Safe Birth-in-a-Box

 While most women in Africa now deliver their babies in health facilities, majority of South Sudan births still occur at home using traditional practices that increases cord infections and mortality. South Sudan mothers and newborn lack access to safe, clean delivery, largely because they live in hard to reach homes. We have developed cost effective ways of preventing  unhygienic home births  and cord infections that has proven to eliminate infections and reduce mortality. Applying innovative cord care daily eliminates bacteria that causes sepsis and reduces risks of death. The innovation is an ideal solution to provide immediate low cost approaches to modern cord care, improve  home delivery hygiene to mothers and newborn in poor setting. Our solution provide clean delivery and reduces cord infection drastically reducing death while improving survival.

At the current rate, it will be nearly 100 years before mothers and newborns in South Sudan have the same chance of survival as those in North America. About 1 million newborns die every year in Africa and 75% of these deaths are preventable. In South Sudan, the prevalence of unhygienic home births and traditional  cord care practices have resulted in one of the highest mortality rates in the world. Neonatal causes primarily infection, asphyxia and prematurity account for 42% of under-five deaths. In South Sudan, 64% of neonatal deaths are caused by infection and sepsis from infected cords and is one of the main pathways for infection leading to neonatal death. Only 4%  of the mothers practiced good cord care and 80%  of women delivers in unclean home environment in the absence of innovative technologies and 90% live in mud grass thatched hut. Instead, in traditional approaches to newborn care, mothers use old rags and clothes for delivering and warming the infants and after cutting the umbilical cord, apply ash, water with salt, powder from a burnt match stick, milky fluid from the leben tree, soil mixed with oil, and combination of herbs, increasing cord sepsis and mortality .

Our innovation is building and expanding our distribution network of Safe Birth- in -a- Box (chlorhexidine-equipped safe delivery kits) coupled with educating the required health care and community health providers in a cost-effective, scalable way. We are scaling a quick, low cost solution to get rid of unhygienic home delivery and rudimentary cord care to discard the traditional practices. Our solution   contains  chlorhexidine digluconate, a broad spectrum antiseptic effective in reducing mortality. Daily chlorhexidine application to the umbilical cord stump during the first week of life is good for newborns who are born at home in settings with high neonatal mortality of 30 or more deaths per 1000 live births. By introducing Safe Birth- in-a-Box, we estimate to reduce neonatal mortality by 50% and improve clean home births by 70%. In South Sudan, the alternative solutions to chlorhexidine for umbilical cord care are unhygienic traditional practices (application of soil, herbs, unsafe water, oils, ash or other materials) that contribute to high infections and mortality rates. Our evidence showed that a neonate receiving chlorhexidine gel treatment was over 2X times less likely to die from an umbilical cord infection than control groups not using chlorhexidine. 

Our solution targets the growing needs for safe, clean, low-cost and scientifically proven maternal birth and cord care in hard to reach communities in conflict setting of South Sudan. Our solution provides one  mobile stop community clinic or center where mother, newborn benefits from clean delivery and cord care, easy to use and apply by the mothers and Community Health Workers in any humanitarian setting drastically reducing maternal and newborn sepsis. Our solution  primarily  directly benefits the mother and newborn of any gender in hard to reach communities in conflict setting. For newborns, our solution chlorohexidine gel application rids newborn off from the use of the rudimentary traditional cord care applications and make cord care safe from bacterial infections.For the mothers, our solution makes home births clean and safe.  For our secondary beneficiaries comprising  the government, heath workers and the community, our solution addresses the grappling issue of high maternal and newborn mortality. We worked with Ministry of Health Reproductive Health Division on our first pilot in South Sudan to provide clean  home births and  safe cord care among the hard to reach communities. Our solution benefits all the actors in health care systems.

Our solution provides mobile center where mother, newborns benefits from clean delivery and cord care, easy to use and apply by the mothers  in any humanitarian setting drastically reducing maternal and newborn sepsis. Reducing maternal and newborn mortality using Safe Birth -in -a Box  align with the maternal  and newborn challenge of MIT Solve.  Our solution directly benefits the mother and newborn of any gender in conflict setting. For the mothers, our solution promotes clean home births. For newborns, our solution rid them off from use of the  traditional cord care applications and make cord care safe from bacterial infections. 

No other maternal and newborn solution can achieve rapid, clean, low-cost elimination of unhygienic home births and cord care among the communities living in hard to reach and conflict setting. Our innovation introduced Safe Birth- in- a-Box to South Sudan for the first time. Chlorohexidine equipped in Birthing kit is only technologies that leverages maternal and newborn tools that provides one stops center care. 

Our solution is hugely disruptive enabling clean safe delivery and cord care that can easily be deployed to any part of the South Sudan even experiencing conflict that could increase access to clean delivery and cord care at reduced cost. 

Traditional unhygienic home birthing conditions and newborn applications of soil, herbs, unsafe water, oils, ash or other materials contributes to high mortality which is available to the mothers at no cost.

 The current traditional practices to newborn care, where mothers are using old rags and clothes for delivering and warming the infant and apply various combinations of soil, ash, salty water, and herbs to the cord contributing to sepsis and mortality. 

The practices are being used because they are accessible and cheap and without knowledge, they seem like the only best option. We address this problem by making clean home delivery package and chlorhexidine cord care accessible to mothers. 

Our solution prevents the use of the only cheap available traditional practices by the mothers that promotes sepsis. our solution keeps the cord clean and prevent infection while the content of birthing kit promotes safe delivery.

Our technology in the Safe Birth-in- a- Box is an innovative approach that quickly promotes clean home birthing and prevent neonatal cord infections thus reducing chances of bacteria entry to the mother and the newborn at the same time. The innovation is simple, low technology and effective that supports the mothers and the community to understands and use protective and transformative power of preventing infections resulting from unhygienic home birthing environment and traditional cord applications. The power of using the technologies prevents over 90% of the bacteria causing infections for both the mothers and the newborn.

1)The Chlorhexidine component: completely eliminates the pathogens at the cord thus mitigating and preventing cord sepsis.

2)The hygiene Component: This comprises the soap, surgical blade cord tie, gloves, sheet and gauze: this tools   promotes clean delivery for the mother

3) Educational training materials containing pictorial newborn care guide, tips that focus on capacity building for health workers, mothers and the communities on the use of the technologies.

The  solution will be made available at healthcare institutions to be used by Community Health Workers and Health providers during home birth and immediately after birth to prevent infections and mortality. The hygienic care components (disposable baby wiping cloth, cotton and gauze, ensures clean delivery preventing infection.

The cloth and gauze mucus extractor, small blanket and cap which is used for whipping and covering help to prevent asphyxia and temperature loss reducing mortality due to hypothermia. The chlorohexidine gel in the  solutions  prevents neonatal cord sepsis.

Our solution has the features of providing low cost, standalone tools that can provide rapid infection prevention and reducing morbidity and mortality using simple infrastructures. 

A most important key challenges for the country emerging from conflict is the lack of health infrastructure for maternal and newborn health services. With more poor and vulnerable communities in hard to reach settings, no health care, 80% of the mothers give births at home in unhygienic environment, using old rags and clothes for delivering and warming the infant, applying  various combinations of soil, ash, unsafe water, and herbs to the umbilical cord, the only way to ensure mother and newborn survive from the highest causes of morbidity and mortality is to prevent  and  reduce infection acquired at births through unhygienic birthing and cord applications. 

Our fast and one stop infection prevention tools is the only solution that meet health care need of the mothers and newborn in situation where health services are limited. The innovative solution provides protective clean birthing environment and cord application to the mothers and newborn at very low cost. 

In our pilot phase, we have proven that 90% of the mothers had clean delivery without infection and 83% of the newborn were free from cord sepsis and survive death. 

Our solution also discouraged the use of traditional practices for cord care in the communities. So our solution is cost effective in reducing infections, morbidity and mortality in simple and direct way for the first time in South Sudan.

Theory of Change for Safe Birth-in-a-Box: To achieve the programmatic improvement of the overall health of the mothers and the newborn, through the deploying of solution, we have developed an integrated approach which we call our Theory of Change(TOC) for Safe Birth-in-a-Box by first empowering of the health workers and community health workers, creating enabling environment by working with Ministry of Health, partners and distributing the solution to the end user and making it available.

 Our Theory of Change will be achieved through implementing activities, output, outcome and impact as described below:

Activities

Activities: Adding chlorhexidine gel to Birthing Kits for home births

Activities: Training and educating health workers and mothers in its application. Scaling is achieved through

Activities: working closely with the South Sudan Ministry of Health at the National, State and County levels and

Activities: Coordinating with the private sector and international research and evaluation partners as well as local implementation partners

Activities Distribution of the solution to the mothers in the communities

Outputs

Outputs: Innovative product produced and available

Outputs: Health workers and community health workers gained competency on clean birthing and cord application

Outputs: Partnership established with MOH at all level

Outputs: Coordination mechanism for distribution established

Outputs: Distribution mechanism established 

Short term Outcome: Health workers and community Health workers demonstrated ability to apply chlorhexidine gel to the newborn umbilical cord

Short term Outcome: Community Health workers and health workers demonstrated ability to educate Short Term Outcome: mothers on clean home delivery and chlorhexidine cord application daily for 7 days

Long term outcome: Health workers train mentor and trained other health workers on clean home birth and cord application

Long term outcome: Community Health workers train and mentor mothers and community on clean home birth and chlorhexidine cord application daily for 7 days

Long term outcome: Reduced mortality and morbidity among mothers and newborn

With our first pilot in the hard to reach communities in South Sudan, we have impacted on 3,814 mothers and their newborn with access to clean  birth and safe cord care application through free distribution of the Safe Birth -in-a Box (Chlorhexidine Equipped Birthing kit).

We further educated over 200 health workers of various cadres and 400 Community Health Workers in the use of our product which revealed  high satisfaction along the use of  the product in hard to reach communities for safe delivery and newborn cord care. 

In one year, we expected to reach 400,000 mothers and their newborn. In 5 years, we expect to deploy and distribute 2 million chlorohexidine Equipped Birthing Kit in the rural areas improving clean home delivery and safe cord applications, thus reducing infection and mortality. In terms of impact, our solution allows clean and safe delivery and cord applications to be widely and conveniently accessible in hard to reach communities at low cost making it more scalable and sustainable. From the perspectives of hard to reach communities in conflict settings, our innovation will allow

1) women to potentially have close to clean, safe access to clean birthing kits and cord application thereby reducing risks to birth related and cord infections in the first week of life.

2) reduced infection and mortality rate among the mothers and newborn within the community (Cord infection, tetanus, puerperal infections) and

 3) reduced cost of accessing innovative innovation that potentially reduce their high risk to infection and death.

We will be expanding our solution within the hard to reach and vulnerable communities in conflict settings and we expect to expand and deploy it to 1,000,000 mothers and their newborn babies in the next years through 2021. By 2023, we expect to reach an estimated 2 Million mothers and newborn in South Sudan and Uganda. 

We are already working with the government and Ministry of Health on ensuring that, the innovation is integrated into the existing Maternal and Newborn Health services.

We are developing the optimal distribution system by reviewing the 3 years in built scaling plan developed together with Ministry of Health.

 We are aggressively leveraging the support of the angel investor and other donor to ensure our product reach the poor and vulnerable mothers and newborn. Since our innovations is non-revenue based, we shall be working with our largest manufacturer Kampala Pharmaceutical Industries (KPI) to reduce the cost of the chlorhexidine and the Birthing Kit to $7 from $11 per which is cost effective. 

We will be working with our early adopters to procure the product and expand our services and explored option for community distribution on cost reimbursement/sharing approaches particularly in Ugandan setting.

The Solution (Safe Birth-in- a-Box technologies) is driven by mission to improve the quality of mothers and newborn  living less than $1/day by reducing the public health risks, supporting clean birthing and cord care environment, meanwhile building  and expanding  optimal and resilient distribution system. In bid to scale up our scale up goals, we foresee the following barriers and challenges in short, medium and long terms. 

1) Raising sufficient funding to scale activities given our solution is developed for low income and hard to reach communities in conflict settings in addition to our organization being located within region prone to conflict: 

 2) Tackling some of the cultural sensitivities in many of the communities such as the application of white fluid from the Leben- Leben tree that might affect the end use of the Chlorhexidine Equipped Birthing Kit.  

3) Beyond successfully piloting and building the crucial partnership with government and MOH, we anticipate that in order to achieve scale at rapid pace, we will need solid on ground innovation team. The inherent inertia in the government system as our partners often slows on the ground. 

 4) Risk of Corruption: In South, we are familiar with issue of corruption: BHECO safeguards against fraud in a number of ways. In a conflict-affected context like South Sudan with a limited economy, bribery, corruption and fraud are significant risks. However, we cannot operate effectively on a long term basis if we are caught up in bribery or corruption. 

1) Raising sufficient funding: To overcome the barriers, we have started to work with some smart partners to help generate funding through donation, angel funding and partnership. 

Our generated data during the pilot phase that  has demonstrated the potential of our innovation has enable us to have more discussions with promising partners and donors. We also believe that MIT-Solve can help us to navigate these barriers by providing a valuable support partnership for resource mobilization.

2)Tackling some of the cultural sensitivities: We have done our best to engage the communities during the pilot and will continue to engage the communities to educate on the advantage of our solution best fit to address the problem. As we spend more time on the ground, our ability to address cultural sensitivities will hopefully improve. Also, working with trusted local partners helps us get up our learning curve quickly.

3)Implementing partnership challenges: We plan to build a very strong system of implementation at all levels. We will take steps to prepare before launching the scale so as to bring together and optimize the existing value chain and collaborating with different actors at all levels. We will also leverage Government, MOH strong motivation and push towards solving the health problem in the country at a fast pace.

4)Risk of Corruption: We  have controls and procedures in place to prevent, detect, deter and deal with bribery, corruption and fraud, and there has been no incidence of fraudulent activity within the organization since its creation.  

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BHECO was founded in 2018 by Christopher Vunni. Currently we have 4 full time and 4 volunteer and part times. We have 3 Founders who are  unpaid volunteer. One-part time, volunteer who is working as  PhD researchers and , 1 Volunteer in Maternal and newborn as specialist and project lead, 1 as innovator on Maternal and newborn health and 2 volunteer on Research, monitoring and Evaluation. We also have other experts with diverse background which include Kevin McKague PhD, Cape Breton University, researchers Assist. Professor Dr. Dimitri Alexander, Director  MOH, Adam, Healthy Entrepreneurs and Moses, Director Kampala Pharmaceutical Industries. 

Our team has been working on this project since 2018 bringing together over 60 years of proven record of successful Maternal and newborn innovation, entrepreneurship, commercialization, public health system, maternal and newborn health, and community health system.

1)Our founder /CEO Dr. Christopher Vunni PhD, in Public Health who conceives the idea has over 18+ years of experience in Public health, maternal and newborn health and Community Health, He is the Project lead and Principal Investigator. He is experienced in leading collaborative health and Research projects in South Sudan.

 2) Kevin McKague (PhD) Co-Project Lead with 27 years of research and implementation experience in 14 African countries including multiple large projects in South Sudan.

3)Dr. Alexander: Key MOH Director General Ministry of Health and internal champion for supporting the scaling of chlorhexidine throughout the country.

4)Heather Krause Lead for Impact Evaluation and Data Analysis.

5) Dr. Desire Kamazi:  Lead for M&E, Training and Quality Control Lead with a PhD in Community Health with extensive experience leading M&E on Maternal Child and newborn Health and Community Health projects.

6) Dr. Logan Cochrane: Long-time Canadian resident of East Africa & Professor at Carleton University. Lead researcher for the portfolio-wide ($106M) learning initiative Comparative Study of Activities and Modalities for Resilience Building in South Sudan commissioned by the Canadian Government

8) Sunday Nyadru, Lead Trainer with extensive experience in maternal and child health projects.

8) Dr. Odwa Atari South Sudanese-Canadian Professor of Health Geography with extensive research and experience in South Sudan.  

Our initial pilot funding was from Grand Challenges Canada(GCC) that has made us to successfully complete our pilot phase of low cost simple technology among the community in hard to reach conflict setting. 

We partnered with Kampala Pharmaceutical Industries, our manufactures of the low cost technologies. During our field pilot testing, we partnered with Ministry of health at national, state and County level. 

Our NGO Partners, South Sudan Health Association (SSUHA) which supports the local health system at the Community Level is our trusted partner on the ground within the conflict affected communities.They mobilized the community and the mothers and helped us in enrollment of the mothers including the supply chain system of the innovative product.They have supported us in getting introduction to the key local stakeholders and decision makers at the pilot project location in South Sudan. 

We have also partnered with another local NGO, Health Access and Food Security South Sudan who facilitated the Community Health Workers to conduct pregnant mothers and household follow up visit. Additional with our project team,Health Access and Food Security South Sudan  helped to facilitate training education for the Community Health Workers and awareness creation for the mothers and community. 

We have also partnered with the Juba College of Nursing and Midwifery(JACONAM) in designing the training modules and acquiring the training mannequin that enable us to integrate the solution to teaching of the nurse and Midwife students     

Our business model has been designed to ensure mothers and the community including the Ministry of Health in hard to reach setting coming from conflict to get value for the innovation product than the cost invested in getting it on course. 

While the mothers and newborn benefits the most including their communities, in long run and over 5-10 years’ time, the government and Ministry of Health will benefit more and recover all the investment through direct reduction of Disability Adjusted Life -year (DALY) and mortality leading to direct and indirect economic saving. 

Most significant, our Safe Birth-in-a- Box (Chlorohexidine Equipped Birthing Kit) ultimately benefit millions of mothers and newborns in hard to reach location with varied socio economic background particularly vulnerable mothers. 

We have also thought it wise to ensure that our model remained significant in delivering and sustaining the innovation to the mothers and the communities. This requires building economical sustainable venture that can be taken up by the government and Ministry of Health. 

We will then expand and optimize the private sector for the distribution of the product, as the innovation is design for the poor communities living less $1 per day. We will leverage partnership with donors, and angel investors to provide support to ensure the scale up continue to save the mothers and newborn.We will also  work with Government to have the innovation integrated into the existing health services. 

Our Team founded the solution with clear mission and objectives of building and delivering sustainable solution for the newborn. To expand, this venture, it is imperative to critical mobilize sustainable long term resources to support the poor women and their newborn. We have embarked on the following  path: 

1)Grant: we have received small grant from Child Health Foundation, secured funding from Birthing Kit Australia and we are seeking funding from Grand Challenges Canada. We are also mobilizing resources for USAID-DIV for our scaling activities. We shall also be participating in international and national competitions to raise funds for expanding our solutions.

 2) Working with private sectors: We have already engaged with KPI. At the time of the pilot, we have realized the importance of working with private manufacturer to produce our innovation in scale. We worked with the manufacturer during the pilot to understand our expectations and have accepted to work with us in the scale up by producing the innovation at half the price. This venture will support the growth and production. In the long run, it will greatly push the rapid scaling of the solution. We will start distributing the innovation through the private stores to generate revenue for financial sustainability 

3) Our solution was not designed for revenue generations but to build sustainable approach for supporting the vulnerable mother and newborn in hard to reach settings to be sustained over time. We will integrate this solution with the existing health services within the government planning and budgeting.  

The Solve Challenge is greatly aligned with our innovation of expanding maternal and newborn Solutions. We are looking at leveraging the partnership of Solve Challenge community to get feedback for our mission. 

The price and grant from Solve will significantly support us to build and expand our work to other hard to reach and vulnerable communities so that we can reduce neonatal mortality by 50% by 2022. 

We are applying Maternal and newborns challenges because our innovation mission aligns with what the challenges is aiming to address. We are looking to expand access to high-quality, affordable care for women and newborn health care services. 

In first place, we want to promote clean delivery and reduce infections and mortality by providing one mobile stop care center for both mother and the newborn as alternatives to the unhygienic home births  and traditional cord applications. 

We will also promote training for health workers and mothers to give ability to adhere to the best practices to deliver cutting edge for clean delivery and cord care services to mother and families. 

We are also enabling cost effective technologies by expanding the proven Safe Birth -in -a- Box (Chlorohexidine Equipped Birthing Kit) solution at community addressing the high mortality by reducing the unhygienic home birthing environment for the individualized mothers and newborn.

We believe that the partnership will help us to navigate and offer valuable support to address the challenges of mobilizing funding and creating model that can attract funding from other angel investors, donors and multi donors   

To scale and sustain our tested simple, low and cost effective to the intended beneficiaries, we are planning to raise a significant funding for the deployment of our Safe Birth -in -a- Box (chlorohexidine Equipped Birthing Kit). 

We are putting our solution to leverage the SOLVE ecosystem to find funders and supporters aligned with our objectives and impacts.

We are looking for partnership with the government and donors to procure and deploy our Low cost technologies at large scale in South Sudan. 

We anticipated to gain support with our evidence and cost effective tools of reducing maternal and newborn mortality. We would like to work with NGO both international and national that implement maternal and newborn services within the community in conflict setting. 

We also hope to partner with other Solve teams to establish synergies and collaborations to amplify all our efforts to deliver better services to vulnerable communities.    

Our work is human centered. Our innovation product is for the mothers and newborn in communities with poor access to health services. It improves home birth and safe cord applications, provide better communication, and systems efficiency to achieve the goal of healthier (pregnant) maternal and newborn population. 

The prize award will allow us to achieve our objective of expanding the chlorohexidine Equipped birthing kit in hard to reach communities in South Sudan through 

1) working with the manufacturer to produce more of the innovative solutions for the scaling that will go beyond the SOLVE award. We introduced the solution to South Sudan for the first time. We conducted interviews and focus groups to determine the optimal distribution channel to make chlorhexidine gel available, and we found that by far the most effective option was to include the gel in birthing Kits.

 2) training and educating and sensitization health workers, CHWs and mothers in its application. The effective application of chlorhexidine to the umbilical cord requires a training for CHWs, traditional birth attendants and other health workers involved in antenatal and postnatal care. 

The module has been developed as part of our pilot and is easily added to existing refresher trainings. Mothers and community members will also receive sensitization sessions to promote the advantages of chlorhexidine cord care as well as the benefits of delivering with a trained health worker. This grant will primarily support our team salaries, our innovation product, equipment access, travel to site, shipping, materials and field support.

Our work is human centered. Our innovation product is for the mothers and newborn in communities with poor access to health services. It improves home birth and safe cord applications, provide better communication, and systems efficiency to achieve the goal of healthier (pregnant) maternal and newborn population. 

The prize award will allow us to achieve our objective of expanding the chlorohexidine Equipped birthing kit in hard to reach communities in South Sudan through 

1) working with the manufacturers to produce more of the innovative solutions for the scaling that will go beyond the SOLVE award. We introduced the solution to South Sudan for the first time. We conducted interviews and focus groups to determine the optimal distribution channel to make chlorhexidine gel available, and we found that by far the most effective option was to include the gel in birthing Kits. 

2) training and educating and sensitization health workers, CHWs and mothers in its application. The effective application of chlorhexidine to the umbilical cord requires a training for CHWs, traditional birth attendants and other health workers involved in antenatal and postnatal care. The module has been developed as part of our pilot and is easily added to existing refresher trainings. 

Mothers and community members will also receive sensitization sessions to promote the advantages of chlorhexidine cord care as well as the benefits of delivering with a trained health worker. This grant will primarily support our team salaries, our innovation product, equipment access, travel to site, shipping, materials and field support.