Totohealth

A mother to community health workers' referral system and care kit in marginal areas of Kenya.

At Totohealth, we have worked with Community Health Workers and Volunteers (CHW/CHV)as our eyes in the community to on-board pregnant women and caregivers to the Totohealth Platform. (Totohealth is a mobile health innovation engineered to enable pregnant women and caregivers from low-resource settings to detect fetal and child development abnormalities as well as improve access to vital maternal and child health information for just $2 per year).

 Here, we have created an incentive program where for every mother who on-boards the program, the CHW receives a USD 0.4 pay. Over time, we have seen that there is a need to create a more sustainable model for our interaction with the CHV. So far, we have trained 2500 CHWs in 6 of the 47 counties in Kenya, but only on areas relevant to Totohealth.

Our solution is creating a comprehensive solution from which the frontier health workers can have a steady source of income by creating a referral system where pregnant women and mothers are referred to a CHW for basic consultation and accompanying to the health facilities. This would require us to train the CHWs on basic care for maternal and child health, a solution which we will deploy via Totohealth mHealth application. The application will link the huge customer base already on our system to the nearest CHW for consultation or guided accompanying to the nearest health centre. This will also help us to collect valuable data on their performance, specific topics of consultation, ANC clinic completion rate of the pregnant women, and stimulated decisions for delivery under skilled birth attendance and in return create a revenue stream for CHWs from fees collected.

To enable the frontline workers to effectively perform their functions, we will equip them with a basic care kit, a package-containing items for diagnosis and care such as MUAC tape and weighing scale, tape, bandages, antiseptic wipes, sanitary towels, cotton wool, thermometer, and disinfectants. The kit will enable the CHW to also conduct first aid in case of emergencies, diagnose malnutrition cases and promote hygiene. 

Our solution is an application of an existing technology. The existent Totohealth platform aims at creating behavior change in pregnant women and caregivers with children below 5 years. This in turn, is a rich market from which, if the correct linkages are provided, is a revenue stream for the involved Community Health Workers(CHWs). Parents will be linked to the closest CHWs for basic care and accompanying to health facilities. Our process involves training of the CHWs first, and equipping them with the right tools to properly execute their functions on the front line.

Mobile phone penetration in Kenya above 95%, with all phones capable of SMS and calls. Our solution is based on SMS and Interactive Voice Response(IVR) (provided in vernacular languages) for maternal and child health education for the parents. For the CHWs, we will employ similar methods to train them on front line intervention, and employ the Totohealth platform for the referral of pregnant women and caregivers to the nearest CHW. The platform has capacity for us to collect vital information and reports from the CHW of the parents under their care.

We plan to create a differentiated training content, with different languages and CHW kit based on the differences in health needs for the 47 Counties in Kenya. This is because not all counties face the same health challenges, and therefore a tailored training program is necessary. On the same note, we plan to grow the number of CHWs we have trained from 2500 in 6 counties to 3500 in 9 counties. We plan to conclude investigating the best methods for referral and feedback on the Totohealth platform and settle on the most effective method.

Our plan is to launch Totohealth services in the counties with the biggest burden of maternal and child mortality in Kenya. 15 of the 47 counties contribute to 90% of the child and maternal mortality in Kenya. Here, we will have trained and equipped approximately 6500 CHWs and register at least 200,000 pregnant women and caregivers on our maternal education platform. The long term goal is to adapt our solution for each county as we roll out our program in the whole country.

We partner with county governments to access the CHWs deployed in each area of the county, from where we register and train them for the service. Pregnant women and caregivers on the other hand can either register themselves for Totohealth through an SMS short code or can be registered by the CHWs. The care kits are provided either at the point of training or from specific health centers within the counties. Once registered, the service is personalized and delivered to the mobile phone in the method and language most convenient for the beneficiary.

Today, we have over 39,000 mothers registered on the Totohealth Platform. Based on the stage of pregnancy stage or age of the child, they receive tailored messages each Monday and Thursday at 9am on topics such as clinic visit reminders, pregnancy warning signs, child wellness alerts and more. We have also trained 2500 CHWs who register the mothers and caregivers on the platform. We pay them USD 0.4 for every parent they register to the platform.

We expect to register up to 80,000 parents in the next 12 months, and estimate to cross the 200,000 mark in 3 years’ time. Our child and maternal education efforts will help them to effectively nurture health and stimulate informed decision-making for critical activities such as delivery under skilled attendants, completion of ANC and child vaccination visits and family planning decisions. This in effect reduces the associated child and maternal mortality. We expect to train 1000 more CHWs and equip them with care kits, with that number approximately being 6500 in 3 years’ time.

I have skills in leadership and management, having a MBA in global Business and Sustainability, and I am passionate about the impact we want to have in our society. The management team is comprised of passionate people with skills ranging from business development and strategy, paediatrics and public health, accounting and financial management and application development and automation. We also have consultants who work with us in case there is an interest in an area of specialty not catered for in the team.

Our social enterprise operates in a hybrid model. We charge USD 2 per year for our opt-in users. We solicit for grants to help deploy projects which cover bottom of the pyramid users who are in great need of the service, but are unable to pay for themselves. Additionally, we sell the maternity kits at a retail price of USD 20. We are currently in talks for corporate partnerships to push the numbers for opt-in users for profitability. For bottom of the pyramid users, we are seeking long term sponsorships from their county governments.  

Currently, we are on a fundraising campaign to meet a financial requirement of $300,000 which would enable us to boost our impact numbers to 200,000 users and 6,500 CHWs on the Totohealth platform. We believe that this opportunity would go a long way in helping us ultimately reach the goal we have set for 2020.

Equally, this opportunity could also help highlight our activities for potential networks and partnerships which we are currently looking out for. We believe getting like-minded partners will help create the collaborations necessary for even greater impact.

One of the challenges to how much impact we can have is the number of people who receive our service, especially among the communities most affected by child and maternal mortality.  Unfortunately, the people most affected are bottom of the pyramid users, who can barely pay for the service themselves. This presents a barrier to us on how to create the most impact yet remain sustainable while serving not just those who can afford the service but the marginalised communities as well. Proper networks with parties willing to help can help us jump this barrier.