Health 360⁰ Mobile App for Mothers

The main problem is low access to quality maternal, neonatal and child health services due to poverty and fragmented service provision spots.  Lespoir proposes the application of technology to create a one-stop comprehensive subsidized solution for mothers.

1. Establish a maternal health app that is linked to medical referrals, social economic and livelihood opportunities.
2. Advocacy and partnerships with slum-based private sector for quality affordable or subsidized services.
3.  Catalyze increased recruitment into the government Linda Mama medical cover run by the National Hospital Insurance Fund (NHIF).
4. Increase male-involvement in the childbearing process and securing child registration, physical security, emergency response and social protection.
5. Facilitate linkage of government-managed Community Health Workers with private facilities
6. Promote private health providers participation in Continuous Medical Education and on the-job training conducted by Ministry of Health on revised algorithms.
7.  Establish  mentorship and support system for adolescent and a first-time mothers.

Impact will be 100,000 mothers served.

Access to affordable quality maternal and neonatal among residents of informal and slum areas. The Food for Agriculture in 2014 report indicate that women suffer greater food insecurity that complicates their access to health and treatment when they need it most when compromised by early pregnancy, poor state of maternal and neo-natal health services  and sexually transmitted illness including HIV. The situation in Nairobi is no different from the national statistics on indicators of good health. For example 36% of those interviewed at health facilities report having faced one form or the other of gender-based that hampers access to facilities like the one run by L’espoir MedicaL Center.

Findings from analysis of UNICEF (2015) and UNFPA (2015) quantitative data show a huge lack of knowledge, low self-esteem and efficacy that affect young women’s decision-making power especially concerning the reproductive health including child-bearing and health spacing.  Within the household, the research generally showed that most women have little ability to afford quality health services without getting male involvement yet the same data showed young women can make certain health-related decisions in the absence of their male partners if they have subsidized schemes for loans, savings or direct cash transfers. 

Health 360⁰ Mobile Application Linked to Maternal Health Subsidies

Lespoir Medical Center proposes to apply a Health 360⁰ Public Private Partnership (PPP) technological model to maternal and neonatal health that ensures working with both government and private sector that result in actual maternal health service delivery.

The project will identify and formalize partnerships with foundations such Safaricom Foundation,  Volunteers from Austria, Association of Private Health providers and other donors With the County Government of Nairobi to generate funding for subsidies from private sector the project will refund private health facilities recruited in the project’s catchment in Nairobi County.  The subsidies will cover pre-natal , deliver and post-natal costs and related small loans and employment opportunists. Candidates for subsidies will be identified by community health workers and government social workers upon voluntary application. 

The project will also enroll providers on the Mobile App including small and medium enterprises for loans and savings, paralegal services providers for legal ad, men groups for social support of fathers, children registration and nutrition support and social safety nets including counseling. Mentor ship and telephone counseling  especially for first-parent and victims of violence. 

The potential population of reach within the catchment of the facility is 100,000 with majority (70%) being below 35 years. Qualitative information gathered through focus group discussions and key informant interviews in the process of developing this call response indicate that  the main barriers to access to health services as week life strengthening skills, low income, poor livelihoods,  low self-efficacy and attitudinal barriers by parents and significant others towards sexual  and reproductive health. 

L’espoir Medical wishes to utilize the requested funds from development partners and community own donors to alter the health indicators in the catchment area and make a significant contribution to no mother losing life while giving life.  The current strategic guidance however prioritizes the following groups for urgent action in this program:

1.            Adolescent and young mothers 16-35 years old in informal settlements

2.            Persons affected by violence, abuse and neglect due to mental health of all age sets

3.            Migrant population male and female 18-35 years in urban settings

4.            In and out of school youth 10-24 years in rural and peri-urban

5.            Persons living with disability of any form across all the age sets

Lespoir Medical Centers to contribute to the Challenge priority for maternal and neonatal health which seeks ways how  every woman, new mother, and newborn can access  care they need to survive and thrive. This it will done by applying mobile technology for comprehensive integrated survives supported by a medical and social support subsidy scheme for the poorest of the poor in slum areas. 

The target populations face  challenges to access services due to low, knowledge, skills and financial constraints even when services exist. Current services are offered at different locations which can be made into a one-stop on phone. 

The private partnership model for improved access to health presents provides pregnant women with a total market approach to services they require during child bearing experience. The fact that the model utilizes mobile phones that have high penetration and use in  urban slums guarantee rapid uptake by women. The bonus subsidy provision will incentive the women to enlist for financial literacy  and savings schemes that guarantees additional and sustainable livelihoods even as they graduate out of the project after utilizing the services. The application of mobile data capture and will also promote accuracy and generation of project alumnus database that can form networks for recruiting mother-mentors and project champions in subsequent periods.  The data be consent of the beneficiaries will also be available research to advice future projects and national data. The platform also offers a real-time referral tracking scheme for needed medical and social services.

The software hosted at Lespoir's headquarters able to be accessed across the country but with a pre-screening for verification and qualification on account of geographical and level of income. The app will have a tele-nursing ability to provide maternal counselling on phone addressing matters such as false labor and post-spur-tum support like laction and nutrition. It will provide comprehensive  maps for the nearest points of care for both medical and non-medical wrap around services like financial literacy, saving and loans. 

The app will ability to track weight, patients progress records for due dates, reminders, ultra sound appointments  and confirmation of follow-up visits by the community health workers and specialists. It will dis-aggregate data by age, vulnerability and special needs for personalized attention and track performance of loans and subsidies on sliding scale of amounts. It will have ability secure and back up bio-metric and photographic data.

The information will be backed off-line and archived as per the Ministry of Health policies and procedures.  

In Kenya mobile telephony is already in use by the financial sector in speedy processing of finances and this can be rapidly up scaled in the project with a bias to increasing efficiency and coverage of comprehensive services. The application to be developed will learn from lessons in the researched mHealth project in Kenya that lists several lessons and considerations. This include overcoming user-literacy, increasing off-grid methods like solar for charging telephones and simplification of the app. 

Experiences of the Medic Mobile will be relied upon through their digital Community Health Toolkit (CHT) to train community health workers while avoiding duplication. The CHT provides  resources to design, build, and deploy digital tools for community health.

Research on integration such as the one by Susan Baxter, et al in The effects of integrated care: a systematic review of UK and international evidence studies will guide the project in rolling out its integration and comprehensive approaches to health combination with non-health services. 

The L’espoir Medical’s Project’s theory of change:

Young women observably limit their participation in community activities including health seeking due to several factors that include low income, knowledge and being overwhelmed by pre-existing male dominance in the East African Region. Several efforts at correcting this have been attempted with varied results motivating L’espoir Medical to seek an amendment to the space of women especially those aged 15-35 in health thus this concept.

The theory of change postulates that altering levels of income, individual attitudes, self-esteem, self-efficacy, communication skills and critical thinking will transform young women to their own force for change with a boost from male of all ages through changing the access to quality women’s health. The project also observes women’s own attitudes are a critical success factor for assured positive health outcomes. The project will invest in personal attitude exploration exercises with individual young women to cultivate favorable attitude adjustments. 

 All young women attending sessions will be voluntarily screened for reproductive health related risks including sexually transmitted infection and alcohol or drug use that affect treatment. Subsequent one-one sessions with trained providers will include a strong element of referrals to wrap-round services like financial literacy, urban agricultural methods on poultry and fish farming and table banking within women groups. There will also be general counselling, spiritual assistance, legal redress and inter-spousal arbitration where need. The project team believes strongly that lasting outcomes will require partnership with government, multi-agency teams and strengthening of local networks that engage this teams continuously.

L’espoir Medical commits to learner-centered approaches that cater for cultural sensitivity and variance in literacy levels. Project beneficiaries and secondary audiences will be constantly engaged in workshops and sessions to provide relevant and priority health generative themes. 

The project’s communication will be both through mobile phones and face-to-face sessions with small groups being the main mode supported by community outreaches and printed materials to cater for low literacy with some local community radio programs reinforcing key themes.  Advocacy will be purposed to gain provision of protection to young women who may become vulnerable to attack.

The project population to be served in the stem year will be 100,000 from the denominator of 250,000 gathered by our monitoring and evaluation team. to be counted as reached or served they individual counted must have enrolled into in the scheme and utilized four or more of the maternal medical and social and economic services.

The organization will inbuilt  a robust data for decision making system in the main data capture and analysis protocol to tack performance on a real-time basis for management purposes and feedback generation for government, donors and stakeholders.

The project’s goal:

The proposed project aims at increasing access to quality medical and social services for the most vulnerable of young women in Kenya with a focus on individuals with of cases teenage pregnancies, coerced sex, unplanned pregnancies and infections that may risk own or unborn babies health by 2024.

Special considerations and project values:

L’espoir Medical will proactively prioritize the poorest of the poor; most vulnerable and persons with disability, low literacy and pre-existing barriers to health services such as victims of rape or violence and low self-esteem and efficacy. The project will also provide economic opportunity and linkage to employment to vulnerable young women to augment on health needs.

As its core values in the project L’espoir Medical commits to respect of human rights for all, non-discrimination, teamwork, transparency, restoration of hope and quality of medical and related social services.

Project Objectives:

• Increase institutional capacity of L’espoir Medical Health Services to  manage and implement a robust young women’s reproductive health project  by 2024
• Increase 250,000 young women knowledge and skills on Life Strengthening Skills like self-esteem, efficacy, critical thinking and communication on reproductive health, by 2024
• Increase resource leverage and/or allocated funding by government and partners for reproductive health in Nairobi by 2024
• Increase male protection for young women advocates involved reproductive health promotion and advice  work by 2024
• Increase insurance coverage of young women’s business, urban agriculture like poultry and fish rearing and artisan assets by 2024 

Financial: For complete and timely roll-out of the comprehensive  public private partnerships it will require the securing of all budget components within the same timelines such that no sequenced item is left behind.

Technical: The project will require an increased investment in its ICT infrastructure requiring a thorough ICT audit and procurement plan and supporting budget. 

Environmental: Some of the proposed livelihoods and small income capitals will be employed in the project will depend on conducive weather 

Legal: The legal regime in Kenya will continue being pro-poor and the legal officers will be pro-active and deliver on the mandates on time. 

Cultural:The population of urban slum being prone to incitement by partners with competing interests, gatekeepers and space.

Market:The individual will be able to fully understand the need's of the population and adjust plans accordingly.

Mitigation plan

Financial: Increased fundraising and timely negotiations and contracting signing for  public private partnerships for subsidies and facilities. 

Technical: Conduct a thorough ICT audit increase staff capacity through training and and procure as advised by the audit 

Environmental: The project will train the community members on business viability and non-rain fed urban farming that is not dependent on conducive weather 

Legal: Project staff will continually be oriented on laws and procedures and hold joint meetings with legal officers on period format

Cultural: Continued sensitization's of leaders and holding frequent feedback meetings with stakeholders

Market:Conduct proper mapping of sites and refreshing providers database every six months

Full-time-7

Part-time-4 

Contractors-2

The project will under an overall project director has a background of ten years in engineering including signals management in security firms and is already posted at the hospital. He will who will be based within the main L’espoir Medical office in Nairobi. The director will deputized a deputy director programs who has over ten year experience in health and social programs in Africa who will provide overall oversight and report to the project’s board on project activities through monthly meetings and submission of a quarterly report that includes the expenditures report. He will supervise the three project officers who will be in-charge of day respective county programs, planning, implementation, monitoring and evaluation. The director will also supervise the finance and monitoring program officers who will plan activities, engage beneficiaries, plan trainings and sessions and conduct mentoring and supervision. They will meet monthly and prepare monthly reports to be shared with government, donors and stakeholders. A pool of consultants will be sourced from time to time to boost the teams capacity to deliver the best products and services and conduct external audits. 

1. Mashcom Sytems: ICT software and hardware

2. Arrow Africa: Shared mission, networking and services provision

3. National Oragnization of Peer Educators: Recruitment and traing of trainers and community health workers

4. National STIs Control Program: Policy and standards for service provision

5. ECLOF: Micro-Finance training and access to financial literacy for women

The business model is driven by four pillars:

1. Marketing of quality health services in both public and private health facilities: To succeed, the project proposes to aggressively market and promote the scheme through community health workers, women groups and community radio. The marketing will cover health and livelihood benefits of the scheme and MobileApp while offering publicity to the private sector partners as responsible corporate responsible entities thus boosting their brad profiles and public image.
2. Gradually transform subsidies scheme into a small-fee health insurance: The project will systematically wean off the women with improved incomes into a small fee contributory scheme for long term heath needs access. This will be done by assessment of improved incomes and support of government social workers.
3. Train, incubate and certify women in entrepreneurship and business skills: The project will support on-line training and incubation of certified women to start viable income generating activities and business. Those opting for employment the project will promote employment into the manufacturing and construction sector of low-to medium skilled opportunities.
4. Strengthen collaboration with the government-run UWEZO fund for women and micro-enterprise institutions: Upon effective registration of qualified members, the women arranged in groups will be handed over to the Uwezo Fund for training and access to small loans and business support.

Sustainability will be built on three core principles: improved economic ability of enrolled mothers; strict out-based approach to participating health facility in both public and private facilities; and diversity of investments and fundraising.

Improved economic ability of enrolled mothers: All mothers as part of being accepted at enrollment into the scheme will be required to sign up for entrepreneurship, business and employ ability skills on-line and mentorships training and certification. Through partnership with ECLOF Micro enterprise and the government run UWEZO fund for women, the project will source experience trainers to deliver content and mentor the mothers and advocate with both to increase loaning by acting as an intermediary guarantor.

Strict output-based approach (OBA) to participating health facility in both public and private facilities: The participating health, economic and social institutions will sign memoranda of understanding to formalize their acceptance of only receiving support upon accurate reporting on outputs. Those that record higher outputs will thus receive higher allocation while those recording low outputs will receive more on-the job training to improve in areas they may be experiencing difficulty in meeting allocated targets. Funds wastage will be minimized.

 Diversity of investments and continuous fund-raising: Lespoir in its strategic plan proposes to offer the private sector consultancy services in wellness and occupational safety and health that include assessment of worksites for COVID19 preparedness and response. This will generate unrestricted income that will be in-turn injected into Health360 degrees small fee insurance scheme which is the second phase that will replace  subsidies.