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Health Camp Drive (HCD)

Enabling health care for pregnant women with emergency health situations in refugee camps & host communities via USSD/Toll free lines/App.

Photo of Baluku Isaya

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*Please Upload User Experience Map (as attachment) and any additional insights gathered from Beneficiary Feedback in this field

We have come to understand the need for HCD project services in the context of a refugee camp setting. There is women’s willingness to seek for health care; however, access is a challenge. Their ability and will to afford small costs for such a service they need for their health makes HCD project relevant and necessary in the refugee camps. Within the camps there is diverse skills required by the HCD project, hence refugee women & youth will be offered some employment and earn a living.

Why does the target community define this problem as urgent and/or a priority? How is the idea leveraging and empowering community assets to help create an environment for success? (1000 characters)

Women refugees carry a burden of protecting their families in hardships. As primary caregivers, they are also at risk of gender-based violence. This happens not only as they flee conflicts, but also on arrival in camps. Palorinya settlement with its poor health infrastructures has over 180,000 refugees, in addition to risks of maternal/childbirth deaths & malnutrition cases among others, e.g during our beneficiary research one woman said long distances to health centers with unavailability of ambulances prevent refugees from seeking professional treatment. These centers are often overcrowded & lack sufficient staff to serve patients in a timely manner.
Health Camp Drive project will leverage on existing structures & potential of skilled refugees as agents to enable access to timely care by empowering them to be Health Camp Ambassadors, Quick Health Drivers & trained camp midwives to offer high quality care services using USSD/Toll free/App in solving access to health care challenges.

How does the idea fit within the larger ecosystem that surrounds it? Urgent needs are usually a symptom of a larger issue that rests within multiple interrelated symptoms - share what you know about the context surrounding the problem you are aiming to solve. (500 characters)

Uganda’s maternal mortality is high at 430 per 100,000 live births (UNFPA 2017). Government owns refugee settlements, not UNHCR (UNHCR 2016). Health services are not sufficient for people living there. Some clinics are private & expensive, some are funded by many donors & coordination among actors is often a challenge, this hinders achievement of SDG's (3,5,9,10,15 & 16). Location of camps to government referral hospitals is problematic & serves as a barrier to MHC, e.g Palorinya is 136km2 long.

How does the idea affect or change the fundamental nature of the larger ecosystem that surrounds it (as described above) in a new and/or far-reaching way? (500 characters)

Using ICT tools (USSD/Toll Free/App) in communication-transport system, using trained & skilled refugees as standby nurses, midwives on mobile clinics near camps and quick health drivers "motorcycle taxi" service providers to offer transportation to & from the clinics at an affordable cost. This will increase the number of women able to access health care. Refugees have the potential to drive positive change in health care condition.

What will be different within the target community as a result of implementing the idea? What is the scope and scale of that difference? How long will it take to see that difference and how will it be sustained beyond BridgeBuilder support? (500 characters)

In camps, women give birth in temporary shelters & no enough health-care staff to provide life-saving care. Using USSD/Toll free & App services will benefit over 10,000 women/children in 2 years. Decrease local resentment, improve equity & host community's willingness to protect refugees. 5% reduced MMRs from current 11%. For sustainability, our clients pay 30% of total cost, motorcycles also will charge affordable transport fees from hosts, build partnerships with government structures & UNHCR.

How has the idea evolved or responded to your user research during the Beneficiary Feedback Phase and any further insights provided if you participated in the Expert Feedback Phase? (1000 characters)

The user research conducted from Palorinya camps, Moyo district (A,B,C&E zones) on use of Maternal Health Care Services-MHCSs (Antenatal care-ANC) showed 8% of women from zone A received ANC from a doctor. Women from zone B were more likely to receive skilled care (20%) than zone D women (3%), while only 2% of the women in C seek the same. Women tend to seek ANC very late, the first time at 6 months or more. They attributed this to long distances and transport means to clinics.
User feedback has allowed us to make our idea more focused and compelling to them. Based on the feedback, we assessed the state of MHCSs in and outside camps and the involvement of ICT tools and other stakeholders. As a result, local health authorities and host members need to be involved at strategic implementation to own the project.
There shall be monthly Mobile Clinic cCamp (MCCs) for ANC & screening expectant mothers to be delivered to quality health units by our standby nurses and quick health drivers.

What are the key steps for implementation in the next 1-3 years? (You can attach a timeline or GANTT chart in place of a written plan, if desired.) (1000 characters)

HCD will take these steps;
Prepare infrastructure; development of ICT tools; USSD/Toll free lines/App & mobile clinic units. Recruit Health Camp Ambassadors (HCAs), Quick Health Drivers (QHDs) & nurses/gynecologists. ICT tools will have multi-task functions where HCA's access Standby nurses’ location & availability of nearby services, truck Toll free callers & App alerts cases seeking QHDs services, with notifications received on the mobile phone.

Coordinate organizations/stakeholders involved, carryout awareness & do product/service training. HCAs, QHDs & nurses/health workers will be trained.

Installing the product/service, perform final verification in production & monitor solution. Our solution will be moved from development to test & scale up. We shall ensure our service components are successfully, e.g new hardware, databases, & program code. The team will spend time monitoring the implementation. In case of a problem during/after implementation, will be addressed & fixed.

Describe the individual or team that will implement this idea (if a partnership, please explain breakdown of roles and responsibilities for each entity). (Feel free to share an organizational chart or visual description of your team). (500 characters)

Baluku Isaya, an expert with 9 years’ experience in development & community health, good clinical practices & subject research, reproductive health & a social entrepreneur.
Mugabi Sharp Robert; an IT & software engineer from Makerere University, has worked with ministry of ICT on software and design projects.
Dr. Denis Katya; a clinical doctor and gynecologist with 7 years’ experience in emergence response including areas of conflict & natural disasters.
A team of skilled refugees from camps.

What aspects of the idea would potential BridgeBuilder funds primarily support? (500 characters)

HCD project model is designed to change ways health care delivery in refugee settings is done & eliminate unsafe deliveries & birth complications to reduce maternal MRs. Funds will be used for project support mechanism, design Unstructured Supplementary Service Data-USSD a menu-based service designed/builds as real-time open session between application & end-users. Design/develop a Toll free number system and App models, support acquiring/installing mobile clinic units & running costs for 2yrs.

In preparation for our Expert Feedback Phase: What are three unanswered questions or challenges that you could use support on in your project? These questions will be answered directly by experts matched specifically to your idea and needs.

Access to quality health care, including maternal health care services and emergency obstetric care is important when it comes to cutting back on the number of women and infants who die in childbirth, though it can be difficult in the kinds of conditions women are living in at refugee camps. Our outstanding questions are;
1. How many skilled refugees would own smartphones and how many languages do we need to cover to provide effective MHCSs in ensuring up-take and continual use of USSD/Toll free calls/mobile app by HCAs, QHD and health workers apart from initial planed training?
2. What specific service information do refugees need in particular when it comes to health rights challenges of ineccess to maternal health care education & how would we achieve our goal without involving reproductive health issues to the young girls the next futures mothers?
3. How to best adapt our ICT Tools within the parameters necessary to address the needs of women/young girls in different refugee settlement and how would we create sustainable partnerships with government health ministry agencies and UNHCR to achieve our project targets?

Final Updates (*Please do not complete until we reach the Improve Phase*): How has the idea evolved or responded to your user research during the Beneficiary Feedback Phase and any further insights provided if you participated in the Expert Feedback Phase? (1000 characters)

Primarily, our target HCD Mobile service users were our own trained HCAs, QHDs, Standby nurses and end user beneficiaries who are the refugee pregnant women in need of maternal health care through using free phone calls/messages. But, after our research & feedback, we realized that to make our model more sustainable we should directly also train health workers from health facilities about our HCD Mobile services and be able to link emergence cases to QHDs and also answer key health questions from toll free callers and USSD system.
Extending health services within and outside the refugees foot-steps, will create sense of harmonious living and peace.

During this Improve Phase, please use the space below to add any additional information to your proposal.

HCD Mobile App Service

1. Development background and the Team.
The main goal of this project is to develop functional ICT tools of USSD & Toll Free service in a mobile clinic tax Service system. The system will consist of several basic elements:
• Main server
• USSD, Toll Free line and Android Client application for customers/beneficiaries
• Android Client application for HCAs, QHDs (taxi like drivers) and Standby nurses

Our beneficiaries/Customers will be able to order our QHDs-Mobile emergence response services to a position via USSD, Toll Free line and Android Client application system for customers/beneficiaries. After the order has been received, main server will determine the zone from which the order or an emergence case has been reported and after that, automatically selects the HCA and the QHD with the Standby nurse from the virtual queue of the appropriate zone and dispatch it to the received location. The beneficiary will receive the code of the HCA and the number of the QHD which will pick her up for health facility delivery. As soon as the HCA locates the caller or the case, he/she will tap on send pick up code to QHD, the moment the QHD accepts the order or pick up, he got from the main server. If the immediate QHD rejects the order or doesn’t respond to it in a certain amount of time, IT will be put at the end of the queue and the order will be forwarded to the next QHD in the queue. While driving through the camp or host community, the QHD with a nurse of midwife will change virtual queues as they change camp zones they are driving in. The QHD motor of tax ambulance will be removed from the old queue and put at the end of a new one.

The integration strategy of the system will be feature– based. The development will begin with the core functionality and new features will be added with time. There will be several milestones and new features will be introduced in every. After the feature is developed, first it will be tested standalone and then it will be integrated in the system. After the integration, new series of testing will take place. After the system is fully developed and tested, it will be delivered to project supervisor in 3 parts: Web application for server, Android client application for HCAs, QHDs and Standby Nurses, and USSD, Toll Free line and Android Client application system for beneficiary or customer use. The system software will be followed with the necessary project documentation.

2. Organization
Although all team members are not to be in the same place, the team is actually geographically divided in three locations in the same country-Uganda:
Central team (4 team members)
Refugee camp team (3 team members)
Host community team (1 team member)

The work on the project is divided in three categories: Organization, Documentation and Presentations, and Implementation. It is decided that all team members equally participate in every project part.
2.1 Organization
Project leader (PL)
Project leader is responsible for the team in general. His responsibility is to always be informed about every important issue. His responsibility is also to inform others about those issues. He should also be monitoring the work of all team members during system development and implementation.

Team leader (TL)
Team leader’s responsibility is to monitor Refugee and host community team and inform team leader about important issues that are taking place on that side.

Others
All team members share responsibility of organizing internal meetings, meetings with the project supervisor, dividing project tasks and delivering documents on time. Tools: Google groups, Skype, Google calendar, Doodle.

3. Documentation and Presentations
Documentation and Presentations are both responsibility of every team member. Every document that is required to deliver is entrusted to several team members (number depends on the document). After they write the document, other team members should check it and make corrections if necessary. The content of the documents will be discussed on weekly meetings.
Presentations should be made by team members, who are going to present them, and checked and corrected by other team members. It is agreed that two or more team members will be presenting. Tools: Google docs, Dropbox, SVN

4. Implementation
Since the project is to be divided in three major parts, the project roles are defined similarly:
a) HCAs, QHDs & Standby nurses Taxi system Mobile Application developer (2 team members)
Responsibility: developing mobile application that will be used in QHDs/Standby nurse mobile motors/taxis/clinic trailers.
Communication: with server side developers.
b) USSD, Toll Free line and Android Client/beneficiary application Mobile system developer (2 team members)
Responsibility: developing mobile USSD, Toll Free line system embedded in the mobile application that will be used by beneficiaries who want to order HCD service.

Note that you may also edit any of your previous answers within the proposal. Here is a great place to note any big final changes or iterations you have made to your proposal below:

To make our HCD project more clear to understand how our ICT tools model will work in solving three dangers that pregnant women face and causes death. I have used a wire-frame to illustrate the models as it was advice by one of the community coaches. The model carter for both on and off line users whether you have a smart phone of no, anyone can use this model to access maternal health.

HCD project service model leverages on mobile technology as it involves user friendly basics to respond to emergence cases in a refugee camp settings and rural remote places using localized and trained HCAs, QHDs and standby nurses model to tackle timely needs of pregnant women.

Anyone with who can access or have mobile phone and or can access a Health Camp Ambassador (HCAs) can get the HCD Mobile service by just sending an emergence code message for free to a given number e.g ‘3131’, and follows the simple instructions in a preferred language to share the zone or village location, choose their preferred product service they need (HCAs or QHDs), get connected with standby nurse and be delivered to the health care facility in time.

Timely access to health has always been a fundamental social concern, and anxieties about the availability and affordability of health care. Because environmental factors play a fundamental role in shaping human health, locational issues are of central importance to addressing health questions. A variety of place-based influences affect health, including physical circumstances (e.g. altitude, temperature regimes, and pollutants), social context (e.g., social networks, access to health care), and economic conditions (e.g., quality of nutrition). Because locational influences are myriad and constantly shifting, and because people themselves are moving around at unprecedented rates, understanding the health impacts of where people live is one of the most challenging, yet important, contemporary geographical problems, HCD Mobile service model of using ICT tools work to solve this if well implemented.
HCD Mobile service model reduces the burden of displaced and rural pregnant women’s barriers to access to timely quality health care by providing individuals with ready access mechanism to maternal care services, adequate nutrition foods and information.

Explain your project idea (2,000 characters)

Health Camp Drive (HCD) project bridges peace and planet, It employs evidence-based interventions to address three dangerous delays that pregnant women and children in displaced communities face and causes death; delays in getting good nutrition, information on deciding to seek care, reaching a health facility in time, and receiving quality care at health facilities in time.

Maternal and infant mortality rates remain high, 340 and 43 deaths per 1000 live births, with complications requiring Emergency Care that is unavailable. This continues to increase as the number of refugees increases to enter into the country.
With active health facilities being owned by individuals offering expensive services, access becomes limited for both the poor rural majority women and men in refugee camps.

HCD project uses ICT tools model of Unstructured Supplementary Service Data (USSD) a menu-based service designed as real-time open session between application & end-users, a Toll free number system & Mobile App integrated in a communication-transport system. Pregnant women in emergency situations calls using a toll free line number, a smart phone with a Mobile Application will link and locate the caller & a nearby HCAs, immediately the QHDs receives a call signals, the App automatically generates the nearby HCA within the callers’ locality and the QHD seeks confirmation of the reported case from the App generated HCAs; on receiving the response from the HCA inform of a notification, QHD immediately drives to the location with a standby nurse/gynecologist using improved motorcycle trailer & the woman is picked, taken to a nearby health care facility on time to receive maternal care service.

HCAs endlessly carryout health education outreaches with trained nurses/doctors to provide quality care services and identify/refer obstetric emergencies, accurately records birth, maternal and neonatal deaths. HCAs & QHDs will also supply nutritious foods & train on vegetable growing.

Who are the beneficiaries? (1,000 characters)

Health camp drive project targets to improve the well being of pregnant refugee women, youths & men (17-45yrs) in post war communities along the Rwenzori and Northern Uganda regions which have had displacements & hosted refugees, by creating enabling environment for timely access to quality health care and nutritious foods whenever needed. It shall be done through a series of activities we shall conduct within the next two years. This shall stimulate demand for maternal health care during/after pregnancy or childbirth, & foods grown in camps. Hence, reduced cases of maternal deaths & malnutrition. Because delays in getting information and deciding to seek care, not reaching a health facility in time and receiving care at health facility shall be unheard of, demonstrating an improved use of reproductive health care services. Young women, men and youth will be employed as Health Camp Ambassadors, peer educators and Quick Health Drivers hence increased incomes and improved livelihoods.

How is your idea unique? (1,000 characters)

Whereas Uganda has enabling policy framework to maternal health care (MHC), with a number of urban based organizations with High-Tec solutions for strengthening health systems, however, none targets refugees/post conflict settings to address simultaneous women’s limitations to access quality & timely MHC. Existing approaches stop at health center III & above, leaving vulnerable grassroots women at the mercy of expensive private clinics. In solving critical issues that need urgent interventions like maternal & childbirth care, much focus is needed at grassroots e.g refugee camps where displaced women thrive.
YAGANET's Health Camp Drive project is an ICT tools based model (USSD/Toll free line system & Mobile App) in a communication-transport system using Health Camp Ambassadors & Quick Health Drivers/standby nurses/midwives having phones & uses toll free lines to connect pregnant women to healthcare centers in time. Related models have proved viable in similar settings in Iraq and Syria

Idea Proposal Stage (choose one)

  • Prototype: I have done some small tests or experiments with prospective users to continue developing the idea.

Tell us more about your organization/company (1 sentence and website URL)

Young Agro-Green Africa Network (YAGANET) is a social enterprise working as a center for turning environmental challenges facing rural economies into youth and women led green descent employment opportunities by creating a network of health rural green safe jobs.
We empower vulnerable economies with green entrepreneurial skills to enhancing natural resources, boosting poverty eradication and promoting safety and health of women and children.
https://www.facebook.com/Young.AgroGreenafrica.net/

Expertise in sector

  • 1-2 years

Organization Filing Status

  • Yes, we are a registered non-profit.
  • Yes, we are a registered social enterprise.

In 3-4 sentences, tell us the inspiration or story that encouraged you to start this project.

My passion towards solving the problem is more associated with my story of how I became a health social worker. I grow up in a rural community of no hope along the Rwenzori mountains with poor transport network, seeing my own pregnant mother delivering on the way during war and watching my own brother die in the camp searching for care, walking over 40 kilo miters, was my hardest moment in life. As young boy, my dream was to become a community health worker to save displaced women, girls & boys.

Please explain how your selected topic areas are influenced, in the local context of your project (1,000 characters).

Uganda is currently home to over 1.3 million refugees, over 800,000 South Sudanese to the north & 220,000 Congolese to the west seeking refuge among others.

Wars cause a grave harm to health of individuals in the turmoil of violence/displacements, death/disease in addition to destruction of health infrastructures. This complicates post-conflict recovery plan that ultimately fosters lasting peace. Health initiatives effectively reduce levels of morbidity & mortality in the midst of wars, promote conflict prevention & have a positive impact on peace-building.

Uganda’s policy on refugees grants a household 30 by 30m plot of land. Humans are at the center to sustainable environment & entitled to healthy life in harmony with nature/planet. Health is a basic human right; we rely on healthy ecosystems to support healthy communities. Well-functioning ecosystems provide essentials for human health; including nutrition/food, clean air/water & help to limit disease & stabilize the climate.

Who will work alongside your organization in the project idea? (1,000 characters)

YAGANET as organization has a full project team and a management team. Most decisions are made through regular project meetings and in-person field reviews by management and exchanges with key stakeholders and beneficiaries.

We shall have services of the field and medical coordinator who will be responsible for making day-to-day project decisions and communicating with the relevant partners and stakeholders, including working closely with HCAs, QHDs, Standby nurses and other health workers from already identified health facilities/ health actors. We shall engage the UNHCR health department and Uganda’s ministry of Health through the District Health Officers (DHOs). Our activities and actions shall always be informed by rigorous monitoring and evaluation ensures the success and sustainability of our actions.

Please share some of the top strengths identified in the community which your project will serve (500 characters)

The leadership within the host community and local health structures which ensure that the refugee response is well-integrated with the surrounding communities and environment. Although tensions exist, but there is strong relations between the hosts and refugees communities are generally cordial. Additionally, as aid programs shifts from emergency to development phase, there's an opportunity for integration of refugees & host communities through Refugee & Host Population Empowerment framework.

Geographic Focus

Health Camp Drive targets Rwenzori & Northern regions of Uganda in hosts & refugees camp settings.

How many months are required for the project idea? (500 characters)

The project idea shall require 24 months of implementation, from inception, product designing, , testing and prototyping and scaling up.

Did you submit this idea to our 2017 BridgeBuilder Challenge? (Y/N)

  • No

24 comments

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Photo of Kathleen Rommel
Team

Hi Baluku,

What an inspiring project that utilizes technology and community mobilization to address a pressing need. I had a few quick questions for clarification:

In the refugee communities you work with, do most individuals have access to a phone?
I understand the push for sustainability, which includes participants paying a portion of the cost for their transfer and services. Does this cost still become a barrier for some, or are they typically low enough that these services are accessible?

Great work!

Photo of Baluku Isaya
Team

Hey Kathlem,
Thanks for your comments.

About your first question “In the refugee communities you work with, do most individuals have access to a phone?”

Information communication technologies (ICT) such as mobile phones and the internet are a common presence in the day-to-day life of refugees in Uganda. Despite (or perhaps, because of) the remote locations of for example Nakivale, Palorinya and Kyangwali in Uganda’s rural countryside, refugee residents there rely heavily on mobile phones for their daily communication needs. According to our survey, roughly 70% of these rural refugees regularly use mobile phones to communicate, even though, due to limited access, internet use is only available to around 10%, and as a result of the introduction to ‘Over the Top Tax-OTT’ the 10% internet use my further reduce.

However, some statistics say; for example, as cited in the New vision of 3rd December 2017 https://www.newvision.co.ug/.../digital-solutions-sought-challenges-facing-refugees-u...Country director Dan Church Aid, Karin Elisabeth Lind, mentioned that information penetration in the refugee communities remained low with phones infiltration at only 30% and digital literacy as low as below 10%. And “this makes it complicated to effectively mobilize refugee camp villages for food, agricultural outstanding information on seed varieties, inputs, markets or education opportunities”, she said. In addition, Emilienne Cyuzuzo, in charge of cash and digital solutions Dan Church Aid at Bidibidi refugee camp, in Yumbe district, said: “the over 21,000 basic phones, they gave out in the camp of 287301 did not serve the purpose since they are not digital enhanced.”

Our HCD project model is unique in a sense that it does not 100% necessary depend on phones or digitally enhanced phones and on our end user beneficiaries’ ownership of a phone. But the existence of our Health Camp Ambassadors-HCAs in every zone of a refugee camp whom we give phones and make sure that every HCA is known to everyone in a particular zone he/she serves through our effective and frequent refugee awareness and mobilization about our HCD mobile services, makes it easier for every refugee in need to be served at an affordable cost.

At least during our beneficiary research, one of the key feedbacks was that in every after 3 refugee camp household 1 person has a cell phone, and that in 1/3 adults in the household with over three adults can access a phone. Meaning there won’t be any barriers to access a phone in case there is an emergence case within the most 4-5 nearby houses that requires HCD Mobile services. Since the HCAs is within and known to them it is easier to reach him or her and connects with the QHDs/Standby nurses.

Concerning the question of a cost for the transfer and services, whether this cost still become a barrier for some, or they are typically low enough that these services are accessible?

Our major aim is to save a life, I may not guarantee that every refugee who needs our services cannot fail to even raise the little overall 30% cost we ask from them after the transfer and other care services have been offered.
However, the cost is not higher that the refugees in need of emergences care will not use our services. For refugee clients who cannot afford to pay the 30% cost immediately after being discharged from the health facility he/she or the care giver is given enough time to go and mobilize for the money. In such situations the HCA will keep truck of such beneficiary.

Our camp based monthly Mobile Maternal clinic a services are for free of charge, unless when an identified case requires obstetric care that needs the service of the QHDs. The purpose of the monthly Mobile Maternal clinics is also carter for those who cannot afford transport to health facilities. And also identify and keep track of pregnant women in the camp.

Refugee communities are often integrated within vibrant and complex economic systems. Recognising and understanding this represents an opportunity to turn humanitarian challenges into sustainable opportunities.
Thanks,
Cheers
Baluku

Photo of Kathleen Rommel
Team

Hi Baluku,

Thanks so much for taking the time to answer these questions. It's incredibly interesting to learn more about your project, and I wish you the best of luck!

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