Enhancing Maternal and Child Survival

This project aims to improve access, utilization and quality of Maternal and Child Health care among the refugees and host communities in Northern Uganda. Our strategy is to design an Enhanced Health Care System (EHC) that covers and strengthens the six WHO pillars of the health system including refugees and community owned initiatives for prevention of maternal and child deaths at community and lower primary healthcare facilities. We shall use a quasi-experimental design to compare the outcomes of the implementation of the EHC using the Locate (L)Link (L)Treat(T) and Retain (R) strategy in one cluster, Refugees and host community owned initiatives in another cluster and control clusters. A baseline and end-line surveys will be conducted in which maternal and under five childhood outcomes will be compared. Prevention of maternal and child death at community and primary health will have huge impact on health and development globally.

Maternal and child mortality and morbidity are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. In sub-Saharan Africa between 20 and 70% of all births occur in health facilities,5–15% of all newborns are resuscitated by skilled health workers and between 10 and 15% of these babies are born in facilities with resuscitation equipment. Despite enormous recent improvements in maternal and under 5 health indicators, Northern Uganda may not realize Sustainable Development Goal 3. Recurrent conflicts in South Sudan and Democratic Republic of Congo continue to cause huge displacements of people into refugee settlements in the region. Existing reports show that the refugees population in Uganda stands at 1.3 million with over 70% of this population located in Northern Uganda (UNHCR, 2019). However, the influx of refugees has brought additional population pressure on natural resources and basic social services in Northern Uganda.  The ratio of health workers to patients at health facilities is low.  With the emergence of COVID-19, reproductive health services for mothers and new born among refugees and host communities are further exacerbated. Improved access to and use of healthcare services is urgently required

 Our strategy focuses on provision of EHC as interventions using LLTR model at lower primary health facilities. In this model, Smart Antenatal Mobile village health teams go house to house in the refugees’ settlements and host communities to locate pregnant women and newborns Locate(L). They exchange contacts, initiate routine ANC/MCH clinic attendance and scheduled ANC/MCH clinic appointments using user friendly mobile phones with lower primary health workers at their initial visits Link(L). The ANC/MCH clinics provide complete EHC services to each pregnant mother who visits the health facility Treat(T). Pregnant mothers are tracked and those who default are followed up and their compliance ensured Retain(R). EHC interventions will involve a range of services; early identification and surveillance of the pregnant woman and newborn babies, management of pregnancy-related complications, treatment of concurrent illness in pregnancy, screening for diseases,  immunization,  presumptive treatment of malaria in pregnancy (IPT), obtain weights for all under five children and pregnant mothers and diagnosis of malaria using rapid diagnostic tests etc.  The expected outcomes include overall increase in antenatal care attendance, health facility deliveries, improved quality of care leading to reduced maternal, and child mortality in refugees’ settlements and host communities.

The primary beneficiaries of this solution are pregnant women in refugees settlements and host communities in Northern Uganda.  With the influx of refugees reproductive health services have been greatly hampered and these have continued to deteriorate health conditions. The proposed model will enable stronger interface between primary healthcare facilities, refugees and host communities. These community engagements will hasten health improvements; increases antenatal care attendance, health facility deliveries, improved quality of care leading to reduced maternal, and child mortality and morbidity in refugees settlements and host communities. Several researches are being conducted under different subjects; health, nutrition, mental health, maternal, gender and others to address the needs of the refugees and host communities in the region.  However, the ones which was done by this applicant was  to assess health systems response to Neurocysticercosis in Northern in an effort to understand the functionality of health systems (Alarakol et al, 2018).  Currently, we attach Medical students from Gulu University for internships programs in different health facilities in the region. Through internships, students are assigned tasks to identify health related needs in refugees and host communities and document them for local health authorities.  This has created community and health facility or institutional partnership engagements.

Early identification, case management, treatment and the efficient timely administration of health support services to pregnant mothers and their newborns using EHC model helps in providing access and utilization of healthcare services at the refugees settlements and host communities.  This directly helps in providing solutions to healthcare gaps that are currently being experienced in the refugees’ settlements and host communities due to the huge numbers of refugees who largely depend on poorly inadequate healthcare services. Therefore, EHC model will significantly contribute to the well-being of the refuges and their host communities and will fulfill the Sustainable Development Goals 3.

Access and utilization of reproductive services have always been very difficult among the rural communities due to poor health systems in the region.  Therefore, improving access and utilization of these services at the primary healthcare facilities through provision of EHC is vital. The LLTR model provides a unique approach that targets pregnant mothers and their new born in the refugees settlement and host rural communities and link them to a nearby healthcare facility at an early stage. Through this initiated platform, pregnant mothers have routine contact using user friendly mobile phones for reproductive health services at health facilities. Additionally, what make our model unique is that smart antenatal mobile village health teams look for pregnant mothers in the refugees settlements and host communities and ensure they are linked to a health worker in order to get the necessary reproductive health services they need for their sustainable health.This is vital because through this initiative all intending mothers are early identified and registered into routine reproductive health services which they normally don't receive when  left on their own to initiate these practices.Therefore, our solution approach stands in the pillar; "locate pregnant mothers and their new born where they may be found".  This is innovative and novel and if this practice is well executed, we shall improve access, utilization and quality of maternal and child health in refugees settlements and host communities in Northern Uganda. This is in line with Sustainable Development Goal 3 for good health and well-being.

A core component of our solution will be the use of mobile phones application.  We intend to ensure that all the registered pregnant mothers in the refugees Settlements and host communities are provided with user friendly mobile phones.  These phones will be registered at the lower primary health facilities and shall be configured to show the identity, time,location, name of the pregnant mothers  when they make makes calls. The phones shall be toll free allowing pregnant mothers to make calls without limitations to the health workers and the smart antenatal mobile health teams when in need of their services. There will be health information systems at the primary health facilities in the refugees and host communities that capture detailed data from pregnant mothers in the settlements and relay or transcribe into the district health information systems.  Database from different pregnant mothers in the refugees settlement will therefore be generated and transmitted according to the district health information database. Therefore mobile phones will primarily be used by the pregnant mothers to access  essential reproductive health services when they need them, be able to follow ANC/MCH schedules for routine antenatal care and be able to interface with a health worker and village health teams during tracking and monitoring compliance  to reproductive health services by pregnant mothers. At the same time, the data  will be used to provide health information regarding maternal and child health in the refugees hosting districts.

Globally, there are an estimated 5.7 billion unique individual mobile
phone subscribers, with significant continued growth in LMIC (Ericson, 2019).
There is increase hope that mobile phone technology will assist in overcoming barriers to health system functioning and service delivery
and many developing countries are integrating m-Health components (Labrique et al, 2013). m-Health is used to refer collectively to the use of mobile technology for health-related functions, including data collection and management, service delivery, health communication and diagnostics (WHO, 2019). Despite this growth, heterogeneity of m-Health study designs and contexts continue to hinder the determination of effects on maternal and child health  outcomes. A Study of m-Health interventions which targeted pregnant women reported improvements in antenatal and neonatal service utilization, but evidence of effects on maternal and neonatal outcomes was limited,  (Sondaal et al, 2016). Mobile phones are the primary m-Health technology and the most relevant to behavior change interventions. They have largely been use routinely for communications among many various communities.  However, their uses have been limited among the refugees settlements and the rural communities due to their inability to own mobile phones.  Pregnant mothers are usually the most affected since they are unable to communicate when in need of reproductive services. Therefore, providing them with mobile phones will make their communication easier and  be able to attend antenatal services and other scheduled reproductive services.

The proposed application of LLTR model  is one of the strategies we intend to use in order to obtain significant outputs from our activities for the improvement of the lives of pregnant mothers in the refugees settlements and host communities.  We hope that when pregnant mothers are provided with registered mobile phones they will use them for accessing reproductive health services. The use of mobile phones provide platforms through which pregnant mothers can be routinely tracked and monitored for all the ANC/MCH clinics scheduled  required for the well-being of the mothers and new born. Additionally, pregnant mothers can use these phones to access vital health information from healthcare workers and the smart antenatal mobile village health teams at their locations without them traveling to the health facilities.  This will in turn enable all the registered pregnant mothers in the refugees settlement and host communities to routinely receive essential healthcare services that relate to their health needs. The outcomes of this activities will be enormous since all the pregnant mothers  and their new born who will be provided with essential reproductive health services in the refugees settlements and host communities will certainly attain good health.  The most anticipated outcomes and impact of this study is when pregnant mothers in refugees’ settlements and Host communities enjoy good health as a result of robust reproductive health services among the population in the region and they are able to engage in productive ventures to improve on their livelihoods.This outcome is in line with Sustainable Development Goals (2) for zero hunger and (3) good health and well-being.

The influx of refugees from South Sudan and Democratic Republic of Congo (DRC) into Uganda continues to increase due to the ongoing conflict in the region. Currently, it is estimated that about 10,000 pregnant mothers live in the refugees settlements and host communities in Adjumani and Lamwo districts, Northern Uganda. This number is expected to rise as more refugees continues to trickle into Uganda from the South Sudan and DRC. Therefore, in one year about 10,000 or more will be served with the proposed solution.  In five years up a minimum of 50,000 or more pregnant mothers will be served with the proposed solution.

Goal: The main goal of this solution is contribute to the improvement of maternal and child health among the refugees and host communities in two districts of Adjumani and Lamwo, Northern Uganda. We shall initially  conduct a baseline survey to determine the number of pregnant mothers and new born in refugees and host communities in the target region. This shall be followed by designing and implementation of the EHC using the LLTR model in primary healthcare facility in refugees and the host communities.  As part of the sustainability plan, we shall incorporate capacity building of healthcare workers and village health teams in our solution. Additionally, we shall investigate the impact of EHC implementation on maternal and newborn in the refugees and host communities. Furthermore, we shall investigate the refugees and communities practices that improve the maternal and child health survival in the refugees settlements and host communities . We envisage up to 50,000 or more pregnant mothers in refugees and host communities will  benefit from the proposed solution. This will have an overall impact on the health and productivity of refugees and host communities in the refugees hosting districts.  If this model succeed, we hope to scale it up in other refugees hosting districts in Uganda.  Thereafter, this can be replicated in all regions affected by refugees globally.

Financial: The proposed solution will have to use significant amount of funds to be able to implement the EHC package in the next year and the next five years. As of now, we can't yet figure out how we shall be able to execute the proposed exercises.Therefore, financial limitation will have significant effects on how the proposed solution will be implemented.

Legal: Despite the relatively open regulatory environment for refugees in
Uganda and the many existing initiatives by refugee innovators, there
are many constraints that still need to be addressed to bolster
refugee-led innovations. Women who are engaged in community based activities experience problems in how to market their products in order to improve on their livelihood. The refugees movements are are still restricted and thus they are unable to look for markets for the products and services.

Technical and legal: Refugee innovation in Uganda is rich and diverse, and is supported not only by international agencies but also through community-led
initiatives. However, refugees still face many barriers to innovation.
At a national level, Uganda is aware of its need to further support
science and technology innovation, but does not mention refugees in its
national policies.Also Networks problems.

Cultural: Having diverse cultural philosophies and practices at the refugees and host communities are serious set backs in  the execution of the proposed solution at the refugees and host communities  since each of the ethnic groups would prefer practice their own culture at the sites, making fulfillment of the proposed goal difficult.

Financial: As an effort to overcome the financial limitations, we hope to aggressively seek for funding from potential funders through joint grant application platform with willing partners and individuals who would like to partner and participate in the contribution to the plight of the refugees and heavily burden host communities in refugees hosting districts in Northern Uganda. We hope through sustained effort of seeking for funding, we shall be able to overcome the the current financial limitations.

Legal: Although Uganda has one of the best policies in the world, more still needs to be done on refugees policies so that the plight of the refugees are properly handled through policies that impact on their welfare.

Technical:Governments and the international community can help to minimize these barriers by considering how they could best support refugees to take their own ideas forward – through better access to financing for
personal and business development, provision of more opportunities to
bid for business grants, and by sharing information on existing services
that refugees may be able to access themselves.Through this project we shall advocate for improvements of refugees led innovation through better policies. We shall use refugees settlements and areas of host communities which have networks coverage.

Culture:  We shall advocate and encourage the organization of the different ethnic groups to be located distinctly at different sites of the settlements for clear identify and to build cohesiveness and free interactions among  the refugees and host communities while preserving cultural identity and practices.

All the team members  work in Gulu University (GU) in Faculty of Medicine.  However, the individual members are from different departments mainly from Maternal and child health, Medical Biochemistry and information, Pediatrics. GU embraces community engagement in all its core functions of teaching, research and innovation. The curricula of training both undergraduate and graduate levels emphasize deliberately structured courses on community engagement. Available evidence shows that the community engagement approach has had positive impacts on both the students and host communities. The community orientation makes GU disseminate researched knowledge, technologies and innovations for immediate application for Socioeconomic community transformation.

All the members of my team are full time staffs of the University and usually engaged in teaching and research.

Dr. Alarakol Simon Peter, who is the team leader for this project has vast experience in working with the communities.  He Holds a PhD in Molecular Parasitology and has several laboratory and community health research experience .  He has participated in a number of health systems research  focusing on Neurocysticercosis among the patients with epilepsy.

Dr. Pebalo Francis Pebolo. Holds a master in Obstetrics and Gynaecology.  Has several experience on reproductive health.  He is interested in improving access and utilization of reproductive services among the refugees and host communities. He has several experiences in dealing reproductive health among mothers and their new born.

Mr. Wlater Onen Yagos. Holds a masters  in Public  Administration and management and a bachelor degree in Library information Science.  He has several experiences on community health research and using mobile application technology in community's research.

We have partnerships with Makerere University in areas of research and innovations. We are routinely involved in joint grant applications, joint implementation of the research projects, participating as external examiners and development of manuscript for publications. We are currently working on joint COVID-19 project focusing training of refugees and host communities on the recommended preventive measures on COIVID-19.  We have also submitted a joint grant application to build the capacities of the health workers in refugees’ settlements and host communities for quality diagnosis, case management, treatment of COVID-19 to improve the healthcare services of the refugees and host communities for sustainable health and development in the region. If funded, we hope to use the project to improve the lives of these vulnerable groups.

We shall provide healthcare services to vulnerable refugees and  communities in refugees hosting districts in Northern Uganda. Our model of operations will be embedded in the WHO 6 pillars of health systems strengthening with specific focus to healthcare services delivery.  Through the EHC model using LLTR, we shall ensure that essential healthcare package are provided to pregnant mothers and their new born. The services process will be coordinated at the lower primary health facilities in refugees settlement and host communities. Pregnant mothers and their new born  will be the primary targets since they are the most affected persons in the communities.  Most of the services we provide will be reproductive services.  Our initial source for funding is through the current solve funds.  However, we hope to scale up this services to other refugees affected communities in other part of the country should this model show promising outcomes.  Therefore, this will require that we seek for more funds elsewhere.  We hope to seek for partnership and through this platform, we believe we shall get some relief funds for the project.

Financial sustainability  is a challenge with the kind of project we intend to be engaged in.  Since our project focuses on improving healthcare services to mothers and their new born, we may be limited with funds to sustainably fulfill this goal. However, we shall continue to seek for partnerships a cross the globe for financial support through joint grant applications to potential funders.We hope that through this platform we may identify individuals, organization who would wish to support the vulnerable communities such as those of the refugees and the host communities in Northern Uganda. Additionally, we shall advocate for our model of solution to be embedded in Uganda and UNHCR strategic framework for refugees in the region through policy change that focuses on approaches for long term financial sustainability for improving maternal and child in refugees hosting districts in Uganda.

Financial barrier remains a challenge in the execution of the proposed solution.  In our proposed solution, we have designed an implementation plan which we shall work with when we receives the fund.  This plans require that we get sufficient funds so that we are able to implement the proposed solutions. Therefore, by applying to Solve we hope to get the funds that will enable us implement the EHC packaged proposed in our solutions for the refugees an host communities in Northern Uganda.

We hope that through this pilot project we shall be able to provide comprehensive EHC package to the pregnant mothers and their new born in the refugees and host communities in order to improve on the access, utilization and quality of reproductive services. In order to fulfill this tasks, there is need to have partnerships with other interesting parties so that we all make our contributions in the improvement of maternal and child in the refugees settlements and host communities for sustainable health and development in the region. Partnerships provides an opportunity to participate in the implementation of our shared goals irrespective of our institutional differences.

We proposed to partners with Makerere University because of their tract record in provision of institutional leadership in other projects.  We hope to benefit from their leaderships through writing and submitting joint application for for funding. We shall earnestly work together in the process development as well as participating in writing and implementation of the solutions. We shall also involve partnering with interested Solve's members, MIT Faculty or available initiatives interested to to partner with us.  We believe that through this partnership we shall gain from the technical inputs they will render to our solutions.

Our project focuses on the refugees and the host communities in the districts of Adjumani and Lamwo, Northern Uganda. Specifically, the project focuses on  maternal and child health. It is hoped that when a woman is provided with the necessary reproductive health  services, she has the capacity to produce a health child that grows into a productive adults in a society.  Health is directly related to resilience and productivity. Therefore, this fits in line with  Andan Foundation prizes, a Swiss non-profit foundation

dedicated to supporting solutions that promote refugee resilience,
self-reliance and integration. We shall use this fund to implement the proposed comprehensive health care systems for the improvement of maternal and child health at lower primary health facilities in the refugees settlements and host communities in Northern Uganda. We shall use the LLTR model, an innovative tool that will be used in the implementation of this vital health care package in the improvement of access and utilization of maternal and child health care services in the region.

Our project focuses on improving access, utilization  and quality of maternal and child health in the refugees and host communities in Northern Uganda.  Therefore, this fits in line with Vodafone Americas Foundation, which supports technology-focused projects that advance the needs of women and girls, and that promote a world where women’s voices can be celebrated.  This project will use the fund to support the women community based innovation projects at the refugees and host communities through tailored training to enhance their capacities to run these project.  Most of women in the settlements and the host communities lack basic formal education but are engaged in a number of community based income generation projects as a source of livelihood. However, they are deficient of essential business and entrepreneurship skills, thus the majority of these women only aim at engaging in small scale of businesses. Those who try a fairly large scale business do not run them well and they often make losses.  Therefore, we  shall provide support training on business and entrepreneurship skills to scale up their capacities to handle the community based innovation projects at the settlements and the host communities for the improvement of their livelihood in the region.

One of our strategies in the  improvement of maternal and child health involves building the capacity of health workers and village health teams in refugees and host communities.  Therefore, this fits in line with the Health Workforce Innovation Prize which expand and support the health workforce for newborns, pregnant women, and new mothers in low-income countries. We shall use this fund to train healthcare workers and village health in the provision of efficient health services maternal and child health through training in reproductive health services. Our focus will involve building capacities of health works force and village health teams to competently handle healthcare  challenges including early identification of pregnant mothers, ensuring timely referrals of village health teams, consistent tracking and monitoring, improvement of health workers' assessment and referral capabilities at lower primary health facilities, and/or introduction of new tools or methods for treatment among others in the refugees and host communities in Northern Uganda.

Uganda is unlikely to achieve Sustainable Development Goals (3) good health and well-being, 4) quality education, 5, clean water and sanitation with the current influx of refugees from Democratic Republic and Southern Uganda which has put population pressure on the limited natural resources and basic social services in Northern Uganda.  With the presence of COVID-19 in Uganda, the Refugees settlements and host communities in Northern Uganda may be the hot-spots for COVID-19 due to inadequate health facilities and healthcare workers. Pregnant women and their new born  will suffer the brunt of this pandemic due limited access and utilization of essential reproductive health services in the region. The main transport for use by most people including pregnant mothers and children going to the nearest primary health facilities in Uganda are the motorcycles services known as the "boda boda" . However, due to the Ugandan presidential directives of stopping Boda Boda from carrying anyone including pregnant mothers unless authorized has resulted into a drop in significant clinic attendance. Persistent fears of contracting COVID-19 from others in the hospitals or health centers have resulted into a drop in the health facility or hospital delivery. Refugees and host communities will disproportionately suffer from shortages of  essential reproductive health services in the region and this will no doubt put their lives into jeopardy.Our focus in this project is to improve access, utilization and quality of maternal and child health in refugees and host communities in Northern Uganda.  This will be done in partnership with primary health facilities in the refugees hosting districts in the region. This fits in line with the The Bill and Melinda Gates Foundation that support solutions that improve maternal and newborn health in low- and middle income countries. We shall use this funds in scaling up access, utilization and quality of maternal and child health through intervention using EHC systems at the primary health facilities in the region. If successful, this model will be scaled up in other refugees hosting districts in the region.