Medic Mobile: Expanding Integrated MNCH

In Uganda, maternal mortality remains high at 440 maternal deaths per 100,000 live births & 46.4 child deaths per 1000 live births. Most maternal deaths are directly related to pregnancy and childbirth. Health workers are unable to track mothers & newborns within their care. The loss to follow up makes the local health system unable to take responsibility of the mothers & children within its reach. In this context, ACODEV in partnership with Medic Mobile will use a built open-source software- "Do It Yourself" version technology based platform that runs locally on a windows computer and communicates with any mobile phone in the field, using Do It Yourself, Community based health workers are able to register maternal and child health cases in their communities, receive automated SMS reminders about upcoming healthcare appointments, report danger signs and communicate with managers and teams at clinics. The model will be replicated nationally.

Maternal mortality is unacceptably high. Estimates for 2017 show that some 810 women die every day from pregnancy- or childbirth-related complications around the world. 94% of all maternal deaths occur in low and lower-middle income countries (WHO 2019 report). In Luwero District of Uganda, 230,474 are mothers (2014 census report); 80% of these women live in remote areas where maternal and child health services are limited. Mothers are not adequately informed of the dynamics around maternal health and antenatal care. Information on health centers, dates upon which to visit and the need for professional monitoring is lacking. Some mothers think the only time one needs to see a health worker is at a complicated delivery, usually at a stage too late for any medical intervention. The health workers are not able to track mothers who come within their care at any stage. Vital medicines from the National Medical Stores delay at times and therefore make antenatal and postnatal visits that require medication incomplete, hindering the quality of maternal and prenatal care.

Medic Mobile’s DIY Package for Maternal & newborn care, runs locally on Windows computer and communicates with any phone in the field. Using Medic Mobile, community health workers can register pregnancies, newborns, and other related health concerns in their communities, receive automated SMS reminders about upcoming antenatal/postnatal care appointments, report danger signs and communicate with health managers at clinics. The platform displays real-time data about a health facility’s maternal health program, allowing managers to evaluate program effectiveness and make data-driven decisions to increase impact. The DIY Package also includes a cost estimator to assist with budgeting, suggestions for participatory design methods, a step-by-step implementation guide, reference guides for community-based and facility-based users, and an impact-monitoring framework. The DIY's performance is accelerated more by the amount of maternal and child health information and ANC, PNC reminders send to the village health teams who are able to reach directly to the mothers and children for updates. In-turn Village health teams communicates back to the DIY at service delivery point with information on registered pregnancies, ANC, PNC visits, immunization  for children, danger signs among others. This enables health workers to respond quickly through a referral process or community based health care response.

The solution will target Poor women in remote areas that least receive adequate maternal health care. Emphasis will be accorded to women that are HIV Positive, disabled women, and the urban poor who are living in three town councils of Luwero, Bombo and Wabulenzi respectively. We have been able to work with 10 health facilities in Luwero through systems strengthening, training midwives and nurses in basic emergency obstetric care, we have provided medical equipment to 10 health facilities to help provide quality maternal newborn care to mothers & children in their reach. Our understanding and engagement with the mothers documenting their ideas of how our solution should help them; mostly mothers' suggestions are considering the solution to integrate home-to-home village health team visits with updated information on quality maternal and child care as a continuum of maternal newborn care. As a project, these ideas have been incorporated in our solution whereby village health teams will led the referral process through the mobile phones linked to the Do It Yourself Medic platform. The solution will bring maternal health care services close to mothers, it will reduce cases of preventable maternal and child deaths through timely health service response by health workers.  

We are providing a technology based solution to the mothers whose challenge is the inability to move long distances accessing quality medical services in time before there're danger signs that could lead to maternal and child deaths, our training and deployment of village health teams in remote areas provides updated maternal health information, and report cases through DIY for medical attention. Experience in using this solution has shown an active utilization of real-time data generated to help make decisions by health managers providing unmet maternal health needs-based services to mothers. 

The solution is unique and innovative in a way that it's a Community Health Toolkit (CHT), an open-source community to design, build, deploy, and monitor digital tools for community health workers. In addition to open-source software frameworks, the CHT includes reference applications and design guides to help partners like ACODEV and users bring the toolkit to our own settings. Using medic mobile applications, you are able to access and utilize integrated features to support crucial health system workflows: reporting information about deaths of patients and enabling sophisticated supervision of community health workers. With thoughtful design and attention, the medic Mobile Standard package system now supports integrated postnatal care, immunizations, and malnutrition workflows to better coordinate the health and development needs of early childhood. Using the medic mobile solution, you're able to show data performance to other stakeholders in the country via  integration with DHIS2, the leading district-level data tool used by more than 60 countries in the world. Our approach is one of its kind in Luwero district where no other technology based intervention related to maternal and newborn health has been implemented; this will create a new landscape in providing on-point health services to the highly low resource settings.

Medic Mobile serves as the technical steward for the Community Health Toolkit (CHT) open source project. The CHT provides resources to design, build, and deploy digital tools for community health. It includes open source software frameworks and applications, guides to help design and use them, and an active community for creation, collaboration and support. The software included in the CHT was created for people delivering care in hard-to-reach areas and work with or without connectivity. Tools built using the CHT run on basic phones, smartphones, tablets, and computers, supporting people doing critical work in communities, health facilities, and management offices. 

The Community Health App: The Core Framework makes it faster to build full-featured, scalable digital health apps that equip health workers to provide better care in their communities. Key user groups include community health workers, supervisors, nurses, health system managers, and even patients and caregivers. The framework deals with health systems roles and reporting hierarchies, and supports five highly configurable areas of functionality: messaging, task schedules, decision support workflows and care protocols, person profiles, and analytics. The core features are flexible enough to support an exceptional range health programs and local care provider workflows. 

https://medicmobile.org/annual...

https://medicmobile.org/annual...

https://medicmobile.org/annual...

In Uganda, maternal mortality remains high at 440 maternal deaths per 100,000 live births & 46.4 child deaths per 1000 live births. The high Maternal and child deaths attributed to the lack of adherence to regular health visit schedules in the MNCH continuum( ANC, PNC, EBF) due to financial costs, lack of awareness of the visit benefits, long distances, cultural beliefs and concerns about the quality of care among others. Medic mobile phone based technology links mothers to health services  through an active tracking and utilization of real-time data generated to help make decisions by health workers providing unmet maternal health needs of mothers. As a result pregnant women will complete all eligible visits and receive focused ANC services; deliveries will occur at health facilities where there are skilled attendants and emergency care; women will be retained in care after birth for essential follow up services that are contained in the PNC service package; routine mother and child monitoring up to 12 months post delivery; children receive all immunizations in time. 

As a result of the above interventions, we  expect to see an increase in infection control among mothers and newborns; management of pregnancy and birth related complications; guidance to mothers on nutrition; identification and prevention of pregnancy risks; child immunizations following WHO standards, family planning counseling and services; consequently, there will be an improved maternal, newborn and child health outcomes including maternal and new born survival.

Phase-1(Pilot)  ACODEV had a one year pilot in 2 Health Centers (Bwera Hospital and Karambi Health center III) in Kasese District supported by 30 trained Community Health Workers (CHWs) with 15 CHWs attached to each health center. Each CHW had a target of 7 referrals for mothers, translating to 84 mothers in the pilot year per CHW. The total numbers reached were1260 referrals per HC and therefore a total of 2520 mothers in the 2 health centers during the pilot phase.

In phase 2- ACODEV will work in 10 Health centers(Luwero hospital, Nyimbwa HCIV, Kalagala HCIV, Zirobwe HCIII, Kamira HCIII, Makulubita HCIII, Wabusana HCIII, Bombo Referral Hospital, Butuntumula HCIII and Katikamu HCIII  with 15 CHWs each with a target of 15 referrals per a month. This will translate into 150 CHWs each making 15 referrals per month; 2250 beneficiaries will be served in month, 27,000 beneficiaries in a year and 135,000 beneficiaries in five years.

ACODEV in partnership with Medic Mobile has got the capacity to scale up the project from 10 health facilities in one district expand to five regions of Uganda. 

In the northern region we will expand to four districts; in the East we will expand to six districts, in the central region we will expand to four districts and western region expanding to three districts respectively. In total our expansion will reach to 170 health facilities; each of these facilities will be linked to 15 community health workers who have to make 15 monthly referrals. This implies that a total of 380,250 beneficiaries will be served on a monthly basis; and 459,000 beneficiaries will be served annually. ACODEV's projection indicates that in three years 1,377,000 beneficiaries will be reached, and consequently 2,295,000 beneficiaries will be reached in five years.
Our approach for local and regional partnerships with health facilities will strengthen our efforts to scale and replicate our interventions. ACODEV will conduct a comprehensive baseline surveys in new areas to document the trends in maternal and newborn survival that will inform the next models of scale.

The success of ACODEV's planned interventions and strategies largely depends on end user behavior and attitudes and also the rate at which technology is incorporated into patient-care workflow at a health facilities. ACODEV anticipates limited technology literacy by end-users, field power outages, and unreliable network connectivity especially in remote locations. 

ACODEV is also cognizant of the fact that digitalized explorations for service provision sometimes overlooks ethical considerations such as confidentiality of client information. It is  therefore urgent that the human rights and technology stakeholders to explore together the resolving of technological, legal, and ethical issues raised when digital technology is used to document human needs, linkage to services and any rights abuses that may arise.

ACODEV plans to train health facility workers and Community based health workers on how to operate the medic mobile "Do It Yourself" application to meet the standards to technological application. ACODEV will conduct community technology education targeting mothers so that their adaptability to its use in their everyday life is taken up for improved quality access and utilization of Maternal and child health survival. Community dialogues will be conducted to address any behavioral and attitude issues related to the interventions. 

Not Applicable

ACODEV will have the following staff;

Full time:

01 Project coordinator, 

02 Project Field Staff, and

01 Finance officer

01 Monitoring, Evaluation, Learning and Accountability Officer

Part time(on Level of Effort): 

01 Executive Director

01 Program Manager, 

01 Communications and Advocacy officer, and 

01 Administration officer)

Contractors: 

02 Medic Mobile technical staff. 

In total , a team of 11 staff will work in the project.

The Coordinator of the program is highly experienced in Health Systems strengthening, particularly in coordination of clinical and socio-economic service linkages for Maternal and Newborn Health (MNCH), he also has proved leadership capabilities as seen in the running of similar programs at ACODEV.

The other team members including field officers, finance and  M&E officer are equally competent in the areas of maternal newborn and child health. They will competently deliver on the program interventions using the proposed technological approach.

Medic Mobile has highly experienced and independent technologists with the capacity to provide capacity of teams in the utilization and scaling up of the Medic Mobile: Do It Yourself version. 

We currently partner with Medic Mobile which is supporting us in the installation of the mobile applications, training health workers and community health workers on the how to apply the application.

We also partner local government particularly the District Health Officer and Community Services Department. 

We also partner with other clinical partners like MildMay, Reach Out Mpuya, Uganda Care, Save the Children, Catholic Relief Services; Our partnerships with these partners helps us in synergizing on advocacy issues, referrals and linkages.

ACODEV works with community structures such as Village Health teams, para-social workers who do referral for clinical and social economic services. We also work with vulnerable  women groups by strengthening their capacities in sustainable livelihoods; we utilize the local leadership structures to promote our programs sustainability and national funding. Our services we provide are directly related to the needs of our beneficiaries.

ACODEV raises resources through proposal writing or placing grant requests to different donors/foundations. These are granted in line with ACODEV's thematic areas.

ACODEV also has a Leadership Centre which offers training courses in governance, leadership and Management to civil servants, organisations and individuals who in turn pay money that goes into the organisation as revenue.

ACODEV has got a vocational center in Bwera, Kasese that offers vocational skills including tailoring, Kneating, poultry, carpentry, welding among others..where 20% of students get scholarships from the institution and 80% make a payment which is a source of revenue as well.

ACODEV has developed a strategy to complement the service linkages and service provision to Program  beneficiaries; to enabling access to low cost health commodities, a social franchise model that will promote sustainability of service access. These commodities will be sold through incentives to community health promoters and they include nutrition products, malaria and diarrhea treatments, dewormers, Family planning commodities among others. This approach is being explored as source of revenue for the organisation as well. 

We at ACODEV  are always excited to collaborate with other entities doing similar work for cross learning purposes. As part of the Solve’s global network, we hope to link up  with potential partners around the world who are generating solutions to the world's problems too. We're looking to grow our institutional partnerships in the area of MNCH. With our strategies already piloted, we hope to scale up; we are counting on MIT Solve's connections to gain access to a broader pool stakeholders for technical, financial and strategic partnerships.

Our Partnership goals are focusing on:

Promoting ACODEV's sustainable service delivery and institutional operations; We are also targeting to see ACODEV in a space where technology utilization in service delivery is adopted across our programs for a wider-reach; We are anticipating to have a funding sustainability strategy through our partnerships; ACODEV expects to strengthen its platforms in areas of branding and marketing its products to the wider population through marketing.

We would be excited to partner with foundations like Bill and Melinda Gates foundation, Rockefeller foundation for strategic and technical purposes in areas of funding. We would also love to partner with other Solve previous and recent prize winners for cross-learning purposes. 

The team will use the innovation prize to implement  a technological solution that will target Poor women in remote areas that least receive adequate maternal and child health care. Emphasis will be accorded to women that are HIV Positive, women with disabilities, and the urban poor who are living in three town councils of Luwero, Bombo and Wabulenzi respectively. We have been able to work with 10 health facilities in Luwero through systems strengthening, training midwives and nurses in basic emergency obstetric care, we have provided medical equipment to 10 health facilities to help provide quality maternal newborn care to mothers & children in their reach. Our understanding and engagement with the mothers documenting their ideas of how our solution should help them; mostly mothers' suggestions are considering the solution to integrate home-to-home village health team visits with updated information on quality maternal and child care as a continuum of maternal newborn care. As a project, these ideas have been incorporated in our solution whereby village health teams will led the referral process through the mobile phones linked to the Do It Yourself Medic platform. The solution will bring maternal health care services close to mothers, it will reduce cases of preventable maternal and child deaths through timely health service response by health workers.  

In Uganda, maternal mortality remains high at 440 maternal deaths per 100,000 live births & 46.4 child deaths per 1000 live births. The high Maternal and child deaths attributed to the lack of adherence to regular health visit schedules in the MNCH continuum( ANC, PNC, EBF) due to financial costs, lack of awareness of the visit benefits, long distances, cultural beliefs and concerns about the quality of care among others. Medic mobile phone based technology links mothers to health services  through an active tracking and utilization of real-time data generated to help make decisions by health workers providing unmet maternal health needs of mothers. As a result pregnant women will complete all eligible visits and receive focused ANC services; deliveries will occur at health facilities where there are skilled attendants and emergency care; women will be retained in care after birth for essential follow up services that are contained in the PNC service package; routine mother and child monitoring up to 12 months post delivery; children receive all immunizations in time. 

As a result of the above interventions, we  expect to see an increase in infection control among mothers and newborns; management of pregnancy and birth related complications; guidance to mothers on nutrition; identification and prevention of pregnancy risks; child immunizations following WHO standards, family planning counseling and services; consequently, there will be an improved maternal, newborn and child health outcomes including maternal and new born survival.

The team will use the award to implement  a technological solution that will target Poor women in remote areas that least receive adequate maternal and child health care. Emphasis will be accorded to women that are HIV Positive, women with disabilities, and the urban poor who are living in three town councils of Luwero, Bombo and Wabulenzi respectively. We have been able to work with 10 health facilities in Luwero through systems strengthening, training midwives and nurses in basic emergency obstetric care, we have provided medical equipment to 10 health facilities to help provide quality maternal newborn care to mothers & children in their reach. Our understanding and engagement with the mothers documenting their ideas of how our solution should help them; mostly mothers' suggestions are considering the solution to integrate home-to-home village health team visits with updated information on quality maternal and child care as a continuum of maternal newborn care. As a project, these ideas have been incorporated in our solution whereby village health teams will led the referral process through the mobile phones linked to the Do It Yourself Medic platform. The solution will bring maternal health care services close to mothers, it will reduce cases of preventable maternal and child deaths through timely health service response by health workers.