Thari

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth (World Health Organization, 2019). Of the 536,000 women worldwide who die each year from complications of pregnancy or delivery, 99 per cent are in developing countries. Of those, half are in sub-Saharan Africa (United Nations,2012).In Botswana, the Maternal Mortality Rate (MMR) increased from 133.7 to 166.3 per 100,000 live births between 2018 and 2019 (Statistics Botswana, 2019). This is despite the high utilization of obstetric health services with 94% of pregnant women attending antenatal care, 95% delivering in health facilities, and 85% attending postnatal care. The leading cause of neonatal death is preterm birth complications, while the top causes of maternal deaths are abortion (24%) and obstetric hemorrhage (20%) (Republic of Botswana, 2018), with most instances of maternal and child mortality occurring in health facilities.  

Many factors contribute to the high MMR in Botswana. Data suggests that women often lack the knowledge to respond to maternal complications until it is too late. Furthermore, many mothers relocate to their home villages in rural areas for up to three months following hospital discharge, with limited transportation to and availability of health services. The failure to seek emergency obstetric treatment may be caused by cultural practices and therapies. Early hospital discharge, shortage of clinical personnel, limited transport and equipment for follow-up at home, and high rates of HIV/AIDS also exacerbate the MMR in Botswana.  

Thari, the proposed solution, uses inclusive low-cost mobile solutions such as Unstructured Supplementary Service Data (USSD), Short Message Service (SMS), Interactive Voice Response (IVR) and voice technology to reduce maternal and newborn deaths in Botswana by linking pregnant women and new mothers to maternal healthcare providers. Thari” means pillar, from the saying “mosadi thari ya Sechaba” which means women are the pillars of strength in our communities. Thari strengthens prenatal care and postpartum follow-up, solving the problem of reaching women with maternal health information and communicating with them when they leave health facilities. Mobile phone adoption is over 100% in Botswana, with the vast majority using feature phones. Using low-cost, scalable mobile technology that is accessible to both feature phones and smart phones will be an effective method of reaching women.

Thari will be available across Botswana to pregnant and new mothers enabling them to access prenatal and postpartum healthcare information, to identify and respond to indicators of ill health during pregnancy and after giving birth, and to seek care. It will have the following components:

• USSD/IVR for early warning: USSD/IVR will be used to alert expectant and new mothers to go the nearest health facility when experiencing symptoms. A series of short questions will be sent to the woman and based on the response, an alert will be triggered to the new mother and a healthcare provider via SMS. 

• SMS/IVR for maternal health education: SMS/IVR will be used for push notifications and informative tips for new mothers. It will also be used for alerts based on the USSD survey that go to both the health care provider and the woman. 

• IVR for meaningful narratives: IVR will be used to disseminate educational content. This will include content that is both entertaining and educational that drives awareness of SRHR among women. 

• Voice for individualized care: The voice solution will enable mothers to contact our call center which will be directed to healthcare providers or healthcare facilities as required. 

• USSD and SMS to enable networks for care: The solution will strengthen communication among maternal health service providers in MoHW facilities across the health districts.

• IVR and USSD for data collection: IVR and USSD will be used as a data collection tool for data that can be used not only for improved service delivery but for further research in the area of maternal health 

By connecting mothers in rural and urban poor populations to maternal healthcare providers and delivering Sexual and Reproductive Health and Rights (SRHR) messaging we will develop strong support systems around mothers (medical staff, family members) and reduce maternal and newborn morbidity and mortality in Botswana.

We aim to serve 150,000 women in Botswana within child bearing age i,e 15-49 years of age in the first year of rolling out Thari.

Our anticipated outcomes are that:

• Women will access relevant information throughout pregnancy and post-partum  

• Women will self-monitor post-partum in direct communication with maternal healthcare workers and facilities through Thari 

• Women will report and get early warning in maternal and child health emergencies. This can avoid unnecessary health facility visits, thus preventing exposures to diseases such as Covid 19 that can complicate their health and increase the burden of ill health. 

Our team is well positioned and highly exprerienced to deliver this solution because our portfolio  is  built  on  serving  those  who  are  digitally  excluded  by  economic  and  geographic  factors  –  the  poor  and  the  rural. For instance Our project team involves experts Dr Mabel Magowe has 40 years of extensive experience in practice, theoretical and clinical teaching, research in maternal child, and reproductive health and policy development and Jenny Lidikwe who is an Award  winning  filmmaker and scientist who has  spent  the  past  15  years  in  Africa  working  to  strengthen  health  systems.  Brastorne  staff also were integral  in developing the current  health system and policies in Botswana. In Botswana  our staff have been involved  in national  projects  such  as  the  Botswana  Aids  Impact  Survey  (BIAS  IV),  the  national  census  and digitising  health forms  for Statistics  Botswana and  Ministry of  Health.  Our  staff  has  also  been  instrumental  in  management,  developing  and  deploying  key  Ministry of Health  systems  such as  PIMS,  OpenMRS  and the  data warehouse.  We  therefore have the  capacity to develop  best in class monitoring and evaluation systems,  assist  with interoperability  and data  exchange between  core  systems, as   well as  ensuring that  any development  is according  to policies  governing data.     

Additionally, We  work  collaboratively  with  the  Ministries  of  Health  and  Gender  Affairs,  Statistics  Botswana,  the  University  of  Botswana,  UNICEF,  Orange  Botswana,  BTC  and  Mascom.  Thus,  we  have  generated  the  capacity  to  steer  a  coalition  of  private  and  public  sector  actors  to  achieve  a  reduction  in  maternal  deaths  by  linking  women  with  maternal  healthcare  providers  through  mobile  technology. 

Furthermore our  solutions  do  not  operate  in  isolation  and  are  designed  to  be  flexible  enough  to integrate  with,  for  instance,  government  health  systems.  Therefore,  the  nature  of  our  services  is  that  we  operate  as  part  of  ecosystems  and  coalitions

 Our motivation for applying to Solve is to obtain further assistance from the Solve network on how we can better provide access to maternal health services to rural unconnected women.  We would like to showcase African talent, increase awareness Brastorne solutions on an international level. and to bring attention to the importance of the partnering with mobile telecommunication providers by adapting existing technologies to new business models targeting the rural poor with Thari as a case study. We also wish to benefit from the technical and business acumen of the MIT network, connecting with thought leaders and industry experts to grow Brastorne into a pan-African enterprise. Multiple additional comprehensive solutions will serve the undeserved, create jobs, and improve gender equality, food security, and youth empowerment. 

Smartphones have been revolutionary, including in Africa; some 200 million Africans benefit from their use. Yet, not everyone benefits from the power of the Internet or the reach of mobile apps. Less than 20% of Africans have Internet access, mainly because the business model of the digital economy is exclusionary. Brastorne’s innovation is in leveraging the infrastructure of the digital economy—telco networks, and the low-cost data protocols not currently used for app-like services. We create a brand new business model for the digital economy, targeting the rural poor on the mobile devices and networks they can access, and providing them with Internet access and digital services they need for as little as $0.03 per day. We use simple mobile technology primarily used for the banking sector, and while USSD and IVR themselves are not innovative, Brastorne’s use of them is. We create a community of rural users that did not previously exist.

Using Thari as an example, Brastorne creates health ecosystem connecting hard to reach pregnant women in rural areas to each other and to healthcare service providers and digital economy without bankrupting them with exorbitant data charges. Moreover, Thari multi-channel approach enables access points into the community regardless of location, type of phone, or literacy level. This solution is catalytic, because it is easy to use and can be used by anybody across all telco networks.

The Department of Sexual and Reproductive Health Services in the MoHW steers the delivery of maternal and child health services through antenatal, postpartum and newborn health services within the broader health system. The MoHW does not have a specific programme to reduce maternal mortality, though Botswana has committed itself to achieving SDG 3. Our project would complement and accelerate government service delivery by providing a direct line of communication with our users providing them with faster access to government specialists and health facilities. We would, in effect, be bringing maternal health services closer to women.

Brastorne's Thari solution ensures the inclusion of marginalised women and families in health care facilities. We aim to benefit 150,000 mothers in Botswana during their pre- and post-pregnancy stages with providing necessary and emergency care in remote areas. Also, 50,000 women and family members will receive free over the phone initial consultation, contributing to SDG 3: Good Health and Well-being. 

In detail, the target group-specific outcomes are: 

• 150,000 pregnant women will receive medical information and care. 

• 50,000 women and their family members will receive free consultation. 

• 800 people have participated in awareness creation seminars 

• 5 call centre staffs will receive job opportunities. 

• 20 midwives and nurses will receive job opportunities

Our system allows for automated collection of information such that de-identified data related to demographics, knowledge, attitudes, and systems utilisation which can be linked with health outcomes for continuous quality improvement. Thari will allows the interaction between users and system to be logged and data collected. This data will include demographics, effectiveness of the messaging techniques (call to action), perceptions of the model and preference, and ultimately adherence to the campaign. We will evaluate Thari’s impact on a biannual basis. Brastorne will produce reports to be shared with experts as well as funders, the Government, and the general public. 

We will collaborate with the MoHW’s monitoring and evaluation department to collect data regarding women’s and newborns’ outcomes from medical facilities. The key indicators will include:

• The % change in the maternal mortality rate in participating health facilities or regions

• The difference in maternal morbidity and mortality rate between participating women and non-participants

• The % retainment of participants at birth compared to initial enrolment

• The % retainment of participants at six weeks postpartum

Our mission is to connect the unconnected. Our theory of change starts from two basic premises: first, if we provide functional apps on feature phones that offer social connections, educational opportunity, economic opportunity, and access to the Internet and relevant information at <$0.05/day, then the African rural poor will use them. Second, if Africa’s rural poor use digital apps, they will enter the digital economy, and their livelihoods, income, opportunity, and quality of life will improve. Our activities are focused on partnering with telcos to enable these apps to be made available to the rural poor via USSD, and building the functionality of each app, including local languages, simple user menus, and IVR features. We also provide extensive user support, reachable via menu and staffed call centers.

 Our direct outputs vary by solution, but include the number of registered users, including their demographics (age, gender, location), the number of daily and monthly users, and the number of Thari users accessing maternal health information. Our short-term outcomes for Thari are pregnant women in rural villages are connected to health care systems and thus have access to health care services. Our long-term outcomes are reducing maternal and new born mortality.

Our business model relies on, and our technology platform uses, USSD and IVR to bridge the digital gap for underserved communities. USSD (Unstructured Supplementary Service Data) is a Global System for Mobile Communications (GSM) protocol that is used primarily as a data protocol through which to transmit text messages—similar to Short Message Service (SMS). USSD uses codes comprised of the characters available on a mobile phone. A USSD message, which can be up to 182 characters long, establishes a real-time communication session between the phone and another device—typically, a network or server. With USSD, users interact directly from their mobile phones by making selections from various menus. Unlike an SMS message, during a USSD session, a USSD message creates a real-time connection. Thus, USSD enables two-way communication, as long as the communication line stays open. As such, queries and answers are nearly instantaneous. 

IVR is an automated Interactive Voice Response system that can interact with a voice caller. The caller listens to the IVR menu and responds by pressing a key on his/her phone, and t the system reacts accordingly. Based on the caller’s answers, the system provides the caller with the desired information, in this case, Sexual reproductive messaging and maternal health information.

Brastorne is a youth-owned company and its management strongly believes in youth empowerment. The staff is comprised 100% of youth, including the founder of the company. In addition, 65% of Brastorne’s employees are female, and 75% of the executive team is female.

Our primary revenue generator is subscriptions.  Users subscribe using their credit/prepaid airtime for approximately $1.40/month in Botswana and $1.00/Month in the DRC. We derive additional revenues from advertising, contract sales, and market research.

We generate more than $220,000 in monthly revenues, allowing us to be sustainable from subscriptions. However the plan is for Thari to be adopted by the Government of Botswana, hence the focus on integrating with government systems. We also plan to innovate within the project by developing fee-for-service add-ons such as “Uber for Nurses” a means by which nurses can provide home-care services via an app or USSD and pay a commission to do so. In the meantime, we will focus on developing our delivery model and scaling our innovation with the support of philanthropic and corporate organisations.

Previously we have raised the following funds: 

Draper Richards Kaplan Foundation, USA: $200,000 convertible note, 2021

Citizen Entrepreneur Development Agency, Botswana: $300,000 debt capital, 2018

Technical Centre for Agricultural and Rural Cooperation, Botswana: $7,500 grant, 2017

MIT Solve: $48,000

Revenue: Subscriptions: $1,777,426 (FY 2021)