mCARE: Enhancing neonatal survival in rural South Asia

mCARE: Enhancing neonatal survival in rural South Asia

Baltimore, United StatesGaibandha, Bangladesh
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

mCARE is an integrated mobile phone pregnancy and neonatal health information system for community health workers to enhance maternal and neonatal survival

About Project

Problem: What problem is this project trying to address?

Globally, ~3.6 million newborns die every year with a majority of these deaths occuring in low-resource settings, where most births occur at home. This is the case in South Asia (WHO 2010) where evidence supports that reaching the mother/baby during or immediately after delivery is critical to reduce risk of harmful newborn care practices, to provide essential newborn care and referral, and to identify high-risk babies (preterm, low birth weight) to promote optimal home-based neonatal care that has been shown to reduce mortality risk. Despite numerous health improvements, neonatal mortality has remained frustratingly intractable in Bangladesh, at ~65 per 1000 live births, despite numerous efforts. A major barrier to action is lack of access to the critical window of greatest risk.

Solution: What is the proposed solution? Please be specific!

We are developing mCARE, a mobile phone pregnancy and neonatal health information system which allows pregnancy registration, optimizes scheduling of care to pregnant women and newborns, and facilitates timely emergency response. Our project, uses simple and open-source mobile technologies to overcome health system challenges to achieving quality care, such as: limited contacts between the community and the formal health system; incomplete formal surveillance and registration of pregnancy and vital events, rare notification of delivery or birth registration; delays in immediate care seeking for danger signs; and low coverage of essential newborn visits to identify and treat sick infants. Especially exciting is the use of existing knowledge on gestational age to target care to high risk newborns before they experience crises. This project is being implemented in rural Gaibandha District, working in with the Bangladesh Ministry of Health, it is designed for scale into the health system.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

This system works by enhancing community health workers to perform their signal functions using simple, cloud-based scheduling and support systems. Community health workers are connected to their pregnant clients, and their newborns to improve the delivery of antenatal care by scheduling and follow-up, by compressing the time to respond to crises by allowing families to trigger the mobilization of referral systems, and by creating novel windows of opportunity for intervention through innovative use of known data (eg. Gestational age, previous pregnancy outcome). In rural and remote Bangladesh, we demonstrated mobile birth notification and labor notification systems CAN work, reaching >80% of home births within 8 hours, and >60% of deliveries with trained nurses. JiVitA has successfully dispatched nurse-midwife teams at the onset of labor, resulting in highly skilled birth attendance for 89% of 500 pregnancies, 68% of which were before placental delivery. Birth notification systems have allowed workers to reach over 20,000 neonates within 8 hours of life in these rural communities. Based on these past pilot study successes, our mCARE system strives to improve the provision of routine antenatal and essential newborn care as well as targeting high-risk, preterm neonates for immediate attention; this prophylactic, phone-mediated approach has never been tried, and could represent a novel strategy in fighting neonatal mortality, targeting the window of greatest vulnerability in early life.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Though similar interventions have been tested in South Asia, one unique component of our system is the novel use of available information to target care to potential crises before they occur, using trusted community health worker networks and targeting referrals appropriately to competent facilities capable of handling the crisis at hand. We do not anticipate any challenge from our peers for the growth and success of our project rather we believe this to be a great opportunity to learn from and share our experiences with our peers and for this to be a conducive environment to test evidence for developing best practices for mHealth to enhance maternal and neonatal survival. This hybrid system uses multiple technologies, with a focus on user-centered functionality.

Founding Story

From 2005, when mobiles were introduced into remote rural Bangladesh, we studied their impact, in the absence of formal mhealth programs. Studying hundreds of tragic verbal autopsies, we began to note the role that mobile technologies played in averting deaths. Over 50% of women experiencing an obstetric crisis used a mobile phone to either call a provider, arrange transport, obtain financial aid or get medical advice. These observations, combined with successful demonstrations that we COULD reach ~89% of home births during delivery with skilled care for more than 500 births and within 8 hours for over 20,000 births with labor and birth mobile notification, gave us courage to try what others said could never be done. We realized we CAN develop an integrated mobile phone pregnancy and neonatal health information system that CAN further enhance the coverage of antenatal (ANC) and emergency newborn and obstetric care (EmNOC) in this population to improve pregnancy and birth outcomes.
About You
Johns Hopkins Bloomberg School of Public Health
About You
About Your Organization
Organization Name

Johns Hopkins Bloomberg School of Public Health

Organization Country

, MD, Baltimore, Baltimore City

Country where this project is creating social impact

, XX, Gaibandha

How long has your organization been operating?

More than 5 years

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How long have you been in operation?

Operating for more than 5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Equity.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

We are ultimately trying to reduce neonatal, specifically preterm, mortality. We have determined the feasibility of mobile-phone based birth and labor notification systems, demonstrating that in this challenging, remote area of Bangladesh, newborns could be reached within 18 hours of birth and skilled emergency care could be dispatched in a timely way to 89% of deliveries. Building on strong baseline and pilot-stage feasibility data, we have developed the detailed technical specifications for mCARE: an integrated mobile phone pregnancy and neonatal health information system for community health workers which facilitates pregnancy surveillance and registration, optimizes scheduling and delivery of antenatal and and postnatal care and facilitates timely referrals and emergency response.

What has been the impact of your solution to date?

Globally, there has been a lot of interest in the transformative potential of mHealth. Our project has drawn attention to the possibility of this technology to improve health systems and actually impacting on hard public health outcomes such as neonatal mortality. Use of rigorous epidemiologic methods and well-collected community-based data unveiled patterns of mobile use which are unique in this research space. The pilot tests of labor notification and birth notification inspired us to forge this multidisciplinary, multi-stakeholder partnership with a strong emphasis on government ownership. In addition to global recognition as a Top 11 in 2011 mHealth Innovation, the Government of Bangladesh recognized mCARE as being central to the vision and mission of the Government's National 'Digital Bangladesh' Strategic Plan and have demonstrated interest to scale up the project nationally, within the rural public health system, once efficacy is demonstrated with focus on rigor.

What is your projected impact over the next five years?

We have built this, from the outset, with feasibility of scale in mind, first to a district, and then to the country / region. The system is well-aligned with the Government of Bangladesh’s Digital Health vision, and we have formal Government buy-in to support and expand the system, once tested and demonstrated efficacious in reducing neonatal mortality by 20-40%. Public-private partnership models are being explored currently to develop the “phone as an antenatal vaccine” concept – providing antenatal phones to pregnant women at no cost either through an NGO/Government service delivery model, or through a post-pregnancy rent-to-own model. We anticipate documented cost-savings in worker function attributable to the mCARE system which will offset the initial cost of investment.

What barriers might hinder the success of your project? How do you plan to overcome them?

The progress and accomplishments of the mCARE project to date have been overwhelmingly positive. The national and global recognition given to this project, even in early development, was unexpected. Limited startup funding, however, has required careful progress at a slower than desired pace to ensure quality and 'best practices' across the development to deployment / evaluation continuum, but also to ensure appropriate interoperability with the national Government systems, who have requested and received formal partnership status in the mCARE project. We have introduced the mCARE activity to colleagues at the Bill and Melinda Gates Foundation, the Rockefeller Foundation, NORAD, and USAID. We have also discussed possible interest in mCARE scale up with colleagues at GSMA, QualCOMM and WHO

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Integrated mCARE system developed, deployed and preliminary evaluations begun.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Integrated mCARE system designed and developed with end-users.

Task 2

Qualitative assessment of system function and information flow

Task 3

Stable deployment of mCARE in government and NGO workforce

Now think bigger! Identify your 12-month impact milestone

Launching of mCARE system trial to establish efficacy in reducing mortality

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Successfully obtain funding for mCARE trial in rural Bangladesh

Task 2

Train and recruit study staff to implement trial protocol

Task 3

Obtain ethical clearances and begin enrollment of participants

Tell us about your partnerships

mCARE system is aligned with the Bangladesh Digital Health Strategy, and we have formal Government buy-in to support and expand the system, once developed and demonstrated efficacious. Working closely with our existing field research infrastructure, and social programming teams from mPower-Health, a globally recognized mHealth development and deployment group based in Bangladesh, we will be using mixed method evaluation strategies to measure interim process and functionality benchmarks, user and client satisfaction, and some useful proxy indicators of service delivery / receipt.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

At present we are not targeting other specific populations, locations, or markets for our project.

What type of operating environment and internal organizational factors make your innovation successful?

We believe in local capacity-building and in developing highly independent teams of skilled, local staff and scientists. We built, with these partners, a research enterprise that began with 5 people, that now exceeds 850, mostly women, mostly rural - for whom this work is their first employment. Our belief that this project, by women, about women, for the public health of women and their families has been successful because of this philosophy of trust and local empowerment. We also operate in an environment of innovation out of necessity - in rural Gaibandha, the need to create specific solutions that match the environment around us has spurred innovation in many field methods. This partnership is what leads us to excel and build on one another's successes to improve health and well-being.

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