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(Motorcycles + Midwives) -> Remote Villages: Monthly mobile clinics in remote villages of Uganda

We use motorcycle taxis to bring midwives to give health services to mothers during *monthly* one-day clinics in remote villages.

Photo of Kevin Gibbons

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In no more than 3 sentences, please tell us who your idea is designed for and how it reimagines the new life experience.

In areas of Uganda over 5km from the nearest health facility, pregnant women rarely receive the recommended four pre-natal visits to see a midwife, and young babies are rarely taken to get early life checkups and vaccines. We want to break down these barriers to accessing care by using microfinanced motorcycles to bring health workers to remote villages on a monthly basis so that they can give treatment and information to children and expectant mothers.

In areas of Uganda over 5km from the nearest health facility, pregnant women rarely receive the recommended four pre-natal visits to see a midwife, many women are unable to deliver in a health facility, and young babies are rarely taken to get early life checkups and vaccines -- yet services are available for free at health facilities. This gap leads to higher infant and mother mortality and morbidity because the mother and child do not get adequate care and information. We want to break down these barriers to accessing care by bringing midwives and other health workers to remote villages on a monthly basis so that they can give treatment and information to children and expectant mothers, as well as giving them access to emergency medical transportation to reach a health facility.

To do this we shall implement monthly one-day comprehensive health clinics and motorcycle ambulance trailers in remote villages in Uganda. There are four parts to the solution:


1) TRANSPORTATION & MICROFINANCE

First, we engage with the local health facility to choose which villages to target. If the health workers do not have access to transportation, we microfinance a motorcycle or boat taxi to a local resident searching for economic opportunity. The person who takes out the loan runs his own motorcycle or boat taxi business and, as a condition of the loan, serves 3 nearby villages with monthly one-day clinics. On those days that he serves the villages, he is only compensated for fuel. Thus, the taxi driver runs his business for 27 days in a month and must be available for clinics three days that month.


2) MONTHLY ONE-DAY CLINICS

We establish a system to conduct monthly, one-day comprehensive health clinics in remote villages. Three-to-four government health workers (including at least one midwife) and their equipment are transported to villages so they can provide free services, including prenatal checkups, vaccinations, postnatal checkups, birth information, family planning, anti-retroviral treatment, malaria treatment, HIV tests, child checkups, and other life-saving services. Health workers return to served villages once per month to assure continuity of care.


3) COMMUNITY PARTNERSHIPS

We partner with community groups to oversee the project, so that it is eventually successfully transitioned to the community. Community groups collect $0.55 (UGX 2,000) from each patient to pay fuel costs and health worker stipends. This small amount is able to pay the travel expenses ($20-26, UGX 71,000-91,000) of a one-day clinic. Otherwise, services are provided free of charge. Over time, there is less need for an outside organization to oversee the clinic activities.


4) MOTORCYCLE AMBULANCE TRAILERS

In order to provide affordable emergency transportation for deliveries and other needs, motorcycle ambulance trailers will be available at health facilities. When a patient needs transportation, they can request a motorcycle taxi driver to pick up the trailer and then carry them to the nearest health facility. Motorcycle ambulance trailers are manufactured in Uganda by Pulse Uganda http://pulse.ug


The program not only helps to bring healthcare to mothers, children, and others living in remote areas, but also improving the local economy, helping individuals earn a living and become self-reliant. The program is designed to help local communities take ownership of their health and wellness by transitioning these programs to the villages after time.

At what stage is your idea?

  • Piloting: I have started to implement my solution as a whole with a first set of real users.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

We have been running the comprehensive health clinics since August 2015, and in July 2017 we started working with health facility administrators to make sure that midwives attend the clinics. The rollout of midwife services has included advance notice to communities, but we need to implement a more comprehensive strategy for a needs assessment of expectant mothers and children, as well as barriers for health facilities to provide the necessary care.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

1) What are similar interventions for child and maternal health services in remote areas? 2) What are easy, effective research tools to assess the needs of our beneficiary communities? 3) How can we improve the communication between beneficiary communities and the health workers? 4) How can we assure that community groups will be able to sustain the program in the long-term? We have encountered leadership challenges. 5) How can we measure the impacts of this intervention?

Tell us about your work experience:

We founded Health Access Connect in November 2014 and have been implementing monthly mobile clinics since August 2015. We founded HAC to link Ugandans living in remote areas with healthcare resources because of the need we saw in the villages and the supply available in towns and cities.

This idea emerged from...

  • A group brainstorm
  • An organization or company

Are you an expecting, new, or experienced mom?

  • no

Are you a healthcare practitioner?

  • yes

Are you a current employee of UCB Pharmaceuticals or Sutter Health?

  • no

How would you describe this idea (in 2-3 sentences) while in an elevator with someone?

In order to reach pregnant women, recent mothers, and newborns living in remote areas of Uganda, we use microfinanced motorcycles to bring health workers to remote villages on a monthly basis. A midwife gives essential perinatal services and follow up with patients who may not have the resources to reach the health facility. Community leaders collect $0.55 from each patient, which covers the fuel for the motorcycle ($5.50-8) and the travel allowances for the health workers ($4.66 each).

What is the specific problem your idea is trying to solve? 1 sentence.

Due to the expense and difficulty of transportation, pregnant women living in remote areas of Uganda rarely complete the recommended 4 prenatal visits and the follow-up 6-week postnatal visit.

How has your idea improved or evolved throughout the Refinement Phase?

Full user experience map image: https://photos.app.goo.gl/9e2CKeRYxptboqq93 We incorporated motorcycle ambulance trailers as part of the suite of services that should be made available to remote villages. We visited the Coordinator of Midwives in one of the districts that we served, and we have begun incorporating midwives into the clinics that we have been conducting. One of the challenges that we have been addressing is coordination. Midwife services are siloed from other health services, so we needed to coordinate our clinics through higher level district administrators who can coordinate with all of the groups. That's a big lesson! One of our goals was to clearly define which services that we would like to help provide to patients, and the Coordinator of Midwives laid it out for us: 1) PRENATAL SERVICES * Track women based on their expected delivery date and residence * Abdominal exam * General physical exam * Observe the vagina if need arises * Elimination of Mother-to-child HIV transmission * HIV Testing * Counseling * Initiate on Anti-retroviral treatment * Syphilis testing * Hemoglobin test (test for anemia) * Taking general body measurements * Tetanus immunization 2) POST-NATAL SERVICES * Checkups of mother * Checkups of child * Vaccinations * Polio * BCG Tuberculosis 3) HEALTH EDUCATION * Family planning * Prenatal care * Vaccinations * Sanitation * Giving birth at the facility We also learned that if midwives are going to do physical exams at the clinics that we should rent a room for mothers to do their checkups so that they can have more privacy. It costs about $0.55-0.82 to rent a room for a day.

How do you plan to measure the impact of your idea?

# Patient numbers at the clinic in which we specifically monitor the services described above # Patient tracking data for how motorcycle ambulance trailers are used # Before and after statistics in villages served of women completing prenatal checks, facility births, and postnatal checks # Interviews with health workers and mothers

What are your immediate next steps after the challenge?

# Conducting community dialogue with health administrators, health workers, and community leaders using human-centered design facilitation techniques to discuss barriers and solutions to maternal and child healthcare # Coordinating with district health officials to include these services at all 10 villages that we are currently serving # Changing our clinic tracking form to include these services # Attend clinics and conduct feedback interviews with patients

How is your idea different or unique from what is currently on the market?

# Rather than waiting for mothers and children to visit the facility, we bring the facility to them on a monthly basis. # We keep costs low and require community members to cover the overhead costs of the clinics, which makes them sustainable and scalable. # We are serving populations that are difficult to reach and that other organizations do not target. # We are a suite of services to cover essential care for new mothers and young children.

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Spam
Photo of Chelsea Takamine
Team

Congratulations Kevin Gibbons and Health Access Connect Team, for being recognized as an Honorable Mention Idea!

Spam
Photo of Kevin Gibbons
Team

Chelsea Takamine Thanks!

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