Amakomaya (Mother’s Love)

The idea is to explore each house of a pregnant mother, identify high risk pregnant mothers, plot them in GIS map, educate and empower mother and family members with useful audio/Video content on pregnancy  and continuously record health data of mother and fetus by using GMS based fetal heart rate devices. This data will be continuously monitored by skilled health personnel, midwives and nurses trained on midwifery skills  24 hours/7 days a week to support the call center. If any urgency the support call center will immediately take action according to the data available.

Despite Nepal has made tremendous progress in reducing maternal mortality, there are still an estimated 1,200 women who die every year during pregnancy or while giving birth. This translates to an average of three women per day. The high maternal and newborn deaths are the major public health concern of Nepal that have been stagnant in the last decade or more. As of 2016 Nepal has 259 per 100,000 live births which is the second highest maternal death in the South Asia region after Afghanistan. This is because of the three delays relating to maternal death. These include delay in deciding to seek care on the part of the individual, the family, or both; delay in reaching an adequate health care facility; and delay in receiving adequate care at the health facility. Pregnant mothers and family members are not aware of pregnancy related complications and reporting their actual problems to the local service providers at health facilities due to lack of knowledge about the danger signs relating to pregnancy, childbirth and postnatal period and the absence of a reporting mechanism.

In rural Nepal settlements are scattered and pregnant mothers are difficult to identify geolocally. Health workers even cannot estimate which pregnant mother time duration for health facilities visit and what level of preparation will be necessary to serve her. Local government is not informed what means of transportation should be prepared to rescue risk-signed mothers and from which location. Sometimes situations can become worse if the mother has a critical health condition.

In order to address these gaps our solution is a simple android app that will simply record the details of mothers including GPS location of pregnant women and their place of residence in rural and remote areas of Nepal. The proposed application works in offline mode. Also, there is a portable hardware device to measure the fetal heart rate and send data automatically by using GSM technology. 

These data are directly available 24 hours 7 days a week to support call centers, in the respective municipality ward’s offices and health institutions. If there is any urgency relating to maternal health situations based on received available data via mobile application then service providers can take instant decision to address the situation of pregnant mothers.

The target population of our solution is primarily pregnant women living in rural and remote parts of Nepal, who are at greater high risk of pregnancy, childbirth and postnatal period related complications due to lack of access to accurate appropriate information about their physiological process of pregnancy and childbirth including their unborn babies health status and in getting into contact with health workers. Direct beneficiaries, pregnant women will be directly engaging with the help of Female Community Health Volunteers (FCHVs) or themselves in registering their pregnancy status in the mobile application from where they will access accurate information and consultation from professional midwives if they report any danger signs and local health facilities health workers. It will help them to minimise delay in deciding to seek care on the part of the individual, the family, or both; delay in reaching an adequate health care facility; and delay in receiving adequate care at the health facility.

For this year 2020-2022 we are planning to expand our services in more than 10 new municipalities and upgrade existing 3 municipalities of Nepal.

Lack of knowledge about maternal health danger signs to family and lack of availability of real time data such as geolocation, health history, situation of transportation in locality, and distance to the nearest health facilities are the challenges, creating three delays of maternal death in rural Nepal.

Our solution is to explore, identify and continuously monitor mothers using the Amakomaya App integrated with the portable GSM based ultrasound devices. This data will be continuously monitored by a team of midwives from 24/7 call centers.  Any abnormal condition information received will be coordinated to the local government for further management. 

Amakomaya app provides a unique platform to synchronize all the longitudinal data identified with the unique QR-Code ID assigned to pregnant mothers. Female community health workers with a low level of literacy simply can visit door-to-door of a pregnant mother and gather important health data of mother, fetus or newborn with less effort. Even in the absence of internet in the mother’s location the synchronization can happen later on while getting internet connection. All these data are centrally monitored by midwives and experts in a 24/7 support call centre and create possible action lines to be taken by mother, related health worker and local government.

The system collects GPS location of mothers with detailed address, health information of mother, fetus or newborn. During registration a unique QR-CODE ID is issued against each mother. All data are equally accessible by health workers from health facilities, local government and midwives stationed at central 24/7 call centre.  At the same time pregnant mothers and her family members can access need based educational content in audio, video and text format in their own smartphone. If a mother has difficulty, she or her family members simply can press the images related to her danger sign or symptoms in the app will send notification to the health facilities, local government and central level 24/7 call centre. If the pregnant mother could not access the internet or smartphone, she could simply give a call in toll free number with her registered unique ID.

1)  QR-Code: To uniquely authenticate, access or create longitudinal medical records of mother, fetus or new-borns  we are using QR-Code Technology.  Frontline health workers simply scan QR-Code to create or update  mother’s for newborn health data even in the absence of the internet. 

2)   LTE (4G): With the aim of reaching remote and difficult geographical terrain we have installed LTE (4G) telecom sim that supports both 800 and 1800 Mhz frequency in our Fetal Heart Rate (FHR) measuring devices. With the use of  QR-Code authentication system this device  instantly  identifies mother and records FHR data.  Even in the absence of internet connection the device can record the data and later push to the server during availability of internet.  

3)   Artificial  Intelligence (AI): AI technology has been used to analyse all the data such as GEO location, specific ethenic group community members, languages and speed of internet connection during the access of services from users. As per defined multi-resulting AI logic the system instantly decides and provides need based personalized educational content to the beneficiaries. 

4) Big Data: The app collectes large amounts of unstructured data with no particular schema. To store and analyse these big volumes of data we have used NoSQL (Not only SQL) technologies to give better performance and store massive amounts of data as a solution for Big Data. 

The proposed technologies such as QR-Code, LTE (4G), AI and Big Data have been used  massively in commercial projects. These technologies are already tested and matured in various online payment solutions and e-commerce sectors including others. Even LTE (4G) sim-based Heart Rate and Blood Pressure monitoring  Smart Watch are widely available in the market. Therefore, the Amakomaya m-health solution is the combination and fusion of various core technologies that is designed as a low cost solution for developing countries. The proposed solution will be a breakthrough approach, which is the linear technological development that replaces an older generation of technology through it’s focus on combining existing technologies into hybrid products that can revolutionize niche markets  of the developing economy. 

As an android app Amakomaya m-health system will be a solution in creating short term and long term impact to achieve the sustainable development goal-3 targets 3. 1 and 3.2. In order to strengthen the country's national health system for maternal and child health to bridge the gap between demand and supply sides following activities have been proposed.

Activity 1:  Educating and empowering pregnant mothers and family members with audio/Video and text content from mobile devices.

Activity 2: Pregnant women will be explored and recorded and get their residential location in a GIS enabled map.This can be done through any of the following methods. 

1. Self registration from pregnant women: Mothers who have their own smart phone and have access to the internet. 

2. Registration with the help of Female Community Health Volunteers to those mothers who have mobile phones but do not have access to the internet.

3. Registration by the person nominated by the Ward office to those mothers who do not have access to mobile and internet services.

4. Registration from health facilities: Mothers who have visited a health facility are directly registered in the system. 

Activity 3: On the base of defined variables and indicators Artificial Intelligence (AI) logic will be applied to classify pregnant women in three groups and informed to the concerned boundary partners such as local government, health facilities, ambulance or transport system and 24/7 support call center headed by professional midwives. 

1. Pregnant women having normal health conditions (Normal)

2. Pregnant women needs continuous monitor  (Possibly in risk near future)

3. Pregnant women needs instant support  (Highly risk, instant support needed)

Short term outcome:

• Increased pregnant women's knowledge of danger signs of pregnancy, childbirth and postnatal period.

• Increased number of antenatal care and health facility births

• Established proper chain of referral mechanism arranging transportation from community to health facility level 

• Improved literacy on technology among pregnant women and female community health volunteers.

• Improved data quality of health management information system (HMIS)

Long term outcome: 

• Reduced maternal and infant death rate

• Strengthened the National Maternal and Child Health System.

Currently our solution has been serving altogether from five local governments every month 600 new mothers are registered and getting services from solutions. Therefore, for one year the solution served up to 7,200 women. 

In the same way, our solution is providing electronic immunization registration service for up to 1,200 children under age 2 every month.In a year this number reaches up to 14,400. Every year this system has been used by 1,944 Female Community Health Volunteers (FCHVs). Similarly, every year 370 health workers have been used to provide services to the pregnant mothers and infant babies.  

Every year we are expecting to provide services to around 30,000 pregnant women and in five years time we plan to serve each and every pregnant woman in the project area.

We plan to roll out our innovation throughout the country in order to reduce three delays of maternal and newborn deaths learning the lesson from this project. Based on the outcome of the project, it will be able to show visible impact in promoting access to maternal health services to the rural women using real time data and also educating childbirth women’s family and women’s itself and reducing delay in deciding to seek care on the part of the individual, the family, or both; delay in reaching an adequate health care facility; and delay in receiving adequate care at the health facility.

Amakomaya m-health is the AI based automated cycle solution that connects all the concerned duty bearer partners such as local government, health facilities, health workers/FCHVs, citizens, ambulance and transportation system in one application platform and requests to correctly measure and fill the maternal and child health indicators from the human interface. Active human response  toward the triggered event in application from any duty bearer partners is the necessary condition to  continue this automation to establish as a system to function effectively. Lack of active human response and ignorance towards the automated notification on the side of any boundary partners is the  major barrier to accomplish the goal of this system. This barrier is supported by the following cause. 

1. Lack of e-readiness to adopt automation systems internally in their organization. (organization priority) 

2. Lack of a proper national level guideline to follow electronic maternal and child health registration systems. (Lack of plan and vision)

3. Lack of trained human resources  to internalize the automation system in the organization. (lack of infrastructure)

The above mentioned barriers can be overcomed with the following ways. 

1. Preparing national level guidelines to adopt automation in the recording and reporting of the maternal and child health sector. 

2. Creating an e-readiness framework for each duty bear partner to internalize the automation system in their organization by allocating yearly budget to run the system effectively and efficiently in serving pregnant, childbirth and postnatal mothers in the respective municipalities.

3. Provide initial equipment (mobile, tablets, laptops, printer), application tools and training to adopt the automation system to FCHVs, health workers, health coordinator of local government, emergency transport management team at local level and HMIS officers at central level.

In our proposed solution we will be working with our existing 7 team members working for application development (Full time), 4 people for conducting training and coordination (Full time), 6 people working as public health professionals and midwives including professional midwives through Midwifery Society of Nepal to facilitate trainings and workshops including provide instant support from the call center (Full time). 2 Drivers (Full time) 1 Admin officer (Full time) and 1 office assistance. Contractor monitoring and evaluation coordinator-1.

The team members from Amakomaya have 20 years of experience in the field of technology entrepreneurship, developing mobile phone based material for health promotion at the community level.  They are internationally recognized and have worked with partners in Japan and Europe.  

Our team includes information communication technology experts and public health specialists specialized in maternal health experts from two different organisations, namely Amakomaya and Midwifery Society of Nepal. 

The project lead, Mr. Rajendra Paudel is a system engineer, a CEO of Amakomaya has more than 25 years working in rural as well as national and international level working closely with different stakeholders. Through Amakomaya he has already developed the necessary technology tools through its prenatal and postnatal health care mobile phone programs.  

Dr. Laxmi Tamang, a public health professional with extensive research experience with women’s health, power relations in health care, youth health education and gender equity has been actively involved in developing midwifery in Nepal. She has more than 20 years working in this field with a wider network circle and excellent coordination skills in making this happen in the ground reality through stakeholders. 

Amakomaya has been partnering with different organisations, mainly Ministry of Health and Population, UNICEF, WHO and local government bodies including Midwifery Society of Nepal and Women Rehabilitation Center (WOREC) Nepal and Memorial University of Newfoundland. Amakomaya has been providing technical support in developing mobile and tablet applications relating to maternal and child health and implementing by providing training to the targeted user groups, mainly health workers, female community health volunteers and pregnant and postnatal mothers.

Amakomaya is a for-profit organization that has a business model in providing low cost innovative solutions for low-income countries' governments and stakeholders to access niche market. We charge yearly technical support costs from the project implementing organization. Because of the small size of profit such a niche business area is not in the priority for bigger business houses. Therefore, we do not have competitors in this business. For the last 9 years Amakomaya has been developing and improving maternal and child health applications for the government line agencies with the support of donor agencies with innovative features and expanding its business size day by day. The organization is sustaining from the yearly support cost received from government (Local, provincial and federal), donor agencies and others.

Amakomaya is working in B2B model. It directly works with government or donor agencies for providing technology based solutions specially focused on maternal and child health including sexual and reproductive health. We offer our product as an application free of cost to the government, but we charge cost cloud hosting, technical support. Sometime government and donor agencies request us integrated customized hardware solutions such as Android tablets and mobile devices and fetal heart rate measuring devices. We customize as per the requirement requested from agencies and charged as per work volume.