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Sexual and Reproductive Health Services Delivery on Demand

Developing a mobile phone app to connect conflict-affected women in Iraq to sexual and reproductive health services using mobile clinics.

Photo of Bridget Relyea
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What specific problem(s) are you trying to address?

The ongoing conflict in Iraq has caused widespread displacement and the destruction of many health facilities. These issues have increased the three delays of seeking, reaching and receiving maternal health care, and women are now suffering from the lack of available sexual and reproductive health (SRH) services, especially clean maternity units. As a result, maternal and infant mortality remains higher in Iraq than in other countries in the region. In response, WAHA, with a female gynecologist and nurse, run 24/7 mobile delivery units (MDUs) with SRH services near camps for displaced persons. Despite the units’ clinical capacity and ability to easily relocate, there is insufficient communication between HCWs and usage by patients.

What are some of your unanswered questions about the problem(s) you are working to address?

How to ensure that health workers would be able to access the application and be trained in its use?
How to ensure that the application includes all the necessary parameters and is regularly updated?

Explain Your Idea

Our bold idea is to develop a mobile application to facilitate communication between healthcare workers (HCWs), patients and the Mobile Delivery Units (MDUs). The idea for the mHealth tool was inspired by WAHA’s health professionals and coordination staff who have worked in Iraq since January 2016 and highlighted the challenges of ensuring that the MDUs are stationed in the areas where women need it most. Our idea would help to address this challenge by improving and strengthening the efficiency of the MDUs to offer quality, respectful and patient-centered SRH services including family planning, antenatal care, postnatal care, and safe delivery for conflicted-affected and displaced women.

The app has a dual function where HCWs can access the MDUs’ location information of the unit and availability of nearby services, and providers can call out the unit and alert cases seeking MDU services, with notifications received by the MDUs staff. All information transmitted through the application will be consolidated on a central server based in WAHA’s Erbil office and WAHA staff will regularly review data and provide maintenance and updates. During the piloting phase, HCWs will receive a half-day training.

The output measures will include the number of mobile app users, number of inputted cases, number of related medical consultations. The outcomes will be increased utilization of the mobile app and MDUs, and the increased number of deliveries attended by skilled HCWs.

Name the three most important ways that your idea will address your identified problem(s).

Introducing an app for the MDUs will fundamentally change how we deliver SRH care in post-conflict zones by enabling HCWs to easily communicate, triage and access services. The app will ensure that the MDUs are utilized effectively and efficiently to increase emergency obstetric and reproductive health services uptake. Reports show that connectivity is affordable and sustainable and that this type of technology improves maternal health outcomes by getting the right people to the right place at the right time, avoiding birth complications and aiding necessary referrals. This tool has the potential to be scaled up and can easily be adapted to other conflict and post-conflict settings where SRH services are limited and difficult to access.

How is your idea unique?

There are a multitude of mHealth solutions for strengthening health systems and implementing mHealth applications to transform our approach to health and maternal care, however none of which address simultaneously the limitations of the conflict and post-conflict settings and the needs of internally displaced and conflict-affected persons living in and outside of camp settings.

The MDUs have been implemented by UNFPA but their use has yet to be maximized to benefit the largest number of women and families in need. The Uber-like application will be easily implemented and adopted by HCWs. It will effectively assess the movements of the MDUs and utilize evidence-based medical protocols to ensure that pregnant women are triaged and receive the care they need. Currently, there are no systematic ways for HCWs to rapidly exchange on case management and make accurate data-driven decisions to improve care outcomes, therefore this will also serve as a platform for education and communication

What are some outstanding concerns or questions that you have regarding your idea?

SSome of our outstanding concerns, which we hope to address through formative interviews and focus groups with end users are:
• How to ensure up-take and continual use of the mobile application by healthcare professionals apart from initial and ongoing trainings?
• How to best adapt the mobile application within the parameters necessary to address the needs of populations living in different camp settings?

Who are your end users?

The end-users are health care providers for women of reproductive age in the districts served by WAHA and areas that are newly liberated from armed conflict, mainly in northern Iraq in areas like Khazer camp, East Mosul. According to the District of Health (DoH) estimates are difficult due to the constant movement of populations and ongoing conflict, however UNHCR indicates that there are 1.8 millions displaced persons in the Kurdistan region of Iraq where WAHA works, half of which are women and children who are likely seeking health services.
These end users will contribute to the prototype of the application through focus groups and will benefit from training on the app and improved, patient-centered care and workflow management.

Where will your idea be implemented?

  • Iraq

What is the primary type of emergency setting where your innovation would operate?

  • Armed conflict
  • Prolonged displacement

Tell us more about the emergency setting that you intend to implement in

3.2 million people in Iraq are displaced and the liberation of other regions will increase demand for SRH services lacking during occupation. This will increase the need for MDUs due to destroyed facilities and overburdened camps, as experienced in Mosul. This app can transfer to other settings where mobile health services are replacing fixed clinics including natural disasters, other conflict-affected settings (e.g. Syria), or with dispersed, nomadic displaced populations (e.g. Eastern RDC).

What is your organization's name?

Women and Health Alliance (WAHA) International

Tell us more about you.

WAHA International is a non-governmental organization committed to offering comprehensive health care services to vulnerable populations especially women and children. Since January 2016 in partnership with UNFPA, WAHA has provided health services in Iraq in the Sinjar mountains, Mosul, Qayyara district, and Salah Aldin province. Our program and field staff include an obstetrician and maternal and humanitarian health experts and we have close ties with local health authorities and providers, which is essential for sustainable outreach and uptake. We have conducted prior research on using mobile technology, Flask, among Syrian refugees and developed an app for health workers in Senegal, which is informed by end-users throughout the process.

Organizational Characteristics

  • Women-led organization
  • International/global organization

What is the current scale of your proposed innovation?

  • Still in planning phase and does not exist yet

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Our organization is registered in Iraq and our team is based in Erbil, northern Iraq with management and financial support from the organization’s headquarters in Paris, France.

What is your organizational status?

  • Registered non-profit, charity, NGO, or community-based organization.

What is the maturity of your innovation?

  • Early Stage Innovation: exploring my innovation, refining, researching, and gathering inspiration.

Website

Website: http://www.waha-international.org/
Facebook: http://www.facebook.com/wahainternational/
Twitter: http://twitter.com/wahaint

How has your idea changed based on feedback?

The feedback has allowed us to make our idea more clear and compelling. Based on the feedback from the Ideo community and exchanges with our field teams, we assessed the implementation and involvement of stakeholders. Local health authorities and community members will be involved to develop strategic outreach programs, inviting all DoH and other organisation HCWs to attend trainings through health facility-based notification boards and communications mechanism. Our strong partnership with the DoH will ensure that HCWs are informed and actively participate.

Perspectives from our software expert indicated the need to host a central server based in Erbil, Iraq which will process real-time locations services and consolidate data on the urgency, proximity and availability of the MDUs. Based on those conditions, the MDUs HCWs will receive a notification of this need and will respond accordingly. The app will be maintained in the long-term by Souheil Khaddaj at no additional cost.

Who will implement this idea?

Our team has unique field experiences and expertise, which brings this innovative idea to life. Bridget Relyea is a women’s health and gender-based violence project and research specialist who develops the human-centered design and manages the project overall. Alison Wringe is a researcher and reproductive health expert, and along with Jennifer Scott, an obstetrician with a specialization in sexual violence and humanitarian settings, will ensure initial and continual feedback from end-users. Ioannis Malamas, Iraq field coordinator and his team and will implement the mobile app among HCWs and work closely with stakeholders. Souheil Khaddaj is a UK-based software architect who will facilitate the design and adaptation of a flexible component-based mobile app.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

Our organization has a full project team located in Erbil, Iraq and a project management team in Paris. Decisions are made through regular project meetings and in-person field visits by management and exchanges with key stakeholders and beneficiaries. The Iraq project team has a Field and Medical Coordinator who are responsible for making day-to-day project decisions and communicating with the relevant partners and stakeholders, including working closely with the DoH as well as the health cluster which comprises all health actors. Our projects and activities are informed by rigorous monitoring and evaluation as well as when possible, formative research including interviews and focus groups to ensure the success and sustainability of our actions.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

The direct end-users of the app are HCWs providing SRH services to displaced women. As a result of the conflict, the local health system remains largely under-developed and SRH services are under-resourced, meaning that our end-users face day-to-day challenges to provide quality SRH care to patients. We will need to develop a user-friendly app that does not create additional burden in their patient interactions and that facilitates decision-making and work flow. The largest systems-level challenge that affects our end-users is that many of the HCWs work for the DoH and the MDUs are not operated by the DoH. The end-users may rely on traditional systems of SRH care delivery already in place, even if they non-functional or of limited quality, and thus the app may be under-utilized.

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

IMPACT: In five years, we hope that Delivery on Demand is connecting women to quality, patient-centered SRH services across Iraq and in at least 2 other conflict or post-conflict settings, to ultimately provide safe deliveries to over 1 million women.
QUESTION: How do we ensure that the mobile application provides accurate information in real-time that adapts with the changing security context and to new settings?

What is it that most attracted you to Amplify instead of a more traditional funding model?

We feel that Amplify is best suited to developing this idea because it allows us to grow the concept and to design a tool that can change the way we deliver care and eliminate unsafe deliveries and birth complications in conflict and post-conflict zones. Working with Amplify gives us the space to develop a human-centered solution that best suits the lives of those we are trying to impact, through an iterative, creative and participatory process.

Do you intend to implement your Amplify idea in refugee camps / temporary settlements?

  • We aim to implement our Amplify idea in a refugee camp / temporary settlement.

How long have you and your colleagues been working on this idea together?

  • Between 6 months and 1 year

How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • Over 50 paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are registered in all countries where we plan to implement.

My organization's operational budget for 2016 was:

  • Above $1,000,000 USD

What do you need the most support with for your innovation?

  • Product Design

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Photo of Chelsea Takamine
Team

Congratulations Bridget Relyea and team - welcome to the Amplify portfolio! Check out this winners blog post featuring your idea: https://challenges.openideo.com/blog/amplify-reproductive-health-challenge-winners-announced

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