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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.

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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.

30 comments

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Photo of Chelsea Takamine
Team

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

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Photo of Kevin Gibbons
Team

Chelsea Takamine Thanks!

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Photo of Bettina Fliegel
Team

Congrats on the work you are doing and moving into the Refinement Phase Kevin! Some thoughts and questions -

In terms of improving communication between the beneficiary communities and the health workers what do you mean? Communication between medical visits regarding an individual's intercurrent health problems, or communication about community needs?
For community needs have you considered bringing the groups together, community members and health workers, for a brainstorming session using a human centered design approach? In a previous challenge a medical group from the US, working in rural Nepal, did this with a group of mothers of infants to assess what their needs were in terms of pediatric care. That medical team was introducing group pediatric care to the rural communities in Nepal, based on the "Centering" approach to care. Maybe there are some learnings here?
https://challenges.openideo.com/challenge/zero-to-five/impact/solving-for-the-patient-through-group-child-care
https://challenges.openideo.com/challenge/zero-to-five/top-ideas/we-need-to-deliver-group-pediatric-care
(There was a post on "Centering" during the research phase of this challenge if you are curious. https://challenges.openideo.com/challenge/new-life/research/centering)

Is transport currently a barrier for these women to delivering in a medical facility? If yes, have you considered expanding the motorcycle service so that it can also be used as a way for women in labor to get to medical facilities for care?

Good luck developing the project!

Spam
Photo of Kevin Gibbons
Team

Hi Bettina Fliegel Thank you for the great questions and comments! Here are some responses:

# In terms of improving communication between the beneficiary communities and the health workers what do you mean? Communication between medical visits regarding an individual's intercurrent health problems, or communication about community needs?
Great question! I mean how do we improve how health workers communicate with communities about upcoming clinics and what services will be provided. Right now, health workers (who are overworked and not easily able to make long-term plans) shift their schedules around based on demands from multiple actors. We recently met with higher level administrators who suggested incorporating our mobile clinics into their monthly plans so that higher level administrators know what health workers are doing, and health workers are able to incorporate the clinics into their weekly and monthly work plans. We'll see how well this plays out.

# For community needs have you considered bringing the groups together, community members and health workers, for a brainstorming session using a human centered design approach?
We have had three types of community dialogues that incorporate health workers:
1) Initial meetings about the project to explain the setup and see if people are interested and willing to pay $0.55 each
2) Full community town hall meetings in which health workers tell them that they are going to start and explain the mechanics in more detail
3) Community dialogue workshops in which health workers, health administrators, and community leaders discuss how the clinics are going and what could be changed

I think we could incorporate some human-centered design discussion tools into these last meetings. They are expensive for us to put on because we have to pay for lunch, transportation, venue, etc. Maybe if we get this grant, we could organize at least one around the particular topic of maternal and child health services. Thanks for the suggestion! Chelsea Takamine you'll probably have some interest in this!

# Links
These are great. Thanks! I like how the team presented the user experience map. We had started working on one that was similar, and that will help us present it better. I think these rough user experience maps could be a good tool in engaging with health workers and patients like the Group Care for Child Health project. I think we need better definitions of what the barriers to care are and how health workers and patients experience the process of perinatal care. Thank you for this insight! It will be one of our major goals for our next steps.

# Is transport currently a barrier for these women to delivering in a medical facility? If yes, have you considered expanding the motorcycle service so that it can also be used as a way for women in labor to get to medical facilities for care?
Transport is a HUGE barrier to delivering in a health facility. We recently purchased 4 motorcycle ambulance trailers through Pulse Uganda (http://pulse.ug) and pregnant mothers are one of the main users we have in mind. We still haven't worked out some of the major details of who can drive them, how they'll be made available, how much users will pay, how we will maintain them, etc. If you have any ideas of similar models that we could learn from, we would love some help with those decisions.

We didn't include the motorcycle ambulance trailers in our model for this challenge because we are still not exactly sure how it is going to work, and we wanted to keep our idea targeted. Lauren Ito Kate Rushton Do you think we should incorporate the motorcycle ambulance trailers into our model description in the future? It's hard to know how to strike a balance between being concise & targeted and being comprehensive.

Spam
Photo of Bettina Fliegel
Team

Hi Kevin.
Great to learn that transport to medical facilities during delivery is also being addressed for women in the villages you are working with! What feedback have you received about this service from potential users?
A few questions: Are there cultural norms in the villages regarding where a woman gives birth? What is the role of traditional birth attendants in the villages you are working with? Will it be important to educate key influencers about the importance of accessing life saving maternity care in a clinic, so that women will be able to use the transport system you are setting up?
I have read some scenarios in which women have been in life threatening situations during birth and have not been able to afford to pay for an ambulance when there was one. This idea from a previous OpenIDEO was interesting as it addresses access to transport as well as financial planning so that one prepares and saves for the service. It also addresses safety issues, using mobile transfer of funds rather than cash, as it was an idea for urban communities and there was concern regarding theft during transport. Not sure if that is relevant in the context you are working in? Maybe there are some learnings from their ideas?
https://challenges.openideo.com/challenge/womens-safety/ideas/an-easy-safe-and-cashless-transport-system-to-help-urban-mothers-reach-hospitals-in-labor

Another resource. I just found this online. https://www.ridersintl.org/

I also wonder if savings groups might be a way that women in local villages might support each other to save for needs during pregnancy and delivery? (Will the women in the villages need to pay for delivery services at local health clinics?)

In terms of communication, #3 above, it would be great if there was a mechanism to capture feedback directly from women users to share with healthworkers/administrators, so that services could be improved, changed based on input and need. (I discovered this innovative program that uses mobile phones to capture feedback on maternal health programs during the research phase. https://challenges.openideo.com/challenge/new-life/research/care2share)

Spam
Photo of Kevin Gibbons
Team

Bettina Fliegel I really appreciate all your feedback. Thank you!

# What feedback have you received about this service from potential users?
So far we have only spoken with health workers and health administrators about this suite of services. Our next step would be a community dialogue workshop. The idea for emergency transportation and perinatal services came from our discussions with patients in remote areas, but we've yet to present this fleshed-out idea to them.

# Are there cultural norms in the villages regarding where a woman gives birth? What is the role of traditional birth attendants in the villages you are working with? Will it be important to educate key influencers about the importance of accessing life saving maternity care in a clinic, so that women will be able to use the transport system you are setting up?
We need to discuss these issues with a group. From the conversations that I've had with women, I get the impression that most women would prefer to give birth in a facility, but that it's difficult for many women to get transportation and enough money to support themselves while they're staying at the health facility. We need to make those questions part of future discussions. Re: traditional birth attendants: Honestly, I'm not sure what people's relationship with them is. When we have brought it up with NGO partners and research staff, people chuckle a bit, as if it's looked down upon by people who live in towns and cities. We're just beginning to explore expanding maternal & child health services, and we need to investigate some of these insightful questions.

# Reaching hospitals in labor / birth plan
We could definitely use a cashless model as telecom money transfer services are commonly used in Uganda. We don't yet understand the financial barriers that people have. Transportation is relatively affordable for a one-time journey, and then services are free at the facility. We'll have to get a handle on how cost-prohibitive a motorcycle taxi ride to the health facility would be for a pregnant mother. Thanks for the link and the idea!

# I also wonder if savings groups might be a way that women in local villages might support each other to save for needs during pregnancy and delivery?
We have had mixed successes working with community groups. In the beginning we were true believers in working with village savings and loan associations (VSLAs) to oversee our clinics and take leadership of clinic activities in the village, but these groups are prone to leadership problems, distrust, and dissolution. We recently made a decision to shift coordination responsibilities to select community leaders and community health workers since they have been doing most of the work anyway. I think working with VSLAs is great *if* the organization can support the groups with regular visits and possibly incentives. Right now we don't have the resources to do that. That could change! Maybe it should, especially for these maternal & child health services.

# Communication
I really like the Care2Share idea and other similar SMS "push" message campaigns. We would like to start incorporate the idea into our work, but we're just not there yet. We are going to explore *how* we might do something like this in Uganda and then figure out *what* we would do with the tools that are available. For now we are thinking of incorporating user surveys with patients at our clinics and focus group discussions with women who do and don't use our mobile clinics. Considering our capacity, I think that's a good start for obtaining information and figuring out how to distribute information in the future. The best way that we know of is a) use influencers like you recommend, b) hold community meetings, c) use signpost advertisements and stickers, and d) radio programs. Pretty low tech, but that's where most people get their information in the remote areas that we serve.

Spam
Photo of Bettina Fliegel
Team

Hi Kevin.
Good luck as you continue to build the project!

Regarding Care2Share - One thought I had was that there might be learnings from what questions they are asking women using this product, about their experiences with the maternal health system.

Spam
Photo of Kevin Gibbons
Team

# One thought I had was that there might be learnings from what questions they are asking women using this product, about their experiences with the maternal health system.
Thank you for following up @Bettina Fliegel ! I watched their second video, and the testimonials that they have are really compelling. For the two women that they interview it's all about quality of care. We'll definitely incorporate some of those questions into our upcoming surveys. We've just started coming up with exit interview questions for people who attend our clinics. Your feedback and the links have been inspirational. Thank you!

Spam
Photo of Kevin Gibbons
Team

Bettina Fliegel  I found out a partial answer to one of your question about local perceptions of traditional birth attendants by talking to a staff member who is from the communities where we work and has been doing outreach work for many years. Her answer is illuminating.

# What is the role of traditional birth attendants in the villages you are working with?

Many women in Uganda use traditional birth attendants for the following reasons:
1) They are recommended by other mothers. Many of the reasons below are cited, but I get the impression that other mothers have a

2) Health workers at the health facilities can be condescending or uncooperative. Some women have reported problems of working with health workers at the facilities. They can often speak down to them, and patients have bad experiences.
3) Visiting the facility can be too expensive. Services in government health facilities are free, but there are charges for medicine that needs to be bough from a pharmacy, as well as staying overnight in a hotel.

4) Traditional birth attendants are trusted more than health workers. They give herbs to people when they are sick. They have better relationships with people in their communities.

I think we'll have to consider these issues when moving forward with perinatal care interventions. I know other organizations have had successes integrating traditional healers into their activities through trainings. I think we'll incorporate questions about perceptions of traditional birth attendants into our survey of mothers next year. Thank you Bettina Fliegel for the insightful question!

Chelsea Takamine Lauren Ito Kate Rushton 

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Photo of Kendra
Team

Hi Kevin,

Sorry it has taken me so long to respond with these resources, it was so great to talk with you! Omnio/Univadis is the company that provides information to providers via an app, email newsletters, and social networking for clinicians
They previously had a fund-raising arm called HealthE Villages that donated tablets loaded with provider information to medical clinics in remote areas.
The company that makes health videos is called HealthGuru. Another company that makes them is called HealthiNation.

Good luck in this phase!
Kendra

.

Spam
Photo of Kevin Gibbons
Team

Kendra Thank you so much for the conversation and the follow-up! I'll check out these (creatively named) organizations to see if we could work with them or use some things from their models.

Thanks for the help. I wish you a great week!

Cheers,
Kevin

Spam
Photo of Kevin Gibbons
Team

Kate Rushton and Lauren Ito I uploaded a user journey that we made, but it's not easy to view it because it has long dimensions (1600x628px), and, as far as I can tell, the platform does not allow users to zoom in on images. Are you able to view it? Should I break it up so that it's more easily seen?

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Photo of Kate Rushton
Team

HI Kevin,

I am struggling to read the right. In the past, an OpenIDEO member uploaded their document onto Prezzi and posted their Prezzi link in their submission. They also broke it up as well, if that makes sense. Lauren Ito - what do you think?

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Photo of Kevin Gibbons
Team

Kate Rushton I added the panels to the images and a link to the full image in the description. Thanks!

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Photo of Lauren Ito
Team

Hi Kevin Gibbons ,

Congrats again on Refinement Phase! I'm wondering, what are the next steps to implementing this concept? How will this Idea specifically address accessibility in these villages?

It might be helpful to create a user journey to clearly illustrate what the journey different stakeholders involved in this project would look like.

Excited to learn more!

Spam
Photo of Kevin Gibbons
Team

Thank you Lauren Ito A user journey is a really good idea. We'll try to submit one this weekend.

Spam
Photo of Kate Rushton
Team

Hi Kevin Gibbons 

The refinement phase closes on Nov 5 at 3:00pm PST. I look forward to seeing your updates. Please reach out to me if you have any questions at all.

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Photo of Kevin Gibbons
Team

Kate Rushton Thank you! We added some new content and will probably add some more this weekend.

Spam
Photo of Brynn Rubinstein
Team

Hi Kevin! Brynn from the Midwife on Wheels (MOW) project (the American version of Motorcycles and Midwives). What sort of partnerships have you developed with other organizations working the health supply chain in Uganda? I'm thinking of organization like Living Goods... I'm wondering if there's an opportunity to leverage the brand and knowledge of partner groups in the scaling of this idea.

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Photo of Lauren Ito
Team

Hi Kevin Gibbons ,

Congratulations on moving into the Refinement Phase! I'm excited to see your Idea evolve over the coming weeks with the resources and mentorship we'll provide in this phase of the New Life Challenge.

Please tag me here with questions using '@' followed by my name (Lauren Ito).

Can't wait to learn more!

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Photo of Kevin Gibbons
Team

Kate Rushton Thanks! We're honored and excited to make it to the next stage.

Spam
Photo of Kate Rushton
Team

Hi Kevin,

Congratulations on making it to the refinement phase!

Please tag me here with questions using '@' followed by my name (Kate Rushton).

Spam
Photo of Chelsea Takamine
Team

Congratulations on joining the shortlist Kevin Gibbons and HAC Team!

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Photo of Kevin Gibbons
Team

Woo woo! There are some really strong submissions here. I commented on the ideas for the health data bracelet (India) and the tricycle ambulance (Mali). Thanks for connecting us to the challenge!

Spam
Photo of Gilda Given Silayo
Team

It's real nice idea, big up.

Spam
Photo of Kevin Gibbons
Team

Thanks!

Spam
Photo of Lauren Ito
Team

Hi Kevin Gibbons ,

There are less than 3 hours left to contribute to the Ideas Phase, and I see your post is currently unpublished. Was this your intention?

Just a friendly reminder that your post must be published today, (Sunday August 23) by 3:00 p.m. Pacific Time to be eligible for evaluation. At the top of your post you will see a blue "publish" icon. Click this icon to submit to the Challenge.

Thanks and looking forward to seeing you in the Challenge!

Spam
Photo of OpenIDEO
Team

Hi Kevin!

There are 4 hours left in the ideas phase. I wanted to remind you to publish your idea today (Sunday 23 August) by 3:00 p.m. Pacific Time.

Spam
Photo of Kevin Gibbons
Team

Thank you for the reminder!

Spam
Photo of OpenIDEO
Team

Hi Kevin Gibbons !

Great to have you onboard! We notice your post is currently unpublished. Was this your intention? We'd love to have it included on the challenge. If you decide you'd like it included, you can publish it by hitting the Publish Entry up there at the top of your post. Or update it first by hitting the Edit Contribution button. Looking forward to seeing more of you on conversations across this challenge.