Check2Gether; saving lives at birth

In remote areas of low and middle income countries, 40-60% of the women do not receive proper antenatal care. We combine non-invasive diagnostic tests and a smartphone app to a small kit that any health worker can use to identify high-risk pregnancies. The app instantly displays easy-to-read test results and gives advice for treatment or referral. This new concept helps by empowering medical staff in remote areas. Together with group care Check2gether improves compliance to medication and life-style advice and  empower and engage women to act on their test results and raise awareness on nutrition, breastfeeding, family planning, birth spacing, and facility-based delivery. Care in a group changes the user(s)-provider experience, encourages self-care, is empowering and empowers end-users to learn to increase healthy behaviors for themselves and for their children. The improved outcomes result in a better start to life for more babies and children.

A great majority of maternal deaths occur in low- and middle-income countries. Especially in rural areas, 40-60% of the pregnant women have limited access to adequate professional health care. Proper identification of high risk pregnancies is hampered by long distance to hospitals together with shortage of properly educated and equipped staff and limited facilities at community level. Another important challenge is increasing utilization of quality services. This is especially relevant for under-served populations. Pregnant women do not utilize services that deliver poor quality care (in their perspective) and do not provide a safe and encouraging environment. Many complications and even deaths can be prevented when parents take their newborns and children to the doctor before they are seriously ill, when they become more aware about the preventive measures that can be taken, such as a better hygiene.

Elements of high qualitative maternal care are:

• Good and feasible medical and obstetrical care to detect potential causes of maternal disease and offer prevention or adequate treatment;
• Personal, educative and supporting interaction aimed at the empowering of pregnant women and to demand better services.

TNO offers such an innovative healthcare approach by combining diagnostic testing and an effective model of antenatal group care. 

Check2gether is a concept where midwives and community health workers provide antenatal care and diagnostics during interactive, group provision at the community level. Group care replaces the standard one-to-one medical model of antenatal care with a multifaceted model of group care combining medical check-ups with health information and promotion. Each group consists of 10-12 pregnant women with similar gestational age or 8-10 parent-baby dyads. They meet in structured sessions during which they receive:

• medical care; checkups of the mother and child;
• participate in a facilitated and interactive discussion and learn care skills;
• and develop a support network with other group members.

In group sessions, the parents will learn to recognize signs of serious complications and diseases, to take preventive measures and when and how to treat their children and themselves. The integrated tests and app will be used during these sessions to continue testing and monitoring the women’s pregnancies and make referrals when necessary, and ensure earlier advice is being followed. An integrated, non-invasive testing kit and diagnostic mobile application enables professionals to perform key tests for pregnant women to measure blood pressure, HB and glucose and protein in urine, to help identify (pre)eclampsia, gestational diabetes and anemia.

The very first stages of pregnancy up to the second year of a child’s life are of paramount importance for the physical and mental development of both mother and child. Health complications during this period can have significant effects on a person's health at a later age. By giving parents proper advice early on and through fast intervention when problems begin, we can prevent the need for more serious care later. With Check2Gether we make access to health care possible.

Group care for (pregnant) mothers and their partners, is a proven success especially for the most vulnerable women. Evidence shows that women receiving group care have better pregnancy outcomes and increased satisfaction with care. The evidence of benefits is especially strong for groups of marginalized women in underserved populations.

The diagnostic kit contributes to task shifting to community health workers and decentral diagnostics. Check2gether address both the gaps of the screening for high pregnancy risks at the community level and the referral linkages (decrease in referrals from 40 to 15%).

We cooperate with parents, local care professionals, policymakers and other stakeholders. We seek connection throughout the care chain so that every child gets the care he or she needs.

Check2gether is a technology-based mHealth solution because it combines essential diagnostic tests in a decision support system to support the midwife aiming at an average costs of 2 USD per pregnancy.

Check2Gether makes access to high-quality care possible because it’s brings antenatal care in the heart of the community. The screening on high risk pregnancy’s is based on the WHO- and National guidelines.

Group care empowers the pregnant women and midwives to improve experience of care, including improvement of compliance and adherence, resulting in improved quality of care. Infant and child illnesses and poor child development is timely detected.

Currently part-time people.

TNO the Netherlands (RTO):

. Scientists (0.2 FTE)

. Software engineer (< 0.1 FTE)

. Impact investigator (0.1 FTE)

. Business developer (0.2 FTE)

. subcontractor for the development of the app (< 0.1 FTE)

Simavi the Netherlands (NGO):

.project leader and adviser (0.2 FTE)

PHS (Presbyterian Health Services) Ghana (service provider):

. project leader Ghana (0.2 FTE)

TNO is the largest Dutch research institute. With technical know-how we develop and launch new products and services with a sustainable business model. TNO has been active on child health for over 60 years. Last 13 years TNO was already successful on the first 1000 days in Surinam, Ghana and Indonesia by introducing an innovative model of healthcare for pregnant women, young children and their parents. TNO’s large network in these countries is very valuable in adapting Check2Gether to local people’s wishes and needs. TNO-Industrial innovation has a group active in medical diagnostic innovations. 

Simavi is an International non-profit organization. Established in 1925, we strive for a world in which women and girls are socially and economically empowered and pursue their right to live a healthy life free from discrimination, coercion and violence. Simavi works with local partners (NGOs, universities, civil society organisations) in 10 countries in Africa and Asia. Core activities in Simavi’s works are technical capacity building and organisational capacity building. 

Presbyterian Health Service-Ghana is a member of the Christian Health Association of Ghana(CHAG) and an implementation agency of the Ministry of Health Ghana. PHS is the  third largest provider of public health  services in Ghana with  a direct constituent of about 3 million across the country with over a hundred years’ experience in the provision health care in Ghana. The PHS is a leader in innovative health care with focus on reaching the poor, marginalized and rural populations.

We are currently partnering with Centering Pregnancy Global to improve group care.

We are currently partnering with Relitech, a Dutch med-tech company. As a subcontractor Relitech is implementing the app.

We will perform a small study in Kosovo together with our implementation partner Action for Mothers and Children (AMC – Pristina).

We have an extremely good relation with PHS (Presbyterian Health Services) in Ghana and we are exploring partnerships with 3 healthcare service providers in Indonesia.

Check2gether is a global solution for many low and middle income countries. However providing a solution for the millions of midwives operating at community level is very difficult.

At this moment we are thinking of two business models:

1. Check2gether will become available for the district health officers. These officers are responsible for the healthcare in the region and most midwives are employed by the district officer.

Check2gether will provide the kit, training and service & support to the districts.

2. (preferred BC) In most rural areas, district health officers rely on health care service providers. When Check2gether is nationally accepted, Check2gether will become available for these health care service providers. These service providers will be trained (train the trainer concept) to provide the kit, train the midwives and provide local service and support.

For a sustainable business model in rural areas of low and middle income countries it is essential that all innovations and developments has to be performed by a global entity. For this we are currently exploring shared innovation and research or co-creation solution. We expect that most of these activities needs to be funded by donors.

Initial pilots has been performed. The lessons learned need to be integrated in check2gether for a good minimal viable product.

These development costs must/will be financed by funding. First, the business model needs to be validated.

A social entrepreneur is responsible for the market readiness of Check2gether. Secondly a pilot needs to be funded to perform a pilot study at regional level to acquired evidence to convince the national government for scale-up. Last, this entity will be responsible for FDA approval and commercialization.

Regular funding could be mixed funding consisting of: premiums from the national health insurance scheme and budget form the regional/district health office or the national ministry of health.

We like to partner with stakeholders in the countries; ministry of Health, private and public organizations to develop and implement a value chain. We look for partners that offer low cost accurate diagnostic tests for example Hb, PB, glucose, infections.

We look for global ambassadors, funders and partner that can support our solution.

Can we make a viable business model? It is hard for midwives to invest by purchasing the kit, is it possible to create a pay per use solution together with all partners in the supply chain?

Service and support in remote areas is challenging. Lack of enthusiastic local figureheads, good infrastructure, long distances and many local districts hampers growth and sustainability.

A sustainable business model is most likely only possible sunk development costs. For that reason we need funding for further development and scale up to other countries. Can we further improve check2gether by co-creation or shared research?

Advisors in this field are more than welcome.

The diagnostic kit of Check2gether is a medical device, for this purpose we need FDA approval and acceptance by the national governments for each country.

We haven’t thought about marketing, yet

We like to partner with stakeholders in the countries; ministry of Health, private and public organizations to develop and implement a value chain. We look for partners that offer low cost accurate diagnostic tests for example Hb, PB, glucose, infections.

We look for global ambassadors, funders and partner that can support our solution.

Check2Gether is a prototype that can be implemented in refugee camps worldwide.  It will give pregnant woman the care and support that they need in difficult circumstances and will contribute to the empowerment and resilience of the family. 

Group care engages women in care because it is a care model in which interactive health education, peer support and medical care are offered in combination. Especially vulnerable women en refugee women, often parted from their network of family and friends and thus lacking support and information can benefit of group care.

It is our experience with Eritrean women that if group care is provided in face to face sessions sometimes  supplemented by online group sessions a strong peer network of women and care providers can be created, even in a situation where women do not live in the same area. This can also apply to a situation of refugee women where women do not always  stay for a longer period of time in one setting.

We will use the Andan Prize to expand and implement Check2Gether in refugee camps. We can start in South Sudan where we already work in a project for refugees and young children. 

We want to create a worldwide community of practice and knowledge sharing around empowering the most vulnerable women, i.e. pregnant women in remote isolated rural areas, by connecting them to quality health care

Pregnant women in developing countries living in medically underserved areas. With pregnancy properly monitored, they’ll be safer, more confident and empowered with relevant information and advice and able to manage their health needs better.

The introduction of Check2Gether is an opportunity to strengthen coordination and awareness around pregnancy and childbirth at the individual and the community level, starting at the rural dispensary and, through the dispensary, the healthcare system.

The price will be used to combine Check2Gether with a service for family planning.

Proper identification of high risk pregnancies is hampered by long distance to hospitals together with shortage of properly educated and equipped staff and limited facilities at community level. Another important challenge is increasing utilization of quality services. Check2Gether helps by empowering medical staff in remote areas.

Furthermore, healthcare providers can better tune in to women’s needs and demands when having more time to work with them, as happens in group care, compared to short one to one medical visits in a more hierarchical setting.

Check2Gether trains midwives and community health nurses to perform antenatal care during interactive, peer-oriented group provision at the community level. Group care replaces the standard one-to-one medical model of antenatal and child health care with a multifaceted model of group care combining medical check-ups with health information and promotion.

The diagnostic kit contributes to task shifting to community health workers and decentral diagnostics. C2G address the gaps in referral linkages (decrease in referrals from 40 to 15%).

We will use the grant to expand and scale up Check2Gether to more low and middle income countries, like Tanzania for example.  We will also use the grant to establish a system transition with (local) partners in the public sector by implementing a guided self-management approach of health and wellbeing at community level under supervision of the midwife, community health worker and obstetrician. Adding m-health and teleconsultation solutions together with improved experience of care will lead to a holistic approach where engaged women have easy access to reliable and seamlessly integrated professional health care.