaced person?] (1000 characters)

Shifra was founded in 2015 by Rebeccah Bartlett, a nurse-midwife from Australia. It has grown since then thanks to the dedicated support of more than 50 volunteers from almost as many countries. Shifra currently partners with Your Creative in Melbourne to manage the digital development of the web-app and Sylaba Translations to undertake cultural consultation, adaptation and translation of content. We also work with Monash Centre for Health Research and Implementation and Monash Business School monitor, evaluate, validate and scale Shifra as a public health intervention. Multiple co-design and digital health needs assessments have been held with Arabic, Dari, Farsi, Khmer, Somali, Hindi, Urdu, Burmese and Tigrinya-speaking women across Melbourne. We have also undertaking user-testing for replication with Arabic and Dari-speaking communities in France. We have partners in Europe, Latin America and the US ready to help us replicate Shifra across 6 new countries.

Website URL:

www.shifra.app

Type of submitter

  • We are a registered Non-Profit Organization

Organization Headquarters: Country

Australia

Organization Headquarters: City / State

Melbourne, Victoria

In preparation for expert feedback: What are three unanswered questions or challenges that you could use support on in these categories? These questions will be answered directly by experts matched specifically to your idea. (600 characters)

We have received positive feedback from people who have used Shifra, but lack the funding to get wider distribution and build a base following: (1) How might we harness the power of social media to increase usage and reach of Shifra? (2) Without the budget to hire a marketing team, what are some practical ways we can increase the visibility of Shifra among our end-users population?
 (3) How do we tie marketing into financial sustainability? We don’t want to sell ads on Shifra since we are committed to providing unbiased health information, what financing options are we not yet aware of?

Did you use the resources offered during the Improve Phase (mentorship, expert feedback, community research)? (2000 characters)

Mentor feedback: We met with our mentor, Maisara on 21 Sep who suggested (1) using young champions (e.g. women in their early 20s) as key knowledge sharers within their local communities. Importantly, we should (2) be sensitive to the triggers that might arise from reviewing content related to wartime and journey experiences (e.g. grief, sexual assault, discrimination). Finally, (3) build on the culturally sensitive content we currently have and ensure this continues into the future when we work with different language and cultural groups, particularly those who live at the intersection of multiple disadvantages. Expert feedback: Our expert, Brittany, reinforced what our mentor suggested. She emphasized the importance of word of mouth for this type of service and recommended connecting with existing health providers and refugee advocates in the community. We partnered with these groups during the development of the app, but there’s an opportunity to circle back around to them now that Shifra has launched. Community research: A colleague, Elisa, is exploring Shifra’s replicability with Arabic speakers in France. She met with Arabic and Dari speaking refugees and found that many women were open to talking about SRH information and need only after discussing healthcare more broadly. We also re-examined user feedback around co-design participation and representation and found that users want to participate in co-design and user testing and to be updated regularly about the broader goals and progress of the app. We see this as an opportunity to recruit community champions as a continual engagement exercise throughout Shfira’s whole replication cycle. Users also wanted diverse images of people (real or animated) on Shifra. They wanted a representation of women with and without hijabs. They also wanted images of hands-on parenting by fathers and of people living with disabilities being portrayed in dignified and positive ways.

In what ways would potential BridgeBuilder funds allow you to pursue your idea that other funding opportunities have not? (1000 characters)

Our previous funding opportunities have focused on expanding service offerings into Dari and creating maternal health videos for low literate users within Victoria, Australia. We haven't had the opportunity to focus on replicating Shifra or on developing internal capability or governance. Bridgebuilder funds would allow us to hire an operations manager (USD$60,000-80,000) who can (1) strengthen Shifra's local & global strategy and governance and (2) implement sustainable and trauma-informed education and leadership workshops for community champions to learn ways to introduce people on the move to Shifra. We also have partnerships with organisations on the ground in Central America who are ready and eager to co-design Shifra's replication locally. This funding would also support us to work with them to focus on refugees and migrants moving across the Northern Triangle Countries (El Salvador, Guatemala, Honduras) towards the Mexico-US border (USD$40,000-$120,00).

What aspects or proportion of the overall idea would potential BridgeBuilder funds primarily support? (1000 characters)

Hiring our first employee would be a game-changer for Shifra! Bridgebuilder funds would cover 100% of the costs of hiring someone to lead Shifra for 1-2 years. Their deliverables would include (1) day to day operations (2) spearheading the education and leadership workshops with the goal of increasing usage and acceptability of Shifra as well as building the capacity of young refugees (3) data analysis and actioning the results with community partners (4) managing functionality of the app (5) fundraising & partnerships (6) overseeing Shifra’s replication efforts in Central America. Funds would also cover 40% of costs for Central American replication (i.e, co-designing with the community, developing the web app in Spanish, and implementing/evaluating a co-designed uptake plan). We have an established partnership with Rotary International and a number of other local and international organisations with in-country partners from this region to reach 100% of funding goals.

What are the key steps or activities for your idea for implementation in the next 1-3 years? (1000 characters)

Phase 1: Localising Shifra web-app to Latinx context (e.g. navigating the healthcare system, right to healthcare for migrants, access to safe abortion, LGBTQI+support services etc.) Phase 2: Prototyping co-designed and user-tested beta version with local SRH partners and health consumers before developing full version. Capacity will be developed for partners to manage Shifra’s local platform independently (if desired). Phase 3: Local content will be developed and translated with local health education and interpreting services and overseen by Shifra’s translation team lead, a native Spanish-speaker. This ensures tone, meaning and language is relevant/ appropriate for this region and context. Co-design uptake plan in partnership with end-users to spread the word in a safe and engaging way. Phase 4: Launch, monitor use, respond to user feedback and continue iterating. Evaluate product and Process

What will community-level impact look like over the timeframe of your idea? How will you determine whether or not you have achieved that impact? And what outstanding questions do you still have? (1000 characters)

IMPACT: By 2022, we aim to engage up to 450,000 Arabic and Dari-speaking refugees and new migrants within Australia. We also aim to replicate into Spanish in order to reach 100,000 refugees and migrants moving across Central America. MEASUREMENT: We will work with at least 8 partners within this region to examine how Shifra is impacting SRH service utilisation at designated health centres along the route using community champions and local evaluators and continue to track web app usage/engagement, what health-specific information is being accessed and in what region this is taking place in. QUESTION: How can we best leverage Shifra’s anonymous data to effect real and meaningful change with local NGOs and ministries of health? How can we ensure Shifra becomes sustainable within the region whilst ensuring it continues to offer end users a dignified and respectful healthcare experience that improves their health literacy and personal agency around negotiating their rights.

Describe the individual or team that will implement this idea (if a partnership, please explain breakdown of roles and responsibilities for each entity). (1000 characters)

1) Rebeccah, a Registered Nurse-Midwife and the founder of Shifra, is undertaking her PhD research on co-designing mHealth interventions with refugee and migrant communities at Monash University. 2) Jess is an experienced maternal and child health expert with over 10 years of experience working with diverse populations on issues of child health, human trafficking, sexual and reproductive health, and humanitarian issues. 3) Lauren is redesigning the way company’s see and use data and has experience creating intelligent user experiences across a range of industries including construction, technology and financial services. 4) Sonia is a veteran of scoping, planning and executing multilingual translation projects to help organisations build relationships with their audience.

Lastly, how did you apply new learnings to your idea? (1000 characters)

Due to limited funds, we made the assumption that getting the word out about Shifra via social media would be sufficient to increase usage of the app. We hadn't implemented a formal dissemination plan yet and our mentor, Maisara, reminded us how a person-person introduction increases trust & interest, especially for taboo & possibly triggering SRH information. As such, we are evolved our idea to create a community champion workshop to further support and partner with our end-users in order to get the word out about the app. In Australia, we are developing partnerships that offer these community champions the chance to develop their public speaking skills by facilitating health workshops. This is a key finding as we move towards replication and will include this insight into our planning and co-designing sessions. We plan to adapt some of the activities from the “Designing with and for Girls” Design Kit as templates for the Champion workshops.

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Shifra's logo

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Photo of Bremley Lyngdoh
Team

These are my last 3 sets of important questions for you and your team before the final review stage begins.

Can you please list 3 bullet points - just one line each - short and sweet of what feedback you got from your mentor on your idea?
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Can you please list 3 bullet points - just one line each - short and sweet of what feedback you got from your user on your idea?
1.
2.
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Can you please list 3 bullet points - just one line each - short and sweet of what feedback you got from your expert on your idea?
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3.

Photo of Rebeccah Bartlett
Team

Hi Bremley,

Here's the feedback from our mentor, the lovely and amazing Maisara.

1. Focus on how Shifra can share its message through young champions (e.g. women in their early 20s) through workshops

2. Ensure that the content is trigger-free by emphasising the mental health support included in the web-app (make it more obvious)

3. Focus on sharing the message that Shifra has been designed with communities to be culturally-sensitive

More to come based on user and expert feedback soon

Photo of Rebeccah Bartlett
Team

Our phenomenal users want:

1. Sexual and reproductive health information embedded within general health information (e.g. navigating new health systems, finding information on employment or accessing social support services).

2. To participate in co-design and user testing and to update regularly about the broader goals and progress of the app. This is an opportunity to recruit community champions as a continual engagement exercise throughout Shfira’s whole replication cycle.

3. Users wanted diverse images of people (real or animated) on Shifra. They wanted representation of women with hijabs and women without. They also wanted images of hands-on parenting by fathers and of people living with disabilities being portrayed in dignified and positive ways.

Photo of Rebeccah Bartlett
Team

Lastly, here are the insights from our wonderful expert Brittany:

1. Prioritize word of mouth to spread the news about Shifra.

2. Re-focus on health professionals, community health workers, and refugee advocates as strategic partners for referrals.

3. When we do use social media, be thoughtful about the story we are telling.

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