Shifra: Mobile Health for Mobile Populations
Respectful reproductive health access, in any language
Our website can be found at www.shifra.io. We are in the process of updated all the content to make it simpler and more relevant without removing any meaningful health information.
What specific problem(s) are you trying to address?
Reproductive health information that is both culturally sensitive and locally relevant is hard to find. Accessing services that offer respectful and discreet care are often incredibly difficult for women from non-English speaking backgrounds, even in countries like Australia where 1/4 people were born overseas and 1/5 speak English as a subsequent language.
As a result, women from refugee (and migrant) backgrounds access maternal child services at a rate 2/3 their English speaking counterparts and in some hospitals only 1 in 86 low English patients will be offered a translator. This means they have an increased risk of perinatal depression, pregnancy/birth complications and refrain from seeking support following rape and assault.
Understanding the role mAdapt plays and the questions I constantly ask myself to ensure we're doing things responsibly and ethically for everyone involved.
What are some of your unanswered questions about the problem(s) you are working to address?
-How do women from refugee backgrounds currently access sexual and reproductive health information?
How do they want to access it?
What/who do they trust to share this information?
What medium(s) to they prefer to use/avoid?
How do they want to digest it (e.g. video, text, cartoon, infographic, PDF)
What would encourage them to seek this information out?
How do we support them to be come autonomous decision makers?
How do we build the trust of their families/partners to support/use Shifra
Explain Your Idea
mAdapt's web app "Shifra" assists women and girls to search for information on pregnancy care, family planning methods, teen health and gender-based violence amongst other comprehensive reproductive health topics. They can also search for local care providers should they wish to seek out services in person.
mAdapt then utilises Shifra's anonymous user trend data to map unmet and unseen need and work with community-based service providers to improve services and reduce resource wastage.
Addressing the specific health concerns of women and girls in refugee scenarios has been
shown to improve the health knowledge of the communities that surround them, and is
essential to increasing their safe and successful integration into host countries.
One of the primary weaknesses of this approach is a general lack of high-quality, digitized reproductive health information that can be provided to communities in crisis.
Supporting women and girls’ access to comprehensive reproductive health services not only
saves lives, it also increases their chances of achieving higher education, longer-term
employment and benefits entire communities through shared information and education.
For women and girls to be given this chance, they need to be recognized by those who
direct health policy and funding and provide associated services within their new
We feel strongly that for women and girls to count, they need to be counted.
User Journey Page 1of4 (PDF didn't work so added as images)
User Journey Page 2 of 4
User Journey Page 3of4
User Journey Page 4of4
This is another example Nur's full user journey (almost completed, some colouring and word simplification to go, plus translation into Arabic and audio recording for low literate users, of course).
We collect anonymous data on user trends so we can work with local health and community partners to act on local need. E.g. if 600 women a week want info, in Arabic, on IUDs, then we can alert local GPs and health providers to this and stat developing more relevant health programs for that particular community
An example of Shifra's content in English and Arabic.
Currently when one seeks health info on other websites, one needs to navigate 3-4 screens in English before finding info in other languages. Shifra meets the user in their home language immediately help them to avoid this confusion and lack of accessibility.
More examples of content in each language. We co-designed for 6 months with communities of refugees, migrants, health professionals, funders and policy makers to ensure the content was relevant and helpful for every stakeholder's goals.
Name the three most important ways that your idea will address your identified problem(s).
1. Increasing accessible, culturally sensitive sexual and reproductive health information in the user's language of choice (inc. visual for low literate populations)
2. Connect users to accessible and respectful sexual and reproductive health services that specialise in refugee and migrant health
3. Map user searches to build on the granular data which determines trends and illuminates unseen and unmet need by geographic regions thereby helping us to work with partners to affect meaningful service and policy change and reduce resource wastage at the local level.
How is your idea unique?
Shifra was designed with refugees because it is for refugees.
We have also enlisted the support of literally hundreds of volunteers and accrued thousands of hours across multiple continents over 2 years. Shifra isn't just a health product or intervention, it is a revolution in how we work with communities to design their own solutions to problems they have identified as most pressing. We apply design thinking to public health challenges and use the data to evaluate our effectiveness and impact continuously. We follow the Lean method to assess scalability in everything we do.
mAdapt transfers the use of evidence-based mHealth interventions from low resource
settings to health systems acutely stressed from the sudden influx of refugees.
Despite extensive research, we have yet to find a mobile health program that exclusively addresses the reproductive health needs of Syrian refugees in Europe, nor have we found any organisation developing a competing or comparable application.
What are some outstanding concerns or questions that you have regarding your idea?
"How will Shifra Make Money?" We know Shifra is sustainable through data sales, advertising, sponsorships, subscription & perpetual licensing and white-labelling. mAdapt’s scale-up plans include supporting in-country capacity by working with local refugee coders, app developers and health support personnel through entrepreneurial mentorship and project collaboration. Shifra will be successful because the community that needs it can and is being trained to sustain and manage it long term.
Who are your end users?
mAdapt uses mobile technology to provide refugees and other non-English speaking migrants (usually aged 13-50) with information concerning their most pressing reproductive health needs. It provides users with real-time information on accessible reproductive health care services in their own language. Supporting women and girls’ access to comprehensive reproductive health services not only saves lives, it also increases their chances of achieving higher education, longer-term employment and benefits entire communities through shared information and education. For women and girls to be given this chance, they need to be recognised by those who direct health policy and funding and provide associated services within their new communities.
My friend Jeff, is helping me create visual stories around using Shifra and seeking help because many of the women I work with don't read in Arabic or any language. I want them to feel proud and knowledgable about the choices they get to make about their own healthy journey and in particular, what happens to their own body.
These women working with us on our Photovoice and GIS Goalong interviews so we could see their physical and spatial barriers in addition to hearing their emotional experiences surrounding accessing healthcare in Melbourne. They are all from Arabic speaking communities and gave permission for their image to be used online.
Co-designing with refugees: we do not show their face at their request. Respecting their dignity and privacy is paramount to building a trusting and safe relationship.
Where will your idea be implemented?
Occupied Palestinian Territories
What is the primary type of emergency setting where your innovation would operate?
Tell us more about the emergency setting that you intend to implement in
At present, one in every 113 people around the world is an asylum-seeker, internally displaced within their home country or a refugee. This is an unprecedented figure. Many of these refugees have immediate reproductive health needs arising from a lack of access to contraception, an increase in exposure to sex trafficking, higher risks of sexual assault, and poor access to pregnancy health care and safe birthing practices.
What is your organization's name?
Tell us more about you.
Rebeccah Bartlett is a Registered Nurse-Midwife and the founder of mAdapt, a digital health tech company designed to improve reproductive health access for refugee and migrant populations. mAdapt’s first product, Shifra, is a web based app currently available in Arabic and English.
Passionate about reducing health disparities in underserved communities and promoting respectful maternity care, Rebeccah works as a midwife as well as for Birth for Humankind, a charity that partners volunteer birth companions with women experiencing socio-economic disadvantage who are journeying through pregnancy and labour alone.
Founder, Rebeccah Bartlett, RNM
Tech and Content/Research Team_July 2017
What is the current scale of your proposed innovation?
National - expansive reach within 1 country
Experience in Implementation Country(ies)
Expertise in Sector
Yes, for more than a year.
What is your organizational status?
Not formally registered but are a formal initiative through an accelerator, hub, or other entity.
What is the maturity of your innovation?
Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.
How has your idea changed based on feedback?
Our feedback has been overwhelming positive and constructive. We knew we needed to simplify the medical language and this was evident in the user testing results. We missed a section on Sex Work but an amazing advocate reached out to us and we are now working with the sex worker community to create the content for this (new) section in time for Shifra 2.0 launch in December.
Finding Champions and Building Public Awareness
Connecting to Help and Determining Influence
Increasing Impact and Measuring Impact
This is feedback based on 6 weeks of user testing online with health professional and academic communities. We are using this to refine and improve Shifra before re-testing with refugee and migrant communities throughout November in time for December re-release.
Prototype Feedback Summary
Who will implement this idea?
-Pilot implementation within Melbourne's Arabic community is currently being managed by myself, Rebecccah Bartlett, a nurse-midwife with 13 year experience in SRH for refugees and migrant populations. I work full time (unpaid) on this and have been doing so for the past 18 months and will continue to do so indefinitely.
-I am being assisted by 1 adult literacy for non English speaking communities expert & 8 health & community advocacy specialist within this area, all of who are volunteers.
-I have a business consultant (also volunteer) who works part time.
-mAdapt's tech works 1/4 time on this as needed and comprises of 4-6 web developers and designers.
-Replicating Shifra overseas will require 1 project manager and 1 tech advisor (both temp. full term) plus in-country partners.
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?
We use the Lean model. We make small changes, test with small sample sizes and then iterate based on these. We then test again and again until we feel the users are happy with the outcome before we expand or scale up. As long as work is undertaken in a respectful and responsible way we are proud of our failures and the failures of other organisations as this is what we learn from.
Personally, having made so many decisions on my own at the beginning, I welcome and encourage (often I beg) for a difference of opinion to ensure (a) I'm not monopolising the process and (b) I can learn something new and different in the process. I love discussion and I know I don't know everything there is to move forward. My weaknesses become my strengths when I make myself vulnerable enough to share them.
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?
(1) Knowledge about what services might be needed and how to access them (physically and especially financially).
(2) Encouraging health professional awareness around the challenges non-English speaking communities face in accessing respectful care that they actually understand. Many fail to see the need for interpreters or are aware that clients often say they understand when they don't out of embarrassment. Being empathetic to their level of understanding and assisting them to access resources that don't rely on 100% literacy rates is essential. Also, encouraging users to do their own (evidence based) research encourages autonomy and independent health decision making and expands their access to topics the health professional may not have thought were relevant so chose not to share.
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?
(1) By 2022, Shifra will be available to communities speaking the top 7 languages within Australia, this means we will be accessing 3.36 of the 4.8 million non-English speakers in the country with essential health information. This means we will also be accessible to millions more users speaking these languages in refugee settings around the world.
(2) How do we find a way to generate revenue (ethically) to maintain, sustain and grow Shifra globally without being reliant on donations by 2025?
What is it that most attracted you to Amplify instead of a more traditional funding model?
The 18 months of HCD training and support. I am committed to ensuring that the voices of the women Shifra has been designed for aren't just heard but that they are listened to and acted upon at every stage of this iterative journey. Partnering with OpenIDEO helps me remain accountable to the HCD model and ensure that I (and my team) don't forget why we started this journey and who it's for. Shifra and mAdapt is as much about the process of getting to the solution, as the solution. They own this.
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?
How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?
Is your organization registered in the country you intend to implement your idea in?
We are not currently a registered entity.
My organization's operational budget for 2016 was:
What do you need the most support with for your innovation?
Business Development / Partnerships Support