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CareGiver Solution for Midwives

The solution could help midwives/HCW monitor expecting mothers, identify risk pregnancies and involve a doctor when required. I suggest a hybrid between Nokia Data Gathering tool or similar, like MoTeCH, and Medica Application from Nokia. Nokia Data Gathering tool allows creating of questionnaires and sending them to the midwives/HCW. Midwives gather data from the expecting moms they visit. Medica Application provides reminders, alerts, plays recorded messages, etc on the mobile phones of the midwives.

Photo of Krassimira Iordanova
14 20

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I introduce a user profile: Asha, a midwife.
Potential list of features of the CareGiver Solution for Midwives:
- Capture and store important data when she visits an expecting mom via a questionnaire (name, age, location, pregnancy stage, previous child deaths, # of children, birth intervals, blood pressure measures, etc.). Ask multiple-choice questions would make it easier and faster to capture the answers.
- Take pictures and store them as part of the data gathering process.
- The questionnaire takes her no more than 30 mins per household. Thus she can cover more households per day.
- The data Asha captures is submitted real time (if possible) to the server database
- An online community of doctors identifies risk pregnancies based on the data received. (similar concept to tickets that service agents pick up and work on)
- The solution will automatically generate alerts for risk pregnancies based on the analyzed by the doctors data (i.e. 6th pregnancy at age 43, swollen feet) that will appear as phone alert or sms on Asha’s mobile phone. - (see visual 1)
- Asha encourages the expecting mom to deliver in a hopsital based on the sms she has received- (see visual 2)
- The solution could automatically make entries in Asha’s calendar on her mobile who to visit (i.e. based on a schema- 1 visit per month from week 4 to 28 of pregnancy, weeky visits after week 36, etc.). This will allow her to plan her day and not miss a visit.
- Asha can call/text message with other midwives in the vicinity using a free number
- Asha can call an emergency number at the base hospital
- Play videos with visual instructions and/or voice over (preloaded content of 7-8 visual guides/videos of 1 mins length on some procedures that demonstrate what needs to be done in the most common cases i.e. where the baby comes the wrong way or how to stop/slow bleeding, which techniques to use, how to avoid sepsis, etc.)
- Receive ring tone reminders (special ring tone) for deliveries that are due within i.e. 72h
- Asha distributes vouchers for hopsital deliveries + transportation once the doctor indicates risk pregnancy.
COSTS:
Technology-related costs:
- Nokia phones for the midwives data gathering platform that is integrated with server side software
- Training costs for the midwives
- Accessible e-record system in the hospitals; training costs and maintenance costs
- Costs for the data transmission
Health care-related costs: Delivery costs and transportation costs to the hospital and back home; Salaries for the midwives and incentives payouts
ECOSYSTEM:
- A large network of trained midwives linked to obstetricians in hospitals (possible partnership model with i.e. LifeSpring Hospitals).
- Network of taxies/buses that accept transportation vouchers that Asha distributes.
ADVANTAGES:
Possibility to identify expecting mothers in remote rural areas and bring maternal care to them instead of waiting for the moms to seek care.
- For the expecting mothers: the "health care" comes to them; they receive vouchers for institutional delivery + transportation costs
- For the doctors: can concentrate on the risk pregnancies, as the midwives take care of the normal deliveries and provide consultation via mobile
- For the community: midwives are often seen as “members of the family” as they are part of the community
- For the midwives: “Just-in-time” communication with a doctor in the hospital when complications arise; knowledge sharing with other midwives via calls/sms


DISADVANTAGES:
Relies on a stable network of midwives and on supporting network of hospitals.


BUILDS (Sarah Bird): MoTeCH could be used as a data gather platform as its current version is centered around pregnancy. MoTeCH runs on much cheaper phones than suggested in the original concept. The current implementation of MoTeCH in Ghana is using Nokia 1680s, which cost about $35 (in Ghana).

What is the minimum level of mobile technology needed for this concept?

Nokia Data Gathering addresses the need of a simple-to-use data gathering platform that is integrated with server side software. The handset client can run on Nokia E61, E61i, E63, E71 and E72 handsets- (see visual 3) OpenMRS as community-developed, open source, enterprise electronic medical record system platform looks like a great platform to use (suggested by Sarah Bird)- http://openmrs.org/ Nokia DataGathering: http://www.nokia.com/corporate-responsibility/society/nokia-data-gathering/english Medica Application: http://store.ovi.com/content/51471

How could this work in a low-literacy context?

The questionnaires could use visuals to capture the answers- i.e. a smily/frowny for yes/no; different size of a mom's belly to define differnet stages of preganancy.

Which partners could help realise and deliver this solution?

  • Oxfam
  • Nokia
  • Mobile operators
  • Other - Feel free to elaborate in your description of the concept

Concept Builds

Sizing numbers from India: 500,000 villages; 150,000 partly trained midwives who serve these villages (1 midwife could serve 3-4 villages). If with the help of education and technology, these partly trained midwives are turned into the professional midwives, this will be of great value (Source: http://www.youtube.com/watch?v=dx3zJmMy0Tg) I interviewed Anka, who lives and works in Accra, Ghana. She is a medical professional. Until 2007 she used to work predominantly in the the rural areas. Question: Do women in rural Africa actually use mobile phones (simple Nokias)? Anka: The mobile phone "explosion" is recent, but as I could see in Accra and driving accrosss Ghana, a lot of people have mobile and use them. At least all business (even small traders) women have :) Literacy rate is as well important. But answer in short: yes Question: Can you imagine that a woman in rural village could use a mobile phone to send sms to a helath clinic or to a midwife in case she has an emergency or has a pain? Anka: Yes. Alternative for less "literate" in build messages linked with numbers or pictograms :) Question: Can you imagine that a woman in rural Africa would be willing to watch educational videos/listen to audos that talk abpre-natal and post-natal care? Anka: yes, people like dramas, listen to songs, ie. Question: do you think it is better to equip women with mobile phones or it is better to equip midwives with mobile phones? What would work better from your perspective? Anka: Both Question: What is the role of midwives in rural Africa from your point of view? Anka: the real support around delivery... but there are traditional midwives as well, the ones delivering about 60% of all women. if there is a good link with the hospital/clinic midwives, the traditional ones can contact if they see danger signs in pregnancy or complications during or after delivery. Iyobosa Ekhato posted: This statistic hit me "Just 1 more midwife could save the lives of 219 women. 700,000 more Midwives are needed to achieve the Millennium Development Goal to reduce maternal deaths by 75% by 2015." I think there is immense potential to equip the midwives with cell phones and educate them. It seems to me a realistic goal!

Virtual Team

Sarah Bird; Iyobosa Ekhato

Evaluation results

5 evaluations so far

1. Does this concept have the potential to save lives related to maternal health in the poorest and most marginalized communities?

A great deal of potential - 66.7%

Some potential - 33.3%

Not a lot of potential - 0%

2. How realizable do you think this concept can be? Think about the real issues faced by low-income communities, such as literacy challenges, affordability of devices and tools, usage costs.

It's very realizable - 50%

There are some hurdles to realization - 50%

This concept is not realistic - 0%

3. How much does this concept leverage resources and partners in existing low-income communities? Thus enhancing positive aspects of the way things work in the community as opposed to taking away what is a valued way of working and living in the community.

This concept works harmoniously with existing resources and partners - 50%

This concept does not work against existing resources and partners - 50%

This concept conflicts with existing resources and partners - 0%

4. Can this concept become self-sustaining and even provide some livelihood value add to the community?

This concept could become a self-sustaining business for locals - 33.3%

This concept still needs some work before it is self-sustaining - 50%

This concept is not self-sustaining at all - 16.7%

5. Will this concept work in low-tech & low-connectivity environments?

This concept is very well suited to low-tech and low-connectivity environments - 50%

This concept needs to be evaluated for technology feasibility - 50%

This concept may be too high-tech for low-income communities - 0%

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Photo of Hima Batavia

I think this idea makes a lot of sense. Front-line workers, whether it be midwives or community health workers need to be equipped with the proper tools - mobile phones increasingly being one of them. I would suggest not being solution agnostic, and rather committing a needs assessment in each country of interest - to develop a program that a) uses a solution that integrates into the countries broader health information system strategy (if applicable) and b) considers how data will flow through this system from the district to national level. In this case, the focus of the project might be on defining the expanded role of the midwife, defining what is the most important data to collect, and how the data will be used and shared amongst relevant stakeholders (i.e. doctors, MOH), to ensure optimal patient care and broader health system strengthening.

Photo of Krassimira Iordanova

Hima, you're spot on! The care giver solution shall be created in such a way that it easily integrates with the countries' broader health information system. On the other hand, for such a solution to scale, it has to be kept as standard as possible (which I believe is not difficult to do, as the structure of the data gathering questionnaire shall be pretty standard).

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