Toto Care Box

Toto Care Box project is a Public Health intervention designed to solve the maternal and newborn mortality problem for vulnerable populations through education and incentivization.
The solution includes a package of 18 low-cost; high-impact essential items intended to optimize newborn survival within the neonatal period and to help women offer ideal newborn care. The package includes a portable newborn bed and is given as an incentive. Also, program beneficiaries are educated comprehensively on maternal and newborn health.
Lives will be impacted through: newborns getting safe, uninterrupted sleep, newborn deaths from malaria, pneumonia, neonatal sepsis and diarrheal infections will be significantly reduced, there would be an increased uptake of  facility-based maternal and newborn services including antenatal care hence better pregnancy outcomes, beneficiaries will have increased knowledge on critical aspects of maternal and newborn health, there would be reduced stigma caused by the high burden of newborn care for underprivileged women.

Maternal and neonatal mortality remains a serious problem both globally and regionally. About 295,000 women died globally during and following pregnancy and childbirth in 2017 according to WHO. Of all these deaths, 86% occurred in Africa and Southern Asia.
Also, globally in 2018 2.5 million children died in the first month of life. Similarly, Sub-Saharan Africa had the highest NMR in 2018 at 28 deaths per 1000 live births. In Kenya 39,000 newborns die annually due to preventable causes. Also, 17 women die daily during childbirth due to lack of lifesaving education.
These unacceptably high mortality rates in Kenya relate to a number of factors which are the basic action points for the Totocarebox program. They include; lack of knowledge on the identification and prevention of common maternal and neonatal infections, low utilization of facility-based maternal and neonatal services, high levels of poverty resulting in increased burden of newborn care and marriage/ childbirth at a very young age. All these factors are preventable.
Our solution addresses the problem through education and awareness creation, provision of 18 essential newborn care items to optimize newborn survival and incentivization of women to attend antenatal care services and to deliver in health facilities.

Totocarebox is an intervention designed to promote maternal and newborn health through education and incentivization. The concept was borrowed from Finland then customized to the needs of Africa. In Finland, babies have been sleeping in cardboard boxes since 1939 as a government initiative to reduce maternal and infant mortality. Finland has the lowest mortality in the world.
The solution includes a package containing 18 essential newborn care items: the box which doubles as crib, mattress, blanket, mosquito net, chlorhexidine gel for cord care, water purifier for safe drinking water, a set of baby clothes, diarrhea kit etc. These items promote optimal newborn survival by reducing deaths from common infections e.g. Malaria and pneumonia. It also promotes safe sleeping for newborns.
For a woman to receive the box, she must:
Attend at least four antenatal care sessions.
Deliver in a health facility
These are recommended by WHO and significantly reduce maternal and newborn deaths. Also, women are trained on various aspects of maternal and newborn health upon receiving the box. 
Home follow-ups are then conducted to check on the effectiveness of the intervention. Feedback data is collected using smartphone questionnaires before impact reports are generated.

The target population for Totocarebox program is poor, marginalized and underserved women who give birth under difficult circumstances which predisposes them to death. The program serves women of reproductive age including expectant teenage girls. Primary characteristics of these women include: low literacy levels, low socio-economic status, marriage at a very young age, poor living conditions, inaccessibility to quality maternity services etc.
Our main areas of focus include informal settlements, disaster prone areas and centers dealing with vulnerable expectant women and newborns. The primary beneficiaries of the program are newborns born to these underprivileged women and the program seeks to give them an equal and dignified start to life.
During the concept phase of the program, detailed focus group discussions and interviews were carried out by the project team together with the target women and other stakeholders in health. These helped in understanding the needs of the women and thus in modification of the program to suit their needs. Routine surveys with the beneficiaries are currently being used to collect feedback on the changing needs and program trends over time. The targets are engaged through training sessions.
The project will address the needs of these women through; provision, incentivization and education. 

The main problem addressed by the Toto Care Box program is maternal and neonatal mortality from preventable causes among poor, marginalized and underserved women and newborns. Through the program, access to maternity services as well as other sexual and reproductive health services is increased.
The program uses incentivization to encourage women to attend at least 4 antenatal visits and to deliver in health facilities. This helps prevent birth-related complications and as well increase uptake of maternal services. The incentive given is a box containing 18 low-cost, high-impact newborn essentials which ensure optimal newborn survival.

What makes the Toto Care Box solution innovative is the fact that the solution uses simple materials (cardboard) to make a more vital item, baby cot which can be used flexibly across various high need areas.
Also, the solution unlike other rigid forms of promoting maternal health can be easily modified to suit the needs of vulnerable women and newborns in any setting. The items in the box can be changed basing on the priority given to a particular component of maternal health.
The solution is innovative because it encompasses a unified approach involving both material empowerment and knowledge generation. It is therefore most suitable in curbing the maternal and newborn mortality problem especially for the African continent.

The Toto Care Box solution being an innovative idea modified from a concept initially in Finland uses technology in its development. The core technology currently being used in the solution is the google forms application which aids in the development of questionnaires for data collection purposes as well as dissemination of the findings.
The application is used by Community Health Volunteers working in the grassroots who feed program data using their smartphones into the online forms for purposes of research and accountability.
Also, the solution uses technology in the sense that the box made out of cardboard is designed to be used as a portable baby cot together with a fitting mattress and blanket. This enables it to be used by poor women living in the target areas with ease and as an alternative baby bed.
We are now working to develop an application that would be linking poor women to health facilities where they can get quality healthcare at a cheaper cost before we can give them the box together with training.

Our solution is developed from a concept practiced in Finland since after the Second World War. In Finland, babies have been sleeping in cardboard boxes since then as a government initiative to reduce maternal and neonatal mortality. For this reason, Finland has the lowest maternal and newborn mortality in the world.
We modified the idea to suit the African context and for three years now we have been able to secure over 5,000 maternal and newborn lives in Kenya. We look forward to a greater impact since the solution has proven to be the perfect answer to the problem.

Toto Care Box (TCB) is guided by three core objectives; to incentivize women to attend at least 4 ANC visits and to deliver in health facilities, to reduce newborn deaths from preventable causes e.g. malaria, pneumonia and diarrhea and to equip women with up-to-date knowledge on maternal and newborn care.
These objectives are achieved through a number of specific activities including;  giving incentives (Toto Care Boxes) to women who comply with the program criteria, training women on various aspects of maternal and newborn health to promote ideal newborn care, awareness creation on all aspects surrounding sexuality and parenting.
The direct deliverables of the program include; newborn care packages (Toto Care Boxes) and trained women and girls.
The outcomes from the above deliverables include; newborns and women receiving ideal care which eliminates chances of diseases and childbirth-related complications. Also, the general public is made more aware and knowledgeable on all aspects of maternal and newborn health.

Currently, the Toto Care Box program serves 5,000 women and newborns in over five informal settlements of Kenya (Kibera, Kayaba, Ruben, Lang’ata, Kawangware etc.).

In one year, the program is expected to be serving at least 100,000 women and newborns in at least three African countries. By the end of five years, the program will be serving approximately 1 million maternal and newborn lives across Africa.

Our goals for the next 1 year include:
To scale up program activities through stimulating partnerships in order to serve at least 100,000 individuals by the end of the year.
To map out and implement the program in at least 3 high need countries in Africa.
To team up support for the program through embracing local and global partnerships in order to magnify program potential.
To engage the national government to support the program through generation of facts-based evidence and research.

5-Year goals:
To further expand the program so as to serve at least a million individuals across Africa.
To implement and start operation in at least 5 African countries.
To lead a multi-national campaign for women and newborns as part of advocacy and awareness creation.
To engage various governments to support the program through generation of facts-based evidence and research.

Financial barriers
The Toto Care Box program being charity oriented and non-profit making in nature, incurs a huge burden of expenditure which often results in financial constraints. The high demand for program deliverables (the box and training sessions) cause sudden breakdowns in activity flow thus limiting the full potential of the program.
Market barriers
The constantly changing market prices for vital Toto Care Box items cause budgetary constraints which affect the execution of the program. The organizations ability to procure the commodities is affected by market changes in price.
Cultural barriers
Due to misleading cultural beliefs and myths greatly rooted in our target areas, the program faces some resistance especially with regards to family planning and birth control. Majority of the beneficiaries shun from discussions revolving around family planning and birth spacing for reasons of their limiting cultural affiliations.

We plan to overcome these barriers through:
Involving the national government through synergistic partnerships which will have a greater overall impact and as well cushion financial inadequacy. We are also currently looking out for interested partners both locally and globally who will support the program through tough financial times. The growth of the business arm of the organization is also looked upon as a great advantage to the program in future.
We plan on increasing our miscellaneous budgetary allocations to cushion us against the constantly changing market forces which affect program execution.
Through education and awareness creation we are now able to demystify misleading cultural beliefs which hinder the program and thus impact potential is magnified.

Our solution team consists 40 individuals.
15 Full-time employees, these include 5 trustees, program coordinator, M&E officer, the admin among others.
15 Community Health Volunteers (CHVs) who are part-time employees working in the communities to collect impact data as well as implement the program through facilitating referrals.
The remaining 10 members of the solution team include the distribution manager and the technical team who carry out essential program activities such as marketing, repairs and distribution. They are contracted by the organization when need arises.

Lucy Kaigutha - Founder and Director
She is a Public Health and International Development professional with experience gained within Global NGO and Corporate entities. As the founder and director of Toto Care Box (TCB), she possesses problem solving and analytical skills. She has worked in projects with AMREF, Kenya Red Cross and the Nairobi City County. She has demonstrated the ability to research, plan, implement and manage projects.

Helen Wanja - Finance Officer
She is a Public Health and Finance Specialist worked on the Kenya AIDS Indicator Survey (KAIS 2012). She has diverse international experience working in corporate, NGO and university sectors both in the financial and public health arena. She is currently the Finance Officer at TCB.

Angela Kavila-Kwinga - Operations Officer
She is a UK trained pharmacist who holds a post graduate certificate in clinical pharmacy. She has 12 years of community pharmacy and Primary care trust experience. She has dealt with drug budgets, formularies and medication reviews where her team managed to save £60,000. As Operations Officer for TCB she is passionate about health and as a mother of three, the TCB cause is dear to her heart.

Jacqueline Wairimu - Marketing and Public Relations
She is an experienced pharmacist and has over 13 years’ experience in technical pharmaceutical and administrative management. She has worked as a hospital & district pharmacist, program manager, development officer in both the public and private sector. Currently Jacqueline is involved in Marketing and Public Relations for TCB.

We currently partner with local NGOs including community-based organizations, churches and health facilities:
NGOs- Lotto Foundation, Afristar, Absa, Buckles solicitors etc.
Health facilities- Lengo medical clinic, Dream Centre, Ruben Centre etc.
Churches- Nairobi chapel
We partner with these organizations to facilitate the Toto Care Box program in various target areas. The organizations provide financial support which aids in the running of the program activities. All of these partnerships are however temporary and with no future commitments.

Our business model involves a baby shop which sells to the public especially high-end women. The business was mainly started to serve the purpose of generating revenue for the organization’s charity arm.
The products we sell in the baby shop include; Moses baskets (baby cots), baby carriers, Toto wraps, breastfeeding pillows, lactation cookies, breast pumps etc. Apart from these products, we offer childbirth classes to women in order to enable them have a fulfilling pregnancy experience and positive outcomes. The classes are conducted by Lamaze certified trainers and involve four sessions distributed in a month.
The business meets its purpose because feedback from the clients reveals that they are satisfied by our products which are of quality and at convenient prices. The customers need these products and services because they enable them provide ideal and recommended newborn care as well as have a positive outcome on their pregnancies. Through the business we have been able to facilitate some of the programs in our charity arm.

To enhance the sustainability of the Toto Care Box program, three main processes have been of importance to us; the annual Toto Care Box Family Fun Run, the Toto Care Box baby shop and donations and partnerships.
Through the Toto Care Box annual family fun run which is conducted every May, we have been able to raise funds as well as create awareness on the program and this has gone a long way in sustaining our program activities and making us known to partners. This year was however unfortunate to us because the run did not happen following the Covid 19 pandemic.
Our baby shop which sells baby products as well as childbirth classes has also been a great source of revenue for the Toto Care Box program. The proceeds from the sales are directly channeled to the charity so that poor and underprivileged women can continue to benefit from the program.
Sustainability for the Toto Care Box program has also been made possible through sustained donations and partnerships. Individuals and organizations have shown great support to the program through giving donations in the form of items, money or volunteering. This has seen us operate despite the many hurdles. The Lotto Foundation and Absa bank have enabled us give 300 mothers hope through the Toto Care Box package.

We apply to Solve mainly because we are aware that our solution would have much greater impact were it not for various limiting factors derailing our efforts. Through Solve’s help, barriers to our intervention including both financial and with regards to revenue generation will be sorted. This would enable us to work and achieve our goals of securing millions of maternal and newborn lives in Africa.
We therefore apply to Solve to seek financial assistance as well as positive ideas that would help us develop our strategy to impact many individuals. We believe that partnering with the Solve team will ease our operations and escalate our impact.

Our partnership goals are geared towards; seeing us use/ adopt technology-based approaches to reach a wider target group and access donors, harness our potential in product distribution and effective service delivery, obtaining revenue through stimulation of synergistic partnerships and teamed up support for the program. Apart from that, we look out for partnerships that would help us market what we do so as to gain more support and acceptability in the communities we work in and those we intend to work with.
We therefore have open arms for any partners or donors who would like to be part of our noble and life-saving cause.

We would like to partner with organizations and initiatives that have the interest of women and newborns at heart such as Solve members and MIT faculty initiatives. We have also look forward to working with other global initiatives for women and newborns such as Child.org, UNICEF, Pathfinder International and USAID.
We wish to work with these partners through synergistic approaches that would see more maternal and newborn lives being saved or impacted. Both financial support and penetration of high need areas would be highly appreciated by us at Toto Care Box.

At Toto Care Box, it has always been our hope to work with women in refugee settings. This is because our greatest calling is in protecting lives of vulnerable women whose autonomy has been compromised by the happenings around them. From our research, refugee women and newborns born to them suffer the most bearing in mind the burden of caring for a newborn.
Our package, the box accompanied with training would help greatly in promoting the resilience of refugee women and their newborns and this would in turn ease their integration into programs that would better their lives.
We therefore wish to be considered for this prize which would help us explore an area we have interest in. Getting the prize would see many refugees impacted positively through programs that would promote their resilience to suffering and harsh conditions.

The Toto Care Box solution perfectly qualifies the innovation for women prize. To begin with, this solution’s main aim is to improve the quality of life of vulnerable women and girls across Africa through improving access to quality Sexual and Reproductive Health (SRH) services including maternity care. The solution pays keen interest to the well-being of expectant women and newborns within their neonatal period in the endeavor to reduce mortalities from preventable causes such as birth complications or absence of skilled birth attendants.
Toto Care Box also looks forward to being a leading women’s sexual and reproductive health rights advocate not just in Africa but also globally. This in the organization’s view will help in the treatment of women with dignity especially with regards to quality care and protection from preventable deaths, something lacking in the current set-up.
The solution therefore not only promotes the well-being of women and girls currently but also looks into the future generations. Should we be considered for this prize, we will be placed at a better place to advocate more for women’s rights.

Our solution qualifies for the health workforce innovation prize because apart from promoting access to quality healthcare for women and newborns, it works to strengthen the health system through capacity building. We have been able to train health workers including nurses and midwives in over 9 health facilities which we have worked with to secure the lives of newborns and vulnerable women.
Apart from training the health workforce, we help in the strengthening of the referral systems by mapping out high need areas and identifying health facilities offering emergency obstetric care. This has helped a lot in the reduction of deaths relating to delays or inaccessibility of health facilities.
We have also worked with health facilities in the pursuit to modify the nature of their service delivery. This has been instrumental especially in attracting young people to the facility because the services are more flexible and friendly to the youths.
We therefore wish to be considered for this prize because it would help us extend our impact to a vast area and thus more lives will be secured through quality healthcare.