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Menstrual Regulation Mobile Application

Ipas + Hesperian Health Guides will pilot test a comprehensive mobile resource to address women’s reproductive health needs in Bangladesh.

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What specific problem(s) are you trying to address?

Women and girls in crisis and fragile settings face many obstacles to obtaining safe abortion and contraceptive care at a time when managing their reproductive lives is crucial. Access to safe reproductive health services in these settings is limited, and when it exists, women in need—such as Rohingya refugees in Bangladesh—often have little information about it. Bangladesh has decentralized menstrual regulation (MR) services with medicines provided by midlevel and allied health workers up to 10 weeks after a woman’s last period. This mobile application (app) will give community health workers the security and confidence to assist women, plus information about referrals, when to seek further care, and prevent a potential unsafe abortion.

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

Because this issue is understudied, we do not understand women’s pathways, needs, and desires for accessing reproductive health services in crises-affected, humanitarian, and fragile settings. We also need to better understand how community health workers and other intermediaries in these settings fit into the broader picture of providing resources for women’s referrals and information about accessing safe services.

Explain Your Idea

Ipas and Hesperian Health Guides have collaborated on content and design to create an abortion (or menstrual regulation in the case of Bangladesh) counseling, referral or self-use resource for use on mobile phones or tablets. This app is almost ready for beta-testing. Using Hesperian’s strong network of partners and resources, the app is being built for maximum translatability. After the initial download, the app can be used offline, more appropriate for low resource settings. We will adapt the app for use in Bangladesh, where MR—or the induction of uterine bleeding after delayed menstruation—has been included in Bangladesh’s family planning program since 1979.

Pilot testing begins with a targeted list of users with characteristics similar to the target group of end users. Invitees, such as health-care providers or community workers, are invited to join in a consultative process to try the app and provide feedback on aspects such as the user experience, what information is missing, improvements in navigation, counseling, and directing women to facility-based MR services, all employing an iterative process using interviews and small focus groups. User testing will include a combination of automated user data and in-person user testing. These user perspectives are meant to lay the groundwork for a much larger-scale multi-country release and launch, likely in multiple languages, and will provide information necessary to develop a more formal evaluation plan.

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

Our end beneficiaries will be refugee women and girls—predominantly Rohingya refugees—of reproductive age living near Bangladesh’s border with Myanmar. The project will be designed to address unmet need for MR and contraception to terminate or prevent unwanted pregnancies. The project will address this problem by: building evidence to provide needs-based solutions to improve refugee women’s access to reproductive health information and services; creating a resource for community health workers who work to provide refugee women access to information and resources for reproductive health services; and providing a framework and evidence to take this idea to scale and bring safe abortion and contraceptive access to refugee women globally.

How is your idea unique?

A prevailing myth about safe abortion in humanitarian settings is that there is no need for these services (McGinn & Casey 2015). However, women and adolescents in crises face unique obstacles to preventing and terminating unwanted pregnancies, and the need for services increases in fragile and crisis situations. Yet contraceptive and abortion care is sidelined; the humanitarian community fails to address this problem even in countries where it is legal. Traditional health training and information dissemination methods in these settings are often difficult. Our idea is unique in that it aims to increase access to and information about safe abortion and contraception directly to the hardest to reach women in the hardest to access settings, without lengthy, expensive trainings that make health worker shortages more acute. Improvements and technical updates can be “pushed” to the end user when the phone/tablet is connected to the internet, updating them with the latest evidence base.

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

Menstrual regulation is long-established within the health system in Bangladesh but we do not know the attitudes and beliefs of members of the various cadres of community health workers on this. Also, how will cultural norms, language, and beliefs challenge the process?

Who are your end users?

Government health workers, such as Health Assistants and Female Welfare Assistants, are the primary bridge between the community and health services offered by the government. The capacity of the government field workers to raise awareness of and refer services for MR and contraception is limited. In addition to their limited knowledge, they also lack job aids and behavior change communication (BCC) materials to facilitate conversations with community members. Field workers will serve as an important link between women and girls in communities and the health-care system where capacity is already being built.

Where will your idea be implemented?

  • Bangladesh

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

  • Armed conflict

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

A massive humanitarian crisis is unfolding in Bangladesh as Rohingya refugees flee state violence in Myanmar. Many refugee women have suffered rape or other sexual violence, leaving them in dire need of comprehensive sexual health care, including MR and contraception. However, these critical services are quite limited, and Rohingya women and adolescents facing unwanted pregnancy are forced to navigate termination or delivery without safe, appropriate services or supportive social structures.

What is your organization's name?

Ipas and Hesperian Health Guides

Tell us more about you.

Ipas is a global leader in the development and facilitation of woman-centered, comprehensive contraception and safe abortion care. Ipas will provide technical direction to Hesperian Health Guides in this project. Ipas currently provides technical assistance to humanitarian agency partners independently and through a decades-long engagement in the Inter-Agency Working Group on Reproductive Health in Crisis (IAWG).

Hesperian Health Guides is a nonprofit health information and health education source that supports individuals and communities in their struggles to realize the right to health. They develop easy to read materials produced in many languages.

Organizational Characteristics

  • Women-led organization
  • International/global organization

What is the current scale of your proposed innovation?

  • Community - 1+ communities within 1 country

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • Yes, for more than a year.

Organization Location

Ipas is an international NGO with offices in 20 countries.

What is your organizational status?

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

What is the maturity of your innovation?

  • Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.

Website

http://www.ipas.org

http://www.hesperian.org

How has your idea changed based on feedback?

Feedback both from the expert reviewers and from our own community of reviewers has strengthened our idea. Because of the feedback, we are working diligently to clarify how our end users will engage with the project and app, and how that engagement will ultimately affect the beneficiaries of the information contained in the app. Because of the legal and policy framework for menstrual regulation in Bangladesh, end users for the app will be community/front-line health workers. Through the review and refinement exercise, we have narrowed our initial focus on understanding how best to help health workers engage with the tool, with an ultimate goal of better serving women in need of care. Additionally, we are thinking more about how the tool can ultimately reach more marginalized groups, such as women with disabilities. Feedback has also led us to include an additional confidence building step in the pilot implementation, along with creation of an app user support group.

Who will implement this idea?

Ipas staff with research, clinical, and humanitarian technical expertise, along with Hesperian staff, will advise on the overall structure and roll-out of the pilot project. Ipas staff in our Bangladesh office will help directly implement the project with logistical support from staff from a global humanitarian service delivery NGO with which Ipas has a formal signed memorandum of understanding.
Ipas is currently committed to support 200 public health facilities nationwide in the country. Ipas Bangladesh has established a unique focus on developing and increasing access to high-quality integrated contraceptive care, menstrual regulation, and postabortion care services in the public sector. Ipas Bangladesh also has established strong relationships with government ministries.

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?

The project fits extremely well with both Ipas and Hesperian's current strategies and organizational values. Ipas has a new commitment and team around human-centered design, as well as a department focused on innovation. The Ipas process for buy-in has involved review and sign-off by leadership on the innovation team, as well as country office buy-in. Hesperian Health Guides uses a human-centered design approach (and has for many years) to ensure that the health information they develop and distribute is relevant, approachable, accessible, and motivating. Hesperian knows this means being open to adaptation and modification of existing plans to reflect user input collected through review and field testing. Buy-in at Hesperian involves group discussions with staff and advisors.

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?

Our end users face challenges that are constants in settings of acute crisis, including: a population that is by definition in flux and difficult to track; competing needs from the humanitarian community, such as an emphasis on food security and WASH; poor systems and infrastructure available for the displaced community; and recent trauma.

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: By 2022 we aim to have a refined, easy-to-use mobile application released globally with free access in more than 50 languages that users accept, prefer, and use to help women in fragile and conflict settings gain greater access to safe, quality abortion and contraceptive care.
Question: Can this tool be adapted and used by intermediaries as a counselling and referral tool, and will women seeking care want an intermediary to be involved in their reproductive health decisions?

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

With our new emphasis on human-centered design, innovation, a focus on end-users, and reaching women in crisis settings, we found the Amplify model as an exciting opportunity for piloting this collaborative project. As Ipas and Hesperian have already collaborated on the development of this tool, we believe that the Amplify model provides a truly innovative way to effectively test and refine the tool. More traditional funding mechanisms rarely allow this level of uncertainty and innovation.

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 1 and 2 years

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

  • Between 10-20 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?

  • Understanding User and/or Community

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Photo of Chelsea Takamine
Team

Congratulations Bill Po 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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