mHealth for Mother and Child: An mHealth tool to identify high-risk pregnancies and assess maternal health
- Corporate social responsibility
- Health care
- Health education
- Infant health
- Maternal health
- Reproductive health
- Women's issues
Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.
Christopher
Kyriacou
AMAR International Charitable Foundation in the United States of America (AMAR U.S.).
(202) 638-0330
1616 H St., NW
, DC, Washington
, MY
More than 5 years
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Idea phase
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).
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.
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.
More than 10,000
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.
Conducting a survey to collect baseline data regarding pregnancy in the marshland governorates of Maysan, Basra, and Thi-Qar.
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.
Monitoring and evaluating the success of TBAs’/WHVs’ use of the IVR system, and adjusting their use of the software per such evaluations.
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.
Monitoring the health and ultimate delivery of pregnant women assisted by the IVR system.
Ensuring that pregnant women identified as high-risk act upon their referrals by TBAs/WHVs through follow-up inquiries.
Facilitating cooperation and communication between hospitals, AMAR’s Primary Health Care Clinics’ (PHCCs) maternal child and health care units and AMAR TBAs/WHVs
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.
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.
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.
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.
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.
Please select up to three in order of relevancy to your project.
PRIMARY
Limited diagnosis/detection of diseases
Limited access to preventative tools or resources
Lack of access to targeted health information and education
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.
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Leveraged technology
Enhanced existing impact through addition of complementary services
Influenced other organizations and institutions through the spread of best practices
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.
Government, Technology providers, NGOs/Nonprofits, For profit companies, Academia/universities.
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.