S-PAQ : Digitization of maternal healthcare for Africa

494,000 maternal deaths occur in developing countries, with 6,000 in all developing countries. 94% of all maternal deaths occur in low-income countries and most maternal deaths are preventable with proper healthcare service. Maternal death rates are highest in developing countries due primarily to flaws in the social, economic, and political conditions of the countries involved, combined with a grossly inadequate quantity and quality of available health care services.

In particular, in developing countries where resources such as human resources, financial resources, equipment and consumables are limited, appropriate health examinations and screenings are generally not available. Due to the inability to distinguish between critically ill and healthy patients with proper screening, many patients gather in a small number of well-equipped medical facilities, failing to fulfill the government-determined division of roles, resulting in a health system Overall efficiency remains low.

The key is to ensure that proper screening is performed even in small health facilities. It doesn't happen because it has to solve all the many individual challenges to do so. For example, electricity, telecommunications, human resources, medical equipment, training opportunities, after-sales service systems, financial sustainability of medical facilities, etc. If even one of these is missing, the effectiveness and sustainability of the solution cannot be guaranteed. "There is nothing in the field" is a major obstacle to problem solving. 

S-PAQ helps local healthcare workers in low resource setting to deliver primary healthcare examination and screening for pregnant women with application and medical devices to navigate proper clinical procedure. The package has three components as follows.

. 1) Navigation software platform with easy to use protocol, Electric Medical Record and reporting system to the department in charge of medical statistics.

2) Hardware including IOT medical device such as portable ultrasound device, mobile CTG device, rapid test kits and solar panel & battery system.

3) Analysis and improvement service using Machine learning technology. Although at the initial stage the protocols are programmed by rule-based but as the data accumulates, the system will be optimized with Machin learning solutions such as for protocol and criteria of evaluation of patients, referral system and training.

The hardware components can be flexible to add or reduce equipment. However, the solution is a turn key package as even the most basic facilities such as electricity is not available in many healthcare facilities in Africa. Although this package is developed mainly for primary healthcare for pregnant women at small clinics, this can be also used for mobile clinics or home-visit services. 

The user of S-PAQ is healthcare workers in low resource setting. For example, a nurse who works at primary healthcare facility in an outskirt of Kinshasa DRC has to give cares for pregnant women without any support from medical doctors, no specific equipment not electricity. With S-PAQ, she will conduct a quality antenatal checkup alone at any time.

The primary beneficiaries are pregnant women who cannot access to high quality healthcare service because of lack of capacity at facilities. After S-PAQ installation, high quality primary healthcare service at neighbor healthcare facilities will be available for them. The customers who pays for our solution are Government and donors. As S-PAQ is a turn key solution, the customers do not need to confirm compatibility of new device with other equipment nor availability of electricity. Accessing to the data base of S- PAQ platform, they can follow the actual situation in medical statistics. 

During the pilot project we jointly executed with the ministry of health in DRC, all operators in 10 hospitals used our solution with portable ultrasound examination. We got a 99% of satisfaction from patients. From around 1,000 cases of digital antenatal examination, more than 20 cases of abnormalities or miscalculations are detected because of S-PAQ. 

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First, the S-PAQ is innovative as a complete digital platform that integrates applications and multiple hardware. After patient authentication with an NFC card, the smartphone application navigates the healthcare professional through a standardized examination process. In the process, multiple IOT medical devices are used, including a smartphone-connected portable ultrasound device. The data acquired by the sensors of medical devices is linked to the patient and stored in the NFC card and cloud database. One of the innovative aspects of S-PAQ is to utilize IOT equipment and provide it as a package that includes inexpensive non-IOT equipment such as quick inspection kits.

The second innovation is AI-based health abnormality prediction and health diagnosis process optimization. Data sets can be obtained by storing the database of prenatal examination, delivery, and newborn examination in one account. The prototype only implements a rule-based alert display function, but as a result of data accumulation, machine learning will enable more accurate anomaly detection and prediction in a few years. It will also be possible to make policy recommendations to change current government guidelines, such as screening indicators and timing, to data-optimized guidelines.

The third innovation is not digital, but a thorough standardization of health screening and a significant simplification of training programs. In collaboration with an experienced obstetrician and gynecologist, we have developed a program that allows midwives in developing countries to learn the ultrasound measurement techniques necessary for basic screening in a week using portable ultrasound equipment. The overwhelming shortening of the training, which normally takes more than a month, is that the service content is specialized for the primary screening in the field. 

1. Hold trials with 10 maternal healthcare centers in DRC, collaborating with an international medical NGO, IGPC 

 2. Established partnerships with The Ministry of health, a private hospital, an association of gynecologists and that of midwives in DRC.

3. More than 200 set of S-PAQ have been requested in financial plan 2022 of the ministry of Health in DRC 

 4. Hold a workshop to elaborate a road map to standardize our solution in DRC with the reproductive health direction in the Ministry of health in January 2021

5. Received a request for a quotation for 6 kits from a foundation in Tshuapa province in DRC