Solution Overview

Solution Name:

Health Referal and Clinic Reminder App

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One-line solution summary:

To help health care facility systems to maintain access to essential health services for mothers and children in the context of COVID-19

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Pitch your solution.

The COVID-19 crisis has led to some public health restrictions which has caused reduced morbidity and health care outreaches to achieve social distancing. This has led to decreased access to timely and frequent antenatal care and delivery in hospital especially in developing counties. This could result in a raise in maternal and neonatal mortality ratio rate and pregnancy related complications. Technology can help to form and maintain active collaborations  between mothers, CHWs and HCWs for continuity of health care through implementation of a digital referral, clinic appointmnt tracking and SMS appointment reminder system. In addition,  the system can provide a HCW with information to plan client visits to enforce social control measures, provide an emergency alert and response mechanism and offer an opportunity to offer health services through different ways e.g telemedicine through a CHW or directly to a mother where possible.

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What specific problem are you solving?

Women in developing countries face a much higher change of death in their lifetime compared to those from developed countries— 1 in 160 compared to 1 in 3,700.In Kenya, the maternal mortality ratio, and the neonatal mortality rate stand at 362/100,000 live births and 22/1000 live.Many of these deaths can be averted through timely and frequent access to antenatal care and delivery in hospital. Project data shows that 81.4% and 69.9% of pregnant women in focus sub-counties in Nakuru and Baringo counties, respectively, made one visit during pregnancy, while 30.2% and 39.0% in the Nakuru and Baringo focus sub-counties, respectively, completed four ANC visits recommended by the World Health organization (WHO) in 2019. The COVID-19 crisis has made the situation worse .Public health restrictions to manage infection spread has resulted in reduced morbidity and health outreaches, decreasing opportunities available to access essential health. This calls for new strategies to ensure continuity of health care services.Technology can help through promotion of strong collaborations between mothers, healthcare providers and community health workers while maintaining social distancing.Studies have demonstrated that mHealth SMS systems significantly improve uptake of essential services during pregnancy and after delivery through delivery of health tips and appointment reminders. 

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What is your solution?

Afya Uzazi has implemented an mHealth system with significant success. The project is proposing to enhance the  system by adding a digital mother and child health services referral, digital appointment tracking component and a feedback mechanism between a HCW and CHW to ensure successful healthcare referrals. The system will also include support for sending maternal and child health clinic appointment reminders, multilingual SMS messages and a portal for managers to conduct supervisory work. CHWs will enroll and refer mothers to a preferred health care facility. This will be accessed by a HCW who will then enroll the mothers into the appointments tracking component and initiate delivery of SMS appointment reminder for missed appointments. The HCW will also be able to alert the CHW if a mother fails to arrive at a health facility. The current system sends appointment reminders for ANC and SBA health services only. The system will be improved to send PNC and Immunization reminder messages. It will be designed to run on a smartphone and allow customization for universal adoption. Free and Open source software development and data management systems (Java, Android, PostgreSQL) will be used for easy and cost effective system transition and scaleup. 

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Who does your solution serve, and in what ways will the solution impact their lives?

The current implementation of the software is serving approximately 7000 mothers in Nakuru county. Afya Uzazi studied the data from the National Health Management Information System (KHIS) which revealed that in Kuresoi South and North sub-counties in Nakuru County,  22% and 41% of pregnant women accessed 4th ANC and SBA services, respectively, which is low performance compared to national statistics which was 49% and 65% for 4th ANC and SBA services respectively in 2018.  The project rigorously evaluated interventions to adopt to improve this and discovered that delivery of SMS clinic appointment reminders can encourage mothers to honour antenatal care clinic appointments and deliver at a health facility. Afya Uzazi jointly with the Department of Health of Nakuru County, designed an mHealth system to deliver appointment reminders. The same approach will be adopted to enhance the system.In addition, a user centric appoach will be used through focus group discussions with HCW and CHW for to garner user acceptance. Through a more elaborate refferal and appointment tracking system, more mothers will have access to the essential health care required for more positive outcomes during pregnancy and the immediate post partum period.

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Which dimension of the Challenge does your solution most closely address?

Expand access to high-quality, affordable care for women, new mothers, and newborns
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Explain how the problem, your solution, and your solution’s target population relate to the Challenge and your selected dimension.

In the project area, most pregnant women do not seek timely antenatal care (ANC) and delivery in hospitals,critical to reducing the risk of preventable life-threatening complications during pregnancy and childbirth.The situation is made worse by the restrictions due to COVID 19.The enhanced system provides potential for the mHealth solution to help health systems maintain access to essential health services  in the context of COVID-19 which in turn promotes the health and well being of women, new mothers and newborns and will be scaled to have a global effect.

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In what city, town, or region is your solution team headquartered?

Nakuru, Kenya
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What is your solution’s stage of development?

Pilot: An organization deploying a tested product, service, or business model in at least one community
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Who is the primary delegate for your solution?

Dr. Marsden Solomon

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More About Your Solution

Which of the following categories best describes your solution?

A new application of an existing technology
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Describe what makes your solution innovative.

Software applications have been developed to provide referral and SMS appointment reminders for increased service uptake , however the enhancement implements two strong innovative approaches to solve the same problem. First, It Enhances collaborative efforts between the CHW and HCW through a strong feedback mechanism i.e once the CHW refers a mother to a health facility, the HCW is able to get the information and enrol the mother into the appointment tracking component when the mother arrives at the facility. Mothers who have not arrived at the facility will be flagged out for further followup by the CHW. The CHW can now focus on creating linkages between target populations and health care systems while the HCW provides essential healthcare services. Second, the app offers multilingual support meaning the beneficiaries will not only receive health messages, but they will also be able to understand them.

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Describe the core technology that powers your solution.

Free and open source software development and database management systems will be used to build the enhancement. This is to support easy and cost effective system transitions and scaleup. The referral component of the system used for creating linkages with healthcare facilities, the clinic appointment tracking component and the Managers supervisory tool will be built from Android software development kit to run on a mobile phone or a tablet. The SMS dissemination application will be developed using PHP. PostgreSQL will be used as the database management software.

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Provide evidence that this technology works.

The project implemented the current mHealth system in the project coverage area where the number of pregnant mothers completing four antenatal care visits and delivering in hospitals was lowest i.e in Kuresoi North and Kuresoi South sub counties of Nakuru county in Kenya. With just six months of deployment, there has been a significant increase in the number of mothers accessing antenatal care. Other Studies and interventions have also demonstrated that mHealth SMS systems significantly improve uptake of essential services during pregnancy and after delivery through delivery of health tips and appointment reminders. Examples include: (1) Wired Mothers intervention in Zanzibar (WHO, 2014) and (2) Healthy Pregnancy Healthy Baby Text Messaging (Mobile Alliance for Maternal Action, 2013) intervention in Tanzania and Medic Mobile. 

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Please select the technologies currently used in your solution:

  • Software and Mobile Applications
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Select the key characteristics of your target population.

  • Pregnant Women
  • Infants
  • Rural
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Which of the UN Sustainable Development Goals does your solution address?

  • 3. Good Health and Well-Being
  • 10. Reduced Inequalities
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In which countries do you currently operate?

  • Kenya
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In which countries will you be operating within the next year?

  • Kenya
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How many people does your solution currently serve? How many will it serve in one year? In five years?

The current implementation of the solution serves an estimated population of 10849 pregnant mothers and will be scaled up in the next year to serve an estimated population of 23,978 pregnant mothers.  With enhancement of the system , the population served is expected to grow as the system is replicated in other regions.

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What are your goals within the next year and within the next five years?

With additional funding, in the next one year, the project will complete the design and development of the  enhancement . The project will aim at achieving routine and efficient use of the system in Nakuru and Baringo counties in Kenya. This will be made possible through already established partnerships with the County Governments and the demand for scale up of the current mHealth system implementation by Departments of Health due to resulting  success from the implementation.The intention is to use the two counties to pilot the approach which will be carefully monitored and evaluated for replicability by other counties and agencies.

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Solution Team

 
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