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Hi Moses,
Thankyou for your feedback. Just to respond to the pointers that you have highlighted.
1. The internet condition that will support a connectivity required for video conferencing is a major factor in your project. Have you considered alternatives if connectivity is an issue?
Yes we have. We have a store and forward mode in placed in our system that enables to store patient information in offline mode and then transmit to the specialist when the connectivity is restored. In addition we are also utilizing mobile technology to empower our users to connect to specialists with their phones/ smartphones.

2. I can see the diversity of equipment people will use to access the service, which is great--will you also build capacity of users to effectively use those tools? How will you do that?
For capacity building of female health providers and frontline health workers, Sehat Kahani deploys an online portal of blended learning program. All inducted health providers will be able to access the online module from the convenience of their home or professional organization. The portal will be compatible with smartphone, Tablet and laptop interference. These courses are a crucial component of our first goal of capacity strengthening of diverse service providers to help them apply increased knowledge and understanding of sexuality, sexual and reproductive health and rights (SRHR) in their practices and service provision. Successful certification will be provided to those health providers who demonstrate that they can provide safe and effective sexual and reproductive health care in community and primary care. Our trained intermediaries then train our end users [i.e. adolescents and young women] to effectively utilize the digital tool to avail seamless SRH services.

3) How do individuals find out about available services? How do you get girls to hubs? What’s the attrition rate?
The following methodologies were utilized to assess the barriers, perceptions and increase uptake of SRH services delivered to adolescent girls by utilizing telehealth medium.
1. Capacity Building workshops: Sehat Kahani in collaboration with relevant community stakeholders deploys 1-week training for frontline female providers and female health specialists. The objective is to train them to counsel adolescent girls with regards to their sexual and reproductive health needs and connect to an online specialist using real time technology.
2. Door to door E- health education campaign: Sehat Kahani deploys a door to door health education campaign. Each community health worker is equipped with portable tablet and internet device is responsible to mobilize and provide health education and services to inducted beneficiaries. If needed they are referred to a centralized Sehat Kahani telehealth clinic to avail services. Usually we have observed a 60% follow-up rate among our end users to avail SRH services via our platform
3. Focused group discussions: Cohorts of inducted beneficiaries are engaged in a focused group discussion facilitated by a moderator. The beneficiaries are shown a docudrama [an educational video]. An initial questionnaire is filled out by them before showing the docudrama and another one will be filled out by them after showing the docudrama. The idea is to facilitate dialogue to understand the barriers faced by adolescents to avail SRH services
4. Mohalla campaigns: Separate sessions with community elders and women of the communities are arranged to apprise them of Sehat Kahani outreach program for adolescent girls. Cohorts are engaged in health education and promotion activities to educate community about the need of addressing early child marriages, menstrual health and other reproductive health issues.
5. SMS for community awareness and participation: All enrolled beneficiaries continues to receive health education, promotion and awareness SMS via Sehat Kahani online portal. The SMS portal is also utilized to receive any user feedback and comments.

4) “Have you explored the ways in which girls and young women would want to connect with a provider....would they prefer a video chat? voice call? to connect through a peer or near-peer to feel more comfortable? it will be important to not assume we understand the "who" and "how" here.
We conceptualized our idea based on the following parameters
“For whom?”—Population groups that are the beneficiaries of services. Of particular concern are marginalized groups (i.e., adolescents in displaced regions) because they are especially vulnerable to poor health outcomes. Other vulnerabilities to poor SRH outcomes include disability, gender inequalities and younger age, or developmental stage.
“Where?”—Types of settings where service delivery takes place.
“By whom?”—Types of provider delivering these services. In our case this will be the community health workers who will be delivering SRH services under the supervision of home based female specialist
Based on our prototype and need based surveys, we analyzed that girls and young women preferences varied from using audio or video medium to verbalize their concerns to a home based specialist. While during our pre-demo rounds we encourage our users to avail video consultation facility, we also empower them to utilize the medium they are more comfortable with to share their voice and needs. Our solution therefore is dependent on our user consent of whether the user wants to avail audio or video consultation while connecting with the specialist

5) You propose working with two different age groups - young adolescents and older adolescent and young people. Their SRH needs will be very different, how will the strategies for these groups look different to meet their distinct needs?
We have reach to beneficiaries of all age groups. However, we realized that majority of our beneficiaries belongs to younger age group and therefore requires more support in terms of SRH access. For our young age group, our youth focused programmes are designed and implemented according to key principles that are supported by the World Health Organization (WHO) guidelines. Our strategy is to make services youth-friendly, increase community acceptance of young people accessing SRH services as well as increase knowledge and acceptance among young people themselves. For our older adolescent age group [this includes young women who were married in their adolescents] we are designing safe spaces [our e-hubs] in their communities. We usually conceptualized this as meeting points and “one-stop shops,” which are intended to be a friendly, safe, and non-clinical environment where SRH information and services can be provided.

Dear OpenIDEO 
We really appreciate the feedback we have received from experts via this massive platform. These feedbacks enable us to redefine and reanalyze our ideas that help us to improve our reach to untapped adolescents girls and women in need of SRH services located in disaster struck zones of Pakistan.

Below are the response of some questions experts raised:

1) What’s the prevalence of internet and mobile phone use in your target communities? How do you manage when the internet goes out?
As per 2016 statistics, Pakistan has a total population of 192,826,502 out of which 34,342,400 are internet users. This equates to a 17% penetration of internet uptake in Pakistani population. Continuous Internet availability is indeed a major requirement and hence also a concern for the proposed idea. However, keeping the local limitations in mind, we will propose an infrastructure that allows seamless and complete operations of a clinic/ hub/ kiosk in case of a disruptive connection with the central & communications server. The system can work in an offline mode employing store and forward capability to transmit data to central system or directly to consulting physician/ SRH specialist available in a remote location on next availability of the internet. This may not prove to be the ideal solution but it may well serve the purpose of tele-consultation not being occasionally “real time” but always being “store and forward” and that too without any additional inputs required from any type of user.

2) What’s involved in setting up a hotspot in a crisis or disaster zone?
We are in process of securing partnership with telecom companies for provision of dedicated bandwidth for wireless connecting in crisis / disaster zones of Pakistan. We are also in process to explore options for solar power connectivity for battery-powered modem and wi-fi router to ensure effective connectivity.