About six months ago, right after the presidential election, we received a call asking if our SPINN Patient Engagement & Community Care Collaboration Platform could be configured to help solve the extremely high rates of maternal and newborn morality in Nigeria. Now, after six months of research and interviews with experts and people in Nigeria, we have developed a framework to improve maternal and newborn health through technology-enabled entrepreneurship. Below is a short summary of that work. Or, if you prefer, please watch our video discussing this important work.
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Background: In Nigeria, pregnant women are 80 times and newborns are 9 times more likely to die than in the US. At the core, so many people die because of limited access to and utilization of antenatal care before delivery and skilled health services at birth or in crisis. The rapid expansion of mobile telecommunication coverage has led to increased use of mobile health apps and strategies to improve access to information and coordinate care, but technology alone cannot solve the problem. To reduce the disparity between high-income countries and low and middle-income countries (LMIC) like Nigeria, we must stop treating the poor as victims and instead start seeing them as resilient and creative entrepreneurs as well as value-demanding consumers. There are examples of proven business and service delivery models for consumer goods and other services developed in other communities where the average income is less than $3,000 per year, referred to as the “Bottom of the Pyramid” (BOP). These models have not previously been applied to pregnancy or newborn care in Nigeria or LMIC.
Objective: Our primary objective is to determine the feasibility of adapting these proven service and delivery models to fit the healthcare needs of pregnant women and newborns in rural Nigeria. Our secondary objectives are to determine (1) the acceptability of this new service delivery model among pregnant women and community health workers, and (2) the usability of online and off-line mobile technologies by women and health workers to support this new service delivery model.
Methods: We will use a three-tiered service delivery program with community health entrepreneurs at the local level, skilled midwives and nurses at the regional level, and access to specialists via telehealth at the state and national level. Supporting this, we will leverage an existing online and mobile technology platform. We will recruit 300 pregnant women who will participate for 12 months, through pregnancy, delivery and the first 30 days of newborn care. We will recruit community health entrepreneurs in each community and will recruit midwives and specialists through affiliations with a major university in Nigeria. We will use Glasgow’s Reach, Effectiveness, Adoption, Implementation, and Maintenance framework as a guide to assess the implementation, acceptability and usability of the program.
Results: We have entered into agreements with two states, Kebbi State and Cross River State, in Nigeria. Working with state ministries of health, we will select local communities and recruit 150 pregnant women in each state to participate in the program. Women will be enrolled in the program for twelve months as they go through pregnancy, delivery and the first 30 days of life.
Phase 1 June to September, 2017: We will conduct field work in Kebbi State and Cross River State selecting one local government area in each state to participate in the study. The result of this field work will be a business and functional requirements analysis that serves as a work plan for both states.
Phase 2 October to March, 2018: We will configure the applications, hire and train local staff and recruit local health leaders.
Phase 3 January, 2018 to March, 2019: We will recruit 300 pregnant women and enroll them in the program. Each participant will remain in the program for 12 months including pregnancy, delivery and the first month of newborn life.
Phase 4 April to June, 2019: We will analyze and report the results of the program.
Conclusions: Findings from this study could offer insights into a new approach to delivering antenatal and newborn care to the BOP that could result in a decrease in loss of life and improvements in health outcomes associated with pregnancy, deliver and newborn care. This same model, if successful, could be extended to other nations and other health conditions.
Funding: We are presently raising $50,000 to conduct field research in Nigeria and prepare an implementation plan. Please contact Doug Dormer if you would like to learn more.