WATOTO for Caregivers of children

Management and monitoring the health of children has not changed in over 20 - 35 years (in many low and middle income countries). Little involvement of parents, families and other health workers- HW. Time is lost due to paper reporting. Integrated/Interoperable systems are lacking. Individual or general data doesn't exist.

Watoto, is a mobile App on Android. Watoto is able to be interoperable and interconnected with other systems ( National Health Information System, National Registries, Laboratories, etc). This App could work in an offline mode too. It gives the opportunity to the caregivers to encode vaccinations and growth curve measurements. By entering the name of the patient,Watoto will automatically recognize the patient and his/her medical history and provide a longitudinal health record.

It allows caregivers and HWs to enter, monitor and track health indicators like growth and compulsory childhood vaccinations and be alerted when deviations from the standard data occurs.

According to the WHO, in 2018, 4.0 million (75% of all under-five deaths) occurred within the first year of life. Furthermore only 5 of the 49 countries categorized as low-income economies by  the World Bank meet the minimum threshold of 23 doctors, nurses and midwives per 10 000 population that was established by WHO as necessary  to deliver essential maternal and child health services. across the planet.

The UN's global strategy 2016-2030 on women, child and adolescent health attempts to address these issues by using the 3 strategies of Survive, Thrive and Transform which Watoto can support.

Watoto has the capacity to add value to survival and ongoing better health of children by not only providing longitudinal health records for children (transforming the health data system) but also using the engagement of caregivers and HWs to extend the reach of the health sector (transform) beyond the limited numbers of doctors and nurses. It also can promote thriving children by automating alerts and providing guidance when children are not on par in health with their peers - survive and thrive.

Watoto, is a mobile App on Android. Watoto is able to be interoperable and interconnected with other system ( National Health Information System, National Registries, Laboratories, etc). This App could work on offline mode.

1. Parents, children and family members

Discussions on field (specifically in Rwanda) with patient and patient’s family, show that more than 80% of them want to be more involved in decisions about their care. It appear that more could be done to involve people in their own health and care, to involve communities and the voluntary sector in improving health.

Watoto aims to transform child health information services allowing better monitoring of every child’s health and providing access to information for all those that are involved in the child’s care.

2. Community Health Workers, Midwives and other types of birth attendants and nurses.
Observation of several weeks in clinics and hospitals has shown us that they are key players. They need a real time access to patient data and a digital data sharing system between professionals. Watoto will help them in different way:

• Reminder list of tasks for patient (immunization, Growth curve, etc)

• access to the history medical record of the patient

• Create a new history medical record of the patient

• Identify incomplete vaccine schedules
  

• alerted on diseases and malnutrition

• Help on the diagnose and actions to be taken

• Automatic report for the Health authorities. 
• Vaccines stock management

Child health and mortality is a pressing problem for low and middle income countries as many of these countries lack the resources to adequately provide care to children and their mothers, due to many reasons. This has meant that these countries will fall short of achieving the UN SDGs Number 3- Good Health and Well Being for this target population. Watoto can support the achievement of this goal by not only being able to place the information necessary for caregivers to monitor their child's health but also provide the necessary alerts and information for any necessary intervention.

Our “competitor” or other similar solutions are the paper-based record keeping systems in most Low Income Countries for maternal, newborn and child health. 

This classic approach often based on paper, results in time lost reporting and justification due to the paper reporting and encoding the paper reporting in to the national “Management Information System” (e.g in Rwanda  This paper system don’t give sustainable evidence on the medical acts carried out, as a result there is a risk of a lack of liability and accountability. In order get new medicinal doses, to manage the stock and to allow to the authorities to estimate the percentage of vaccine wastage, midwives must calculate manually the number of vaccinations given and report it in the National Health Information System, which further slows the delivery of services to the patient.

Watoto offer an Integrated/Interoperable systems. Individual or general data (e.g number of immunization for the year X) will be captured and easily scanned and reported on dashboard. For the Individual Data, caregivers will be alerted if problems arise and action to be taken will be suggested for (e.g. alert in the case of an abnormal growth curve, alert on vaccination missed but need to be caught up, etc).

With Watoto, parent or family are integrally involved by  an interface that allows them to : access to the history medical record of the patient, reminder to the patient about appointment, map the nearest health facilities for the patient.

Watoto, is a mobile App on Android. Watoto is able to be interoperable and interconnected with other systems ( National Health Information System, National Registries, DHIS2, Labware,  etc). This App could work on offline mode. 

This app replace and digitalize paper home-based record. We currently focus the App on immunization and children growth tracking. 

For caregivers watoto offers an interface that allow to them:

• Reminder list of tasks for patient (immunization, Growth curve, etc)

• access to the history medical record of the patient

• Create a new history medical record of the patient

• Identifie undonated vaccines

• alerted on diseases and malnutrition

• Help on the diagnose and actions to be taken

• Automatic report for the Health authorities. 

• Vaccines stock management

• access to key health information at the point of care to improve decision making.

• Professionals delivering preventative programmes of care will be alerted by a failsafe management service when an intervention is due or has been missed.

For parents:

• user interface and accessibility by parents and family 

• reminder (for immunization, appointment, etc) 

• geolocalize nearest health facilities, 

To the National programme:

• Create automatic statistic and organised data on dashboard

• Vaccines stock management facility

• Better view on the immunization coverage  

• Public health professionals will have access to more comprehensive, more up to date datasets to be better informed

• It becomes possible to deliver personalized health promotion materials to people and enter into dialogue with them. As parents, families, carers and young people begin to use personal health records routinely.

Watoto use Android system and this system is already used in many health technologies 

Watoto can operate offline, so it's convenient for low income countries like Africa. 

The interoperability system works already. We worked with Rwandan Ministry of health  On  active case-based surveillance system (CBS) for HIV. We developed an integrated health information systems that synchronizes data entry and reporting across various health databases (LabWare, DHIS2, OpenMRS, etc) to reduce transcription errors, and eliminates data capture errors, and reduce the time spent in reporting.

Watoto addresses the need to provide easily accessible, understandable information on a child's health indicators like weight and vaccination uptake in order to reduce the number of children who either die under the age of 5 or face a poor pathway for their onward development.

1. Activities:

• Buy-in from stakeholders on the front end of the app as well as the data back end.
• Advocating and encouraging caregivers and health care workers to upload the mobile app Watoto to be able to monitor, track and intervene in the health of the child.

• Engage with relevant stakeholders on how to analyse and use the data gathered for decision making.

2. Outputs :

• Watoto pilot app is created with input from relevant end users.
• Number of uploads and active use of Watoto.
• Reduction in paper based reporting.
• Data sets being produced for health care workers/Government representatives to use in their decision making.

3. Short- term outcomes

• Caregivers are more confident in identifying and addressing their child's health issues.
• Health Care Workers have more time to do medical care as opposed to paper based admin.
• Government representatives are able to analyse and use data gathered by Watoto for their decision making.

4. Long -Term outcomes

• Health Care Workers and caregivers are better able to identify and avert negative health issues in children.
•  Health outcomes of children who caregivers use the Watoto app are better.

Current number: 0 (It’s a prototype for the moment). 

If we take Rwanda as Country test for Watoto and focus for example only on vaccination Watoto would reach the caregivers of 97% of all children within a year. For other countries, we would utilise a similar national scale interventions, riding on our existing work within those countries. This would include using existing data platforms to collect, consolidate and analyse the data collected by Watoto.

Our goal is to reduce deaths and improve health of children and mothers under SGD 3.

Immunizing children against preventable diseases and tracking the growth of children are critical to achieve this goal.  

With Watoto and in collaboration with Ministries of Health, Civil society, NGOs and family, we would be able to save million lives by preventive actions: Immunization follow up, growth curve monitoring, pregnant women follow up as well as collecting the necessary data to allow decision makers to make effective and efficient decisions for the health of the children and their mothers.

Our approach is to transform child and mother health information services allowing better monitoring of every child and mother’s health and providing access to information for all those that are involved in the child’s care, where appropriate, to ensure that all children get the best possible start in life.

The most important barrier we face is  lack of financial supporting.Sourcing funds for this type of project is not easy due to general lack of resources in low and middle income countries. We believe that significant and long-lasting benefits accrue from investing in the health, quality of life, productivity, and economic growth of women and children and this makes this investment worthwhile not only for the children and their caregivers but also for the overall country at large.

The second barrier is a technical one. In low and middle income countries we face issues like: being able to reach a  population in rural area and who don’t have access to electricity, phones or internet access.

For financial challenge, we have to continue to search partners and donors for Watoto. We already work with several public and private institutions on other projects and will advocate for their involvement in Watoto. By showing the value of including Watoto into existing disease data systems, we hope to get the financial support of donors and implementing countries as it would take little to no investment for them to add Watoto into their existing systems.

The technical challenges are slowly being overcome as mobile phones and the access to the internet which usually follows is penetrating into these rural and hard to reach areas. Watoto itself has a offline function which allows data to be uploaded and downloaded only when there is data connectivity available. 

We will continue to innovate, learn from others and trial new ideas that overcome some of these technical challenges.

4 part-time staff have worked on the solution.

Watoto is an extension of existing tools created by the Savics team. Savic's tools have been implemented in over 13 countries with over 200 000 records being entered into the various solutions. These solutions are interoperable, built with input from the end-user as well as being implemented in multiple languages. This background, existing experience and solutions places Savics and our team in the perfect position to bring Watoto to the market by leveraging on these capabilities.

We work in partnership with the Belgian Biomedical research and development group of KU Leuven University.

KUL :

• provide access to relevant studies and last evidence on maternal and child health.

•  Support the drafting of activity reports, project web-page, business plan, and other deliverables.

The value proposition: Enhance Maternal, newborn and child health monitoring including caregivers and provides Government representatives with the data necessary to make child health related decisions to prevent disease, poor nutrition and maternal and child mortality.

Donor networks, building the Brand of Watoto with Savics and a solution dedicated Website.

2. Key Activities include

• Buy in by local stakeholders including Government, NGO's and community organizations.

• Remote installation of  Watoto Mobile App

• Customization of Watoto mobile App according the Client needs. 

• Document drafting (User guide) with end user input
  

• Support services to client including data consolidation and analysis guidance.
  

3. Type of Intervention   

• Offline Mobile App installation.

4. Customer Segments include:

• Midwives

• Community health workers

• Pregnant women and Children under 18 months and their family

• Government representatives
• NGOs

5. Impact Measures include

• Number of patients included in Watoto  system

• The number of families that connect to this application

• Long term child health impact.

6. Key Stakeholders include:  Ministries of health, Public and private hospital and clinics and NGOs.

7. Major Costs include :

• Staff

• Website

• Web App customization
  

• Back-end data report customization

8. Surplus would be used to add new functionalities on both the back-end and the front-end of the solution, marketing to drive the demand of the solution.

9. Revenue

• Grants 40% (reducing overtime as the fee for service revenue model grows in demand)
  

• Watoto purchase by Ministries of health, NGOs and other development cooperation agency 60% with growth due to the fee for service revenue model.
  

The revenue generation model is a combination of fee for service as well as low income client. These models allow us to work with low income countries governments and international child health organisations (who pay a small fee per user) to access and use Watoto, its backend data platform and other data analysis requirements. The end user’s costs in low income countries can be absorbed by the Government or reduced in partnership with telecomm providers. We will capitalise on our existing relationships with low income country Governments (13 countries) which will allow us to extend their existing digital health platforms and systems to incorporate Watoto.

We applied to Solve as the child and maternal health challenge is directly aligned to the aims and vision of Watoto. It was a great opportunity to merge our financial and other needs by applying for the Challenge. The funds, other support and partnerships winning the challenge will afford our solution would be critical to scaling this solution in low and middle income countries. This is a good tool with low investment required by the end users, for it to move from a proven prototype to a pilot and to scale, this challenge would provide the way for this to be attained.

We want Watoto (like other tools we created) to be self sustainable with the ability to attract and retain its own revenue. In order for this to be achieved we would need to focus on our business and revenue model as well as solid marketing campaign to drive the demand of the tool.

We would be glad to have the input of Child Health experts and advocates as well as experts who have been successful in creating income generation from social welfare projects/solutions in low and middle income countries.

Watoto reduces the paper based admin that takes up the precious limited time of health care workers, it increases their efficiency in accessing data on their child patients as well as providing them with a longitudinal view of their patients health. The solution also automates issues that would require their attention and input as opposed to trying to complete this in a time consuming and cumbersome manner use a paper based system.

Our solution is intended to benefit the health children from low and middle income countries by using easy to access and use technology to augment the lack of a suitable number of doctors and nurses per capita, in these countries.  The award will allow us to not only contribute towards being able to pilot our solution but with further investment, we can also add in other health indicators that are relevant to the ideal growth and development of a child.