Na'

Social causes have been shown in low- and middle-income countries to account for 25 -50% of maternal deaths. Our solution aims to lower this by 30% over the next 5 years in Nigeria through improving access. Na’ identifies individual pregnancy risks using simple algorithm following a pregnant woman filling a short community-based form and using that to bridge her knowledge gap. It also identifies barriers to physical access, proffer community-based solutions, and improve clinic preparedness through timely and confidential information transmission and follow up systems. Hence methodically curbing the three delays of maternal mortality.

When scaled, Na’ will improve health demand/seeking and supply/delivery through gap identification beyond maternal health into other healthcare delivery systems including child and emergency health. 

Social autopsy reveals that Maternal Mortality (MM) stems from a pregnant woman’s inability to access quality and timely care during and after pregnancy. According to WHO, MM rate in Nigeria ranks one of the highest the world at 800 deaths per 100,000 live births, contributing over 50,000 deaths of about 295,000 deaths recorded globally each year.

Furthermore, social causes of MM broadly classified as the three delays: decision making, effective access, and poor clinic preparedness respectively, together account for approximately 80% of maternal deaths. Studies from other developing countries further reveal that the first delay (decision making) accounts for 55.6% of cases, while the second (effective access) and the third delays (clinic preparedness) account for 18% and 26.4% respectively.

Impact studies also show ranging consequences of MM on demography, economic, health, and psychosocial lives of children, families, and societies. When not corrected, Nigeria will lose the window of reaping its demographic dividends since this affects mostly the younger population.

Our solution addresses the three-delays through improving family knowledge on MM, adopting community-based solution in transport schemes, and creating an ethical and confidential information interphase between the individual, community, and health facilities to ensure political awareness and clinic preparedness.

Our solution, Na' uses initial information from a pregnant woman to determine her possible risks through simple algorithm, and sends her short messages to enlighten her on risks associated with her pregnancy. This rides on the premise of several studies suggesting that knowledge influences attitude. Similar messages are sent to her spouse to understand his role and support during her pregnancy.

The platform reminds the woman of all her calendars and alerts the clinic, her spouse, and the community health worker (using the existing CHIPS) should she miss any visit for a follow-up.

Our  system can identify the closest clinically prepared facility (service mapping to be conducted on the platform using citizen generated data) and advise her to relocate closer to a health facility (should she be far off) as she is approaching her due date. In case of an emergency, alerts are sent to her spouse, a catchment driver who helps deliver her to the optimum facility who have also been notified and have access to her records, therefore prepared in mobilizing human and commodity shorten decision making. The system comes with a free Electronic Medical Records (EMR) platform to support this service for clinics.

We are targeting rural and urban women between the ages of 15 & 49 years, clinics, healthcare providers in Rural and Urban. Rural women are mostly poor and live in remote areas, and are the least likely to receive adequate health care. The maternal mortality rate in rural areas is estimated at 828 deaths per 100 000 live births, compared to 351 deaths per 100 000 live births in urban areas. In a bid to understand their needs, we carry out both formal and informal surveys to understand their issues. We are also currently collaborating with the UNFPA, and UNICEF in Nigeria. These interactions have greatly informed and provided perspective as well as iterations during the design phase of our application. We believe our solution will help connect more women to clinics, get more family members and spouse engaged and equipped to provide support, and also provide clinics with adequate information to provide better care to pregnant women. Through Na’  clinics are able to deploy our follow-up tool to track and provide post-delivery care to ensure the health and safer of both the Mother and baby.

We have identified 3 delays as contributing factors that impede effective access for our target population. We are addressing these issues by using Na’ to 

1. Promote Social behavioral change through improvement of knowledge via information dissemination.
2. Improve access of women to Hospitals, ensuring adequate care management is provided through key reminders and follow-up mechanisms.
3. Provide sufficient patient data for adequate Hospital preparedness especially during emergencies
4. Implement a financial protection mechanism, for women’s health, through health risk sharing and fund pooling, by providing an effective and digital way for women to save.

Most of the solutions out there are clinical tools that seek to improve access of women to care. Our solution is innovative because it focuses on the social aspect of women's health required to ensure that clinical solutions are effective. Our solution looks at the social factors impeding access to care and closes these gaps. We have been able to through Na’ improve the access of women to care provided by hospitals, passing pertinent patient information to the hospitals to help tailor care to the unique/vast requirements of women and newborns, while educating the women on their possible risks and where and how they can access the care needed to survive.

Through Na’ we have also developed an innovative way to deploy social health insurance for women through cooperative societies and savings groups.

Na’ is a web, mobile and USSD based platform. When pregnant women register on Na', Na’ uses a simple algorithm to identify possible health risk factors of the woman during pregnancy, and then helps her to register with a hospital. Registration and health information of the pregnant woman is received through Na’s EMR solution which works both on and offline. The Hospital uses the EMR to interact digitally  with patients & also collect & manage patient data

Na’ provides a reminder system to ensure the pregnant woman attends all her antenatal visits and also take her pills, as well as a follow-up system to monitor the health of the mother and baby after delivery, while helping the mother keep to the baby’s immunization schedules. During emergencies, (using an emergency USSD code or via the mobile app), the women is a able to trigger a panic alarm that automatically alerts  a  hospital through the EMr as well as via sms, to prompt them to prepare to receive the woman or refer her to a more equipped hospital. Na' also automatically contacts the next of kin to inform him/her of the emergency and what hospital she is being transported to, and automatically connects her to a driver who locates her house, and takes her to the hospital (Her primary health center) ensuring the safety of the mother and baby.

This project was originally carried out in the Philippines in 2008 where there was need to improve access to health. When Hamira started working with the Zuellig Family foundation (ZFF)  foundation in 2013, the pregnancy tracking and early warning system initially started as a clinical excel based tool to help health workers identify index pregnancy risks to enable preparedness and referral systems. We have attached a presentation carried out in 2013 by Hamira when working with the Zuellig foundation. 

We have also attached a link to USAID site about this initiative. USAID was the only sponsor of the project at the time.

If women die due to the three delays (Delay Decision making, Delay in Effective access, and Delay/poor clinic preparedness), then improving their knowledge and that of their spouses in a way that addresses the three delays as well as arming the clinic with the requisite information for preparedness on every index case, will ultimately cut down maternal mortality by its current 20-50% estimate. 

This is because inadequate information and knowledge hampers the ability of pregnant women or their spouses in prompt decision making, affecting also the preparedness of the clinic. The absence of a systemize transportation network affects required access during emergencies. 

Our solution currently serves no one. But we hope to reach about 150,000 next 12 months. In one year we hope to reach over 200,000 women from two project states. We are already deploying a digital solution for health insurance in some states in Nigeria. We are going to use this existing networks, and partnership with the Minsitry of Health, and the Ministry of Women Affairs in Nigeria, we project a reach of 200, 000 women in the first year, and 1.5 Million women in 5 Years 

Our primary goal is to lower Maternal and infant mortality by 30% over the next 5 years in Nigeria through improving access. Through partnerships we are establishing in Nigeria, as well as others in other parts of Africa, we hope to reach over 1.5 Million women in the next 5 years.

Our major plan of achieving this is by working with NGOs already addressing issues of Maternal and infant mortality in Africa. Because Na' is a social tool, it offers a complimentary approach to already existing initiatives addressing these issues in Nigeria, and beyond. Our aim is to strengthen already existing programs, as well as reach regions yet to be accessed through technology. 

We have identified three major barriers we foresee as impediments to our impact in the next five years.

Financial Barriers: 

The technologies required to deploy our solution for both urban send rural vary slightly. This means we have to deploy two kinds of technology for different users. This greatly increases our cost. As we get more users onboard, we require scaling which comes with additional infrastructural cost. This impediment makes it challenging expanding to new communities across Africa because we deploying our solution for free.

Cultural Barriers: 

In a gender unequal society like Nigeria, patriarchy and culture has attributed social and economic power to the male gender, where men decide where and when women can access clinical services. Due to cost, most women are unable to afford primary health care and get little or no support from their spouses.

Market Barriers: 

Poor knowledge reduces market demand for healthcare, ability to afford care also affects our level of impa

Financial Barriers: 

Because of the cost that comes with deploying our solution for free, we have ventured into other areas of health with the purpose of generating revenue to Carter to the associated expenses that comes with maintaining and scaling our solution. We have other pid initiatives like Nucleus, which is a Health Insurance management solution states in Nigeria. We also have FUSE, a cooperative management software for cooperative societies in Nigeria. A percentage of revenue from these paid initiatives are allocated to sustaining Na. We are also applying for grants from donor organizations are in talks to investors who are interested in providing capital for equity.

Cultural Barriers: 

We are aware of the cultural challenges and are going to carry out massive campaigns and orientation programs to get men more involved. Na’ has been designed to send periodic educative messages to pregnant women and their spouses. We believe this is a great way to get more men involved, and informed. We are also setting up a social health insurance scheme to help women save for heath care. We believe this scheme is an also an avenue for women empowerment through cooperatives.

Market Barriers: 

To better reach communities we are working with both the health ministry and women affair to improve our adoption rates, and help us with market penetration.

Our company is a social enterprise.

We have a total of three Staff which is made up of the founders. We all work full time in the company.

I started a technology company with Modupe called TechFusion that helps the unbanked and underbanked individually in Nigeria save monthly. Our experience with building and deploying technology for the poor, helps us in the design and deployment of Na’ for our bottom of the pyramid customers.

We have also built a case information management system (CIMS) for the UNFPA Nigeria to help record and manage female genital mutilation, as well as gender-based cases in Nigeria.

Hamira is a medical doctor and has over a decade of experience designing health systems that address women’s health

He was part of the team that developed the Wireless Access to Health in the Philippines where point analysis shows a drop in maternal mortality. He has had both government and UN experience running the emergency transport scheme (ETS) in Adamawa state, first as a field officer and later as a coordinator.

He has served in rural villages addressing maternal and child health as a clinical and administrative officer in emergency settings in Nigeria and South Sudan, and in rural settings. 

He has served under WHO under the community health worker development program where he has garnered experience in rural health education focusing on maternal and child health. 

He has worked and designed gender-based programs under the international rescue committee, American University of Nigeria, and UNFPA.

Our collective experiences better positions us to effectively Na’ in addressing Maternal and infant issues in Nigeria and beyond.

We are currently in the process of establishing partnerships with the Ministry of Women Affairs in order to effectively reach women. We are also doing same with the Ministry of Health, to reach primary health care centers and hospital across Nigeria. Our aim is, through the Ministry of Health, deploy free EMRs to government owned clinics and hospitals, to provide more access to women, since Na’ connects with our EMRs, aiding better access.

Currently we have an existing partnership with the UNFPA. We designed and deployed a case information management system (CISM) for Female genital mutilation and Gender based violence cases in Nigeria. Through this project, we have already established ourselves as competent conduits of digital solutions for this arm of the UN. We are currently discussing and mapping out strategies for implementing pilot projects of Na’ in existing project communities. Our plan is to deploy Na’ through their existing Gender based violence programs and measure the impact before scaling it to the bigger communities. 

Our company is built on a Platform Business model. As a platform company, our technology is offered to our users for free. We are both a B2B (offering EMRs to hospitals), and B2C (offering a mobile app or USSD technology to pregnant women who are end users). Na’ Electronic Medical Records (EMR) will be deployed for hospitals to help them manage appointments of women, manage a real-time health database, easily & effectively render postpartum services to both mother & baby. Na’ mobile App and USSD technology will be deployed for pregnant women to improve or provide better access to hospitals, ensuring adequate care management is provided through key reminders and follow-up mechanisms. The ultimate aim of our model is to provide more access to healthcare by helping hospitals through our EMR easily connect with pregnant women using Na’ at no cost to both the hospitals and women.

On one hand, hospitals need our EMR to manage a realtime patient database, as well as a hassle free way to structure their administrative activities in an organized manner for high impact. on the other, women need more care and attention during pregnancy, requiring immediate access to primary health care, especially during times of emergencies for their safety and that of their baby.

Through Na’ we will also deploy affordable basic social health insurance services using the cooperative model. This model provides a means for women empowerment, and a financial protection mechanism for health care, through health risk sharing and fund pooling.

FineFeather is an External Social Enterprise. This is because the activities that generate money for the company are distinct from our social impact activities. We have discovered from interaction and research with impact communities that price is a major barrier to our bottom of the Pyramid (BoP) users, and could greatly affect our impact model. We want to eliminate barriers that stand in the way of the solutions we are providing to maternal and infant health challenges.

As stated earlier, our platform will be offered for free to users, while achieving financial sustainability through sustained donations and grants. We are also looking to raise investment capital.

We also have other paid products like Nucleus (a health insurance management tool to help state governments in Nigeria manage their health insurance programs), FLARE (a utility platform for purchasing electricity tokens online), FUSE (a cooperative management software to help cooperatives solve their routine back office challenges). These are alternate sources of income we believe will help us stay financially sustainable while prioritizing social impact.

We believe solve can help us better address the barriers we have identified as Impediments to our venture. 

• Financial barriers: By becoming a Solver, we have the opportunity of access to grants and investments from potential Investors . We believe access to a supportive community of funders will help ensure the sustainability of our work, keeping us focused on achieving our overall aim of reducing maternal and Infant mortality.
• Market Barriers: our aim in a few years is to establish our presence in other African countries in order to address maternal and infant mortality issues. Through Solve, we have already identified a company called E Heza based in Rwanda, that has an existing complimentary initiative. E heza is a solver and is using technology to improve infant health by providing a health record management application to effectively monitor the nutrition levels of infants. Partnership with E-Heza will help expand our reach to other African communities like Rwanda experiencing similar challenges. 

In summary, the network provided through MIT Solve communities of peers, founders, and experts during solve’s 9 month program, will go a long way in shaping our level of impact in our immediate community. Other benefits like mentoring and strategic advice from solve and MIT networks will helps us are in areas of business model iterations, Improved expansion and better scaling of our Services, refining our revenue model, and most importantly marketing and proper exposure. These are areas that need strengthening for us to fully achieve our goal.

At the moment, we are all focused on developing our technology to ensure it is well suited for our impact communities. We believe that more iterations will take place during the course of our software interaction with users. This focus on refining our technology makes us oblivious to other equally important aspects of growing a company like business model iterations, effective distribution of our services, Marketing, exposure etc. By reflecting on the questions asked in this application, we already see areas we are not well grounded that require strengthening. We believe that experience from our potential partners will go a long way in strengthening us , by helping us avoid common pitfalls, as well as adopting certain organizational cultures that will ensure that longevity of our company and impact.

As stated earlier we are always keen on working with a solver from Rwanda (E-HEZA). Through this application we were able to find out about their work in Rwanda. 

We are also working out partnership with the Ministry of women Affairs in Nigeria, to facilitate access to women through their networks in all 36 states of Nigeria. To effectively get primary health centers in Nigeria to use our EMR, we are working with the Minsitry of Health.

We have also working on partnering with USAID by working with some of her implementing partners working is areas of maternal infant health. 

These organizations listed already have vast experience working with our target population. Their experience will help us better refine our solution for maximum impact, and also increase the acceptance of our initiative since they also have certain level of successful access and in our project communities.

We are qualified for this process because our solution addresses challenges faced by refugees. Our Project communities includes states (Adamawa, Borno, Benue, Plateau, Yobe States) ravaged by the Bobo Haram insurgency, and Fulani Herdsmen attack.

These states are known to have the highest number of refugee camps. Even though these camps exist and provide basic primary health care, there are not established based on proximity to facilities, but solely based on safety.

We will use the Andan prize for innovation to expand our work to reach refugee camps. Through Na’ we will improve access to facilities in these camps, and places devastated by crises. We will deploy the social health insurance component of our software for people affected by crises, by starting a collective risk sharing and pool funding initiative, as well as a women empowerment scheme for refugees through savings, by establishing cooperatives.

Since most these communities devastated by crises will barely have access to a smart phone or internet service, we will use the cluster system (by coordinating our activities with IT exposed individuals in these camps). Through these clusters, we will improve access for women to secondary and tertiary care, and also provide a means for self empowerment through cooperatives.

We qualify for this price because we are sing technology to empower women, by establishing women cooperatives. These cooperatives will be managed by girls and women trained to use technology in managing the day to day routine back office operations of the cooperative.

The aim of using technology is to help the cooperative keep a well documented record of the savings and contribution of each member, and also give them regular updates on the standings of their accounts with the cooperative. We will deploy USSD technology to help women and girls who are members of the cooperative, easily apply for loans from the cooperative. Through our software, we will help girls and women save small amounts for their health (Social Health Insurance). We believe heath insurance schemes in Nigeria do not take into consideration the uniqueness of girls and women, and therefore excludes them. Our technologically driven  platform will be deployed solely for the promotion of women health, and self empowerment of girls and women in Nigeria.

Our app (Na’) improves access for pregnant women to hospitals. Through our app, a pregnant women is able to know her possible health risks just by filling a form, it then connects the woman to a health facility, sending all her possible risk information to the health center so that care can be provided to her based on her needs.

We are qualified for this prize because our solution addresses social issues that are responsible for maternal and infant deaths in a country like Nigeria with one of the highest rates in the world. Na’ connects to an EMR specially designed to help and equip health workers preparedness in administering care especially during emergencies, by notifying the relevant health workers on the health risk of women and the type of emergency, giving them adequate information and time to prepare or refer her to another facility, in the event they are ill equipped to administer care.

Because of our offline/online EMR deployed for free to clinics, health workers are now better equipped to provide care. 

Our App (EMR), helps health workers to also provide postpartum care, by deploying a follow-up mechanism that monitors the health of the Mother and newborn after they are discharged from the hospital. The EMR also alerts the hospital if the Mother or baby are in danger, for prompt response and preparedness.

We are qualified for this prize because Our App (Na’), is a social tool that better improves the access of women to care by connecting them instantly to a clinic, that also educates pregnant women on pertinent clinic tests during the course of her pregnancy, and provides a reminder system on her medication and antennal visits. Our App also creates an immunization schedule, and provides postpartum reminders to ensure the new born receives all the required shots to stay healthy. Through our EMR, health workers are able to easily provide postpartum care to monitor the health of the mother and new born.

For us to effectively reach out to women across Nigeria, we are working with the Minsitry of Women Affairs, to use existing structures for effective coverage. We strongly believe that this initiative will be the flagship program of the Minsitry of Women Affairs in addressing Maternal and Infant health in Nigeria. We are also working with the Minsitry of Health to deploy our EMR in all government owned facilities in the country. We will carry out trainings and empowerment programs, to ensure these facilities are fully equipped in term of knowledge, to effectively deploy our tool for optimal care for women and new borns across Nigeria

“According to the world bank, Nigeria According to the World Health Organization (WHO), Nigeria had the second highest number of annual maternal deaths in the world in 2010 and contributed 14% of all maternal deaths globally. Nigeria has a maternal mortality ratio of about 814 per 100,000 live births as at 2015”. 

These deaths reflect inequalities in access to quality health services, highlighting gaps between the rich and the poor in Nigeria.

Even though the rates in Nigeria are relatively than other African countries, according to data from UNICEF, “Sub-Saharan Africans suffer from the highest maternal mortality ratio – 533 maternal deaths per 100,000 live births, or 200,000 maternal deaths a year. This is over two thirds (68 per cent) of all maternal deaths per year worldwide”.

We believe we are well suited for this prize because our solution is designed to reach Millions of women in Africa, Na’ (Our pregnancy tracking and followup system) is designed to reach over 500 Million women in Africa for the primary purpose of reducing the prevalence of maternal and infant mortality. Our goal through Na’ is to educate women on risks during pregnancy and how to manage these risks. We will use Na’ to provide more access to care for women. Through Na’ we will ultimately establish social health insurance for women in Africa, one that focuses on their health needs based on their uniquenesses. While addressing the health challenges of women through the social health insurance scheme, we will establish women centered cooperatives for self empowerment and risk sharing to improve the living conditions of women, especially those in rural communities.