Umwini Digital Health Networking (UDHN)

In Sub-Saharan Africa, Malawi is ranked among countries with high maternal and infant mortality rates, 22 and 43 deaths per 1000 respectively. Child Legacy Organization is creating Malawi’s first community based approach called Umwini (Ownership) digital health networking which aims to improve maternal, neonatal, and child health outcomes by providing maternal mothers with the right and timely information about maternal and neonatal health in areas that lacks modern ways of sharing information like TVs and Radios. In resource limited countries like Malawi the problem seems to be doubled when knowledge is scarce for women in the reproductive age group. The solution encourages local women to have access to the right information in relation to pregnancy and life after delivery.  Global scale up of this solution especially by developing countries where women have limited or no access to health information would tremendously have great impact in reducing maternal and neonatal deaths

Sub-Saharan Africa has the highest rates of infant mortality worldwide and Malawi is no different. In Malawi where a large proportion (84%) of the population still resides in rural areas, where healthcare access and delivery is often poor.  Malawi’s neonatal mortality rate (NMR) is 22 deaths per 1,000 live births. Maternal mortality ratio (per 1000 live births) 43, Stillbirth rate (per 1,000 births) 22, Preterm birth rate (per 100 live births) 18.

Most MNCH programs have often focused on provision of services at facility level neglecting community interventions. In resource-limited settings such as Malawi, health service is under extreme pressure due to shortage of qualified personnel and resources, this community-based digital approach will be an effective first step in reducing mortality. Malawi is among the countries that continue to have high maternal and neonatal death rates, and a major part of what contributes to this problem is the continued late or low turn up of pregnant mothers in seeking healthcare services. In this intervention, the organization sought to integrate community and healthcare providers through involving pregnant women and their husbands in the underserved rural areas of Malawi and this is believed to enhance maternal neonates and child health outcomes. 

Umwini Digital Health Networking, a community based technology approach designed to effectively engage and integrate pregnant women, women of reproductive age and healthcare providers at the primary level to foster participatory to maternal neonatal and child health to improve MNCH outcomes in rural areas. Pregnant women faces many limitations in seeking healthcare services due to a number of factors; limited transport means to access, inaccessibility of maternal related information, the conservative culture that prevents women from accessing  healthcare, and high level of illiteracy. These women are there mostly misinformed as they resort to unreliable sources of information, however, integration of the community and healthcare providers will help demystify some of the myths that dominate the communities. This networking will involve women’s groups practicing participatory learning and action through whatsapp groups and once a week a healthcare provider will be visiting the each village. Women with the help of health providers will be engaged in meetings to identify and prioritize the maternal problems and be involved in planning for locally feasible solutions. Interactive methods will be encouraged at these meetings, including stories, games and pictures, to discuss prevention, care seeking and treatment for common maternal and infant problems.

Historically, rural areas, especially in developing countries like Malawi, face isolation and have poor levels of access to services and facilities, often including healthcare services. This lack of access to services and facilities puts rural areas at a distinct disadvantage compared to many urban centres. Child Legacy Hospital has increased the number of skilled birth attendants in our underserved region, established a free rural ambulance transport system for emergencies to improve overall maternal health and increase community productivity.  Child Legacy Hospital through its Umwini solution expects to have tremendous impact in the community as maternal and neonatal related information will be readily available in the community and hence familiarization with pertinent information. This will enable them to make sound decisions which will promote best practices such as timely health seeking behaviors in the community. Rituals and myths that surrounds pregnancy have been seen to be contributing to maternal and neonatal deaths will eventually lack acceptance in the community as more women will be a washed with maternal and neonatal health information provided by health professionals in participatory groups including whatsapp groups.

The primarily target of the developed solution is pregnant women and women of reproductive age group are secondary targeted in the utilization of the solution. CLI prototype facility through its Umwini Digital Health Networking solution will address the barriers to accessing quality healthcare by pregnant women and women of reproductive age group in a rural settings. Our trained staff will be working together with women in intervention groups, and integrating the community and SBAs at the primary level will boost communication between these women and healthcare providers.

UDHN solution is unique, as it has never been used to implement maternal health related issues in an African setup, a model that will engage maternal mothers, women of reproductive age and healthcare providers using whatsapp groups in maternal health related information sharing.  Umwini digital health networking is a first solution to use whatsapp as a mode of maternal and neonatal related information dissemination to maternal mothers including pregnant women, nursing mothers, and non-pregnant women of reproductive age.  In Africa, social networks is a relatively new development and is always sought after by a majority both in rural and urban areas due to its enhanced communication possibilities to millions of people across the globe. The social networks like whatsapp has a potential to reach a large number of beneficiaries to the solution users across the continent, and to be used for development-related purposes as it is becoming widely recognized by the growing number of development-oriented projects and programs that specifically make use of technology.

Social Networks like whatsapp can support and strengthen the information dissemination better, more accurate, safer and faster way in connecting pregnant women, nursing mothers, women of reproductive age and healthcare providers through whatsapp groups.  The solution has a strong value for health care services even in rural areas both in effectiveness and efficiency in sharing maternal related information.

Umwini Digital Health Networking will revolutionize the way in which social networks’ solutions like Whatsapp are used around the globe. Child Legacy Organization created UDHN because no existing whatsapp social networks have been used as digital health networking solution to engage maternal mothers including pregnant women, non-pregnant women of reproductive age group and health services providers in the rural areas of the country, and in an African setup. UDHN utilizes whatsapp technology to improve the quality and efficiency of maternal and neonatal health at the local level, while promoting the adoption of national health protocols and compliance with national information dissemination requirements in order to achieve lasting improvements in healthcare outcomes.

Mobile solutions have strong value for health care both in terms of effectiveness and efficiency as is thought of bridging the relationship gap between medical professionals and patients. The potential for mobile whatsapp to reach a large and growing base of users across the continent, and to be used for development-related purposes, is becoming widely recognized, evidenced by the growing number of non-health related oriented projects and programs that specifically make use of mobile whatsapp.

A social network solution that provides a platform for participatory maternal and neonatal information sharing and discussions has a potential to reach a large number of beneficiaries and improve health outcomes. Social Networks like whatsapp can support and strengthen the information dissemination better, more accurate in a safer and faster by connecting maternal mothers, non-pregnant women of reproductive age and healthcare providers through whatsapp groups. For example, Malawian Media Houses use social networks such as whatsapp groups to reach millions of Malawians with their breaking news daily so that Malawians from the rural areas should not be left behind with current developments in the country. Our innovative digital health networking will engage and encourage maternal mothers and women of reproductive age group to participate in maternal and neonatal deaths reduction and strengthen healthcare workers’ ability to provide high quality healthcare, delivers essential health information to underserved population in rural areas of Malawi, and supports global scale.

Umwini Digital Health Networking, a technology approach designed to effectively engage and integrate pregnant women and nursing mothers, women of reproductive age group and healthcare providers at the primary level to foster participation in maternal neonatal and child health related information sharing in rural areas of underserved population. Based on the a pilot study in which women from rural areas where assessment was done as why they prefer giving birth to their children at home or with the aid of traditional attendants than at hospital with skilled birth attendants, it was found that most women have limited or no access to reliable sources of health related information about pregnancy and contraceptives. These women are there mostly misinformed as they resort to unreliable sources of information, however, integration of the community and healthcare providers will help demystify some of the myths that dominate the communities. Women with the help of health providers will be classified in whatsapp groups and engaged in discussions and information sharing to identify and prioritize the maternal problems and be involved in addressing identified problems with both hospital and locally feasible solutions. Interactive methods will be encouraged at these meetings, including stories, games and pictures, to discuss prevention, care seeking and treatment for common maternal and infant problems.

Since the launch of its maternal, neonates and child health services in 2015, Child Legacy International (CLI) with support from private donors has successfully facilitated reached out to thousands of people living in rural Malawi. To date, CLI Hospital has attended to over 18,000 pregnant women during Antenatal Care , over 6000 babies deliveries and postnatal checks(mothers) 6298  who would have otherwise not have had access to any healthcare.

In one year, Umwini Digital health Networking would have reached to 12,000 maternal mothers, women of reproductive age group with services targeting the marginalized rural areas of Lilongwe.

In the next five years, the solution would have reached to 60,000 pregnant women, nursing mothers, and women of reproductive age group from thousands villages in the rural areas in Malawi. During the pilot period, developers are continuing to add functions and work with the community leaders to ensure the effective and efficiency of the designed solution. We aim to increase the quality of care provided to pregnant women, nursing mothers and women of reproductive age group by at least 50% one year after UDHN solution implementation, leading to significant improvements in maternal and child morbidity and mortality. During this time, The UDHN Project will work closely with Malawi Ministry of Health to prepare for the expansion of Umwini Digital health networking throughout the country, thus improving the quality of care to over 6 million mothers and children by 2025.

Over the next five years, UDHN with funds from solve will expand its solution across the country to support high quality maternal and child healthcare throughout other regions in the rural areas of Malawi and beyond where access to maternal related information is difficult. Our vision is for UDHN to serve as the primary care digital health networking utilized in rural areas to serve millions of people across the country and Africa with a platform for maternal and neonatal health information sharing and discussions.

UDHN will buy and distribute smart phones and distribute them to both pregnant women, maternal mothers and women of reproductive age group to ease access to maternal and neonatal health information.

Umwini digital health Networking is being requested throughout the country of Malawi because it serves a critical role in providing effective and efficient maternal related  information sharing and discussion platform at the level of rural areas where most pregnant women and non-pregnant women of reproductive age group are provided with few or no maternal related penitent information.  Illiteracy is very high for most of the targeted women in the rural areas as most of them have never attended any formal education. To add, the roads in these areas are so poor that it is making life difficult for social health services to be taken to these communities in rural areas. Lastly, Child Legacy Organization which runs o limited funds to implement this solution to the rural areas of the country.

The ratio of medical professionals to patients is too high due to lack of funds to recruit more staff. 

Umwini Digital health solution team will be translating the maternal and neonatal health related information from English language to local languages and also encourage maternal mothers and women of reproductive age group to share and discuss maternal related information in local languages in order to address the communication barrier.

Few people from these rural areas have got smart phones, they don’t have TVs and Radios as alternative means of accessing maternal and neonatal health related information. With Umwini Digital Health Network funds, these people will be bought smart phones so that through social networks like whatsapp as a platform where they can access needful and accurate maternal and neonatal health related information and participate in maternal and neonatal deaths reduction. Through solve funds, the organization will recruit more healthcare providers especially nurses that will help in the implementation of the solution in the underserved areas on the country. 

A total of 5 full time staff and 1 part time staff working on our solution.

I will be working with my organization, Child Legacy International to implement the proposed solution. Our team consist of 5 people each with a different expertise; Dr. Joseph Makondi, Medical Doctor, Grace Soko- Health Program manager, Wisdom Khwalala-Health Knowledge Management Officer, Richard Chitedze-Senior Clinical Officer, and Charity Mchiela-Community Nurse.

Wisdom Khwalala-Health Knowledge Management Officer shall be working as the Team Lead whose responsibilities will include; designing maternal health and family planning messages as well as providing technical information. As an inspiring communicator he has the ability to tailor messages to different target groups, to engage and listen and have the flexibility to adapt to changes which is necessary for project cohesiveness.

 Richard Chitezdze will be working as a chief clinical officer, he is a clinical officer with 17 years’ experience working in healthcare, passionate about reproductive health rights and will be working as the project coordinator maintaining regular communications with beneficiaries and other project stakeholders. He will be also working hand in hand with Charity Mchiela as a community nurse. 

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To ensure sustainability of the solution, general patients other than maternal mothers are charged a filing fee of $2.5 during consultation as part of ensuring users’ ownership of the project in the community. We also plan to raise money by ordering and selling inexpensive Delivery kits containing essential supplies required at childbirth and also a small fee from the beneficiaries will be charged that will be used to  cover ongoing costs including technical support, mobile gadget maintenance, and literature translation.

To ensure project sustainability, the beneficiaries will be charged a small subscription fees to ensure sustainability and longer term operation of the operation. We also plan to make money by ordering and selling inexpensive Delivery kits containing essential supplies required at childbirth and also essential for  women of reproductive age groups like sanitary pads which are not available in the rural areas. 

Poor people especially in developing countries like Malawi are subject to the stress of the heavy demands of everyday life and in many cases forget to go and access healthcare information. Umwini Digital Health Networking solution is a community-level intervention engaging communities and health services providers to provide crucial information on maternal and infant health and link the community through formation of women's groups in the community to train mothers in basic aspects of healthcare for themselves and their babies. On other hand, our work in the community focuses on identifying the agents who act as promoters of change in the community and on using their influence in forming community networks and have a decisive influence on reducing personal or cultural barriers to access, as well as delay in seeking medical help.

Healthcare financing is a major hindrance to adequate and satisfactory health care services delivery in any country and has been cited as one of the major challenges in developing countries such as Malawi. Being a part of SOLVE’s beneficiaries will give our organization an opportunity to develop more ideas and solutions that will change the perception of maternal mothers and women of reproductive age group and  improve maternal and child health outcomes in an  African setup. Furthermore, being successful in this challenge would provide an opportunity for networking and learning from other successors and would be a stepping stone to achieve Maternal and child healthcare mile stones in an African setup.

 Child Legacy International Organization  would require support from all partenrs that would like to embark on projects in the area of martenal and neonatal care.A good  network with these partners would help us access leadership and mentorship skills and promote our solution.

Child Legacy also works with partners such as Malawi ministry of health and Sponsel foundation that have the final step in reaching our primary beneficiaries in the rural areas.  Our organization thrives on building strong partnerships with cultural custodians, ministry of health, and other organizations that we share common goals in the field of maternal and neonatal health. 

We would like to partner with Solve, so that it would help us in mentorship and evaluation in order to meet the intended purpose of the funds we will receive. 

We would appreciate any collaboration that would help sell our solution to other partners sharing our interest.

The rural population has lower life expectancy, higher incidence of disease and more exposure to risk factors (more chronic malnutrition, more non-spaced pregnancies, a higher incidence of diarrhea and respiratory illnesses in children) and worse health indicators (maternal mortality, chronic malnutrition, neonatal and infant mortality). In addition, out-of pocket health spending is higher and financial protection lower than in urban areas. In our solution, we aim to improve maternal and neonatal health in rural and poor areas by mainly focusing on building up access to maternal and neonatal health services information by bring healthcare services information  closer to rural areas through technology modalities including family planning information which can reduce maternal and neonatal deaths.

In addition, Malawi is one of peace loving countries in Africa, and most refugees have fled for refuge such as Burundians and Sudanese. The Umwini Solution ensures refugee inclusion to combat maternal and infant mortality in Malawi. Primarily focusing on providing maternal and neonatal healthcare services to pregnant women, nursing mothers and women of reproductive age reaching them in their hometowns and villages and advocating for better access to healthcare at primary healthcare centers in the Underserved communities.

In an effort to promote behavioral change in rural areas where people are typical villagers and abide to their traditional cultures, integrated innovative technology solutions are recommended integrate and coordinate maternal an neonatal health services to  improve maternal and neonatal health outcomes.  The evidence shows that technology interventions on MNCH are more effective in populations living in extreme poverty in rural and remote areas of Malawi.

Healthcare financing is a major hindrance to adequate and satisfactory health care services delivery in any country and has been cited as one of the major challenges in developing countries such as Malawi. Child Legacy has insufficient funds to implement its Umwini solution. Being SOLVE’s beneficiary will create a platform to further promote sustainable innovative solutions that would improve our healthcare services. The sustainable innovative solutions will pave away for health providers to develop more ideas and solutions that would benefit maternal mothers and women of reproductive age group by eradicating barriers in maternal and child health in African setup. Furthermore, being successful in this challenge would provide an opportunity for networking and learning from other successors including their experiences both successes and failures. Child Legacy through its Umwini solution believe that being SOLVE beneficiary would be a stepping stone to improve and promote  Maternal and child healthcare in African setup.

In this modern world, solutions that are technology based are recognized crucial interventions for reducing some of the most common barriers in accessing maternal and neonatal services especially in the rural communities. Delaying in seeking help when there is a health problem and is normally related to lack of knowledge about health, being unable to identify signs of risk, and/or lack of autonomy to make the decision, and also delaying in accessing the health facilities because of physical distance, lack of transport or high cost of access are the most problem in the underserved population in rural areas. This solution targets the rural communities where demand is high to encourage use of prenatal, institutional delivery, puerperium and postpartum services.

The Umwini Digital Health Networking solution bridges the healthcare information gap existing in under-served communities though  delivery of valuable and accurate maternal health related  information and  safe reproductive health to pregnant women, nursing mothers and women of reproductive age through their WhatsApp groups on their smart Phones. For the vulnerable women who cannot read, healthcare providers will render voice messages to personalize information in local languages within the context of health information sharing and discussions at primary level.

Bringing the solution closer to demand would alleviate the financial and geographical barriers, but also the personal barriers, including culture, the social norms proper to the communities in which people live and the perception of their own health. Our solution attempt to motivate behavioral changes in demand so that women increase their use of essential maternal and neonatal health services and adopt behavioral changes in order to reduce maternal and neonatal deaths.

The solution will reach out to the beneficiaries and engage health providers with pregnant women, nursing mothers and women of reproductive age as the beneficiaries of the solution in the rural areas of the country, without leaving behind refugees in the same category who have fled their countries of origin.