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How might we improve maternal health with mobile technologies for low-income countries?

Challenge Brief

OpenIDEO has partnered with Oxfam and Nokia to explore how mobile technologies can be used to improve maternal health (particularly in pregnancy and childbirth). We’re asking you, the OpenIDEO community, to come up with inspirations and concepts around improving the knowledge and access to maternal health services, specifically where mobile technologies can be used as a tool to aid this. We’re focusing our solutions in low-income countries, such as Burkina Faso and Bangladesh. In many such countries fees for health care prevent millions of mothers from seeking the professional care they need or where under-investment means health works or medicines are unavailable.


THE SCALE OF THE PROBLEM

1,000 women die every day in pregnancy and childbirth – adding up to more than 350,000 deaths each year. Over 90% are preventable.

In 2000 world leaders set themselves a set of targets to significantly reduce poverty around the world, MDG 5, to reduce maternal deaths by three quarters, is the most off-track of all the MDGs.

The causes of maternal mortality are multi-faceted and deeply engrained in gender inequalities and decades of under investment in public health care.

Some of the big issues


Cost of healthcare – User fees for health care push 100 million people into poverty each year and block access to skilled birth attendance for those too poor to pay.

Healthcare personnel stretched – Just 1 more midwife could save the lives of 219 women. 700,000 more Midwives are needed to achieve the Millennium Development Goal to reduce maternal deaths by 75% by 2015. Overall the World Health Organisation has estimated that over 4 million more health workers are needed around the world.

General access to information and care during pregnancy and childbirth – Women need more access to basic information on safe motherhood and to their right to decent quality health care based on need and not ability to pay. Information can help empower women to claim their rights and protect the health of themselves and their unborn child.

Gender inequality – Women and girls have less access to education, assets, services, and security, in general - 12 percent of women suffer domestic violence during pregnancy – WHO multi country study, 2005.

Access to education in general - Women who complete primary education marry later, exercise better birth control and are more likely to use modern health services – K. Watkins, Oxfam Education Report, Oxfam GB, 2001

PHASE 1 – INSPIRATION

In the Inspiration phase, we’re asking you to look around and tell us what inspirations are already out there around this issue…

What are some existing products/services/campaigns (anywhere in the World) that are improving health (any type of health issue, not just maternal) in the community?

What are some of your own experiences with maternal health and where did the system succeed or fail for you? How could it be improved?

What are some innovative uses of mobile technology already out there that we could be inspired by?

PHASE 2 – CONCEPTING

In the Concepting phase, we’ll ask the community to contribute their own mobile solutions to improve maternal health. These could be new products, services, campaigns, systems.

We’ll ask you to think a little deeper about the feasibility of your concept from technology and business perspectives. 

PHASE 3 - APPLAUDING & EVALUATION

Once the Concepting phase is completed, we'll ask the community to return and applaud their favourite concepts. The top concepts will also be evaluated more thoroughly for criteria like business viability and technological feasibility.

ABOUT OXFAM

Oxfam is a vibrant global movement of passionate, dedicated people overcoming poverty together. Since our creation in 1942 Oxfam has consistently been at the forefront of identifying new ways to tackle poverty. People power drives everything we do. From saving lives and developing projects that put poor people in charge of their lives and livelihoods, to campaigning for change that lasts.

To have the biggest possible impact on the lives of poor people worldwide, Oxfam concentrates on three interlinked areas of work:

Emergency response
People need help in an emergency – fast. We save lives, swiftly delivering aid, support and protection; and we help communities develop the capacity to cope with future crises.

Development work
Poor people can take control, solve their own problems, and rely on themselves – with the right support. We fund long-term work to fight poverty in thousands of communities worldwide.

Campaigning for change
Poverty isn’t just about lack of resources. In a wealthy world it’s about bad decisions made by powerful people. Oxfam campaigns hard, putting pressure on leaders for real lasting change.

Read more from Oxfam...

ABOUT NOKIA

Mobile phones used to be toys for yuppies. Now, they have become tools for development. Nokia's aim is to see that the potential of mobile phones is fulfilled.
The goal for this challenge is a happy, healthy mother and child. Even though the challenge is structured around mobile technology, our view is that it isn't really about the technology, it's about what you do with it. Of course, that's a marketing slogan but it's also true.

At Nokia, we are very optimistic about the potential of mobile communication in health, whether or not we're involved. We are also mindful of the old saying, 'when all you have is a hammer, everything looks like a nail.' So, working with Oxfam and a broader community here is a good way to put mobiles in perspective as one tool among many, not a magic bullet. We look forward to hearing from you.


We would love it if you would spread the word to your friends and colleagues.
If you would like to promote the challenge in your office, feel free to download this challenge poster and post it up where people can see it.

Challenge Administrators

Comment on the Brief

If you'd like to leave us your thoughts on this brief, tell us what you think. Be sure to also take part in the challenge.

Join the conversation and post a comment.

January 27, 2012, 03:50PM
The timing couldn't be better to be active around this issue--excited to see the realization of the ultrasound technology access project.

I wanted to share an art-based exhibit on global motherhood that the International Museum of Women (an all-virtual museum based in San Francisco) launched this week: http://mama.imow.org/

Great inspiration, and happy to see the partnership with Every Mother Counts.
January 17, 2012, 02:38PM
This is a great challenge!
December 09, 2011, 11:45AM
You might be interested in this ... from South Africa:

We are a South African mobile software development company with extensive experience in USSD and SMS technologies. MTN South Africa currently runs all of its messaging traffic through our systems.

We developed a monitoring and adherence application that makes use of both USSD and SMS called mNURSE and we are looking for partners to pilot the application.

We designed the application based on recommendations from the UN Foundation Report mHealth for Development as well as other UN documents sourced in South Africa.

However, since it's development, we have not been able to test the efficacy of the solution and would appreciate any help with this.

To get a sense of the application please go to www.mnurse.org
December 08, 2011, 09:43PM
I really think this challenge has the potential to create a lot of impact. It combines the cost-effectiveness and reach of mobile phone technology with one of the millennium development goals where progress has proven very difficult.

In this context, I wanted to highlight the work of Click Diagnostics – a social enterprise that uses mobile technology to provide healthcare, with a particular focus on maternal health.

For example, they enable community health workers to collect health data using sophisticated medical triage-based software on basic mobile phones. The data is then sent to an electronic database where it can be viewed by doctors who reply with targeted instructions. At the moment, they have built up a group of ‘volunteer’ doctors mostly located in US hospitals.

They use this system to provide primary care to at risk populations such as pregnant women, children and newborns. Also included is an emergency management system which provides real time alerts to health workers and helps them arrange ambulances and alert the hospital.

This enterprise would serve as a valuable partner for many of the concepts developed for this challenge. Especially by allowing ideas such as “CareGiver Solution for Midwives” to work with an existing platform, instead of starting from scratch. See: http://clickdiagnostics.com/.
December 08, 2011, 01:48PM
Hi. Maybe I've missed the mention of two exciting mobile innovations in this conversation but if I haven't .... Frontline SMS is being used in delivering mobile solutions in the health sector. And, an innovation born (!) of the Knight News Challenge in 2008 is Freedom Fone which offers easy to use interactive voice response (www.freedomfone.org)
December 07, 2011, 03:13PM
This project looks very exciting, creatively integrating mobile technology and maternal health provides many opportunities to address the important issues of maternal health, prevention and reproductive health at large. I would like to share a complementary case study from UNFPA titled "Mobile Reproductive Health Clinics Make Motherhood Safer in Remote Lao Villages" (http://www.unfpa.org/news/news.cfm?ID=595&Language=1).

While mobile phones provide an innovative approach to the demand side of material health, making the supply side mobile as well is another important aspect of this work. Particularly for rural areas, where local women may have to walk for many hours to reach health clinics and obtain reproductive health services, the mobile health clinic in Lao was able to easily reach many pregnant women and provide quality health services. It would be amazing if this project could find a way to combine the use of mobile phones with something like the mobile health clinic project.
 
I would also like to highlight the project in Lao worked in a holistic way, providing training for schoolteachers to teach students about sexual and reproductive health, population issues, life skills and drug abuse prevention, working working with the ministry of health as well as at the local level on supplies and logistics support to make family planning available in 700 health centres throughout the country.

I look forward to seeing how this project develops and what innovative approaches will be used to improve material health in the countries you will work in. Great work!
Vandana
December 05, 2011, 09:24PM
http://nextdrop.org - NextDrop provides households with accurate and timely information about local piped water delivery, over cell phones already widely in use in India;

As a part of an ongoing project i had an opportunity to talk to Thejovardhana Kote, one of guys behind the novel use of mobile voice and SMS technology who said that if any social project doesn't have business sense it is fails strongly at the start; think about the business proposition. If you can identify who will benefit and who will pay then you have solved the problem.
July 15, 2011, 06:46PM
i think this is really amazing since every one has a mobile phone. there should be a mobile application wherein growth and development of the baby intrauterine and even extrauterinely once the baby is already born is explained in simple terms that can be translated in other language. and in every month or week which serves as classification there should be some reminders on what to do especially what to eat and what to avoid. and here in the Philippines we have something called uzzap which is a form of mobile chat. i haven't personally tried it yet but i think something like that should be made so that gestating women get the chance to meet others who are on the same page as they are which somewhat acts like a support group especially those who suffers from domestic violence. and at the same time, medical professionals should also be made available so that it would be easy and convenient for women to ask questions for them to make the right decisions.
April 21, 2011, 10:43AM
Congratulations! You've put so many great ideas into this competition - it's been really great working (or should we say collaborating?!?!?!) with you. I'm a big fan of this idea. As you know, a version of this was tried in Malawi during their election campaign but with limited success. I think the learning from that and the expertise of this group means this could well become a viable project.
April 20, 2011, 07:02PM
I am new so please forgive me if this was already discussed. This is my first time seeing openideo from a link on the Harvard Business Review. It is so refreshing to see bright-minded people with big hearts coming together to solve problems for people they don't know and might never meet.

As for the mobile nature of this project, I am very glad to see Nokia involved, since it is my understanding that their low-end phones are prevalent in developing countries. It is important to note that many low-end phones are not capable of text messaging. Therefore, it is important to ensure the people served by this initiative have the proper equipment to receive text messages and view small graphics on their mobile devices.

Since I'm assuming we are dealing with feature phones (not smartphones), my recommendation is that the project proceeds with a webapp, or mobile-friendly website, rather than a native app. It is also important to keep the file size of the site tiny to avoid incurring large data charges to the recipients. Most feature phones are capable of viewing internet pages via the older WAP technology, but it is incumbent upon the developer to make sure the site will work with that phone.

If text messaging is available, that might be a cost effective option. I don't know if these phones have cameras in them or if they can be configured to scan QR codes, but that would be another option that could be helpful for public awareness campaigns. The QR codes could be configured with helpful information, or pictures or graphics if we are, as I suspect, dealing with an illiterate population. Then there's that pesky bandwidth/data charge issue if the text message or QR code would link to any sort of training video.

I look forward to learning more and offering my support, including promotion of the project on my multi-national mobile blog. Please let me know if I can be of assistance.

All the Best,
Holly Kolman
Editor and Publisher,
www.mobiEnthusiast.mobi
LinkedIn: http://linkedin.com/in/HollyKolman
April 17, 2011, 06:50PM
Dear All This is to share with you While I was very much involved in working for promoting services for Smiling Sun clinics. There are lot of activity i have done in Bangladesh country wide. you can see my works and different campaigns activity under maternal health promotion in Bangladesh, I was Brand and service promotion specialist. This is to share with you with you about my experince with maternal health service in Bangladesh where lot of challanges are already in build socially and economically. please click the link for details
http://www.smilingsunhealth.com/SSFPEvents/ANCCampaign.aspx
April 13, 2011, 07:20PM
I ma late to get in to the discussion and put my inspiratin and concept in thsi challange. but I have a very interesting experince on this particular issue. I worked for Smiling Sun Franchise Program it is a largest Public health support program after the goverment of Bangladesh Inititives.

We work through the community volunteer that we call CSP community service provider. These CSPs are from teh rural and low income family member and all of them are female. they work as vlunteer and we support them to edvelop their capacity. there are 6000 CSP around country and remote places of Bangladesh. All of them mostly have ceel phone and and based with our 320 clinics where we have train paramedicas and doctors for maternal and child helth service. serving ANC and PNC is teh major chjallange for us and safe delevery has to be ensure to save life so we use these group of women as an enterprenuer to provide information to tthe pregnent women and new mother about teh serviec that they should aval. we design promotiona campaing and use teh mobile phone technology nd reach rmote ANC and PNC customers. we had a trmendaous result that none of of teh pregnent women were died and and they had a safe new born babyand PNC services. A coutry like Bangladesh it is very challanging and we made it. I ave all teh dadat to share with if any one interested.
April 08, 2011, 07:09PM
Hi i don't know how it works. I'm avid internet user been in IT industry for four years been an entrepreneur before that. I even developed health care application :) and very good in handling gadgets let it be android ,symbian,blackberry,iphone . Now i am working in an NGO not so far from Hyderabad , its called KAMAREDDI with a population of 1.5 lakh (roughly) with almost 8 or 9 private mobile service providers (no 3G) .
Why i am telling all this story ... okay, i am telling all this story just to convey how good i am with mobiles and technology ( my self an Electronics and communications engineering graduate from a reputed engineering college) and how difficult its for me to access internet in this not so tiny city ( remember 1.5 lakh population and 8-9 service providers ) with all my nerdy skills . If you are expecting any solution that has to do with internet , just forget. That is impossible for a place like this .. i can say 90% of india .

now lets consider few problems before considering mothers
1.How many mothers in india can read? is there alternative ?
2.Lets consider how many own mobiles ?? ( on contrary, india posses more mobiles than toilets !!!)
3.Even if mobiles are there and women can read , how many can configure internet access ? if can configure how many can afford that bill ?..

okay keep thinking about the solutions to these problems .. i come up with my own solutions and a consolidated answer tomorrow morning .( its already 1 AM here )
April 06, 2011, 03:33PM
I know Im joining late in the game on this challenge, but those active in the evaluation process should look at vocalpress.org (and check out this video: http://www.youtube.com/watch?v=G02IcnkRzjc). This is a product in development right now that could dramatically change the ability to get information to rural parts of the world using mobile technology.
April 03, 2011, 07:07PM
Las year I met Hilmi Quraishi an Ashoka Fellow in India, Under ZMQ’s he provides health services to pregnant women in rural areas. Once a women registers via SMS she will receive weekly tips on what to eat, what vaccines to get, and when to get check-ups. Since men usually carry the phone, the company is tying up with network providers such as Reliance Communications Ltd to reward the user with one free phone call each time an expectant mother logs in. He has built-up the viable business model and network of CSO's to make this work. You should definitvely check out his work. http://www.zmqsoft.com
April 03, 2011, 12:51AM
Some of the comments below suggested that the use of the mobile technologies, might not be widespread in the countries mentioned in the challenge.
I would like therefore to suggest the use of an old "mobile "technology:
Post desired health information on buses- this way a wide audience could be reached .
April 01, 2011, 09:09PM
Brilliant idea! Status of Africa – lend your Facebook status to an African mother or midwife for Mother's Day - check the webpage- http://bbh-labs.com/status-of-africa-lend-your-facebook-status-on-mothers-day
March 28, 2011, 02:09AM
This statistic hit me "Just 1 more midwife could save the lives of 219 women. 700,000 more Midwives are needed to achieve the Millennium Development Goal to reduce maternal deaths by 75% by 2015." Lots is being done to connect social entrepreneurship and the MDG goals. I wasn't aware of this statistic or this particular connection.
March 24, 2011, 09:17AM
I was a part of developing a mobile application which was for social networking in Indian rural areas in form of sms. While piloting the project the biggest challenge for us was to educate people that phones are not only used for calling but also could be used for messaging. Another barrier was literacy. If a person cannot read/write English, then it becomes essential that the available phone has an option to type messages in his/her mother tongue.
In India most phones have Hindi as the second option on the phone keypads while in middle east the second option is Urdu.
Getting these mothers to use the phones effectively can be the biggest challenge.
March 21, 2011, 02:42PM
I am currently working on a consulting project in Uganda for a social enterprise empowering rural women to sell solar lanterns. They are working hard to implement a mobile payment system but I learned today that the biggest barrier is that women in rural areas only use their phones as phones. It has been difficult for them to break away from the idea that a phone is used solely for call-making purposes. Also, due to illiteracy, even mobile aps and programs can prove challenging.

I think mobile is a great way to disseminate information but this definitely needs to be taken into account as a "heads up". I was actually quite surprised to learn that the women had trouble adapting to such technology.
March 18, 2011, 02:31AM
Check out 'The Spoken Web' concept piloted by IBM : perfect for low literacy http://www.transmediant.com/2011/03/spoken-web.html
March 13, 2011, 04:51AM
I'm thinking about the audience and environment for this challenge--can these people read and write? Is there ready access to electricity for phone charging? There are "Nurse Lines" here in Minnesota. Call and ask a nurse, no cost. I'm also thinking Skype--talk instead of texting. Midwife support network would work--this problem needs local solutions in order to communicate in the local language and dialects. How close are medical facilities to the community? Could a public kiosk for medical advice work here? Kiosk must "speak" directions to the user and "Skype" a medical professional/midwife who can talk back to help people.
March 08, 2011, 07:54AM
I think a very important thing we have to remember is that as much as mobile apps are very helpful and a way of life for many in the US, they are not necessarily so ubiquitous in developing countries. I think the best way to use technology is to create a user-interaction that is tailored to the way doctors, midwives and mothers receive their information. For example, if the information is disseminated in more of a "Kindle" look it could be much more accessible to doctors who are used to reading paper. Just something to consider because creating all this technology is great and all, but if it isn't used it isn't effective.
March 02, 2011, 02:45PM
What about using IM, its more cost effective. I know of software that was developed in Cape Town, SA. It (JammiX) is currently used by RLabs (http://www.rlabs.org/) offering Advice and support around around various social ills in South Africa ranging from substance abuse, stress, depression, suicide, rape to just mention a few. They already supporting over 250k ppk using this software.
I know that the WHO will also be using the software soon. Check them out.
February 25, 2011, 10:32AM
@Amos - twitter based medical care sounds like a great idea! Consider posting it in our Concepting section: http://openideo.com/open/maternal-health/concepting/
February 25, 2011, 09:41AM
during the tsunami response in Indonesia, i worked with an organisation that had a team who had a simple project that allowed midwives to text in questions to system that provided answers. it was a fascinating project but it had lots of problems in implementation. now, i would look at a twitter based system that allowed people to tweet in to a dedicated service of sorts
February 24, 2011, 02:28AM
Train women in midwife techniques, teach the benefits of breastfeeding, and use mobile apps to do so. Perhaps we could even build a sonograph app for the iphone. Just hook up an extension and perform sonographs.
February 20, 2011, 10:26PM
Here's a report by UN Foundation specifically on mhealth (in partnership with Vodafone): http://www.unfoundation.org/global-issues/technology/mhealth-report.html there's some cool stats and examples that would be relevant for this challenge. Hope this might be useful too!
February 17, 2011, 07:51AM
Through the Ethos bottled water, Starbucks has been very successful in helping children get access to clean water while also raising awareness of the issue. I imagine that cell phone providers could adopt a similar model that not only finances itself (at least partially), but ties the brand to a meaningful social cause. Another example of a company that has successfully integrated a social cause into the business model is Tom's shoes; for every pair of shoes purchased, the company donates a pair of shoes to a child in need.
February 09, 2011, 04:11PM
In school sex-ed wasn't what it's cracked up to be. Once teachers came around to tell us where babies come from some pupils were already 'practicing'. In other words, way too late.

Since mobile phones can do everything but boil an egg nowadays I think you could pass out phones with simplified apps containing instruction videos or speeches (like f.i. a TedTalk) in the target group's mother tongue.

Butterfly Works has some projects with a similar focus. F.I. http://www.butterflyworks.org/content/4007/learning_about_living
February 04, 2011, 06:10PM
Using the phone for calling vs text or email appears norm. See: http://on.wsj.com/eXBVHa Voice activated systems w prompts would seem appropriate for most ideas? Don't know phone capabilities - assume 4G iPhone they are not?
January 31, 2011, 05:44PM
Inspiration(?); Mobile phone banking is exploding in South Africa; this could be an example of how an unlikely solution takes hold in a specific environment -- the mobile phone use is extremely high despite the high level of poverty (a mobile phone is a must). This technology provides a usefull service and business opportunities. e.g. http://news.bbc.co.uk/2/hi/8194241.stm
January 26, 2011, 05:59PM
Thanks Trevor. Your organization's work is invaluable. Perhaps you could post your comment as an inspiration on the "Inspiration Section" ( http://openideo.com/open/maternal-health/inspiration/ ), to ensure everyone knows about it?
January 26, 2011, 04:28PM
The Center for Health Market Innovations (CHMI) - www.HealthMarketInnovations.org - is a great place to find inspiration for this challenge! It catalogues innovations that improve the health market in developing countries around the world. See here for a list of programs that use mobile technology to improve maternal health: http://is.gd/q7Ito0
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