Lifesaving Intervention Project

Maternal and neonatal mortality continues to be a significant problem in Nigeria. Along with insufficient financing, medical supply gaps, and service delivery challenges, lack of access to maternal care is a key health system-facing issue preventing significant improvements in maternal and child mortality. Even though primary healthcare is designed to provide skilled access to pregnancy care at the grass-root to prevent maternal deaths in Nigeria but evidence suggest that women in rural communities do not use these services. The non-utilization of the primary healthcare services has been traced to lack access, poor quality of care, high cost and unavailability of skilled personnel.

Maternal mortality rates continue to rise, and is one of the highest in the world (917 per 100,000 live births, 2017 UNICEF report). Under-five child mortality rate still remains high according to UNICEF 2020 report (113.8 deaths per 1000 live births). This situation is even worse in Northern Nigeria due to the rise in insecurity where healthcare services have been disrupted and under-funding healthcare sectors by the subnational governments.

This project seeks to train birth attendants and community health workers on lifesaving skills and support them with a mHealth technology to easily diagnose and treat patients in rural communities. 

This project seeks to train birth attendants and community health workers on basic lifesaving skills and deploy an automated SMS-based, free-for-use mHealth medical reference tool, accompanied with interactive educational content to promote improved maternal health practices in remote communities. The mHealth technology is designed to work on any mobile device without the need for internet connection to give access to all health workers in remote communities. It provides users with useful information on important considerations and best practices in sexual health and family planning, pregnancy, labor and delivery, and postnatal mother and infant care, without the need to use the internet. In order to meet both reference material needs and physical material needs, this intervention will also provide a locally made clean birth kits to support improved prenatal care, safe childbirth, and improved postnatal care in rural communities ultimately ensuring clean and safe delivery. Our solution supports high quality maternal and child care services with the goal of reducing the burden of maternal, child and neonatal mortality in Nigeria. 

Direct Beneficiaries

Women and children; This project will directly benefit pregnant women and children through our network of trained volunteers and health workers who provide direct services to them. The pregnant women will also receive free birth kits when they come for delivery.

Community Health Workers and Birth attendants; The health workers and birth attendants will receive a training on lifesaving skills which will improve their competency in patient-care. The mHealth tool will support and provide them with a practice reference to improve their effectiveness and efficiency. The birth attendants will also be engaged as the project volunteers.

Indirect Beneficiaries

PHC facilities; The primary healthcare facilities will indirectly benefit from the improvement in the capacity of its workforce. The free clean birth kits will also be donated to the healthcare facilities in remote communities which improve the quality of their equipment to provide qualitative health services.

The community; The community will indirectly benefit from improved service delivery and access to quality healthcare.

The lifesaving intervention project has been implemented in over 50 communities in Nigeria and in some, the project is currently ongoing. The SMS-based tool has been piloted with over 1000 health workers in Northeast Nigeria and has been well received, demonstrating proof of concept and supporting further development. Currently the tool is used by over 2000 users across Nigeria's Northeast with a promising potential for scale to not only in Nigeria but to other African countries. This project have saved over 1000 women through the supply of lifesaving clean birth kits and pre and postnatal home visit program carried out by our volunteers known as home health volunteers. With this project, it’s believed that it will accelerate the vision of reducing maternal, child, and neonatal mortality in Nigeria.

This solution has been deployed since 2019 and very few communities have benefited so far. I hope to leverage on the Solve's established network of expert professional to identify partners and collaborators to accelerate the growth of this idea in order to reach more remote communities who may require this intervention to improve their health indices. 

Considering the reputation of Solve and its rich network, I hope to gain public presence through Solve to scale my idea and attract more supporters and collaborators.

Most fascinating about this SMS-based technology is that it does not require the internet nor smartphone to function. It works on any mobile phone that can send and receive SMS even in the remotest community. It is easy to use by CHWs and users are not charged for sending and receiving any information on this platform. This technology eliminates the cost of data to browse the internet, the time taken searching for information on practice manuals or guides. It’s a friendly job aid for community health practitioners to provide high-quality care in low-resource settings. This technology allows the health workers to practice with confidence as it links them to highly reliable medical information and best practices.

In the next 12 months, I hope to scale the lifesaving intervention project to 50 additional communities and 5000 additional health workers using the SMS tool as their practice guide in their daily practice.

In the next 5 years, I hope to see my solution been adopted and endorsed by the primary healthcare policy makers so that more communities can be able to access high quality care to accelerate the achievement of the Universal Health Coverage in the country.

Data will be collected through the attendants register on the number of trained health workers and birth attendants. Number of clean birth kits distributed in the communities will also be noted and the number of pregnant women that was delivered using the birth kits.

The team will monitor the usage of the mHealth tool via analysis code that automatically generates daily reports detailing number and types of queries, number of unique users, and all feedback messages.

All these information will be reflected in our quarterly and annual reports to support decision-making.

It is thought that with additional training, capacity building, and necessary material resources, community health workers (CHWs), including community health workers and birth attendants, could play a significantly increased role as frontline workers and help ensure that more women give birth with adequate assistance and thus reduce mortality. In addition, several studies have demonstrated the potential of mHealth interventions to meaningfully improve healthcare delivery capacity by CHWs in low- and middle-income countries.

 A qualitative study of various stakeholders’ perceptions about CHWs and community midwifery revealed that many believe that equipping existing CHWs with the necessary skills and resources is more viable path forward than attempting to fund and train an entirely new cadre of workers. It is therefore necessary to understand what interventions might be necessary to empower CHWs to better serve in this role.

In many low- and middle-income countries (LMICs) like Nigeria, community health workers (CHWs) act as a bridge between the community and the formal medical system. CHWs typically do not receive formal professional training or a tertiary education degree but do receive training for a number of tasks they are expected to perform as part of their role. These roles include patient education for chronic disease management and infection control, disease management with pharmaceuticals, antenatal care and birth attendance, and immunizations, among others. In Nigeria, the community health workforce is composed of community health officers (CHOs), community health extension workers (CHEWs), and junior community health extension workers (JCHEWs), who exist on a spectrum from providing mostly in-home/community care and support (JCHEWs) to working mostly within primary healthcare facilities (CHOs). As with healthcare providers at any level, CHWs must develop a substantial knowledge base and have reliable medical reference sources available in order to provide optimal care. Previous reviews have highlighted the negative impact of insufficient primary health worker training and knowledge on patient outcomes. In a cross-sectional study of 56 primary and district health facilities attending to 1000 hypertensive patients in Nigeria, researchers found that only 39% of non-physician healthcare providers were able to correctly identify treatment goals for uncomplicated hypertension and only 28% of patients were deemed under control. A study evaluating CHWs in Amhara, Ethiopia observed a 20% increase in errors 18 months after a training intervention seeking to improve maternal and newborn care delivery.

Given these challenges with traditional reference sources, there has been substantial interest and research in mobile health (“mHealth”) interventions for closing knowledge gaps among CHWs in LMICs. These include things like text message chatbots and offline mobile apps which both can deliver content without necessitating an internet connection. There is significant evidence that mHealth interventions for information access can promote higher quality care.

The idea behind this solution is to utilize locally available resources to address critical healthcare challenges in the community. The clean Lifesaving birth kits are locally produced and it adopts the six principles of cleanliness according the WHO including; clean hands, clean perineum, clean delivery surface, clean cord cutting Implement, clean cord tying, and clean cord care. The basic delivery kit helps to achieve the above principles to cleanliness throughout the birth process thereby reducing infection during and after child delivery.

The mHealth technology uses an SMS messaging to retrieve useful information on important considerations, interactive training materials and best practices in sexual health and family planning, pregnancy, labor and delivery, and postnatal mother and infant care, without the need to use the internet nor smartphone to function. It works on any mobile device that can send and receive SMS even in the most remotest community. It is easy to use by CHWs and users are not charged for sending and receiving any information on this platform. This technology eliminates the cost of data to browse the internet, the time taken searching for information on practice manuals or guides. It’s a friendly job aid for community health practitioners to provide high-quality care in low-resource settings.

The organization does not discriminate and individual based on religion, cultural believe, race, social status, gender orientation in terms of employment, service delivery or partnership. We believe that everyone is equal and that is why our core values depicts all those characters of equality. 

This solution targets three categories of beneficiaries;

The first category are the patients (pregnant women); We support them with the clean birth kits. Most of the pregnant women in remote communities do not come to the health facility for delivery prepared and most times, the facilities to do not have clean birth equipment ready for conducting deliveries. Therefore, providing these women with a clean pack that contents all basic items they need for use by health workers to conduct delivery is very critical and lifesaving. Even though, it is currently distributed for free but most of the women who have used it before will be ready to pay for it if it is available at service point.

The second category are the health workers and the birth attendants; We support them with training and an mHealth technology to improve their service delivery. Most of them do not have access to opportunities to attend trainings organized in cities but through this project, we are providing them with the latest information at their own convinience at no cost to them. The SMS-based technology eliminates the cost of data to browse the internet, the time taken searching for information on practice manuals or guides. It’s a friendly job aid for community health practitioners to provide high-quality care in low-resource settings.

The third category are the healthcare facilities; The birth kits we produce can be accessed by this healthcare facilities at subsidized cost which they can retail it to users at the point of service. This birth kits makes it easy for healthcare facilities to access clean equipment and it eliminates the need and the cost of sterilizing birth equipment because the birth kits are disposable.

My approach to sustainability is to establish a social enterprise in the long-run to support service delivery. The resources to produce the birth kits are locally available to produce at large scale so that individuals, pharmacy stores, healthcare facilities can access them at any time they need.

The second part is to continue to explore grants that will subsidize the cost of the birth kits production and the SMS-based technology. We have been using grants to support this project the pilot to this point.

I also use crowdfunding donations to raise funds to support this project.

For example, in 2020 after launching the lifesaving intervention project in 3 communities (Kabri, chana and Kara) in Taraba State, Nigeria. We distributed 500 clean birth kits to three primary healthcare facilities in those communities to used for any pregnant women that came for delivery free of charge. It was a one year project which ended in December, 2020 and all the 500 free clean birth kits were exhausted. Later we received request from the healthcare facilities to supply additional birth kits at subsidized prices. We did and about 1000 kits were procured by the 3 healthcare facilities in 2021. I learned from this, that people are ready to pay this birth kits as long as it will be made available. We are still working with the 3 health facilities meeting their needs on this. We hope to use the same model once the project period in the ongoing communities comes to an end to ensure sustainable supply of this Kits to those communities.

Another example is that, we secured additional $5000 small grant from 'World Connect Organization' to further implement this project in additional 10 communities last after the initial grant that supported first 20 communities. We also setup an online fundraising campaign on global giving organization platform where we have raised over $3000 dollars since last year in support of this project.