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How might we improve maternal health with mobile technologies for low-income countries? Read the challenge brief

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Flipbook, Midwife, Nokia, SMS

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Mother Mati’s Phone and Flipbook

SUBTITLE: Call Mother Mati for A Trusted Voice. Follow her picture book for a healthy Mother and Baby. SUMMARY: Linking picture flipbook, an automated phone messaging service and an automated SMS service to assist mothers and midwives to take simple steps to prevent major causes of maternal mortality.
WE HAVE MADE SIGNIFICANT UPDATES!!!


Please watch out above video!!!


Don't forget to applaud and comment if you like.


Yay! Yay! Yay!


Video also here:
http://vimeo.com/21727772



Thanks to all in the OpenIDEO community for your suggestions. As you can see, we've incorporated many of them in the above presentation (and their pretty smiling faces). If you have more please let us know.


Presentation also here:
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B_pufhYn0jaXODQ5ZGIwOWItMWI1ZS00Mzc1LTk1NDMtYmFjZjBlZTdiOTc4&hl=en



The below is the original text to our entry. This has been updated in the video and presentation.


PROBLEM
The major causes of maternal mortality including severe bleeding, infections and eclampsia. The solution should involve simple preventions for these major causes.


INSPIRATION
The primary inspiration for this is the success of Oral Rehydration Therapy (ORT): a simple sugar and salt solution given to infants to treat dehydration related to diarrhoea. This simple solutions has saved millions of infant lives.


The diffusion of this innovation owes much to the ability to communicate is in simple, pictorial and culturally specific terms. This included using respected mother figures and simple posters and like the one at the following link:


http://www.who.int/making_pregnancy_safer/documents/924159084x/en/index.html



CONSTRAINTS
The technological constraints are considered below. In short it was decided to stay within the existing limits of the world most popular phone, especially in the third world: The Nokia 1100. High cost and technology solutions are perceived to be a significant barrier to participation.


IDEA
The idea is to connect three media in a low cost way to influence / teach simple behaviours. All three media would be connected by a culturally appropriate voice. In the image example we have place Mother Mita, representing a possible mother figure for Bangladesh - IMAGE 1


1. Flipchart: Have a simple pictorial flipchart with tips for mother and midwives before, during and after birth. Mother Mati's image would be on the flipcharts.


2. Phone: Have a freecall number on the bottom of each flipchart that would go to a pre-recorded message explaining the action to take. Mother Mati would introduce herself and give the tip.


3. SMS Service: Allow the mothers to sign up to a free Mother Mati SMS service. This service would be a text prompt for the mothers to look at specific flipchart cards.


The mothers may in turn they may call Mother Mati for more information. Thus completing the cycle and continually drawing mothers to the book and Mother Mati's voice.


All of the above is in IMAGE 2


EXAMPLES OF FLIPCART TIPS


Three examples of flipchart tips have been included in the images.


1. Before Action: Pre-disinfect towels/blankets etc that the mother's exposed skin will come in contact with during child birth to prevent infection – IMAGE 3.


2. During Action: Midwife to watch hands - IMAGE 4


3. After Action: Swaddle/hold baby after childbirth to promote uterine contraction - IMAGE - 5


EXTRA ADDITIONS: SPEAKER ATTACHMENT
The Nokia 1010 allows a speakers to be attached. Therefore, provide the local midwife with a speaker that can be attached to the mothers phone. The mother brings their phone in and attach it to the speaker. This can, then, be used to bring the voice of Mother Mati into the room and give the midwife creditability. Nokia could, prehaps, provide this speaker and Oxfam the flipbook - IMAGE 6


ACKNOWLEDGEMENT:
My collaborator and all around great and talented guy on this concept was Thomas Nelson. You can see his blog here:
http://www.irvinenelson.com/blog/

What is the minimum level of mobile technology needed for this concept?

We decided that the innovation must have be able to diffuse widely.

Access to higher level and cost technologies are likely limited in the areas of most need.

Decided the solution must be low cost with access to currently existing technologies maximised. This is because though more technologically advanced solutions with higher cost may work better in individual cases they will, ultimately reach less people. Therefore we decided to stay within existing mobile technology.

The Nokia 1100 mobile phone was found to be the most widely used phone in the third world. The key features are the ability to make calls, SMS, program 50 number and attach the phone to a speaker.

Our only 'new' technology to be provided with the innovation is a speakerphone to Decided to assist informal midwives, rather than try to improve access to more formally trained health care professional.

How could this work in a low-literacy context?

One of the primary barriers considered was low or no literacy for mothers. Therefore, all instructions are given pictorially.

Additionally, the first link in the cycle is to call Mother Mati on a pre-recorded message, getting around literacy issues.

Finally, any SMS messages would be very simple and use the aid of the flipbook.


Low literacy levels are only required and the project could still succeed with no literacy.

Which partners could help realise and deliver this solution?

  1. Oxfam
  2. Nokia
  3. Mobile operators
  4. NGOs
  5. Government

Virtual Team

The initial development of this concept is equally shared between myself and Tom Nelson: http://openideo.com/profiles/745745699/

1

Does this concept have the potential to save lives related to maternal health in the poorest and most marginalized communities?

A great deal of potential
Some potential
Not a lot of potential
2

How realizable do you think this concept can be? Think about the real issues faced by low-income communities, such as literacy challenges, affordability of devices and tools, usage costs.

It's very realizable
There are some hurdles to realization
This concept is not realistic
3

How much does this concept leverage resources and partners in existing low-income communities? Thus enhancing positive aspects of the way things work in the community as opposed to taking away what is a valued way of working and living in the community.

This concept works harmoniously with existing resources and partners
This concept does not work against existing resources and partners
This concept conflicts with existing resources and partners
4

Can this concept become self-sustaining and even provide some livelihood value add to the community?

This concept could become a self-sustaining business for locals
This concept still needs some work before it is self-sustaining
This concept is not self-sustaining at all
5

Will this concept work in low-tech & low-connectivity environments?

This concept is very well suited to low-tech and low-connectivity environments
This concept needs to be evaluated for technology feasibility
This concept may be too high-tech for low-income communities
1

Does this concept have the potential to save lives related to maternal health in the poorest and most marginalized communities?

2

How realizable do you think this concept can be? Think about the real issues faced by low-income communities, such as literacy challenges, affordability of devices and tools, usage costs.

3

How much does this concept leverage resources and partners in existing low-income communities? Thus enhancing positive aspects of the way things work in the community as opposed to taking away what is a valued way of working and living in the community.

4

Can this concept become self-sustaining and even provide some livelihood value add to the community?

5

Will this concept work in low-tech & low-connectivity environments?

6

Tell us any additional comments you have about this concept.

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Comments

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Adele Peters

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April 11, 2011, 01:26AM
It might be interesting to work with local artists to produce images for each book that are specific to each region, or alternately, to work with nationally recognized characters (maybe cartoon characters, or perhaps actors in photographs rather than drawings).
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 21, 2011, 07:35AM
Great ideas. Tailoring the message to the culture is important. Perhaps we can get a mother from a tv soap opera on board in some cases where access to technology is better? I remember being in remote Vietnam and Indonesia and some places still having access to tv.
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Samuel Hamner

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April 16, 2011, 10:03PM
It seems like a lot of the ideas here are leveraging the burgeoning SMS networks in developing countries. However, there are lots of people in rural areas who might not be able to read information passed along via SMS. I really like this solution because it also has a component (i.e., the flip book) that uses minimal text/words that will really make it more accessible. Additionally, it may have a better chance of reaching more people because, while SMS is still growing, not everyone still has access.
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 21, 2011, 07:33AM
Hi Samuel. Thanks for the feedback. It's not necessarily just SMS - we've ensured the concept 'could' work if you have low literacy. (essentially see a number and dial). We tried to make this point in the video... hope we succeeded.

 Also, about the access to SMS - you might be right but the breif was about using mobile technologies (basically mobile phones) to improve maternal health. I'd suggest that if you can't access SMS then your almost outside the reaches of this project.

A vaild point though: the most in need are the hardest to get to.

Thanks again.
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Bernise Ang

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April 17, 2011, 12:14AM
What a compelling idea. Props to you both.

Couple of thoughts come to mind:

Woman-to-woman connection: This builds off Veronika's point about new/not-so-new mothers presenting themselves as women who've been through the childbirth and new motherhood experience. This is extremely powerful. In the spirit of leveraging existing networks which you guys have emphasised (fantastic), what if those religious organisations and community networks could be used to build buddy/support groups of mums/mums-to-be? Some countries may already have HCW networks (like Bangladesh, through the nonprofit BRAC, for example), based on their province/district/village etc, and a source of support that is near your home is something many mums-to-be may find handy.

Adoption by mums-to-be: The system currently looks like it would work great once mums-to-be have picked up the book/phone service. Question is, how do you get them to want to pick this up in the first place? Perhaps the previous point about community networks could help - where trusted relationships confer significance to the having of knowledge around maternal health?

Form of media: This thought was triggered by Robyn's point about many families not coming into contact with books as a form of media in the first place. Well, perhaps context-specific elements of a local culture may help -- from what I understand (Bangladeshi's please correct me as needed!), education is hugely respected in Bangladesh culture. What if the connection between education and books (as a medium) could be better made? Might this trigger aspirational motivation to get the books? And if there was an educational element (either in the same book, or in a follow-on book to incentivise mums passing the original book on to mums-to-be), might that drive behaviour to have the books so their kids could access it in future?

Just throwing ideas out there - I am clearly no expert!
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 06:10PM
Hey, nobody is an expert here, and I think all of this is a great addition. The 'how do you get them to pick it up in the first place' is a great. We have give this some thought: essentially making the design of the thing approachable, free and accessible. But, as the metaphor goes when I worked in a sales job, that only leads the horse to water.

I think the conversion between getting this book to them and getting it to work is very important.

Perhaps more of a field trail question.

But I will admit, something that the idea tries to live on is that it could work without having specialist staff distribute the flipbooks. Other interventions have been able to do this effectively... so we stand a good chance of success, but it is no way a lock.

Thanks again.

Tristan
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Meena Kadri

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March 18, 2011, 07:00AM
Loving the depth of thinking + visualisations here. Go Tristan!
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Prabhas Pokharel's reply to Adele Peters's comment

Prabhas Pokharel

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April 17, 2011, 12:33AM
Regarding distribution channels: the midwife / community health worker infrastructure may be a better way to distribute this flipbook rather than using channels like soft drinks and mobile sim sellers. This would work well for 2 reasons: 1. it would get it to mothers exactly and 2. it comes from a trusted source so that mothers know to trust this information. There is a lot of information about childbirth, hearsay and others that exists in many communities, and new information cannot fight against these: trusted information can. This also might help you to focus the flipbook on childbirth and post-birth information rather than pregnancy information, as you could easily get a "too much information" flipbook, which wouldn't really work I think.
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Prabhas Pokharel's reply to Adele Peters's comment

Prabhas Pokharel

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April 17, 2011, 12:34AM
(sorry, posted in the wrong place, reposting... no delete function :(
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Meena Kadri's reply to Adele Peters's comment

Meena Kadri

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April 17, 2011, 12:43AM
Hey no worries Prabhas... you made me look really good as though it was something to do with what I'd said ;^) Great point about the trusted networks. That's something I really came to appreciate when researching in Mumbai slums.
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Meena Kadri's reply to Adele Peters's comment

Meena Kadri

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April 18, 2011, 11:39PM
ooops – I meant go Tristan *and* Tom in my original comment!
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 06:01PM
All nice points which I essentially agree with. We were not necessarily saying 'use soft drink transporters'. But what we are saying is 'use existing networks/infrastructure' that is our mantra with this idea.

In short, if a network already exists then let's use it. If it's trusted then all the better. Health networks are easily the best of this... however, I will make the point that the areas most in need probably don't have a great health network. So relying on it could be fraught.

So the advantage with using SIM sellers and soft drink distributers would not be the 'trust' but rather the 'reach'.

Even with a lower hit ratio the larger networks can reach more people. With our intervention we have hoped to make it worth without health networks.

But points taken. I think these are questions for a pilot trial.
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Jessica Vechakul

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April 19, 2011, 04:09PM
Dear Tristan and Tom,

You've come up with some great ideas!

I have just a few comments that may help you develop your concept further:

- Distributing the Flipbook through existing commercial channels is a great way to use existing resources. It is unclear whether a company like Coca-Cola would really be willing to distribute these Flipbooks for free. Also, to reach more remote villages, it is often informal retailers transporting smaller quantities than large trucks full of crates. Perhaps you can think of ways to engage this informal sector?

- The fees for calling from a mobile phone are quite high in many developing countries. People often prefer to SMS or send "missed calls" to page others to call them back because they cannot pay for the talk time themselves. Couldn't the Flipbook audio be loaded onto a SIM card? That way, the mothers don't have to pay for talk time to be able to hear Mother Mati.

- Also, every child birthing experience is slightly different. It can be dangerous to have an automated voice message leading the midwife's every action. Often, the correct action depends on the situation (eg. the position of the baby, how dilated the mother is, etc.). It could be alarming for the mother if the midwife did something contradictory to what Mother Mati is saying during the delivery. Perhaps the Flipbook could be a set of general guidelines listened to before the delivery, and the midwife could be allowed to make decisions as needed in the moment.

Good luck!
Jess
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 05:53PM
Thanks for the response! I am travelling for work at the moment, so this will be breif.

In response to your three points:

1. Good ideas. I do think that rather than trying to answer all holes before you start something like this is difficult. I strongly suspect that the holes to remote villages/communities will be much more individual. I don't think that I (or anyone) else can know how to fill those gaps before you start. More importantly, you don't really know where they are before you start. Kind of a learn on the job issue, but a very valid point. Thank you.

2. We have already covered this with our concept, I think. You can ask to receive a call at a specific time of day (signing up to the service). Initially this was to be through a single SMS or phonecall. I s'pose it could go even further to be if you miss that call then you get called back.

3. This an excellent point. I make no pretense that I am totally qualified to make a call about this. It is something that would need to go through health organisations. Again, excellent and important point. Not sure it's a failing in our concept.... more of a 'move with caution' note.

Thanks again.
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 05:53PM
Thanks for the response! I am travelling for work at the moment, so this will be breif.

In response to your three points:

1. Good ideas. I do think that rather than trying to answer all holes before you start something like this is difficult. I strongly suspect that the holes to remote villages/communities will be much more individual. I don't think that I (or anyone) else can know how to fill those gaps before you start. More importantly, you don't really know where they are before you start. Kind of a learn on the job issue, but a very valid point. Thank you.

2. We have already covered this with our concept, I think. You can ask to receive a call at a specific time of day (signing up to the service). Initially this was to be through a single SMS or phonecall. I s'pose it could go even further to be if you miss that call then you get called back.

3. This an excellent point. I make no pretense that I am totally qualified to make a call about this. It is something that would need to go through health organisations. Again, excellent and important point. Not sure it's a failing in our concept.... more of a 'move with caution' note.

Thanks again.
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 05:54PM
Thanks for the response! I am travelling for work at the moment, so this will be breif.

In response to your three points:

1. Good ideas. I do think that rather than trying to answer all holes before you start something like this is difficult. I strongly suspect that the holes to remote villages/communities will be much more individual. I don't think that I (or anyone) else can know how to fill those gaps before you start. More importantly, you don't really know where they are before you start. Kind of a learn on the job issue, but a very valid point. Thank you.

2. We have already covered this with our concept, I think. You can ask to receive a call at a specific time of day (signing up to the service). Initially this was to be through a single SMS or phonecall. I s'pose it could go even further to be if you miss that call then you get called back.

3. This an excellent point. I make no pretense that I am totally qualified to make a call about this. It is something that would need to go through health organisations. Again, excellent and important point. Not sure it's a failing in our concept.... more of a 'move with caution' note.

Thanks again.
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 05:54PM
Thanks for the response! I am travelling for work at the moment, so this will be breif.

In response to your three points:

1. Good ideas. I do think that rather than trying to answer all holes before you start something like this is difficult. I strongly suspect that the holes to remote villages/communities will be much more individual. I don't think that I (or anyone) else can know how to fill those gaps before you start. More importantly, you don't really know where they are before you start. Kind of a learn on the job issue, but a very valid point. Thank you.

2. We have already covered this with our concept, I think. You can ask to receive a call at a specific time of day (signing up to the service). Initially this was to be through a single SMS or phonecall. I s'pose it could go even further to be if you miss that call then you get called back.

3. This an excellent point. I make no pretense that I am totally qualified to make a call about this. It is something that would need to go through health organisations. Again, excellent and important point. Not sure it's a failing in our concept.... more of a 'move with caution' note.

Thanks again.
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Tristan Cooke's reply to Adele Peters's comment

Tristan Cooke

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April 19, 2011, 05:54PM
Thanks for the response! I am travelling for work at the moment, so this will be breif.

In response to your three points:

1. Good ideas. I do think that rather than trying to answer all holes before you start something like this is difficult. I strongly suspect that the holes to remote villages/communities will be much more individual. I don't think that I (or anyone) else can know how to fill those gaps before you start. More importantly, you don't really know where they are before you start. Kind of a learn on the job issue, but a very valid point. Thank you.

2. We have already covered this with our concept, I think. You can ask to receive a call at a specific time of day (signing up to the service). Initially this was to be through a single SMS or phonecall. I s'pose it could go even further to be if you miss that call then you get called back.

3. This an excellent point. I make no pretense that I am totally qualified to make a call about this. It is something that would need to go through health organisations. Again, excellent and important point. Not sure it's a failing in our concept.... more of a 'move with caution' note.

Thanks again.
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Prabhas Pokharel

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April 17, 2011, 12:35AM
Regarding distribution channels: the midwife / community health worker infrastructure may be a better way to distribute this flipbook rather than using channels like soft drinks and mobile sim sellers. This would work well for 2 reasons: 1. it would get it to mothers exactly and 2. it comes from a trusted source so that mothers know to trust this information. There is a lot of information about childbirth (hearsay, superstition, etc.) that exists in many communities, and simply *new* information cannot fight against these: it has to be trusted.

This also might help you to focus the flipbook on childbirth and post-birth information rather than pregnancy information, as a flipbook with "too much information" is very much a potential risk here.
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Hima Batavia

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April 10, 2011, 11:04PM
I really like the attention an consideration you have given to developing the personality of Mita. I can see this working really well in a type of pregnant women support circle (kind of like saving groups prevalent in many developing countries). CHWs would identify pregnant women in an area, and encourage the creation of a support group that might meet once a week or month (whatever is feasible). The group could be given a speaker, and listen to a lesson from Mita. The CHW could be in attendance for additional questions, and referencing the flip book as often as possible.

I think your focus going forward should be on context specific content creation, and the development of an encouraging, caring, nurturing and informative individual. This could be used in a variety of ways and programs. Good luck!
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Avi Solomon

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April 04, 2011, 11:31AM
Tristan,
Here's a version of the recordable storybook that Robyn was referring to:
http://www.hallmark.com/online/in-stores/recordable-storybooks/
One would have to figure out a way to lock the recordings though!
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Tristan Cooke

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April 04, 2011, 08:37AM
Darn it! Posted three times and I can't delete them! (Please do administrator... and this comment too)
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Tristan Cooke

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April 04, 2011, 08:19AM
A comment, via email from my brother in law who works for a government aid in Australia and has been to Afghanistan and about to go to Pakistan for a 3 year posting that I thought was relevant to share:

Hey Tristan - Just listening to your mother mita presentation with Thomas. From a development perspective I think it sounds pretty good. Health and maternal health is a big focus of our aid program, indeed for all international development agencies, so any innovations in this area are to be welcomed. I wish you luck - maternal health is one of the toughest areas to make a difference. We can get kids to school, improve literacy, get people on scholarships to universities, even make headway against corruption and improve governance, if somewhat incremental. But maternal health indicators go backwards. One major issue is of course cultural. It appears to me that you're tried to build in culturally appropriate advice within the concept. But it will still be tough, particularly in Islamic countries, where, not surprisingly, some of the worst indicators for maternal health occur.

One quick observation - we don't use 'first' and 'third' world terminology anymore. That's a legacy of the cold war, when the first world were countries aligned with the US, the second with the USSR and the third were non aligned. The terminology today is developed and less developed. Aid specialists and NGO's, the type of peeps who would be interested in your concept, won't take you seriously if you use that type of language. Similarly many countries take real offence being referred to as 'third world'. We have to use very careful diplomatic language in our briefings and talking points for Ministers when they go to less developed countries. A good example is India and China. Obviously they have large swathes of their populations living in poverty, where they'll struggle to meet millennium development goals on health and maternal health, despite recording huge numbers of economic growth rates as they open up there economies. But if you refer to them as third world, they'll put a fatwa on your arse and be hugely offended. Pakistan another great example. Terrible indicators in health, one of the worst in the south asian region for maternal health, but an extremely proud and nationalistic country. Improving maternal health in Pakistan even by a few percentage points is one of the major challenges for all development actors. Millions of dollars have been thrown at the problem. But refer to them as a third world country, they'll tell you to piss off and damage will be done to the good work and sweat and tears that have gone into building trust into the relationship.

I'll be interested to see how you go with this, for the obvious reason that its something relevant for the development world.
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Tristan Cooke

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April 04, 2011, 08:19AM
A comment, via email from my brother in law who works for a government aid in Australia and has been to Afghanistan and about to go to Pakistan for a 3 year posting that I thought was relevant to share:

Hey Tristan - Just listening to your mother mita presentation with Thomas. From a development perspective I think it sounds pretty good. Health and maternal health is a big focus of our aid program, indeed for all international development agencies, so any innovations in this area are to be welcomed. I wish you luck - maternal health is one of the toughest areas to make a difference. We can get kids to school, improve literacy, get people on scholarships to universities, even make headway against corruption and improve governance, if somewhat incremental. But maternal health indicators go backwards. One major issue is of course cultural. It appears to me that you're tried to build in culturally appropriate advice within the concept. But it will still be tough, particularly in Islamic countries, where, not surprisingly, some of the worst indicators for maternal health occur.

One quick observation - we don't use 'first' and 'third' world terminology anymore. That's a legacy of the cold war, when the first world were countries aligned with the US, the second with the USSR and the third were non aligned. The terminology today is developed and less developed. Aid specialists and NGO's, the type of peeps who would be interested in your concept, won't take you seriously if you use that type of language. Similarly many countries take real offence being referred to as 'third world'. We have to use very careful diplomatic language in our briefings and talking points for Ministers when they go to less developed countries. A good example is India and China. Obviously they have large swathes of their populations living in poverty, where they'll struggle to meet millennium development goals on health and maternal health, despite recording huge numbers of economic growth rates as they open up there economies. But if you refer to them as third world, they'll put a fatwa on your arse and be hugely offended. Pakistan another great example. Terrible indicators in health, one of the worst in the south asian region for maternal health, but an extremely proud and nationalistic country. Improving maternal health in Pakistan even by a few percentage points is one of the major challenges for all development actors. Millions of dollars have been thrown at the problem. But refer to them as a third world country, they'll tell you to piss off and damage will be done to the good work and sweat and tears that have gone into building trust into the relationship.

I'll be interested to see how you go with this, for the obvious reason that its something relevant for the development world.
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Tristan Cooke

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April 04, 2011, 08:18AM
A comment, via email from my brother in law who works for a government aid in Australia and has been to Afghanistan and about to go to Pakistan for a 3 year posting that I thought was relevant to share:

Hey Tristan - Just listening to your mother mita presentation with Thomas. From a development perspective I think it sounds pretty good. Health and maternal health is a big focus of our aid program, indeed for all international development agencies, so any innovations in this area are to be welcomed. I wish you luck - maternal health is one of the toughest areas to make a difference. We can get kids to school, improve literacy, get people on scholarships to universities, even make headway against corruption and improve governance, if somewhat incremental. But maternal health indicators go backwards. One major issue is of course cultural. It appears to me that you're tried to build in culturally appropriate advice within the concept. But it will still be tough, particularly in Islamic countries, where, not surprisingly, some of the worst indicators for maternal health occur.

One quick observation - we don't use 'first' and 'third' world terminology anymore. That's a legacy of the cold war, when the first world were countries aligned with the US, the second with the USSR and the third were non aligned. The terminology today is developed and less developed. Aid specialists and NGO's, the type of peeps who would be interested in your concept, won't take you seriously if you use that type of language. Similarly many countries take real offence being referred to as 'third world'. We have to use very careful diplomatic language in our briefings and talking points for Ministers when they go to less developed countries. A good example is India and China. Obviously they have large swathes of their populations living in poverty, where they'll struggle to meet millennium development goals on health and maternal health, despite recording huge numbers of economic growth rates as they open up there economies. But if you refer to them as third world, they'll put a fatwa on your arse and be hugely offended. Pakistan another great example. Terrible indicators in health, one of the worst in the south asian region for maternal health, but an extremely proud and nationalistic country. Improving maternal health in Pakistan even by a few percentage points is one of the major challenges for all development actors. Millions of dollars have been thrown at the problem. But refer to them as a third world country, they'll tell you to piss off and damage will be done to the good work and sweat and tears that have gone into building trust into the relationship.

I'll be interested to see how you go with this, for the obvious reason that its something relevant for the development world.
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Kartik

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April 03, 2011, 11:07PM
Excellent work! The Flip Book idea is quite intuitive. Consider having local actors to voice the character. For example, in India telly-soap actors have tremendous pull with audiences. Hearing their favorite characters suggesting steps might increase the trust and impact factors of the message.
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Maricarmen Sierra

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April 03, 2011, 07:38PM
Hi guys, congratulations on making it to the 20 finalists!
Living in Mexico, I have spent a lot of time in rural areas during different social work, and i wanted to point out some context facts about rural communities that may help you re-design or re-think part of your strategy:
- People in rural communities get a lot of written material from local health clinics, NGO´s, etc.. How will you incentivate women to use your booklet instead of any other? I feel you could take out all the basic info like how to wash hands and really show in depth knowledge on maternal health in very easy to understand drawings.
- One thing that happens in rural areas is that everybody has a cell phone but with no credit on it. If they ever make a call it´s because it represents an urgent matter. I don't think they will use their credit calling an "automated" message, which might be very bizarre for a rural lady that has never heard a machine telling her what to do. Have you thought about the cost that represents for them making that call?
Good luck in the competition!



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An Old Friend

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April 02, 2011, 01:17PM
Hey Guys, Nice work! I haven't had a chance to read all the comments-- but one think you could do is combine the phone and flipbook into a "talking book" using Mother Mita's voice so that women who have no literacy can get the information directly from the book. A talking book is one of those books that has pictures on every page and buttons that are associated with the picture (or something along these lines), so women just have to push the button to hear the content. This means you could also have only one version, perhaps-- that is pictorial, low literacy, and has some additional information for women who are literate. I would keep the language to a minimum, in either case, and make sure that there is only one concept per page to ensure greater understanding.

I would also focus on making the phone line a hotline-- I realize you have back-up operators, but I think in most country settings a hotline of some sort could be set-up and talking to a real person is always nicer than a recorded message. But, I agree, that in cases where a hotline isn't cost-effective or for some other reason, a recorded message is better than nothing!

A companion manual that goes with the midwife and includes more technical information (such as information on misoprostol) could also be helpful. Additionally, when you adapt your materials in country, you will need to pilot test it in community groups and use their illustrators, etc... to get the right types of pictorial representation. The community groups can also be utilized to distribute the flipbooks.

The last thing that I'll add, just to think about, is that most families don't have a book in their home-- any type of book (except maybe the phone book in some limited cases in urban areas). People haven't been exposed to this form of media in the same way that we have. Although this will make it unique, it may also be that a different mode of delivery for a particular community would be more appropriate. Or, it may work better as a job aid for midwives, with a companion community mobilization component that utilizes street drama or radio in combination with the community-level talking book to get the message out.
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Meena Kadri

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March 31, 2011, 04:03AM
OMG! We're loving the lengths you guys have gone to for refinement!
Outstanding ideating! Global applause from the OpenIDEO Team.
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Vincent Cheng

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March 31, 2011, 03:49AM
Absolutely Tristan. BTW, awesome video guys. You've really done a great job of fleshing out and explaining your concept in depth. Worth the watch!
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Tristan Cooke

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March 31, 2011, 02:09AM
Thanks Vincent.

I like the idea of over the air downloads... but not sure you can do this on the Nokia 1100 - the phone who's capacity we are targeting.

http://en.wikipedia.org/wiki/Nokia_1100

However, there is huge capacity to update this idea.

This idea would work really well with smartphones but don't want to put the cart before the horse. Our whole idea is based around 'what is the existing infrastructure'.

Certainly, one way we are getting around this people registering to 'recieve' calls from Mother Mati. Certainly, not good for repeat viewings... but likely to be easier to make free.

All that said, we could more clearly articulate a plan to grow the idea with improved resources/ infastructure.
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Vincent Cheng

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March 30, 2011, 01:59PM
Hi Tristan, just letting you know that Siri & I posted some further thoughts about alternative delivery/storage mechanisms on Siri's related concept. Am copying it here for your reference.

Siri: "Vincent, your suggestion on how to cut call costs got me thinking of other possible ways. Perhaps it would be less costly if the audio was sent as a voice message, and the messages were either offered as a subscription or "ordered" by sending a text with the numbers for the pages you were interested in hearing about? Thoughts on this?"

Vincent: "Interesting voice message idea Siri. This would work if the charge for listening to voicemail is less than for regular calls. Also, in cases where phones can store & play audio (beyond tones), there may be opportunities for over-the-air downloads (like how you can download a ringtone once and it can then be played as many times as needed). Anyways, which of these ideas makes sense will depend on the common phone charges and capabilities for each region. Your original call approach is the simplest to implement and I wouldn't be surprised if it makes the most sense in the most places right now. Just throwing out other possibilities that may make sense in the future or currently in specific areas."
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Vincent Cheng

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March 30, 2011, 01:59PM
Hi Tristan, just letting you know that Siri & I posted some further thoughts about alternative delivery/storage mechanisms on Siri's related concept. Am copying it here for your reference.

Siri: "Vincent, your suggestion on how to cut call costs got me thinking of other possible ways. Perhaps it would be less costly if the audio was sent as a voice message, and the messages were either offered as a subscription or "ordered" by sending a text with the numbers for the pages you were interested in hearing about? Thoughts on this?"

Vincent: "Interesting voice message idea Siri. This would work if the charge for listening to voicemail is less than for regular calls. Also, in cases where phones can store & play audio (beyond tones), there may be opportunities for over-the-air downloads (like how you can download a ringtone once and it can then be played as many times as needed). Anyways, which of these ideas makes sense will depend on the common phone charges and capabilities for each region. Your original call approach is the simplest to implement and I wouldn't be surprised if it makes the most sense in the most places right now. Just throwing out other possibilities that may make sense in the future or currently in specific areas."
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Tristan Cooke

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March 30, 2011, 04:00AM
Hi All!

Wow. Nice comments (don't forget to applaud!)

Okay, responses:

Crystal: Having a different, and culturally appropriate, figure for each region was part of our initial idea. The journal idea is really interesting. It would require some thought, but I like the idea of an 'action' you take with the flipbook. The idea of giving the flipbook more cultural and personal relevance can only help.

Vincent: Totally. One thing I do like, if this concept actually works, is that is can grow and improve with the technology.

OpenIDEO: Thanks! Very happy to be selected. About to update this with a video that includes (and appropriately recognises) a number of additions inspired by a number of people. Really giving this 'use other peoples ideas' concept as much as we can.

Veronika: Again, great idea. In fact, it's already in the update we are working on. However, I think you are really looking at a way to leverage the interaction between mothers. Really good idea. Not sure if we need to 'trigger' that behaviour or it will happen naturally with the handover.

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crystal nelson

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March 30, 2011, 02:02AM
Yes I agree on many of the comments so far. The first thing that caught my eye was that your initial character is an Indian woman. As OpenIDEO pointed out, it would be great to have multiple characters/flip books that women from other cultures can relate to. I also love the comment about creating an income opportunity for community members to assemble these flip books. Have you thought about employing translators from villages to help with the voice overs so that there is also cultural specificity in the languages? That would be another employment opportunity for someone who is bilingual and eager to utilize their skills for such a great project. Additionally, what if you added a section to the flip book where mothers can add to a shared journal that would grow as each flip book is passed on? Such a method of accretion will not only further personalize the exchange but will also enable mothers to pass on valuable information, self-discovered solutions to problems they encountered, stories/songs that their children loved, and other experiential knowledge.

Great concept and cheers on being in the top 20!
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Vincent Cheng

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March 29, 2011, 08:39PM
Congrats Tristan & Siri on your strong related finalists concepts that combine the audio of mobiles & the visualization display capabilities of physical flip booklets. Just wanted to point to the future possibilities of using limited capacity, low-cost, copyable/sharable SD cards in cases where phones support this to store the audio (& maybe backup images), which could save on call costs.
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OpenIDEO

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March 29, 2011, 02:02PM
Hi Tristan,

Congratulations for being one of our top 20 finalists in the Maternal Health challenge!

We really like your idea of a simple communication tool to teach mothers about health issues and the idea of using a well-known character to be the champion for this cause.

As part of this Refine phase, we're urging you to dive deeper in the details of your concept and give some thought as to the content of these flip books. What sort of issues can we address in this format?

We also ask you to develop the character of 'Mother Mati' with regard to introducing her to different cultures across the globe. Should she be visually dressed different in different parts of the World? Could she be a character other than a person to cross cultural barriers?

We encourage you to work with Krassimira http://openideo.com/profiles/1496897674/ to incorporate her thoughts from: An Audio Guide through Maternity http://openideo.com/open/maternal-health/concepting/an-audio-guide-through-maternity/ So you can build a stronger concept together.

When you're ready to update your concept, please click the 'Update this' button on the right-hand-side of your concept and fill out our 2 new fields:
- Concept Builds - Here you can list additional builds on your concept
- Virtual Team - Here you can credit others in the community who have contributed to your concept.

Cheers!
OpenIDEO
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Veronika

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March 29, 2011, 09:14AM
There is one aspect, I´d like to stress which is an important side effect I think: When women pass on their flip books, they also present themselves as women who already went through the pregnancy and "education" provided by the service of your concept. Maybe the pregnant woman did not know the woman passing on the flip book before, so this act is establishing a contact/friendship to a person who can help out the pregnant woman - thanks to her experience - in the future. I think this moment should be supported by your concept, in the sense of "pass on what you´ve received yourself". Maybe women who acquire new pregnant women to the service, get a new flip book for the first months in the baby´s life. I think on a longterm perspective it would be reasonable to use the knowledge that was spread throughout the villages as a human support to your system.
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Tanja Rosenqvist

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March 28, 2011, 05:15PM
I'm thinking that these flipbooks will have to be produced. Why not give a few rural women some nice jobs by providing them with an old laptop, a printer, a laminator and something to create holes in the laminated pages with.
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Avi Solomon

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March 28, 2011, 02:03PM
Great concept Tristan! This made me think of Meena's grassroots comics inspiration - local collaboration on producing the images is always more effective:
http://openideo.com/open/how-might-we-increase-the-availability-of-affordable-learning-tools-educational-for-children-in-the-developing-world/inspiration/17th/

This paper has some guidelines based on fieldwork -"Text-Free User Interfaces for Illiterate and Semi-Literate Users":
http://research.microsoft.com/en-us/people/indranim/text-freeui.pdf
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Nidhi Prasad

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March 28, 2011, 07:21AM
Refining it is! :D
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Tristan Cooke

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March 28, 2011, 05:53AM
Thanks Nidhi!

We're re-doing the concept now and will include that idea. Pretty neat and easilly fits the concept. Expect a vimeo in a couple days!

(Sarah, same goes for you idea - thanks).
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Nidhi Prasad

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March 28, 2011, 04:54AM
Tristan: :) yes! Although a little more expensive, I think automated phone calls in the local language at specific intervals of time will be much more effective. To reduce costs maybe target a few mothers for the automated phone call at first and then ask these mothers to spread-the-word.
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Tristan Cooke

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March 27, 2011, 11:45PM
Sarah - Thanks. That was the idea. And about the hook flip charts: our idea was to make it cheap and 'flip' easily'. However, certainly that is an extra positive.

Nidhi - Thanks. Just checking: you're suggesting that our SMS prompt idea be an automated phonecall? Good idea. Probably a little more expensive but a good option to explore.
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Nidhi Prasad

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March 27, 2011, 05:12PM
I love your idea. Since the mothers might be illiterate or have low literacy rates, how about giving audio tips through phone calls on a specified time of the day everyday?
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Sarah Fathallah

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March 26, 2011, 05:43PM
I'm imagining how easily these flicharts could be passed around within the same village/community. Once a mother has delivered, she would naturally give it to her neighbor, sister or cousin when she is due as well.
This might sound minor, but I really like the fact that it has in your drawings a keychain shaped hook. I know in many villages where there are risks of floods (I experienced this in Laos), people tend to hang stuff on their walls in order to avoid it being deteriorated.
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Tristan Cooke

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March 25, 2011, 12:00AM
Thanks Dara, checked out your concept. Video gaomes right.

"Gamification" is being bashed a bit at the moment... but I do think that if this concepts could connect with kids then that would be useful. And even think that making a game out of it for the kids is the way to go. (gamification seems like a concept that would work better with kids).

Also, and lets be honest, many of the first time mothers will be little more than children. In Bangladesh there are 117 births per thousand women 15-19.

http://globalis.gvu.unu.edu/indicator.cfm?IndicatorID=127
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Dara Parker

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March 23, 2011, 03:14PM
Great idea - could perhaps combine it with my concept to target youth audience?

Given the fact that many youth are forced to take on adult roles in emerging economies (especially where HIV/AIDS has wiped out the working-age demographic), this concept could reach even more people if youth understand this is not just for adults.

Examples: include images of youth playing role of midwife (which they do already).
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Tristan Cooke

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March 22, 2011, 07:18AM
Hi! Krassimira Thanks for the feedback.

Great name by the way!

The idea is that each number on each flipcard would be unique and give an audio recording of the tip on that flipcard. The audio recording would be in the voice of Mother Mita.

For example, the handwashing flipcard would have the spoken out tip for how the midwife should wash their hands.

We could definitely add sections for emergency numbers if they are locally available. If you can make that link clearly it should be made. We could simply have 'press 1 to speak to a helper' in the call.

However, the base intention was to have something that you could build, at low cost, separate of the formal heath system - making sure that it could theoretically work for those most disadvantaged and then be ramped up for those slightly more fortunate.
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Krassimira Iordanova

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March 21, 2011, 09:03PM
I like your concept and I really like the plastic flipcard idea! Just for my understanding: 1) is there a regular contact between a mom-to-be and a midwife? 2) emergencies can be handled via the 5555 number?
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Thomas Nelson

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March 21, 2011, 06:16AM
The SMS messages would just be text, no pictures. Screen size wouldn't be an issue, and the messages could be delivered to any device from an iPhone 4 to the ubiquitous Nokia 1100. I'd also like to point out that a plastic flip book could be quite durable and have high pass-along readership.

Regardless of which concept is ultimately chosen in this challenge, it makes good business sense for mobile carriers to donate services or reduce prices for the project. Healthy mothers are better customers.
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Tristan Cooke

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March 21, 2011, 03:47AM
Agreed on the flipbook being image heavy.

It's a concept sketch and the words here were only to show the intended meaning. Ideally we'd have little to no words in a final product.

As with the funding... well that is the question of all of these projects isn't it. There isn't one that's free. In reality this would be Oxfam's job.

However, the designers role is to thing of programs that will have low cost and high impact. I think it's cost would be pretty low and certainly I'd hope a chance at having a great impact.

We designed it with that in mind.

I suspect you'd also be able to have local mobile suppliers sponsor the initiative out of goodwill and PR.

Thanks for the comment.
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Mokeira Masita-Mwangi

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March 18, 2011, 12:31PM
Hi. Seems very well thought out in terms of leveraging what people already use, trust and are comfortable with. Given the limited screen size it would probably be better to have the images in the flipbook without the text and use these together with the freecall to get the audio explanation. Any ideas on sustainability? Free yes because many cannot afford to pay for such services however what happens in the long term if funding runs out?
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Tristan Cooke

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March 18, 2011, 08:24AM
Thanks Meena, Really put some heads together and proud of the concept. Hope the group like it too.
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