ObGyn on Call

In Rwanda, similar to other low-income countries, maternal mortality is still unacceptably high despite that most of the major causes of maternal mortality are preventable and treatable (WHO, 2019). Lack of information and cultural beliefs and practices are among the main factors that prevent women from seeking and receiving the care they need (WHO, 2019). 

ObGyn on Call aims at creating a reliable source for women's health information and clinical advice in Rwanda, regardless of the geographical location.

With a mobile phone penetration of more than 80% in the country (RURA, 2020), we will increase access to Obstetrician & Gynecologists services through a virtual mobile phone based consultation service.

ObGyn on Call will offer a convenient and affordable way of accessing reliable specialized women's health information and clinical advice from specialists in practice, removing the barrier of long distance travels and waiting times at the clinics. 

The problem we are working to solve is the lack of reliable source for women's health information and clinical advice which contribute to high maternal mortality rate (WHO, 2019).

Worldwide, about 300 000 women die of pregnancy related complications each year and more than 90% of those deaths occur in resource limited countries where Rwanda belong (WHO, 2019). In Rwanda, despite remarkable decrease of 55% over the last decade, maternal mortality ratio remains high at 210 deaths per 100 000 live births while the SDG 3 target is to reduce the maternal mortality to less than 70 deaths per 100 000 live births (UNFPA, Rwanda). Most of of the causes of maternal deaths are preventable and treatable (WHO, 2019). Lack of information and cultural beliefs are among the main factors that prevent women from seeking and/or receiving the care they need before and during childbirth to avoid preventable maternal deaths (WHO, 2019). ObGyn on Call solution consists in creating a reliable, accessible, convenient and affordable source of women's health information and clinical advice.

Our solution to lack of access to women's health information clinical advice consists in establishing a virtual mobile phone based medical consultation service that allows women and the community in general to access obstetrician and gynecologists consultation service regardless of the geographical location.

Our solution aims at connecting the community with women's health specialists while removing the barrier of long distance travels and long waiting times at the clinics.

We have our website already established and every doctor will have a username and password that allow him/ her to access the appointments dashboard. We will have a call center that coordinates all appointment schedules. Clients will be able to secure an appointment either by calling our call center number or going at our website ObGyn on Call link. The receptionists will be responsible for confirming the appointment after confirming service fee payment through our mobile money account. Our doctors, who work in different corners of the country, will be accessing the registered appointments through our online appointment management system. The Doctor on duty will call the registered clients at their booked appointment time. Neither the Dr nor the client will have to travel to the clinic for the service

Our primary target population consists of all women of reproductive age from adolescents to older women in Rwanda. Our secondary target population includes all married and unmarried men who would potentially have a women's health related concern whether related to their wives, daughters or girlfriends.  At our different workplaces, our team has conducted an informal survey among women attending the antenatal and postnatal clinics. The survey was asking women whether they would wish to have a low cost service that allows them to discuss their problems with the obstetrician and gynecologists without traveling to the clinic. Majority of respondents showed interest in a such service. 

ObGyn on call will create a mobile phone based platform that allows women and the community in general to access obstetrician &gynecologists consultation services at the client convenient place and time.

ObGyn on call aims at creating an accessible, convenient, affordable and  reliable source for women'sh health information and clinical advice.

Rwanda has know a rapid increase in mobile phone service use over the last 2 decades. With a  mobile phone penetration of more than 80%, we believe our service will be accessible to the majority of our target population (RURA, 2020).

We seek to address the lack of access to appropriate women's health information and clinical advice. In fact lack of information and cultural beliefs and practices are among the factors associated with high maternal mortality.

Although Rwanda has made remarkable progress in reducing maternal mortality ratio by 55% over the last decade to 210 deaths per 100000 live births (WHO, 2019 ; UNFPA, Rwanda), the rates are still unacceptably high and coordinated effort is needed to achieve the SDGs target of reducing the maternal mortality ratio to less than 70 deaths per 100000 live births by 2030 (SDG 3).

The implementation of a specialized women's healthcare mobile phone based service is new in the country. However the mobile phone based approach to health service delivery is not new since it is being implemented by Babyl Rwanda for general healthcare services. 

Babyl Rwanda which is our big and only available competitor in the country does not provide women's and maternal health specialist services (Babyl services).

our competitive advantage over Babyl is that our service will be dedicated only to women's health and delivered by women's health specialists in clinical practice at different hospitals across the country.

Our solution consists in a new application of an existing technology. 

Our main technology for service delivery will be mobile phone technology which will be supported by our online appointment management system that will connect our call center and our doctors who will be attending client appointments from different parts of the country where they regularly work in different hospitals. Clients from any part of the country will be able to schedule an appointment at their convenient time by either calling our call center or going through the appointment request link on our website. A modest fee Service charge will be paid through our mobile money account and the appointment will be confirmed by the receptionist upon payment confirmation. The doctor on duty will review the scheduled appointment list from the online dashboard and call back every client at the specified time. The doctor's role will be to assess and respond to clients concerns, decide whether physical assessment of the client at a health facility is necessary or not and advise accordingly.

With the application of mobile phone and web based internet technologies, we will be able to use a small number of obstetrician and gynecologists available in the country to reach a big number of people who need our services and remove the barrier of long distance travel and waiting times at the clinics.

Telephone consultation service is used worldwide and has been extensively tested for its effectiveness. Different studies have revealed both public and healthcare providers satisfaction with using telephone consultations (Josip and Aziz 2003). 

Benefits of using telephone consultations have been found to include the following (Josip and Aziz 2003):

• Improved speed and access to services
• Patients convenience
• Possible cost savings
• Increased uptake of various preventive programs

The service is currently available in Rwanda with Babyl Rwanda for general healthcare services. Babyl Rwanda has been operational for about 4 years and has recorded more than 1100000 consultations so far (Babyl Rwanda). The above figures shows community uptake of the service and highlight the need to be extended to maternal and women's health in general which are of important public health value and present aspects that can be improved with mobile health technology approaches.

Mobile phone consultation service in maternal healthcare has been successful implemented in an almost similar settings as Rwanda. A study done on a similar service in Bangladesh (Aponjon’s mobile phone based consultation service for maternal, neonatal and infant health) found both doctors and clients (women, husbands and family members) were satisfied with the service (Alam et al, 2019). The same study revealed that the service was trusted as a reliable source of health information and clinical advice and was used by people from various backgrounds including those from disadvantaged rural areas

For the last decade, Rwanda has remarkably reduced maternal mortality by 55% to 210 deaths per 100 000 live births (UNFPA, Rwanda). However, the current maternal mortality ratio is unacceptably high and coordinated effort is needed to meet the SDGs target of less than 70 maternal deaths per 100 000 live births by 2030 (UN). Majority of maternal deaths can be prevented if women receive the care they need. The main factors that prevent mothers from receiving or seeking care they need include lack of information and cultural beliefs and practices (WHO).

ObGyn on Call is a virtual mobile phone based specialized women's health medical consultation service that will use mobile phone technology to connect the rwandan community to women’s health specialists. With a mobile phone penetration of more than 80% (RURA, 2020) in the country, ObGyn on Call will increase the community access to the small number of Obstetrician-Gynaecologists available in the country. Through the delivery of reliable women's health information and clinical advice, the ObGyn on Call service will allow appropriate use of women's health care services available in existing health facilities with the long term goal of reducing the rate of preventable maternal deaths towards the SGD 3 target. 

Mobile phone consultation service in maternal healthcare has been successful implemented in almost similar settings as Rwanda. A study done on a similar service in Bangladesh (Aponjon’s mobile phone based consultation service for maternal, neonatal and infant health) found both doctors and clients (women, husbands and family members) were satisfied with the service (Alam et al, 2019). The same study revealed that the service was trusted as a reliable source of health information and clinical advice and was used by people from various backgrounds including those from disadvantaged rural areas.

The association between good women’s health literacy,  increased uptake of maternal health care services and good pregnancy outcomes in general as shown by studies (Kohan et al, 2007), supports our goal of reducing maternal mortality through promotion of appropriate use of available women's health services.

• Current number is 0 as we have not yet started our activities
• In one year, we expect to be serving about 9000 clients per year
• In five years, we expect to be serving about 90000 clients per year

For the first 6 months of operation, we expect to be able to serve an average of 20 clients a day ( totaling 20 x 30 days x 6 months= 3600 clients)

For the second 6 months, we expect to be serving an average of 30 clients a day, totaling 5400 clients.

From the above calculations, we expect to serve an average of 9000 clients in our first year of operation.

We have committed ourselves to hard working to gradually increase the number of clients served per day and we expect to be serving about 250 clients per day, totaling 90 000 clients served during the 5th year of our operation.

Our goal for the next year is to be able to offer an average of at least 30 consultations everyday and be able to establish partnership with different health facilities for referral and follow up of clients whose conditions need further physical assessment as judged by the consulting doctors. 

Over the next five years, we aim at having the majority of Rwandans aware of our service and eventually be able to seek for it. We aim at being able to offer an average of 250 consultations a day by the fifth year of operation. Our long-term objectives also include the establishment of a business model that will allow even economically disadvantaged people to access our service.

Barriers to accomplishing our goal would include:

• Clients and different stakeholders beliefs and perceptions about the mobile phone consultations in women's health which would impact the uptake of our service
• Financial constraints in times when we can not raise the necessary funds to cover our day to day activities
• Medico-legal considerations as this approach is new and have aspects that differ from the classic practice. Doctors may have difficulties identifying the diagnosis solely based on the history taken from clients, issuing drug prescriptions when necessary and management of client with identified life threatening condition through referrals to physical health facilities.

• To overcome the barrier of perceptions and beliefs about our service, we will work in close collaboration with governmental and non governmental organizations interested in maternal health to make sure we have the same understanding on the need, safety and effectiveness of our service for women's health promotion. We will make use of different promotional activities to educate the community and promote the service.
• For the eventual financial constraints, we will use two approaches to raise funds for our operational budget. As our service will be paid, in the initial phase when we are not yet able to auto-sustain ourselves from the service sales, we will seek support from different external sources to support our operational budget through grants and donations.
• Our service will be offered by doctors in practice who will eventually be able to identify and address the different medico-legal issues. To overcome the different medico-legal issues that may arise, we will establish specific guidelines for our practice, partner with existing health facilities for continuation of care for clients who need further physical assessment and management.

We are not yet operational but we plan to start with a team of 12 staff that include:

• 1 full time managing director
• 2 full time receptionists
• 1 full time accountant 
• 6 part-time obstetrician- gynecologists
• 1 full time IT officer
• 1 part time legal advisor

The founding members of our company are committed obstetrician& gynecologists in practice dedicated to fostering innovative approaches to women's healthcare service delivery. We have experience working with both public and private health facilities which give us better understanding of the women needs.

This team of Obstetrician and gynecologist makes the backbone of our staff and the remainder are part of the supporting team to achieve our goal. We strongly believe that this team is in better position to deliver reliable women health information and clinical advice to Rwandans and help mitigate the burden of maternal and women preventable mortality.

We have no partnerships established yet.

We are proposing ObGyn on Call, a mobile phone based virtual specialized women's health consultation service that allows the community to access the Obstetrician-Gynecologists expertise and creates a convenient platform that honors all age women's privacy and confidentiality while removing the barrier of long distance travels and long waiting times.

We will have a call center that coordinates the client appointments and doctors will access the appointments dashboard through our website from their respective locations. Appointments can be scheduled though either our call center or our service website link. 

Our target clients are adolescent girls and women in reproductive age and older, husbands or other family members inquiring about women's health related concerns.

To promote our service to  potential clients, we will use our website, different social media platforms and broadcasting media channels such radios and TV. Moreover, we commit to a client centered service approach to build a client pool and have the word of mouth advertising among our service promotion channels.

Our main income will be from client service payments. Our service will be offered to clients at modest fee charge. We will keep raising funds from external sources to support our budget and the surplus will be reinvested in improving the quality and scaling up our service activities.

Our main partners will be the ministry of health, public and private health facilities, mobile phone and internet network operators and other potential funders and supporters.

We are anticipating three sources of funds to sustain our service activities:

• Our service will be offered at a modest fee charge from clients and the income from service sales will be invested to cover the service delivery related costs.
• By the time our service sales income is not yet enough to cover our expenses, we will continue raising funds from external donations and grants to support our budget deficit.
• Loans from commercial banks and other loan issuers are also among our anticipated potential source of funding for our service activities

We are applying to solve for two reasons:

• First, we are seeking for funds to cover the expenses associated with our service delivery costs. Solve funding and potential additional prize funding is a potential source of funding to start implementing our solution
• Second, we are embarking on a social entrepreneurship venture and we believe Solve can have different partnerships for mentorship and technical support on different aspects of our business model.
• Through partnership with Solve, we expect support for addressing the barrier to uptake of our service through mentorship on business marketing models
• We believe Solve partnership can also support us in addressing the medico-legal issues that can be raised by our new approach to healthcare delivery

Our partnership goals are:

• Financial sustainability: we need partnerships to help us keep improving our business model and updating our funding and revenue model to meet our service delivery expenses
• Continuous solution technology updating: We need partnerships to keep our technology up to date and friendly to our customers
• Legal and regulatory considerations: as we need to abide by the laws and regulations, we need partnerships to advise and support us on the legal considerations in social entrepreneurship.
•  Finally, we need partnership on monitoring and evaluation of our service to be able to continually improve its quality and evaluate its impact in the community.

Through Solve, we are interested in partnering with organizations or initiatives working or interested in digital health technologies, business management and monitoring and evaluation.

These partnerships would help us advance our solutions on the aspects of technology improvement and updating, business model adjustments according to the clients and company needs and evaluation of the value we are providing for future planning and scaling

We believe our solution qualifies for this prize since we are using innovative technology approach to advance health needs of women and girls to improve their quality of health and lives in general. If awarded this prize, we will use it to improve the quality of our services and increase the working hours to be able to respond to clients queries as they arise  . Moreover, as women from disadvantaged communities might be unable to access the service either due to lack of access to mobile phones or inability to afford the service fee, we would use the prize in expanding our service access to women from disadvantaged communities. 

In Rwanda, we have one community health worker in charge of maternal and child health in each village and they all have access to mobile phones for communication. We would partner with the ministry of health to allow women without access to mobile phones to access our service through their respective village community health worker mobile phones. For this category of clients, the service would be offered free of charge and the community health workers would be offered a motivation fee for helping us in triage of eligible clients and using their phones for the service.

We believe we qualify for this prize since our ObGyn on Call service is an expansion and support to the scarce health workforce qualified to take care of pregnant women, new mothers and newborn in Rwanda which is a low-income country.

Our approach is to use the available small number of women's health specialists to reach a big number of women and the community in general, in need of the service from the urban areas to the most remote rural areas that would otherwise hardly access Obstetrics and Gynecology specialist services.

If awarded this prize, we would use the funds to improve the quality of the service and establish the strategies to reach women who are potentially unable to access our service since poverty and distance from health facilities are listed among the the main factors that prevents women from receiving or seeking the care they need (WHO).

In Rwanda, we have one community health worker in charge of maternal and child health and all have access to mobile phones for communication. We would partner with the ministry of health to allow women without access to mobile phones to access our service through their respective village community health worker mobile phones and the service would be offered to them free of charge and the fee covered by this prize funds. The supporting community health workers would be offered motivational allowances as well.