Reaching Unreached Using GIS Solution

In 2019, Kenya recorded an infant mortality rate (IMR) of 35/1,000 and maternal mortality ratio (MMR) of 362/100,000. Marsabit County is occupied with pastoralist community and is among top leading in Kenya with MMR of 1127/100,000 and IMR of 44/1000. Pastoralist Mothers are burdened with search of water and pasture for livestock, which keeps them constantly on the move. This situation has seen expectant women, who are mostly illiterate, unable to access maternal child health care services as per national and international standards given that the existing health facilities are static, ill-equipped and distance apart. We will install a coin-sized solar-powered GPS tracking and alert device into traditional jewelry worn by pastoralist women living in Marsabit County so that we can 1) locate the women as they move so that services can be delivered to them and 2) remind the women that a mobile team is due to meet them.

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. Africa and especially sub Saharan Region has the highest burden of maternal and Perinatal mortalities. In Kenya 7,700 mothers die every year to pregnancy and birth complications and 40,000 babies die during the first 28 days of birth. Pastoralist Counties are among top 10 Counties leading in MMR and IMR in Kenya. Marsabit is the fouth highest with a MMR of 1127/100,000 live birth (KDHS 2014) as compared to the global figure of 216/100,000 (UN –Inter-agency estimates) and the SDG goal of 162 per 100,000 live births. Pastoralist Mothers are mostly burdened with the search of water and pasture for livestock particularly during the dry season, a situation which keeps them constantly on move. High poverty level and high illiteracy levels also aggravate the situation. Due to poorly developed and inaccessible health care services,there is: Inadequate ANC and neonatal health service delivery; Inadequate capacity to meet needs because women can’t be located regularly; Inadequate awareness of importance of ANC profile. 

To reverse this situation, we propose to provide an integrated maternal and child mobile service entailing provision of free pre/postnatal, laboratory and immunization services. ANC profile is a cornerstone of health care of pregnant women because it dictates many health interventions they need to ensure safe delivery. Targeted expectant women would be fitted with electronic bracelet to track them and pin point their exact position and given prior beeps through the electronic bracelet to avail themselves to an agreed central point for the services. The “Integrated maternal mobile health care service for Pastoralist Mothers Tracked Via Solar-Powered GPS Bracelets “program differs from other approaches because women can be easily traced, In case they fail to turn up for ANC appointment and also fail to bring their child for immunization using the bracelets. This project will focus on Identification of expectant women in community, Immunizing them against tetanus which is the first step in saving baby’s life, laboratory profiling to detect any diseases for early intervention, continuous ANC follow-up to birth and then immunization of new born up to 12 months with continuous health education.

The solution will target pregnant women in most marginalised area in Kenya. The total population of the County is 459,785 as per 2019 census data. Women form almost half of the population and  about 21% of this population are women of the reproductive age while children under five years are about 20%. The project will work with a locally registered Non-Governmental Organization (NGO) called Strategies for Northern Development (SND), which has been serving the nomadic pastoralist communities in Northern Kenya (Marsabit, Mandera and Wajir Counties) and over the years have implemented several health projects in the area and have better understanding of their needs. A study conducted by the team in 2015 to explore the importance of comprehensive antenatal care services in reducing neonatal mortality in the project area, determined that Children of women who had no antenatal care visits were 2.7 times more likely to die within 28 days of birth compared to children born to women who had 1 antenatal care visit, and 8.5 times more likely to die compared to women who had at least three antenatal care visits. Our approach will reduce maternal and neonatal mortality through early diagnosis of preventable conditions that affect birth outcomes.

While early and prompt laboratory diagnosis have been known to reduce significantly maternal and infant mortality by providing early detection of disease of life threatening condition necessitating mitigetory and remedial strategies in the handling of the expectant mother the same cannot be said of mothers in Marsabit County. Our solutions aligns with the challenge as it seeks to expand access to high-quality, affordable maternal and newborn care for women, new mothers and newborns. There is political good will for the project and great partnership with both faith-based and governemnt health facilities will ensure success of the project. 

Our project will focus on the pastoralist women’s use of jewelry as an
adornment. Among pastoralist women, they prefer wrist bracelets or arm bracelets or more so necklace. However, the bracelet we propose to use look attractive and that is why suggested it be embroiled with beads particularly with preferred colors like red, yellow, green and white. As to why we need the bracelet, it is simply for tracking them given that pastoralist women are ever on move either searching for water or pasture. Equally the groups can help the service providers to triangulate their position and their route maps. Alternative to the bracelet will be fitting the women with electronic chips which will not be culturally acceptable. The bracelet will be designed in such a way to give periodic beeps reminding the women of the pending mobile lab teams’ visits to an area that had earlier been agreed upon. The beep
can be 2 days prior to the visits. This will guarantee high turnout for the mobile visits which translate in the reduction in maternal and neonatal mortality rates. In the proof of concept of our approach, being waterproof, small and culturally designed with bright orange beads made it acceptable for them to wear. The fact that the GPS are powered through solar is also innovative. The bracelets are automatically charged via a tiny fitted solar panel that absorbs light while on the wrist. Few would have been able to afford the device if it was designed to run on batteries.

Our solution will utilize a coin-sized solar-powered GPS tracking and alert device into traditional jewelry worn by pastoralist women living in northeastern Kenya (Marsabit County) so that we can 1) locate the women as they move so that services can be delivered to them and 2) remind the women that a mobile team is due to meet them. The GPS signals from the bracelet devices will be accessed from a secure computer at the operational centre and can be downloaded as .csv or .xls files. The GPS locations are then overlayed on the google maps to identify clustering of the women and in conjunction with the project support team on the ground, agree on appropriate location where best to set up camp. In locations where the GPS signal is patchy, the community are asked exactly where to find the women.

The approach we are proposing has already been piloted using 300 mothers in Marsabit County through a seed grant provided by Grand Challenges Africa through African Academy of Sciences, in partnership with the Bill and Melinda Gates Foundation, to put her concept into practice. During the pilot phase, the project surpassed four antenatal visits for each mother, as recommended by the World Health Organization. There were also zero deaths of both mothers and infants. The project registered 5,099 treatments for under and over fives, more 200 immunizations, 526 laboratory services, 2671 nutritional assessments for under fives and offered health education to over 5000 women. The project was also able to offer over 50 refferals for women. Below are some of the links for the successes of the pilot project.

https://www.globalcitizen.org/en/content/solar-bracelets-protect-kenyan-mothers-babies/

https://www.designindaba.com/articles/creative-work/using-empathic-design-save-lives-pregnant-women

https://news.trust.org/item/20190502074519-kee4n/

The overall goal of the project is to enhance access to quality health care for pregnant women, mothers and infants among pastoralist women in Marsabit County. The jewelry-encased GPS device will help us track pregnant pastoralist women, improve labatory servcies delivery to this population, which will reduce poor maternal and neonate outcomes. While early and prompt laboratory diagnosis will reduce significantly maternal and infant mortality by providing early detection of disease or life threatening conditions requiring refferals. For implementation, we will take the following key action steps:

• Sensitize and train sub county and county level health care workers so that they view activity as part of their scope of work, they will need training in use of solar powered GPS bracelets
• Provide the training to health care workers on how to monitor the GPS signal in order to trace expectant women movement

The Services that project shall give before birth is to identify the expectant mother to whom prenatal services shall be provided which shall include laboratory screening for Venereal Disease Research Laboratory(VDRL), Malaria parasites, HIV test, Blood grouping ,Heamoglobin level and urinalysis using rapid laboratory kits ,this will assist in early detection of disease and appropriate action taken on time. At birth the project shall strive to have safe deliveries at nearest health facilities where appropriate. Where not possible traditional birth attendance shall be expected to provide the service and this shall mean providing them with appropriate skills and protective gears example gloves and mackintosh and  after birth the integrated mobile team will conduct maternal visit where child weight shall be taken and appropriate vaccine given and continuous laboratory test like Hemoglobin level using rapid kit, a long side this visit appropriate health education to the women and the larger community shall be given and shall include importance of breast feeding, basic hygiene and family planning.

Multiple data collection methods will be used to monitor project progress. We will collect data on pastoralist movements over time to share with other programs. We will have more accurate data on common complications of a sub-population of women of child-bearing age. 

Current numbers served: 300

Numbers to be served in a year: 5,000

Numbers to be served in five years: 25,000 

The overall impact of the project is to enhance access to quality health care for pregnant women, mothers and infants among pastoralist women in Marsabit County. We intend to achieve that by documenting success (using various indicators – access, outputs, increases in ANC assessments, decreases in morbidity and mortality), we will expand the project so that it becomes integrated into the project area health facilities standards of care and operating procedures related to ANC and ANC
profile activities. We are sure that this is possible and sustainable because of 1) the inexpensive and highly durable and long-lasting technological tool we will use; 2) the limited interference the tool will cause the women (it will be a piece of culturally relevant jewelry that will not be an inconvenience); 3) the new lines of data on this population of women will aid decision making within the sub-county and hopefully the country as it continues to
address maternal and neonatal health challenges. If the project moves forward, we will seek to publish our methods, processes, and findings in open-access peer-review journals. We don’t want to only share “what works” but to share the “road map” of how we did it so that replication and adaptation to other populations and settings becomes possible. The project evaluation shall be conducted both mid team and end team. The evaluation team shall involve critical implementer’s relevant stakeholders and possible consultants with an expertise in maternal health care.

Our biggest challenge is that more bracelets are required that can cover longer ranges – and, ideally, operate as a two-way system in case of emergencies. This goes hand in hand with expanding the project to cover the whole of the Marsabit county and other pastoral counties

Inability to access the women who crossess the border into the neighboring countries. Due to international laws, it become impossible to access them with outreach services

The area is conflict prone and there are alot of inter-community wars that frequently errupt fuelled by scarcity of pasture and waters

Road network: Marsabit County is predominantly crisscrossed by poorly developed earth road that are impassable during rainy season inhibiting mobility and accessibility  

For the bracelets, we intend to improve on the design of the bracelets to have more long range devices and make them two waysin which case the mother can relay a signal to project team when in distress and receive reminders as well. We will seek to create partnerships and apply for more funding opportunities

For crossborder movement by mothers and issues of conflict in the area, we will work closely with the local admnistration and we will seek to remain neutral and where possible use our soultion as a way to create peace and co-existence within the warring communities

For poor road network, we intend to use four wheel drives for all missions and will work closely with the county governemnt who in the past donated vehicles for project use

There will be 5 core project team and we shall work closely with up to 50 support teams from the government and faith based facilities to offer the outreach services. We shall also engage up to 100 community health assistants through the well elaborated ccommunity strategy for community mobilization and entry. 

The solution willbe channeled through the Field Epidemiology Society of Kenya (FESK). The Field Epidemiology Society of Kenya (FESK) was registered in 2013 as a professional society in Kenya. The organization is a non-political, non-ptofit body created maintain a network of Field Epidemiologists who have graduated from the Kenya Field Epidemiology and Laboratory Training Program (K-FELTP). Its vision is to be a leading network of Epidemiologists in Africa with a mission of building a sustainable network of Epidemiologists in Kenya and the region who can positively contribute to the improvement of Public Health. FESK boasts of a large data base of more than 200 members providing it with a high leverage and comparative advantage in matters epidemiology and public health. FESK has an excellent track record of managing grants and is currently managing three grants with a portfolio of US $ 500,000. FESK has also demonstrated established mechanisms and good track record of successfully undertaking field studies in Kenya. 

We intend to partner with The Strategies for Northern Development (SND), is a registered local Non-Governmental Organization working with nomadic pastoralist communities in Northern Kenya (Marsabit, Mandera and Wajir Counties) as the implementing partner whereas FESK will deal with the administrative and technical aspects of the project. The vison of SND: “Resilient and empowered pastoralist communities who are in control of their lives and livelihoods”. Mission statement: “To empower and enhance northern Kenya pastoralist communities’ resilience to poverty shock, climatic extremes and their impacts through secured livelihood, access to affordable quality education and health care services, as well as good governance”.

We also intend to work closely with county health department as well as other private and faith based health institutions working in Marsabit county. The county government will provide the needed healthcare workers who will be core to the success of the project as well as provide transport logistics for the project. The other partners will provide technical support to the project

The team lead is currently in partneship with AMREF Health Africa Innovate 4 Life which seeks to create more partneships for the project 

The service we intend to offer will be a free service intend to enhance access to quality healthcare services. The services will not be charged but quality antenatal and postnatal services integrated with laboratory services is a key to healthy society. This also has a roll over effect on improving lives and livelihoods of the populations.

For scaling up our solution, we seek to use two paths. First by contuining to establish value for our solution, we seek to work with the county government to integrate our solution into routine service for sustainability. Our alternative path is to continue to create partnerships with like minded organizations and seek additional fundings through donations and grants to upscale the solution.

From the seed grant from the Africa Academy of Sciences and Bill and Melinda Gates Foundation, we were able to prove that our solution can work and help improve access to healthcare and reduce the unneccesary maternal and infant mortalities. However, for the pilot phase, we only used 300 mothers in one of the subcounties in the larger County. We seek to expand our solution to cover more mothers and more counties and improve on the device we are currently using to make it more efficient. This will enable us to continue saving lives of mothers and children in thi vulnrable community and impact positively on their lives.  

We will need more partnership to build a business model for our solution which is currently lacking; improve on the current technology of GPS which is short range to long range for better tracking; seek more partnerships to expand and upscale our solution to a wider population by developing a funding a nd revenue model; develop a robust monitoring and evaluation system to documents and capture processes, lessons learned and success stories and even challenges faced by project for future improvements; and partneships in marketing and media exposure to showcase our work