Matricare

Nearly 95% of all maternal deaths in the world occur in low-income settings, and the majority of these deaths are preventable. Discrepancies in prenatal healthcare delivery in rural Nepal play a crucial in this scenario. According to the latest report published by Nepal’s government, only 55% of all pregnant females in the developing nation attend at least four ANC visits. Adequate antenatal care allows for  identification, monitoring and management of high-risk pregnancies; the lack thereof can adversely affect maternal and fetal health. 

The scarcity of existing obstetric information available to health care workers prior to institutional deliveries is what poses the biggest challenge to promoting safe motherhood. In other words, as not every pregnant female chooses to visit the hospital whether for delivery or ANC/PNC purposes, we actually do not have a correct estimate of the target population. Furthermore, delivering prenatal health care services is impossible when a woman’s first visit to a health care center is for institutional delivery, following labor. 

Another important problem is the lack of awareness among people from disadvantaged communities regarding maternal risk factors that may adversely affect pregnancy and birth. This also stems from a lack of effective communication between healthcare providers and community members themselves. 

Additionally, there is no existing system that efficiently and regularly alerts pregnant females ahead of scheduled ANC, PNC visits and expected date of delivery (EDD), to ensure full attendance. 

Therefore, community engagement, social awareness and health database software can, together, help to increase the uptake of safe motherhood services and upgrade overall maternal health in marginalized communities.

Early detection of pregnancies by female community health volunteers within their catchment area is a prerequisite to achieving adequate antenatal and postnatal care. 

Matricare firstly consists of FCHVs who encourage and guide newly pregnant females to the nearest health facility for their first ANC, after reporting any new pregnancies which are recorded in Matricare software application. Secondly, health care workers and FCHVs then communicate to the mother the date of her first scheduled ANC visit. 

Her obstetric details are then recorded during her consultation in Matricare software application in computers available at health care facilities. These details include gestational age, obstetric risk factors and necessary investigations among others. The main aim of this app would be to notify pregnant females and their respective FCHVs of upcoming ANC visits via phone calls and automated messages ahead of time. It also supports our goal to maintain adherence to maternity care schedules.

Also, if women lose their health records, relevant health information belonging to Matricare clients may be accessed in the future; for example, in future pregnancies. They may be printed or e-mailed in the case of referral to a higher center.

Moreover, the electronic database will provide a pool of data that can be statistically analyzed for updating health reports. It may also assist in identifying the strengths and weaknesses of existing health programs and policies.

The target population whose lives we are working to improve are women and neonates of rural Nepal who are disproportionately underserved. Patriarchy is a predominant theme in traditional Nepalese society, with males being the breadwinner and decision maker in most families, especially in impoverished populations. In many settings, the primary role of a woman is is limited to domestic duties and child-rearing. This pre-determined role is a cultural barrier for women who wish to assert their independence, especially by making well-informed decisions about their finances, education, health and reproductive rights. 

Regular and repeated reminders from health care providers and FCHVs can increase the chances of pregnant women attending all required antenatal (ANC) and postnatal (PNC) visits. We strive to reinforce the concept that the process and outcome of childbirth is largely influenced by a number of factors including continuity of care, a culture of health-seeking behavior, and timely interventions. The understanding that these factors can be effectively addressed and managed through regular monitoring in prenatal and postnatal health check-ups.

Witnessing other females attend ANC/PNC visits can also act as a positive stimulus that encourages health-seeking behavior in women. It provides women with an opportunity to seek and receive health information and exercise her right to make decisions pertaining to her own health and that of her offspring. 

Also, women can provide FCHVs with feedback that they may not otherwise be able to communicate to their health care providers during visits. When this is relayed to health workers by FCHVs, it can also help to enhance the quality of these visits. FCHVs serve as powerful tools, bridging the gap between communities and health care centers.

First-hand exposure to the ground realities of Nepal’s rural health care system is a commonality all members of the Matricare share. 

Co-founder Nahakul Shahi, hails from one of Nepal’s most underdeveloped districts, Kalikot. Following graduation, he returned to his village to serve as a doctor at the district hospital for over three years. The unique perspective he possesses as both a clinician and member of disadvantaged communities has enabled him to competently fulfill clinical and administrative duties in a resource-poor setting. His cultural sensitivity and familiarity with limitations of rural health systems in Nepal has been valuable in conceptualizing Matricare. Moreover, his specialized training has allowed him to contribute towards maternal health, medically and surgically. 

Co-founder Asmita Karki, also a licensed doctor, currently works as a clinical research associate. Having taken part in public health and clinical research both in rural and urban Nepal, she possesses extensive knowledge on health infrastructure, health behavior and the psychological aspect of health care models and interventions. In addition, she can conduct research based on Matricare to assess its effectiveness, to identify its strengths and weaknesses and specific aspects that require change for better results. 

Executive director Smriti Karki, a US graduate in Global Health and licensed paramedic has worked to train primary level health workers in Nepal in her area of work. Her perspective on the social determinants of health and their relationship to public health are integral to the implementation of Matricare. 

Tech support is handled by Bhishan Mahat, a mechanical engineer with software expertise currently working in rural Nepal. Developing the design for the health information application required by Matricare is a task he is qualified to complete. Apart from his professional contacts, being a local leader has made it possible for Mahat to expand his network of contacts and interact with stakeholders from various fields. The promotion and expansion of Matricare can definitely benefit from local, regional and national level parties.

As we are currently at the concept phase, we have not yet launched our project. We plan on launching our pilot project in Kalikot, Nepal and hope to serve the pregnant women and mothers in the district.

We strongly believe in tackling the root causes of a health problem in our search for effective and sustainable solutions. Matricare provides us with the dual opportunity of improving maternal and neonatal health outcomes, while building a universally accessible health information database for mother and child. As we attempt to improve healthcare-seeking behavior in pregnant females, we feel the true potential of Matricare can be reliably assessed by Solve. Being selected would mean receiving the opportunity to collaborate with experts to bring Matricare to fruition. 

Realistically speaking, apart from Matricare software development and implementation, guidance regarding financial and marketing aspects is vital for the sustainability of our project. Obtaining government approval for legalization of institutional subscription and utilization of Matricare is essential to generate the majority of revenue. Being affiliated with the renowned institution MIT, Solve provides its selections with a certain level of credibility that is crucial for obtaining assistance from third parties.  Lastly, as the concept of Solve encourages the sharing of innovative solutions that can be applied in multiple settings, our team would like to participate in this inspiring exchange of ideas.

Simply increasing the number of institutional deliveries using birth incentives is not sufficient to decrease the high MMR in Nepal as this does not ensure prenatal complications can be successfully managed at birth, nor does it guarantee a woman and neonate will not suffer from birth-related complications. The key to safe motherhood lies not only in safe birth practices, but also in satisfactory antenatal and postnatal care. 

Both FCHVs and Matricare software attempt to create a feedback loop for adherence to a pre-planned schedule for receiving maternity health services. Matricare is a two-tiered intervention; both community-based and software-based aiming to target every new mother, instead of only providing health services to mothers who actively seek them. 

FCHV do not require any advanced training, nor is there a need to buy any new commodities. It is easier for mothers to communicate with other females of their own communities rather than directly with males, or health personnel. We are not designing a completely new system, but rather building on an existing health model. It was designed based on experience and evidence-based observations. For all of these reasons, Matricare is a cost-effective, culturally acceptable, realistic and sustainable model and that is where its innovativeness truly lies.

After launching our pilot project, our first focus would be to establish an increase in the number of women who complete the required number of antenatal and postnatal visits and the number of institutional deliveries. We plan to achieve this by decreasing delays in receiving healthcare. We also would like to optimize the functionality of the app, making it adaptable to rural health care systems. 

By the next five years, our goal is to improve the MMR in rural Nepal and display an increase in health-seeking behavior among mothers. We also aim to make appropriate health program and policy changes to enhance patient-centered maternity services based on research performed on the synchronized data from the application. We are also keen on upscaling the use of Matricare app to all government and private health facilities across the country.

Using the number of reported pregnancies in a specific area within a single year as the denominator, we have 3 main indicators: the rate of antenatal services, postnatal services and the percentage of institutional deliveries during the same period. We can use these indicators to measure our progress toward improving antenatal and postnatal care visits in rural Nepal.

We will use mobile-based technology and health information technology to store health data of pregnant women and mother to send automated SMS and automated voice calls regarding upcoming medical visits.

Our solution mobilizes Female Community Health Volunteers, who are selected by the Nepalese government with the intent of prioritizing poor mothers 

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Delay in receiving antenatal and postnatal care remains a contributor to maternal mortality in resource-poor settings. Matricare aims to address this delay by collaborating with Female Community Health Volunteers (FCHVs) selected by the government of Nepal and health facilities in remote Nepal by implementing a health information system designed to operate in low-bandwidth settings. 

By establishing a health information technology customized for remote Nepal, Matricare will serve as an addition to the existing healthcare infrastructure set up by the Nepali government in rural areas. With the key  already in place, our solution is both manageable and economical.

Matricare will collect and store the health data of every pregnant woman and new mother that receives care at a health facility in our network. Our app will then process the health data and notify the pregnant women and new mothers along with the respective FCHVs in their locality of upcoming visits ahead of time through automated SMS and voice calls. The continuity of care in antenatal and postnatal services allows for the early detection of possible pregnancy complications and the delivery of preventative measures to improve health outcomes for pregnant women, new mothers and neonates. 

We plan on initially achieving financial sustainability by collaborating with local and federal government bodies and securing grants. We will also establish close ties with relevant donor groups which in turn will provide additional support and funding to Matricare.

Upon successfully demonstrating the effectiveness of Matricare, our service will be scaled nationally to support interoperability. Sustained revenue will be generated by offering a subscription service to private healthcare providers in urban areas of Nepal.

As Matricare is at the concept phase, we are yet to achieve financial sustainability. By applying to MIT Solve, we hope Matricare will be recognized for the impact it is capable of making and secure preliminary funding to jumpstart our project.