mHealth for Mother and Child: An mHealth tool to identify high-risk pregnancies and assess maternal health

mHealth for Mother and Child: An mHealth tool to identify high-risk pregnancies and assess maternal health

Iraq
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
< $1,000
Project Summary
Elevator Pitch

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

AMAR aims to reduce the number of mothers in Iraq who die or suffer injury during labor and delivery by introducing a decision support tool that traditional birth attendants can use for early identification of those at risk for complications.

Maternal death and disability due to complications during labor and delivery remain epidemic in rural areas of Iraq. These complications are almost always preventable if care is sought promptly and a competent healthcare facility is reached in time for emergency treatment to be rendered. The project will focus on eliminating the delay in pregnant women’s decision to seek care by providing decision support for them.

About Project

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

This project is innovative in two ways. The first innovative element is the integration of an existing human system of preventive health care with a technological tool. The IVR system will provide AMAR TBAs/WHVs with access to information that will improve their capacity to diagnose high-risk pregnancies during home visits to pregnant women. This increased knowledge both empowers TBAs/WHVs and strengthens AMAR’s TBA/WHV programs, which have already been immensely successful in training TBAs/WHVs and improving health care for people living in the marshlands. The second innovative aspect of this project is the combination of a technology decision support system with a local network provider accessed using a toll-free number. The concept envisages that cell-phones and toll-free network access be provided as Corporate Social Responsibility (CSR) by Zain Iraq, recognizing the potential for positive advertising and growth of market share, particularly of network access through privately purchased air time. The result will be a sustainable and expandable system to support health workers at the community level.
Impact: How does it Work

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

AMAR proposes to develop a simple Interactive Voice Response (IVR) tool that would enable Traditional Birth Attendants (TBAs) and other Women Health Volunteers (WHVs) to identify early those pregnant women in the southern Iraqi marshland governorates of Maysan, Thi-Qar, and Basra who are at risk of labor complications outside their ability to manage successfully, so they can refer them to a capable medical facility before labor begins. Each of AMAR’s 560 WHVs in the marshlands currently visits approximately 50 families twice per month, directly benefitting around 80,000 Iraqis. In addition to WHV visits, AMAR’s 30 to 40 TBAs have aided thousands of women in giving birth since a training program began in 2007. AMAR, in conjunction with the mobile phone company Zain, will provide 30 to 40 of its TBAs and WHVs, all of whom will undergo a rigorous selection process, with the handsets and training to use the IVR tool in order to assist pregnant women in the marshlands. The IVR will be delivered in Arabic (Iraqi dialect). Access will be through dialing a designated toll-free number and responding to the menu options. The IVR software will be configured to provide unambiguous decision support for referral and for data collection to support evaluation studies as to effectiveness.
About You
Organization:
AMAR International Charitable Foundation in the United States of America (AMAR U.S.).
About You
First Name

Christopher

Last Name

Kyriacou

Twitter
About Your Organization
Organization Name

AMAR International Charitable Foundation in the United States of America (AMAR U.S.).

Organization Phone

(202) 638-0330

Organization Address

1616 H St., NW

Organization Country

, DC, Washington

Country where this project is creating social impact

, MY

How long has your organization been operating?

More than 5 years

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Innovation
What stage is your project in?

Idea phase

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

Almost three decades of damaging governmental policies, internationally-imposed sanctions, poor management, inadequate resource allocation and three major conflicts have all had a profoundly negative impact on Iraq’s health system. Many talented medical professionals fled the country, and younger professionals who remained were cut off from the major advances in global health care procedures and standards which occurred over the period.

As a marginal/rural area, the southern Iraqi marshlands endured many years of neglect and subsequently active and violent persecution under the former regime, resulting in the forced displacement of virtually the entire population to other parts of the country or to refugee camps in neighboring countries. The return of up to 400,000 people after 2003 placed immense pressure on the decimated and virtually non-existent primary health care structure in the marshlands.

The provision of adequate health care services is crucial to ensuring the stability of this population and to avoiding further displacement to urban areas (which would in turn exacerbate the existing acute problems of squatting, overcrowding, poverty, unemployment, violence and lack of basic services in Iraqi cities).

Share the story of the founder and what inspired the founder to start this project

In 1991 the Iraqi regime of Saddam Hussein began persecuting the Marsh Arabs in southern Iraq, draining the marshes and attacking the villages. Baroness Emma Nicholson visited the refugee camps and Iraqi marshes in September 1991 and, deeply moved by what she saw, subsequently launched an appeal to send much needed relief. As increasing thousands of Marsh Arabs became refugees, the one-off AMAR (Assisting Marsh Arabs and Refugees) Appeal developed into the AMAR International Charitable Foundation. Although the charity has since evolved far beyond this original remit, the AMAR name continues, reflecting our history, and, as the word ‘amar’ translates as ‘the builder’ in some Arabic dialects, reminding us of our central mission – ‘rebuilding lives’.

Baroness Nicholson was inspired to start the specific mHealth project proposed because of her belief that Iraq’s future will be determined by the success of its people—both economically and in terms of their health and wellbeing. The implementation of the IVR system by an Iraqi network provider and the use of that system by Iraqi WHVs and TBAs contributes to both of these components of success. Furthermore, Zain Iraq’s generous support for AMAR’s work can be even more successfully leveraged by using their technology to further increase Iraqis' quality of life.

Social Impact
Please describe how your project has been successful and how that success is measured

AMAR’s WHVs and TBAs have achieved success in delivering health care services to rural Iraqis in the southern marshlands. This success bodes well for the implementation of the proposed mobile health initiative, as AMAR’s TBAs/WHVs will be using the IVR system in order to assist pregnant women.

The innovative and far-reaching WHV program is a cornerstone of AMAR’s preventive health care work, directly reaching approximately 80,000 people a month in the Iraqi marshlands alone. The Foundation was one of the earliest pioneers of this WHO initiative, and has implemented it successfully to global acclaim. Local female volunteers receive training in basic health care principles and provide families with health services during home visits.

AMAR TBAs have also significantly improved reproductive health in the marshlands by attending deliveries and visiting women throughout their pregnancies. During a two-year project with the United Nations Population Fund, AMAR provided TBAs with extensive training in delivering infants and monitoring pregnancies. As a result of this training, the number of pregnant women requiring emergency care decreased from 2006 to 2007 in the catchment area of three health clinics in the marshlands.

AMAR will measure the success of its project by monitoring the number of pregnant women reached by TBAs/WHVs trained in using the IVR system, the number of those women who are identified as having high-risk pregnancies by AMAR’s TBAs/WHVs, and the number of healthy live births achieved by these women.

How many people have been impacted by your project?

How many people could be impacted by your project in the next three years?

More than 10,000

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

The IVR system will be running and successfully implemented by AMAR’s WHVs and TBAs during their home visits, directly benefitting approximately 1,000 pregnant women.

Task 1

Conducting a survey to collect baseline data regarding pregnancy in the marshland governorates of Maysan, Basra, and Thi-Qar.

Task 2

Distributing Zain handsets to 30 to 40 AMAR TBAs/WHVs and training TBAs/WHVs on the diagnosis of high-risk pregnancies and use of the IVR software.

Task 3

Monitoring and evaluating the success of TBAs’/WHVs’ use of the IVR system, and adjusting their use of the software per such evaluations.

Identify your 12-month impact milestone

The average number of maternal deaths and complications will have decreased among the first groups of pregnant women (approximately 2,500-3,000) who received assistance from the IVR system.

Task 1

Monitoring the health and ultimate delivery of pregnant women assisted by the IVR system.

Task 2

Ensuring that pregnant women identified as high-risk act upon their referrals by TBAs/WHVs through follow-up inquiries.

Task 3

Facilitating cooperation and communication between hospitals, AMAR’s Primary Health Care Clinics’ (PHCCs) maternal child and health care units and AMAR TBAs/WHVs

How will your project evolve over the next three years?

Over the next three years this project will evolve in two significant ways. First, it will increase the rate of diagnosis of women with high-risk pregnancies, thereby reducing maternal deaths and complications due to such pregnancies. Through monitoring and evaluating indicators of project success, AMAR will be able to continually improve TBAs’/WHVs’ capacity to use the IVR system to diagnose and refer women with high-risk pregnancies. Second, AMAR will seek to build on the project’s success in the Iraqi marshlands and expand the program to other regions of Iraq and other countries in the Middle East in which AMAR works.

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

Barriers to the implementation of the project might include inadequate coordination between all partners involved, the dynamic security situation in the project area, issues with the physical technology in the remote and harsh environment of the southern Iraqi marshlands and issues with the ease of use of the IVR software. In order to address these barriers, the project will be preceded by detailed planning among all partners, in particular the TBAs/WHVs, the district healthcare system, the district hospital, and the local MOH. So that ownership is vested in the local community from the outset, a lead agency will be established in local MOH and district hospitals that have explicit authority to solve local problems. The involvement of a major telecommunications business as a CSR partner should ensure a robust communications system within which IVR will operate. Careful testing of the hardware and software will take place before full roll-out to ensure that WHVs and TBAs can easily use the system. The additional airtime stipend should incentivize TBAs/WHVs and prevent friction at the community level.

Another potential barrier to successful implementation is incorrect usage of the IVR software by the TBAs/WHVs who will be using it. AMAR will overcome this barrier early on in the project by providing training for TBAs/WHVs, as well as incorporating ongoing monitoring, evaluation, and analysis of the project success.

Tell us about your partnerships

AMAR plans to draw upon its longstanding partnerships with Zain Iraq, the Iraqi Ministry of Health, and the local directorates of health in the marshland governorates of Basra, Thi-Qar, and Maysan. AMAR has already developed strong relationships with all of these partners, which will facilitate the success of its new project.

AMAR’s partnerships with the Iraqi Ministry of Health and the local directorates of Health have proven successful because AMAR works with these agencies to create health structures and systems for the long term. Each of AMAR’s Primary Health Care Clinics (PHCCs) in Iraq is run in partnership with the Iraqi Ministry of Health. In addition, AMAR has provided training for health officials and has also helped the Ministry of Health to develop its health care strategy. AMAR’s founder, Baroness Nicholson, is the Honorary Advisor on Health to the Prime Minister of Iraq.

Zain Iraq and AMAR are working together to build and strengthen the health care and education infrastructures in Iraq. Zain generously supports all of the AMAR Foundation’s public health care and education programs, which are providing vital services to over one million Iraqis. Examples of these programs include AMAR’s mother child health care program, Iraqi widows project, and Women Health Volunteers program.

Explain your selections

AMAR has worked successfully with business, national and regional governments and international institutions such as the WHO, World Bank and UN agencies since 1991 and will continue to do so during the implementation of its mobile health tool project. AMAR will be able to rely on the strength of its relationships with the Iraqi Ministry of Health, local directorates of health and Zain Iraq in order to successfully implement the project.

How do you plan to strengthen your project in the next three years?

Following the success of the initial pilot phase in the southern Iraqi marshlands AMAR will seek to strengthen the project locally and geographically by gaining long-term agreements from partners to continue and expand the system developed. AMAR will particularly seek agreement with the Iraqi government to take over the running costs of the project and incorporate it nationwide into the Iraqi public health system.

AMAR will also look to expand the project to other countries in which Zain operates (Bahrain, Jordan,Kuwait, Lebanon, Saudia Arabia and Sudan).

More generally, AMAR will ensure that the IVR software developed is ‘open source’ and available for utilization by other mobile providers in other countries. AMAR will develop relationships with other mobile network and handset providers in countries where AMAR has worked such as Yemen and Pakistan.

Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.

PRIMARY

Limited diagnosis/detection of diseases

SECONDARY

Limited access to preventative tools or resources

TERTIARY

Lack of access to targeted health information and education

Please describe how your innovation specifically tackles the barriers listed above.

The IVR decision support system will result in a larger number of women with at-risk pregnancies being transported to a capable healthcare facility than previously. This will result in a reduction of maternal and infant mortality and morbidity, measured against baseline study data.

AMAR’s use of WHVs and TBAs to implement the IVR will address the lack of access to targeted health information and education faced by pregnant women in the Southern Iraqi marshlands. WHVs and TBAs provide preventative health services free of charge and are often the only contact families receive with trained health workers. Equipped with mobile handsets and the IVR system, WHVs and TBAs will improve access to key preventative tools that will have a direct effect on maternal health outcomes.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.

PRIMARY

Leveraged technology

SECONDARY

Enhanced existing impact through addition of complementary services

TERTIARY

Influenced other organizations and institutions through the spread of best practices

Please describe which of your growth activities are current or planned for the immediate future.

Leveraging technology, enhancing impact through the addition of complementary services, and influencing other organizations and institutions through the spread of best practices are all activities that will occur with the growth of AMAR’s proposed project in the next few years.

Do you collaborate with any of the following: (Check all that apply)

Government, Technology providers, NGOs/Nonprofits, For profit companies, Academia/universities.

If yes, how have these collaborations helped your innovation to succeed?

AMAR’s longstanding partnerships with a range of key stakeholders ensures acceptance of programs at all levels from the community to government ministries. Collaboration with private companies and academia greatly facilitates the project design phase, ensuring a realistic assessment of project viability through the lense of tried and tested commercial experience. Furthermore, rigorous oversight and constant review during implementation leads to continual improvement of project processes and outcomes.