NINAKUJALI - I care for you

1. We want to address the emotional and mental violence Kenyan women suffer in their experience of maternity care which manifests through the lack of respect and care from healthcare providers but also through the shame and stigma within the society. 

2. We propose a simple-use app with two objectives: 1) educate women, healthcare providers and the community on dignified maternity care and 2) connect isolated women with a community network of volunteers to support them on their motherhood journey so they can enjoy a healthy pregnancy and a peaceful time with their babies. 

3. A global understanding of standards of respectful maternity care can greatly improve the ethics of care in the medical industry which can, in turn, help reduce maternity-related distressed situations such as not seeking medical assistance due to mistrust in the healthcare system or abandoning a child because of shame and isolation.

From obstetrical violence to disrespect and harassment, many women in Sub-Saharan Africa face abuse and mistreatment in their experience of maternity care, both in medical facilities and among their community. Accounts from these women and research on the issue give a horrendous picture: uncaring and abusive medical staff dismissing women’s pain, women being wrongly shamed and accused of not looking after their newborns, humiliation and insult of  pregnant teenage girls etc. Although not well documented, the psychological toll of these too-common practices can lead to adverse health outcomes such as not seeking professional medical assistance or deter other mothers from doing so, endangering their health and those of their children. It also disproportionately affects women from poor backgrounds because their socio-economic condition structurally excludes them from good quality healthcare services to pursue a healthy (physical and mental) maternity. In addition, it makes them more vulnerable to abuse and violence given their isolation and the lack of immediate family and friend support. We believe violence persists because of insufficient education on respectful maternity care and the lack of adequate mechanisms to listen to victims and hold accountable people abusing them.

Our solution is a simple-use mHealth app named NINAKUJALI that acts as a safe space of encounter between: (1) pregnant women and mothers with newborns who need social support throughout their motherhood journey; (2) healthcare workers who want to lead the change in the ethics of maternity care and (3) members of the community who recognise the role of society in supporting these women to thrive as mothers. The app allows members to offer free services to help women (e.g. giving them a ride to their next medical appointment), provides training and educational material on respectful maternity care (e.g. content on the rights of expectant mothers) and serves as a platform where women can share their (positive and negative) stories of maternity care services including reporting abuse. This platform is volunteer-based and is designed to respect privacy and personal circumstances with the aim to provide judgment-free help, in particular to vulnerable women who do not have the support system they need at a particular time or throughout their pregnancy and after the birth of their children.

Our app is directed at women at any stage of their pregnancy or with young children. However, by nature, it targets more specifically women whose socio-economic situation or personal circumstances exclude them from pursuing a emotionally healthy motherhood journey. The app can help break the isolation pattern by addressing the abuse in the healthcare system through education and accompanying women who need it the most via the support network of volunteers. We aim to make this app relevant thanks to primary and secondary research, engagement with local social organisations and through the data collected on the app itself. As a participative platform, we hope to gain knowledge from the community to constantly improve the relevance of the app content so it better serves our target population. We have chosen Nairobi to develop NINAKUJALI as it is representative of the transitions happening in the urban context across Africa (more than half the population lives in informal settlements and extreme conditions, epidemiologic transition, lifestyle change, loss of community links etc.) and can be informative for the scaling-up phase of the app.

Our solution addresses the challenge by tackling the sometimes overlooked issue of abuse in the experience of maternity care which has direct effects on the mental and emotional health of women, including social marginalisation and distrust in the healthcare system which can lead to adverse health outcomes. NINAKUJALI looks at this issue from its roots by providing education material towards respectful maternity care and a storytelling platform to raise awareness and advocate to end abuse. From the women experience perspective, the app aims to empower the most vulnerable women group so they can pursue a healthy motherhood.

Our solution is trying to address the fact that many vulnerable women are victims of harassment and abuse in their experience of maternity care by proposing a cloud soft infrastructure of maternal care based on education and social network of care. Currently, many mobile applications for women focus on the physical health of women and their babies, but not many focus on the mental and emotional health and the importance of respect in maternity care. NINAKUJALI app is dedicated to the development of respected maternity care, through three aspects of education to raise awareness on the dignity of expectant and new mothers, health workers and community/general public in a bid to change mentalities and practices. The difference with conventional or traditional social media applications is that NINAKUJALI is based on a network of individuals,institutions and organisations that share similar visions and thinking on the need for respectful maternal care. Therefore the cloud soft infrastructure will create a safe space that will give more privacy and avoid the negative aspects that can occur in mainstream social media such as trolling, online abuse, phishing and scam).

These two overarching principles of NINAKUJALI, education and social network, are powered by digital technology, more specifically mobile phone application technology. This technology allows expectant and new mothers to communicate and share their story and experience but also connect them with health workers and community members that are willing to volunteer to propose services through the app. 

We want to use the concept of “niche” social media to encourage and ease the sharing of knowledge, experience and story to educate and raise awareness on respectful maternity care.

For the vulnerable expectant mother, this mobile application technology represents a safe space to report any abusive behaviour which could be something they do not consider to do in-person. This application also allows to exercise some sort of control mechanism and oversight on the maternity care services. 

The data collection technology is also an important feature as it can connect institutions and organisations which wish to improve the quality of maternal care in Nairobi. 

For the community members who want to create change around them, this mobile application technology can serve as a platform for them to act towards this change. 

Finally, in order to open up this solution to even more people and to those who do not have access to data in their daily life, the Internet of things (through a simple webpage mirroring the app) and text messages technologies will be used as well.

Mobile application technology has become the dominant feature that is developed in today modern society, and it has effectively proved to support many innovative solutions with its digital technology. Social media and mobile applications represent a new form of public space in this digital era and the fact that there are seven million Facebook users in Kenya and that two million Nairobian own a mobile phone and use internet data shows the potential of a digital platform to develop our solution. 

The number of mHealth apps is increasing by the day and yet are not developed to its full capacity (https://www.ft.com/content/34add2b8-2eba-11e9-8744-e7016697f225). In the domain of maternity care in the Global South, many apps are already being used to improve mother and children health (https://mashable.com/2016/03/13/apps-maternal-health/?europe=true).

Our theory of change is based on three predications:

1. Human health is human development: The current context of the pandemic has evidenced the close relationship between health and the organisation of the society, including the structural injustice embedded in it. We believe the recognition that health is interdisciplinary and does not just belong to the medical field (described in social sciences as the social determinants of health), is crucial for the future of the mHealth technology. Indeed, supporting the most vulnerable women during motherhood does not just improve their own and children’ mental and physical well-being and health, it also gives them more opportunities in life. In turns, they are able to offer a better future for their family which participate in building stronger and more resilient communities. 

2. Small actions can produce big positive changes: studies have shown that women who experienced abuse during maternity are more likely not to seek medical help in the future and deter other women from doing so too. This can create very quickly negative chains of events with adverse health outcomes. However, the circle can also be reversed and this is what NINAKUJALI is trying to do. Helping a pregnant woman with her shopping or calling her once a week to check on her may not drastically change her personal situation if she lives in poor conditions but it may give the breathing space to look after her mental health which will allow her to better provide for her children. That same woman may then offer her support to another woman in difficulty because she appreciates how small gestures can go a long way.   

3. Education is the main development engine: NINAKUJALI explore the power of education in leading change in three different ways:

   1. As prevention mechanism through training, civic education, and storytelling to change perception and address stigma;

   2. As support system through community-support network to break isolation patterns;

   3. As advocacy through data collection to document abuse, report violence and plead for change.

Although it is difficult to precisely access the number of users for our app (as it will rely a lot on the word of mouth and the willingness of women to trust the app and its functionality and of the members of the community to engage with the app), we can use simple data points to project our users numbers and highlight the relevance of such an app. 

According to the 2019 Kenyan National Bureau of Statistics: 

• Nairobi is constituted of 11 counties;

• Over two million Nairobian own a mobile phone and use data;

• Nairobian women in childbearing age (15-34) represent almost 50 percent of the total Nairobi female population (over a million women)

• Nairobi registered over 500,000 births in the past five years

• Kenya counts another five cities of over 200,000 inhabitants (including Mombasa with around 800,000 inhabitants) which follow similar trends as Nairobi

As a result, we project our solution will serve:

• 2020: Around 500 active users (all profiles) in Nairobi representing an average community of users of 50 per county

• Year 1 (2021): Over 1,500 users in Nairobi (with a ratio of two pregnant women/new mother per one volunteer)

• Year 5 (2025): Over 20,000 users across Kenya’s urban areas and other cities in East Africa such as Dar Es Salaam and Kampala (we hope to convert new mothers to volunteers in a user feedback loop, meaning the net number of new users may not be linear over time).

Our vision for NINAKUJALI is to promote respectful maternal care and end psychological violence against women before, during and after childbirth. The realisation of this vision will take many years and will be a combined effort of various small initiatives like ours and bigger actions from public organisations. However, our contribution over the short to medium term is to educate people on the importance of a dignified and respectful maternity care for the well-being and fulfilment of mothers and children and reach out to isolated women so they can live their motherhood peacefully and focus on their health and those of their children. 

As we are in a concept phase, our objective for the rest of the year and for 2021 is to test and launch the app in Nairobi. We believe Nairobi, as explained previously, is a great place to start the app. The aim is to grow the volunteer community base along with the women using the app so they can feel supported in their local areas and see the relevance of the app. With the success of the app in the Kenyan capital, we are hoping to expand it to urban areas across Kenya over the following five years to reach out to more women in need of support. Additionally, the fact the app will be available in both English and Swahili languages has the potential to be opened up to Kenya’s neighbouring countries such as Tanzania and Uganda.

• The biggest challenge we may face in this project is to hold onto the app judgement-free/culturally neutral stance. We have to be mindful of the fact that the app brings together motherhood, which belongs to the private life realm, with the community where, by nature, different cultures and values intersect and clash.  
  

• Another difficulty we identified is the legal risk associated with dealing with privacy, individual medical information and accounts of abuse. The success of the app to the vulnerable women group depends on its ability to secure the confidentiality of the experience they are willing to share while maintaining the highest standard of privacy for any medical record information.

• Thirdly, even though we are dealing with technology, the primary resources and input for the app remain the human capital and the app relies heavily on the engagement of volunteers.

• The limitation of an app-based solution is that it may exclude people with no access to data (who are likely to belong to the most vulnerable group) so we need to find other ways to reach out to these people.

• From a performance perspective, the challenge lies in defining the indicators that can measure performance as the app deals with a lot of qualitative data which are more difficult to collect and analyse.

• On a more material aspect, the financial risk is important to keep in mind as NINAKUJALI is and must remain free and our financing options should be in line with our commitments towards impartiality and transparency.

We intend to overcome the identified challenges and obstacles as follow:

• Judgement-free/culturally neutral stance: At registration, get all the volunteers to watch a short video on how to best care for women during motherhood without judgement and on the consequences abuse and harassment have on these women and have them to agree on our ethics of care T&C’s

• Legal risk: Draft and comply with our own set of best privacy and confidentiality practices in accordance to the laws and regulations in force in Kenya.

• Human capital: Work with a core team of trained social workers and volunteers who can lead the recruitment of volunteers.

• Access to data: 1) Mirror the content of the app onto a simple webpage which can be accessible in internet cafes which are very popular in Kenya and 2) allow for some of the core app features to be performed over the phone or by text message. 

• Performance measure: 1) Define a set of quantitative indicators which can be used alongside and help with the analysis of the more qualitative indicators and 2) review these indicators every three month to improve the quality of the service.

• Financial risk: Not rely on embedded ads on the app but instead raise financial aid through channels which allow us to be free from external pressure.

2 part-time staff (volunteers)

We are two passionate postgraduate UCL students in development who want to contribute to the global SDG agenda at a local level with highly situated knowledge. Although we are not from Kenya ourselves, we were made aware of the issue of disrespectful maternity care with the story of our Kenyan friend who lives in Nairobi which triggered further research on the subject. We believe that with our training as solution designer, we can facilitate the needed conversation on abuse in maternity care.

Cécile: I have a master from a French business school and over eight years experience in financial services. I am well-versed in public speaking and dealing with business partners and clients. I have spent a lot of time in Kenya and Tanzania in the past two years and I believe Africa has the most amazing talents and strengths to learn from. 

Reza: I have a degree in architecture and have over twelve years experiences in architecture, urban design and development in Indonesia. My experience is mainly related to housing development, sustainable development, both in the design and policy. I have interest in housing and human settlements, and participatory approach to urban design. I have worked on projects with community participatory and public engagement. My work with various actors in development (state, private consultant, developer, and non-government organization) has given me a wide perspective of urban planning and development, particularly in the Global South context

Our project is still in the concept phase and we are not currently working with any partners. However, our app will rely on the joint effort between various groups and partners at different levels:

• Enroll volunteers: we plan to work with local grassroot organisations, churches and clinics to identify current active community volunteers as well as women who may need immediate support.

• Manage the training content: we want to repurpose the intensive work already done by various organisations on the issue of maternal care and work with them to create new and relevant content for the app.

• Manage the output from abuse reports and storytelling: 1) we have to partner with organisations which can assist women in their legal journey should they decide to take legal action against their abuser. 2) we want to participate in and contribute to the broader discussion and fight against maternal care abuse by sharing this information (on an anonymous basis) with relevant NGOs, academic institution and public authorities.

Our app business model is two-fold: 

• On one side, we provide and monitor a self-organised platform which works in a similar fashion as a marketplace: people in need of support meet people willing to dedicate some of their time and resources to help others. Our value proposition is to facilitate this encounter and ensure the ethics of engagement (as discussed previously, i.e. free, devoid of judgement and culturally sensitive) is maintained at all times. The strength of this platform should rely on the embedded design of the app and the dedication and commitment of the core team of volunteers and sponsors. 

• On the other side, the app works as a data collector to build a case to advocate for change in women's treatment during motherhood. The key actors in this process are the women themselves with their stories and testimonies but also the partners who will turn this information into a coherent advocacy discourse.

In terms of management of the overall project, the key component is the ability of our management and development team to build strong partnerships with the community, NGOs, public authorities and funding supports to ensure the financial sustainability, the ethics integrity and the longevity of the app.

Our path to financial stability can be laid out as follow:

• Short term (6 to 12 months): Get the initial funding to develop the infrastructure of the app and build the network of partners to launch the app in Nairobi. We plan to get the seed money by applying to grants and prizes from academic institutions such as the MIT Solve program and corporates such as the CEMEX-Tec award. We will also explore doing  fundraising via our social networks.

• Medium term (12 to 36 months): Once the app is live and running, we will continue with the funding options as described above but we will also be able to do crowdfunding and propose research projects with research centers and universities on the issue of maternal care.

• Longer term: depending on the performance of the app and the type of actual funding we will get, we could develop further the features within the app to make it a more integrated mHealth application. As a result, we could be able to collect more medical data that could be sold on an anonymous basis, generating revenues allowing the app to be financially self-sufficient. 

As the app is at the intersection of health, development and technology, we will be able to get funding via different channels.

We are applying to Solve as we would be extremely grateful to have the support of such a renowned institution at the early stage of the development of a project we feel very passionate about. As part of our masters curriculum at UCL, we are trained to design solutions to issues arising in the urban context in the Global South. Our ethics of engagement based on the recognition of the strength of local knowledge and the participation of communities in the project that concerns them is at the core of what we are doing. Given the current environment and our student status, we are not able to go through this participative process that is necessary to design the right app and therefore we need your help and support. 

As for your institution, we strongly believe technology is an essential tool in the socio-economic development of communities. A technology-based solution is all the more relevant in the African context as the continent is leading the world in terms of life-changing innovative solutions. Additionally, as we are about to pursue a career in development, it is important for us to participate in the current debates and discussions around innovation and contribute to the network of start-ups and entrepreneurs who want to make a real change in the world.

In order to successfully complete our project, we will need technical support to give life to our app. We have already worked on the content and core functionalities but we do not currently have the technical skills to launch the app for public use. Similarly, we will need assistance to efficiently distribute the app through the various channels available to us. From the legal perspective, we will seek help to ensure our app is in line with Kenya’s laws and regulations.

In addition to the organisations we want to partner with the everyday running of the app (as discussed beforehand), we want to deploy our existing network to learn from the full breadth of knowledge and expertise. This network spans from urbanism (Center for Urban Design Studies, Ulab Indonesia) to financial industries (AXA, PIMCO), from business school (SKEMA) to student and university communities (UCL, Bandung Institute of Technology) and from local to international networks (across Europe, South East Asia, East Africa and North & South America). As our project takes shape, we also want to expand our network and approach directly relevant individuals within the MIT Solve network, on Linkedin and during events (in person or online).