Salamat: Healthy Mother, Healthy Family

Afghanistan has a dysfunctional healthcare system where under-resourced clinics struggle to serve poverty-stricken patients. They lack basic record-keeping and have no clear way to educate patients or reach them for follow-up.

Salamat ("Healthy") is an app that dramatically improves healthcare outcomes for mothers and newborns. It is the first health app in Afghanistan that accurately and securely stores patient data in centralized records. Providers can access/update patient data on a tablet and remind patients for appointment folIow-up through its automated patient outreach feature, considering only 35% of women complete their follow-ups.

Salamat's 2-year pilot demonstrated its efficacy in transforming maternal health in Afghanistan and other low-income countries by providing a sustainable, cost-effective health data infrastructure and patient-provider connectivity. It also reduces medical errors and incidences of preventable maternal death. Ultimately, our solution will allow local and international stakeholders to customize policies and programs through access to accurate, real-time data.

Every 27 minutes, a woman in Afghanistan dies due to complications in childbirth. The tragedy doesn’t stop with a mother’s death — in 3 out of 4 cases, the newborn dies too. These deaths can be prevented by a solution that addresses three key barriers to high-quality and affordable health care.

1. Lack of maternal health education: 87% of Afghan women are illiterate and don’t complete their four WHO-recommended prenatal visits. 

2. Lack of resources: Health facilities aren’t equipped to help patients make informed decisions about their health. 60% of clinicians report that paper-based patient records are extremely difficult to retrieve and time-consuming to complete.

3. Lack of communication: Once the patient leaves the health facility, pathways to provider-patient communication do not exist.

Every health care provider should be equipped with the tools and resources they need to avoid preventable death. However, because of these barriers, Afghanistan has one of the highest maternal mortality rates in the world. The country is in dire need of an innovative solution that: (a) empowers women to seek maternal healthcare services prior to delivery, (b) enables doctors to easily access and record patient data during the visit, and (c) ensures patient-provider communication post-visit.

Salamat is the first maternal health app in Afghanistan that securely stores patient records while enabling patient-doctor communication and follow-up. It integrates paper-based patient records with digital data in both offline and online capacities. This introduces efficiencies in the system, allowing providers to make informed decisions regarding patient care. Clinicians can use Salamat to: add patient records, procure existing records, remind patients for overdue visits via text/phone, and schedule appointments. 

With funding from Johns Hopkins and USAID, we conducted a 9 month long beta test in five Afghan facilities which demonstrated that:

• 100% of health facilities retrieved patient records within minutes without the need for manual, labor-intensive paperwork

• Retrieving patient records was reduced from 9 minutes to 1 minute, allowing providers to spend more time with each patient. 

• Automated phone/text message reminders resulted in patient completion of the four WHO-recommended prenatal visits by 650%. 

We recognize that scaling technology solutions in under-resourced regions requires adequate training and support for sustainable implementation. Our solution will train clinicians on Salamat and equip them with education/outreach strategies for new and existing patients.  Patients will be educated through a culturally competent curriculum created in collaboration with maternal health programs at UCSF and Berkeley. 

Throughout the last 10 years, our team has supported over 50 health facilities in Afghanistan with medical supplies and education/training on maternal health, malnutrition, midwifery, public health, and hygiene. The Salamat technology annually serves 550,000 pregnant women in 10 facilities in Kabul, Afghanistan by providing access to 55 clinicians and midwives to the app.

Community engagement and human-centered design are crucial to every aspect of our solution. Our project is supported by a strong network of diverse stakeholders and our advisory board consists of Ministry of Health representatives, public health experts, clinic directors, and women from the regional community. 

Our team completed a comprehensive needs assessment and a 9-month pilot with quarterly reports — including provider-patient surveys and community feedback. We used this data to continuously adapt Salamat and learn best practices of serving the target community.

Data from Salamat will be used by the Afghan Ministry of Health and the international community to develop appropriate policies and programs for specific regions, improving access to quality patient care with short-term and long-term outcomes.

Salamat is a proven, innovative, and cost-effective solution that improves service delivery  and diagnostics for women in a country ravaged by decades of war and poverty. Our solution targets the most vulnerable population in the world: illiterate and uneducated expecting mothers who experience complex challenges in accessing care, from stigma and shame, to income, and lack of education. By using the Salamat app, all clinics have access to centralized data for all patients registered on Salamat and are 6.5 times more likely to provide continuity of care. Ultimately, clinicians can reduce preventable deaths and improve maternal health outcomes in Afghanistan.