The Kombra Channel Application (KC App)

An mHealth application to improve maternal health service service delivery in Sierra Leone

Sierra Leone has the highest maternal mortality rates in the world. Many of these deaths occur in health facilities as a result of delays in the provision of quality care. This proposal aims to address this issue by eliminating delays associated with identifying at-risk pregnant women and referring them for advanced care. This will be done through a mobile application called The Kombra Channel App (or KC App). The app seeks to:

• Increase efficiency and timeliness of referrals by reducing time taken to relay patient information between primary and secondary or tertiary health facilities.
• Automate the referral process for better tracking and recording of processes and timelines.
• Facilitate coordination and communication between various community stakeholders such as health care workers, transport providers and community volunteers for improved outcomes for pregnant women.
• Generate and record data on provision of maternal health care in facilities.
• Improve adherence to best practices by promoting and tracking use of checklists in the provision of care
• Improve transparency and accountability in the overall provision of maternal health care.

The KC app works to eliminate delay in seven steps:

Step 1: Immediately flag patients that need emergency care or referral.

Step 2: Notify health workers at the nearest referral facilities of the incoming patient.

Step 3:  Transfer patient information to the referral facility immediately.

Step 4:  Alert a transport coordinator to arrange for immediate transfer of the patient.

Step 5: Track the removal of the patient from the primary care facility to the referral facility.

Step 6: Facilitate transportation of the patient to the referral facility.   

Step 7:  Enable the referral facility to assist the incoming patient without delay.

The app will be piloted in ten community health centers (CHCs) in Kailahun and Kenema districts which have the highest rates of facility delivery. Personal, temporal, geographic and procedural data will be collected and stored on secure servers, thereby strengthening national data collection processes.

Community health volunteers will be trained to perform data entry as support to health care workers, and members of the community will be engaged on various ways to facilitate the process including provision of transport services. Community ownership will be promoted to ensure sustainability of the platform, and robust monitoring and evaluation measures will be put in place.  

The strengths of the KC app include automation of tasks to eliminate delay, utilization of real time information to inform patient care, promotion of accountability for patient welfare and strengthening of data collection processes. Limitations include high set up costs, the possibility of human error in data entry, dependence on local infrastructure such as electricity to charge phones and its inability to be of use to women that never make it to health facilities. 

Our proposal involves the development of an mHealth app that will utilize technologies similar to mobile money apps, enabling the transfer of data at locations where there is cell phone coverage, but not necessarily internet connections. Temporal, geographic and biographic data will be collected, collated and transferred, thereby improving the speed and efficiency with which services are delivered at maternal health facilities, which will translate into a reduction in maternal deaths caused by delays in receiving health care at the service delivery point. 

Our platform connects multiple sectors such as transport, security and local authority to ensure efficient service delivery. This requires a network of mobile phones connected via Premium Rated Service Packages. The phones will also be advanced enough to host our app, which will generate, store and transport data that will then be uploaded onto servers for short- and long-term use. The solution in its entirety is heavily reliant on technology to be feasible, as it automates the referral process and allows for rapid outsourcing of periphery services. 

Goal 1: Reduce preventable maternal deaths caused by delays in health-care delivery through health system technologies in resource-poor settings in Sierra Leone.

Goal 2: Generate data in maternal health to inform evidence-based policy decisions on maternal health in Sierra Leone.

Goal 3: Increase transparency in health care provision through efficient entry, storage and management of routine monitoring and evaluation data under the maternal health domain.

We envision that the Kombra Channel (KC) app obtains wide-scale use in 5 years and is integrated into the national healthcare machinery.

Currently the app is being piloted in the two districts with the highest facility delivery rates, to enable us to focus on the service provision aspect only in the pilot phase, and not demand-generation also. We envision that in the next 3 years the app will be rolled out to other districts and will also include a robust demand generation component. 

The primary users of the KC app are health service providers and volunteers. Health workers will be recruited and trained through the Ministry of Health. Sustainability will be ensured by establishing a revolving system were trainees serve their tenure as facilitators of the app and then train others to continue.

Other users will include service providers from other sectors such as transport and security, all of whom will be recruited through local authorities. The final beneficiaries (pregnant women) will also be engaged as stakeholders through community leaders. All volunteers and providers will be given financial incentives. 

A prototype of the KC app is currently being developed and has not yet been piloted in communities. 

Beneficiaries will receive faster care with improved coordination at the point of delivery, especially in cases requiring referral to a tertiary facility. 

We envision that once piloted the app will serve a minimum of 500 women across ten health facilities in the two pilot districts in the first year. 

Within three years we expect this number to grow to at least 4,500 women, assuming that the use of the app expands to six districts over three years. 

Our team includes medical doctors and public health professionals familiar with the context of maternal health care in Sierra Leone, an app developer, and an M&E specialist.

A few team members have worked for several years in health in Sierra Leone, and are integrated in and familiar with the health machinery and governance structures in country. The combination of technical knowledge, numerous years of work experience, familiarity with the local context and established networks with the relevant stakeholders makes the team ideal for the successful implementation of the project. 

Major costs will include procurement of mobile phones, establishing a server for data storage, training and provision of financial incentives to workers and volunteers and payment of the app developers for software development.

Initially revenue for the project will come from donor funds. A grant proposal is being developed alongside the prototype of our app, and the submission of this project to the Solve challenge is also part of our revenue generation activities. The proposal will be submitted to several donor agencies and the representatives from the private sector, including mobile phone companies who will be encouraged to provide PRSP services for free.

We envision that the benefits of the app will be demonstrated convincingly enough in its first year of use, thereby encouraging its integration into the national health care budget for sustainability. Demonstrated success will be used to continue to request funds for donors until the app is included into the fabric of national health care provision. 

We are submitting our project to Solve because we believe the host institution MIT has comparative advantage and extensive networks in the area of technology-based solutions. We envision that a successful Solve application will connect us with skilled individuals and influential institutions that will aid in the implementation of our project, including in the mobilization of additional resources. We also believe the Solve community will strengthen our proposal with insightful suggestions and diverse perspectives that may be missing from our team. 

Key barriers to successful implementation include:

• Financial constraints
• Proper management of confidential data
• Stakeholder engagement

Solve can assist by providing our team with funds, connecting us to experts that can improve our platform and advise on data protection and management, and lending us additional credibility by associating the MIT brand with our solution. We believe an MIT-backed project will receive ready support from the government of Sierra Leone, and from the directorate of Science, Technology and Innovation.