Salamat: Healthy Mother, Healthy Family
One-line solution summary:
A maternal health app that improves follow-up and continuity of care through improved patient record access, communication and education
Pitch your solution.
Afghanistan has a dysfunctional healthcare system where under-resourced clinics struggle to serve poverty-stricken patients. They lack basic record-keeping and have no clear way to educate patients or reach them for follow-up.
Salamat ("Healthy") is an app that dramatically improves healthcare outcomes for mothers and newborns. It is the first health app in Afghanistan that accurately and securely stores patient data in centralized records. Providers can access/update patient data on a tablet and remind patients for appointment folIow-up through its automated patient outreach feature, considering only 35% of women complete their follow-ups.
Salamat's 2-year pilot demonstrated its efficacy in transforming maternal health in Afghanistan and other low-income countries by providing a sustainable, cost-effective health data infrastructure and patient-provider connectivity. It also reduces medical errors and incidences of preventable maternal death. Ultimately, our solution will allow local and international stakeholders to customize policies and programs through access to accurate, real-time data.
Film your elevator pitch.
What specific problem are you solving?
Every 27 minutes, a woman in Afghanistan dies due to complications in childbirth. The tragedy doesn’t stop with a mother’s death — in 3 out of 4 cases, the newborn dies too. These deaths can be prevented by a solution that addresses three key barriers to high-quality and affordable health care.
Lack of maternal health education: 87% of Afghan women are illiterate and don’t complete their four WHO-recommended prenatal visits.
Lack of resources: Health facilities aren’t equipped to help patients make informed decisions about their health. 60% of clinicians report that paper-based patient records are extremely difficult to retrieve and time-consuming to complete.
Lack of communication: Once the patient leaves the health facility, pathways to provider-patient communication do not exist.
Every health care provider should be equipped with the tools and resources they need to avoid preventable death. However, because of these barriers, Afghanistan has one of the highest maternal mortality rates in the world. The country is in dire need of an innovative solution that: (a) empowers women to seek maternal healthcare services prior to delivery, (b) enables doctors to easily access and record patient data during the visit, and (c) ensures patient-provider communication post-visit.
What is your solution?
Salamat is the first maternal health app in Afghanistan that securely stores patient records while enabling patient-doctor communication and follow-up. It integrates paper-based patient records with digital data in both offline and online capacities. This introduces efficiencies in the system, allowing providers to make informed decisions regarding patient care. Clinicians can use Salamat to: add patient records, procure existing records, remind patients for overdue visits via text/phone, and schedule appointments.
With funding from Johns Hopkins and USAID, we conducted a 9 month long beta test in five Afghan facilities which demonstrated that:
100% of health facilities retrieved patient records within minutes without the need for manual, labor-intensive paperwork
Retrieving patient records was reduced from 9 minutes to 1 minute, allowing providers to spend more time with each patient.
Automated phone/text message reminders resulted in patient completion of the four WHO-recommended prenatal visits by 650%.
We recognize that scaling technology solutions in under-resourced regions requires adequate training and support for sustainable implementation. Our solution will train clinicians on Salamat and equip them with education/outreach strategies for new and existing patients. Patients will be educated through a culturally competent curriculum created in collaboration with maternal health programs at UCSF and Berkeley.
Who does your solution serve, and in what ways will the solution impact their lives?
Throughout the last 10 years, our team has supported over 50 health facilities in Afghanistan with medical supplies and education/training on maternal health, malnutrition, midwifery, public health, and hygiene. The Salamat technology annually serves 550,000 pregnant women in 10 facilities in Kabul, Afghanistan by providing access to 55 clinicians and midwives to the app.
Community engagement and human-centered design are crucial to every aspect of our solution. Our project is supported by a strong network of diverse stakeholders and our advisory board consists of Ministry of Health representatives, public health experts, clinic directors, and women from the regional community.
Our team completed a comprehensive needs assessment and a 9-month pilot with quarterly reports — including provider-patient surveys and community feedback. We used this data to continuously adapt Salamat and learn best practices of serving the target community.
Data from Salamat will be used by the Afghan Ministry of Health and the international community to develop appropriate policies and programs for specific regions, improving access to quality patient care with short-term and long-term outcomes.
Which dimension of the Challenge does your solution most closely address?
Expand access to high-quality, affordable care for women, new mothers, and newborns
Explain how the problem, your solution, and your solution’s target population relate to the Challenge and your selected dimension.
Salamat is a proven, innovative, and cost-effective solution that improves service delivery and diagnostics for women in a country ravaged by decades of war and poverty. Our solution targets the most vulnerable population in the world: illiterate and uneducated expecting mothers who experience complex challenges in accessing care, from stigma and shame, to income, and lack of education. By using the Salamat app, all clinics have access to centralized data for all patients registered on Salamat and are 6.5 times more likely to provide continuity of care. Ultimately, clinicians can reduce preventable deaths and improve maternal health outcomes in Afghanistan.
In what city, town, or region is your solution team headquartered?Kabul, Afghanistan
What is your solution’s stage of development?
Growth: An organization with an established product, service, or business model rolled out in one or, ideally, several communities, which is poised for further growth
Who is the primary delegate for your solution?
Founder and CEO, Alia Rasoully, MS, MPH
If you have additional video content that explains your solution, provide a YouTube or Vimeo link here:
Which of the following categories best describes your solution?
A new application of an existing technology
Describe what makes your solution innovative.
Despite more than 15 years of international aid and billions of dollars invested in improving maternal mortality in Afghanistan, not a single technology-based solution has been implemented to give clinicians the tools they need to make informed decisions about patient health. Providers are overburdened with high patient loads but spend the majority of their time on traditional, unreliable, and time-consuming patient records.
Salamat is an innovative tool that solves these gaps in Afghan's healthcare system including: a) long and tedious paper record processes resulting in long wait times for patients, b) patients without medical cards are refused care, c) no access to previously recorded medical history, and d) lack of reliable health data at the national level.
Salamat provides access to accurate, real-time data and helps clinicians identify maternal health needs. Its key innovative feature include:
Designed in the local Dari language
Based on Afghanistan’s Health Information System (HMIS) which is compatible with Salamat technology, requiring minimal training for clinicians as they are already familiar with the format and questions
Ability to save and document new patient information and diagnoses for future appointments
Retrieves patient records 3x faster than traditional paper-based records
Efficiently shares patients data among clinics
Ability to communicate with patients beyond health facility via automated text message/call options
Ability to function with and without internet in a region where connectivity and internet coverage is often an issue
Maintains patient confidentiality through high security standards, only providing access to medical professionals with a username and password
Describe the core technology that powers your solution.
Our application does not need any type of terminal (i.e. keyboard and monitors), just a tablet device. All health facilities will have functioning tablets to collect and can retrieve patient data. We use Firebase, a google infrastructure, which has demonstrated scalability into thousands of applications. It provides a real-time database and storage options through a cloud-based system. Analytics, databases, messaging, and crash reporting are also provided on the system. Finally, with the click of a button, clinicians will be able to contact patients and remind them of their visit.
Other key technology components:
Username and password for each clinician to store and retrieve patient records and maintain confidentiality
Intuitive Interface - Questions are organized by subcategory
Data Validation - Reduces errors and ensures proper values are collected and then inserted into the app and the cloud-based system
Data Model - Built around the patient profile, has the ability to access patients' medical history, past visit information, and update lab information, and uses algorithms to identify high-risk patients
Provide evidence that this technology works.
Within the past decade, billions of dollars have been invested on healthcare in Afghanistan by the international community, yet only a handful have had a technology-based focus. These efforts faced capacity constraints, lack of proper and adequate equipment, and limited internet connection access. To date, no technology-based initiatives focus on improving maternal health outcomes in the country other than Salamat.
Research findings from the Health Informatics Journal (2016) demonstrate that providers easily track changes to patients’ health status and efficiently note trends in illnesses due to complete health examination records with electronic health data. It removes worry for physicians having to search for physical charts, significantly improving data quality.
An evaluation of a mobile health system’s impact on adherence to antenatal and postnatal care in Kenya demonstrated is ability to efficiently track pregnant women compared to paper-based methods. Registered patients were 3x more likely to attend antenatal visits than patients who were not. They were also more likely to adhere to the recommended post-delivery baby follow-ups. Currently, thousands of pregnant women are registered in the system.
An existing technology solution in Afghanistan, Algorithms for the Management of Acute Childhood Illnesses (ALMANACH) focuses on antibiotic use for children and common acute infection management. Clinicians use a tablet device during the diagnostic process. ALMANACH is one of the only technological approaches that records patient data in Afghanistan. While it is an electronic version of the IMCI (Integrated Management of Childhood Illnesses), Salamat is the first technology geared towards impacting maternal health outcomes.
Please select the technologies currently used in your solution:
What is your theory of change?
Afghanistan needs a solution that empowers women to prioritize maternal healthcare, enables doctors to easily access/record data, and connects the patient and providers. Salamat addresses these challenges by:
Activity: Women visiting health facilities are registered on Salamat
Output: Amount of time it takes to retrieve a patient's health records is reduced by 50%; Providers access/update 100% of patient records
Short-term outcome: Providers make informed decisions about patient health; 100% of patients complete their minimum for four prenatal visits
Mid-term outcome: Providers spend more time with patients, helping them provide quality maternal care
Long-term outcome: All health facilities are equipped with the tools and technology needed to provide quality care
- Activity: Training/education for health professionals on technology and maternal health
- Output: All health professionals efficiently use the Salamat app and maximize its utility
- Short-term outcome: Training and support provided for clinicians, including community health workers and midwives in both urban and rural areas
- Mid-term: training should be so successful that clinics should be able to move from manual/paper based records to digital records 100% capability to do that.
- Long term outcome: Clinics are 100% self sufficiently running the Salamat technology
- Activity: Improve application features and backend reporting
Output: Comprehensive data on social and medical needs of patient is compiled
Short-term outcome: Reporting to international stakeholders on a quarterly basis and highlights key challenges and gaps unique to different regions in Afghanistan
Mid-term outcome: Stakeholder advisory sessions to develop innovative programs from supporting data.
Long-term outcome: Ministry of health and international stakeholders design appropriate policies and programs based on accurate data
- Activity: Develop patient platform using human-centered design
Output: Women and clinicians contribute to the development of this platform to ensure that it can innovatively educate communities (pregnant women, spouses, their families), despite barriers to education in the country
Short-term outcome: Women have access to basic health information, including malnutrition, lactation, breastfeeding, and other public health topics. They also have access to their health history and records.
Mid-term outcome: Artificial intelligence is used to identify high-risk pregnancies and women who require additional emotional and wellness support
Long-term outcome:Women deliver healthy babies.
Select the key characteristics of your target population.
Which of the UN Sustainable Development Goals does your solution address?
In which countries do you currently operate?
In which countries will you be operating within the next year?
How many people does your solution currently serve? How many will it serve in one year? In five years?
Our solution was launched in 2018 and is currently implemented in 10 maternal health facilities in Kabul, Afghanistan, serving approximately 500,000 pregnant women annually and 55 clinicians and midwives.
In a year, we will deploy this technology to all urban health facilities in Kabul, expanding the number of women served to over 3 million. Several planning sessions were held in January 2020 with the Ministry of Health to plan this expansion which will result in access to the Salamat application for over 500 clinicians, allowing them to make informed decisions and improved efficiency of application usage. This will give them the additional time they need to spend with their patients, giving them time to properly diagnose them and understand their needs, and ultimately providing quality care to their patients.
Within the next five years, we will expand nation-wide in Afghanistan, primarily focusing on rural areas, where women are most likely to die from preventable maternal mortality. This expansion will impact an estimated 10 million expecting mothers each year. Furthermore, there is strong potential to expand Salamat to other countries where the population has similar maternal health needs and our team has held preliminary negotiations with organizations in Mexico, Rwanda, Pakistan, and India.
What are your goals within the next year and within the next five years?
Goal 1 - FUNCTIONALITY, REPLICATION, AND SCALABILITY: During our pilot, we collected feedback on challenges and gaps in our app's functionality and performance. We used human centered design and clinic/community involvement to assess Salamat’s ability to improve maternal health outcomes. Using these findings, we collaborated with the Ministry of Health to create an expansion plan.
ONE YEAR IMPACT: All modifications and improvements are completed including bug fixes, software updates, adding/replacing questions, back-end reporting, user experience, and interface, impacting 3 million patients.
FIVE YEAR IMPACT: Salamat is functional and has the ability to scale nation-wide impacting an estimated 10 million patients. It is also piloted in countries with demonstrated interest, need, and potential (Mexico, Pakistan, Rwanda, and India).
GOAL 2 - TRAIN AND EDUATE CLINICIANS AND PATIENTS: We will design a patient platform that leverages a developed curriculum designed by our existing partners and provide access to education for patients in all facilities. We will also train clinicians on outreach and education strategies.
ONE YEAR IMPACT: Clinicians are trained on the application and a training module is incorporated in all facilities, including educational institutions for future users. Develop a patient platform that educates women on antenatal and postnatal care.
FIVE YEAR IMPACT: Internal training is provided to facility staff. Capacity-building and training sessions are tailored to the roles and responsibilities of staff members. Patient platform and health education resources are accessible for public use on topics such as malnutrition, lactation, contraception, hygiene, public health, gestational diabetes, preeclampsia.
What barriers currently exist for you to accomplish your goals in the next year and in the next five years?
In our pilot program, 69% of staff were able to effectively use Salamat while 31% reported they needed additional training and capacity development. Midwives, nurses, and other clinical support staff receive minimal training in their respective field and are not familiar with modern technology. In order for our program to be sustainable, clinicians must be the front-end users of our application. There must be a staff-wide training program to improve clinic community competency and app interface.
Cultural Values and Family Pressures
In Afghanistan, there is a stigma associated with women visiting doctors. Afghans believe that strong and healthy women should be able to deliver with minimal to zero need for intervention by a doctor. 40% of women in Afghanistan do not receive prenatal and antenatal care during their pregnancies. 65% of women in our pilot came to an appointment for the first time, while only 35% came for a follow-up visit.
Although there is demonstrated need for a technology that accurately and efficiently records patient data, investors may be hesitant to support a technology in a region with decades of war. Public health facilities don’t even have basic medication and both public and private health facilities do not have a system in place for consolidated and streamlined records.
How do you plan to overcome these barriers?
The Ministry of Health allocated a multi-million dollar budget for capacity-building. Donors will help address this barrier by funding technical support for 3 years; our goal is capacity-building for clinicians (as front-end users) to model and teach usability to staff reducing overall support over time. Progress will be tracked through self-assessments and quarterly reports. We will also tweak app design based on feedback from our pilot program and conduct through performance improvements so that it is easy to use and more literacy friendly.
Cultural values and family pressures
The automated phone call/text message feature providing appointment reminders has resulted in spousal behavior change in the pilot program. Spouses were not previously educated on the importance of maternal care and once registered on the application, they were 6.5 times more likely to complete their minimum visits. Maternal health education through a patient platform, emphasis on continuity of care and communication with providers will continue to be a core component.
Reach: Our team has a decade of experience in urban and rural areas to provide health access for women and children.
Opportunity: Our partner organizations have invested billions of dollars in Afghanistan's healthcare system and believe Salamat’s potential as an untapped market opportunity. Our deep ties with community leaders, provincial representatives, and the Afghan government will enable us to effectively scale our program.
Sustainability: The private sector has expressed interest in investing in Salamat. Local and international stakeholders will compensate for annual data collection.
What type of organization is your solution team?
Hybrid of for-profit and nonprofit
If you selected Other, please explain here.
How many people work on your solution team?
25 team members, who are currently volunteering time part-time
How many years have you worked on your solution?
Why are you and your team well-positioned to deliver this solution?
Our team consists of experts with decades of experience in international development, healthcare, education, innovation, and technology. Our organization has operated in Afghanistan's most remote areas to reach and transform the lives of women and children who don't have access to basic healthcare and education. Human-centered sustainable design and community-led development are our core pillars.
Members of our team include advisors, volunteers, and board members from:
- Ministry of Health
- Afghan President's office
- Grass-roots workers at the rural level
- Physicians with reputable backgrounds/experience in the US and Afghanistan
Our CEO, Alia Rasoully holds an MBA and MPH from Columbia University. Through Salamat, Alia has developed deeply-rooted ties with local communities and tribal elders to provide innovative healthcare and educational solutions. She established the first cancer center in Afghanistan.
Kowsar Gowhari, JD/PhD in Global Health, is our business and legal strategist. She received her master of Negotiation and Conflict Resolution at Columbia University and worked for the American Red Cross, American Civil Liberties Union, International Rescue Committee, and the U.S. Office of Refugee Settlement.
What organizations do you currently partner with, if any? How are you working with them?
We have a team of global partners.
US: University of California in San Francisco, Berkeley University, and John Hopkins University. Our goal with these universities is to adapt educational curriculum for workforce development and training. We are also working with them to develop a patient education platform. John Hopkins University provided a $100,000 grant to complete our pilot in 2018.
Afghanistan: 10 public and private universities. In March 2020, we signed a Memorandum of Agreement with Malalai University in Kandahar, the second largest city in the country but the lowest number of females enrolled in school. Our goal is to train future medical professionals and provide job placement, internship opportunities.
Ministry of Health: We have signed a Memorandum of Understanding with the Evaluation Unit, the Malnutrition Unit, and the International Relations Department at the Ministry of Health. Our solution was recognized by the Deputy Minister of Health in 2018. We also participate in quarterly advisory sessions to discuss innovation and capacity development of health workers with the Ministry.
Health Facilities: We have provided support and resources to thousands of women and children in over 50 health facilities throughout Afghanistan. We currenlty have a pilot partnership agreement with five health facilities and plan to expand this to all urban health facilities.
Private and Private Sector: We have several local and international private partnerships and donors. Some examples include the Afghanistan telecom company, Roshan and Salaam Nutritional. We collaborate with over 25 nonprofit and social impact organizations based in Afghanistan.
What is your business model?
Value proposition: Quality maternal health for all Afghan women, regardless of their background and socioeconomic status. We demonstrate impact by equipping healthcare systems and providers with a product that efficiently collects data while enabling clinicians to provide quality and continuity of care. Our primary beneficiaries are pregnant women in vulnerable regions.
Key partners and stakeholders: Health systems and facilities who use the application and policymakers, donors, research entities, and other international stakeholders who are in need of data to design informed policies and programs.
Developing, updating, and adapting a mobile app for clinical clinical staff to provide patients with quality care. Features of this app include data collection, consultation, diagnostics, and communication with the patient
Training and capacity development for clinical staff, including but not limited to, clinicians, community health workers, midwives, and other support staff to help them use Salamat technology
Developing innovative and cutting-edge strategies to educate women on their health and well-being
Revenue: We will provide this support at no cost to under-resourced health facilities that are overburdened with high patient loads.The operational cost for expansion and sustainability is very minimal once health workers are trained because the app is already developed with demonstrated success in implementation. For revenue generation, we will incorporate sales strategies that provide health system licensing and subscriptions for private health facilities to subsidize our technology services in public clinics. Grant opportunities and private funding will also support our solution as additional revenue sources.
Do you primarily provide products or services directly to individuals, or to other organizations?
What is your path to financial sustainability?
Today, the number of Afghan women dyin from pregnancy or childbirth may be more than twice as high than numbers provided by government and donor data. There are discrepancies in reporting from entities like the USAID, WHO, and the Ministry of Health and a need for a solution that provides accurate, standardized, and reliable data. Salamat is the first technology that digitizes maternal health data and provides de-identified analytics to local and international stakeholders. Providers also use this information to retrieve patient records and make informed decision on their patient's health. We plan to provide these analytics and reporting tools using a licensing fee.
In Afghanistan, public health facilities are free for all patients and mainly serve patients living in poverty. On the other hand, private facilities charge patients for visits. We piloted Salamat in both public and private health facilities to gauge interested and determine need.The findings from our assessments determined an interest and need in both types of facilities.
We will charge private health facilities a monthly cost for access to our application. This includes services like electronic data collection, automated phone/text message options, quarterly reports, and technical training/support. Our primary customers are private health facilities/systems and private insurance companies.
Profits generated will provide service at no cost to public health facilities, who will benefit from our technology due to their significant patient loads and limited resources.
We will also continue to seek funding from donors and investors to help us achieve our maternal health goals in Afghanistan.
If you have raised funds for your solution or are generating revenue, please provide details.
From 2018 to date, our team has raised over $240,000 for our beta testing and pilot program. The initial development and beta testing of the Salamat application was completed via in-kind and private donations of $100,000. This investment capital allowed our team to build the proof of concept and complete baseline testing and surveys with 10 health facilities in Afghanistan.
Next, we selected 5 public and private maternal health facilities to complete a one-year pilot through a maternal health innovation grant from John Hopkins University which we received in 2019. The total amount of the grant was $100,000 and we raised an additional $40,000 in private donations to support the program. Our pilot was recommended for scale from John Hopkins University to the Ministry of Health who authorized our work plan and supported our initial one-year expansion plan. In 2020, we have held several planning sessions to develop a sustainable plan for expansion of the app and identified several funding opportunities, which have not been confirmed.
If you seek to raise funds for your solution, please provide details.
Our team seeks to raise approximately $1 million over the next two years to complete expansion of our application in all urban health facilities in Kabul, Afghanistan. We have had several planning sessions with the Ministry of Health and they have committed to including our project in their 2021 ‘Technical Development of Health Workers’ budget, which is over $5 Million. Salamat is expected to receive at least $250,000 in funding from this budget in 2021.
Additionally, the USAID has a multi-million dollar budget dedicated to maternal health innovation in Afghanistan and we have been recommended by leaders at the Ministry of Health and our prior grantor at John Hopkins for this fund. We were the only innovation pilot program in Afghanistan recommended for scale out of the 5+ recipients from John Hopkins.
Our team also has strong relationships with the public and private sector in Afghanistan and is exploring opportunities for in-kind contributions for organizations like telecom companies to sponsor and provide free internet and telecommunication services for our program.
The remainder of our funds will come from grants and equity.
What are your estimated expenses for 2020?
Our estimated total operating budget for the remainder of 2020 is $230,000
Technical and Program Costs
Improve application performance and development: $30,000
Technicians, training and support staff: $50,000
Equipment, including laptops, tablets, and other devices/software: $20,000
Volunteer stipend and expenses: $25,000
Admin costs: $30,000
In-kind cost share
US-based staff: $50,000
Office space: $25,000
Why are you applying to Solve?
Our innovative solution has demonstrated potential to transform the lives of millions of women who don’t have access to quality healthcare. We made tremendous progress through our pilot and the support of our existing partners. Specific barriers that the Solve team can help us address are related to technology and market penetration in the region.
Grant support from Solve will allow us to improve Salamat's app functionality and design, and provide technical support and training for clinic staff. This will make a significant impact on our scalability in areas where clinicians don't have adequate technical capacity.
Investment in our solution from MIT Solve, as a reputable partner, will enable us to overcome market barriers in Afghanistan and gain exposure to scale our work. Along with existing funding and support, MIT Solve' will help us increase our investment potential from other external sources.
By joining the Solver family, we will be able to multiply our impact and gain access to the expertise and resources available to successfully scale. MIT Solve's commitment to investing in ground-breaking technology solutions that transform the lives of millions of people aligns with the mission and values of our solution. Your support and connection to a large, robust network and valuable resources will help deepen our impact.
In which of the following areas do you most need partners or support?
Please explain in more detail here.
Solution technology: Our team seeks mentorship and advice for a final prototype of the application for Afghanistan. Because of our global scalability potential, advice and input from Solve would allow us to customize the app that meet the needs of specific regions all over the world.
Business model: Although we have pathways to sustainability and revenue generation, we would like to recruit experts, leaders, and advisors to support us with our business model through the Solve community
Marketing, media, and exposure: Solve's diverse and extensive network will give our product exposure opportunity and achieve to its full potential.
What organizations would you like to partner with, and how would you like to partner with them?
We would like to partner with MIT faculty and existing initiatives that focus on maternal health education components. This will help us to continue updating our curriculum to ensure it is comprehensive and robust. Faculty team can also help us with research design and analysis of our data points in Afghanistan.
Additionally, experts in strategy design and business model concepts will be useful in guiding us to successfully scale and would be a great asset.
We are interested in partnering with Save the Children, an organization that is active in Afghanistan to launch innovative maternal and newborn health initiatives.
Johnson and Johnson, another MIT Solve partner is a global leader in healthcare focused on addressing gaps and investing in bolder and smarter approaches to overcome health inequities. We hope to partner with them to expand to rural and underserved populations.
Do you qualify for and would you like to be considered for The Andan Prize for Innovation in Refugee Inclusion?
Explain how you are qualified for this prize. How will your team use The Andan Prize for Innovation in Refugee Inclusion to advance your solution?
Afghans have been fleeing violence in their country for forty years and are one of the world's largest protracted refugee population. According to Amnesty International, there are more than 2.6 million registered Afghan refugees in the world. Our partner organizations in Greece, Iran, and Turkey, which receive the largest influx of Afghan refugees have expressed challenges, including language barriers and lack of efficient processes, to collect patient physical and social health data. Pregnant women and children arethe most vulnerable groups in these regions.
Salamat has the potential to not only register maternal health patients in these regions, but also track the type of care, the time and place they receive it. Because it is designed in the local Afghan language with an available English translation, international organizations will also use the app to register patients and provide continuity of care. This will improve maternal health outcomes for vulnerable Afghan women beyond Afghanistan.
Do you qualify for and would you like to be considered for the Innovation for Women Prize?
Explain how you are qualified for this prize. How will your team use the Innovation for Women Prize to advance your solution?
Afghan women have suffered major consequences due to poor healthcare systems. Early diagnosis and management, good hygiene, and drug administration, can help maintain pregnant women’s health (WHO, 2018). However, in order for pregnant women to receive this assistance, they must first overcome barriers to healthcare—a struggle that is significantly common for Afghan women.
Another barrier is lack of knowledge when it comes to reproductive health. As of 2017, of the 9.3 million Afghan children in school, only 39 percent are girls are in school (Human Rights Watch, 2017). Women who do not attend school are at risk for health complications and believe “there is no reason to seek health care when you feel healthy, you only see a doctor only when it is absolutely necessary." These statements reflect limited knowledge of ante/postnatal care practices.
Our solution empowers women and girls in the following ways:
It registers maternal health patients on Salamat, reducing the burden on female health workers who can spend more time with their patients, allowing them to voice their concerns and advocate for their health.
Training/capacity development for female health workers will help them efficiently use the app and provide access to necessary maternal health knowledge and data. This will allow them to connect to a virtual network of providers in rural areas and throughout the country.
It develops an innovative patient platform using human-centered design to educate pregnant women, spouses, their families, despite barriers to education in the country. This provides access to basic health information.
Do you qualify for and would you like to be considered for the Health Workforce Innovation Prize?
Explain how you are qualified for this prize. How will your team use the Health Workforce Innovation Prize to advance your solution?
There is a shortage of female health workers in Afghanistan due to limited educational opportunities and cultural restrictions, especially in rural areas. The existing female health workers are understaffed and overburdened with patients who have limited information about their health. Health workers are also required to follow tedious, paper-based patient record-keeping processes that take more time to complete than seeing their patients.
Our product introduces an innovative, record keeping, and connectivity tool to female health workers. It allows them to electronically access 100% of patient records and reduces the amount of time to retrieve it by 50%. This significantly decreases the burden of female health workers. The time they save by using our app allows them to spend more time with their patients. Salamat's access to prior health history helps them make informed decisions instead of misdiagnosing their patients.
Results from our pilot indicate that providers found it easier to access patient records through Salamat as opposed to manual record keeping, patients returned for follow-up care. Female health workers reported it was 3.828 easier to use Salamat rather than paper-based records. The difference between the two is statistically significant.
Our goal is to reduce preventable maternal mortality and ensure continuity of care by equipping medical teams with affordable clinical tools to improve their planning, process, and productivity. Using this prize, we will also provide a virtual care platform for female health workers in rural areas who need additional support from clinicians.
Do you qualify for and would you like to be considered for the AI for Humanity Prize?
Do you qualify for and would you like to be considered for the Bill & Melinda Gates Foundation Funded Award?
Explain how you are qualified for this award. How will your team use the Bill & Melinda Gates Foundation Funded Award to advance your solution?
Decades of conflict and economic instability wreaked havoc on Afghanistan’s healthcare infrastructure. While the Afghan government has made strides since 2003 to increase the quality of and access to healthcare through donor support, Afghan women still face tremendous barriers to basic care, and Afghanistan’s maternal mortality rate remains one of the highest in the world. As of 2015, the country’s maternal mortality rate is 396 per 100,000 live births (World Bank). However, investigations an unpublished study from the United Nations Population Fund demonstrates discrepancies in the provided data, stating that the maternal mortality rate is actually between 800 and 1,200 per 100,000 live births (2017). These discrepancies combined with lack of access to rural areas by the international community to collect accurate data makes it challenging to design, implement and prioritize interventions tailored to the needs of women and newborns.
The majority of these deaths are preventable. However, lack of maternal health education, resources/support for health facilities, and lack of communication between patients and providers contributes to Afghan being considered one of the worst places to be a mother today. The country is in dire need of an innovative, cost-effective solution that: (a) empowers women to seek maternal healthcare services prior to delivery, (b) enables doctors to easily access and record patient data during the visit, and (c) ensures patient-provider communication post-visit.
Our partnership with the Ministry of Health has helped us conduct thorough assessments with patients and health providers to develop an innovative solution that addresses these needs. We developed the first maternal health app in the country based off the Afghanistan Health Management Information System (HMIS), which makes the format of the app user friendly for clinicians who are familiar with the paper-based system. After we completed beta testing in 10 health facilities, we signed a Memorandum of Understanding with the Ministry of Health to pilot the Salamat application in both public and private health facilities in Kabul, Afghanistan. We worked in close coordination with the Afghan government to identify these facilities and used appropriate hospital procedures and guidelines to complete the pilot.
Results from our pilot demonstrate that providers found it easier to access patient records through Salamat as opposed to manual record keeping, patients were 6.5 times more likely to return for follow-up appointments from the automated reminder component on the app, and there was no difference in buy-in for Salamat between providers from private and public facilities.
Salamat improves planning, processes, and productivity of health facilities through its centralized data collection system. This allows them clinicians and staff to run their organizations and provide higher quality care for women. Additionally, it gives local and international stakeholders accurate and up to date data on maternal health in order for them to design relevant interventions needed in a specific community or region.
Our team has designed a long-term scaling plan with the Minsitry of Health and other internal partners. Our one-year goal is to incorporate the Salamat application into all urban health facilities in Kabul, Afghanistan. However, we recognize that scaling technology solutions in under-resourced regions requires adequate training and support for sustainable implementation. Our scaling strategy consists of the following short-term and long-term outputs to make this a success:
Register all maternal health patients on the Salamat application and equipping all health facilities with technology to provide efficient, quality care. This will identify high risk pregnancies and combat inequities faced by extremely vulnerable populations, including women who are uneducated and living in poverty - earning less than a dollar per day.
Training and capacity development for clinicians to use the app and to connect a virtual network of providers, particularly in rural areas where additional support will be needed. This will improve maternal health outcomes for all women throughout the country.
Develop an innovative patient platform using human-centered design to educate women and their families, despite barriers to education in the country. This will enable women to have access to basic health information, including malnutrition, lactation, breastfeeding, and other public health topics. They also have access to their health history and records and deliver healthier babies.
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Since 2003, the Afghan government, in partnership with international communities, has spent billions of dollars on improving the healthcare system throughout the country. However, Afghan women still face tremendous barriers to basic care, and the maternal mortality rate remains one of the highest in the world. Additionally, there are discrepancies in existing data from various reputable entities, including the Ministry of Health, the UN, and USAID. This, combined with lack of access to rural areas by the international community to collect accurate data makes it challenging to design, implement, and prioritize interventions tailored to the needs of women and newborns. In a country where reliable data is so elusive, a stronger focus on monitoring progress, and further investment in it, is desperately needed, or the benefits of the large amounts of aid invested into healthcare system will remain unclear.
Additionally, services from well-trained health professionals and well-equipped medical institutions are important causal factors in reducing maternal mortality. But increasing healthcare provider numbers is not enough; there must be a corresponding increase in the quality of care received to achieve the best outcomes for mothers and their newborns.
Salamat combats these challenges and is the first, innovative electronic health record technology that records and centralizes data, increases access/retrieval of patient records on a tablet, and empowers providers to make informed decisions regarding patient care. The application also has an automated patient reminder feature that contacts them when they are due for another appointment.
Salamat includes the following key features:
Provides patient data at the fingertips of healthcare professionals for easier follow-up and updates
Is based off the Afghanistan Health Management Information Systmem (HMIS), which hospital staff are already familiar with and the Ministry of Health has invested greatly in
Users will be able to continue using the app if there is no internet connectivity
We piloted Salamat in both public and private health facilities to gauge whether or not they would be interested in our solution.The findings from our baseline and endline assessments determined an interest and a need for our technology in both types of facilities. We will charge private health facilities a monthly cost for access to our application.
This monthly cost will include services such as electronic data collection, automated phone/text message options, quarterly reports from Salamat staff, and technical training and support for each health facility. Our primary customers will be private health facilities and systems as well as private insurance companies. Profits generated from these customers will provide service at no cost to public health facilities, who will benefit tremendously from our technology solution due to their significant patient loads and limited resources.
We will also continue to seek funding from donors and investors to help us achieve our maternal health goals in Afghanistan.
- Alia Rasoully President, Founder, WISE Afghanistan