Community-Led Health & the Non-pneumatic Anti-Shock Garment

Technology solutions that address postpartum hemorrhage, the leading cause of maternal mortality, are greatly bolstered by community-led health models. 

Problem: Each day, more than 800 mothers across the globe die in childbirth across. 99% of these deaths occur in developing countries and 66% occur in Sub-Saharan Africa, 33.99% of which are attributed to obstetric and postpartum hemorrhage. Approximately 88% to 98% of all maternal deaths are preventable—the challenge is extending that technology to rural communities and building equitable health systems that can effectively treat all women.

Solution: The non-pneumatic anti-shock garment (NASG) is new technology is proven to save lives. This compression garment reduces blood flow to the lower extremities while preserving blood flow to the vital organs, providing the patient up to 72 hours to be transferred to a tertiary facility where she can receive advanced care. This intervention, combined with our community-led health model involving proactive identification and tracking of pregnant women by Community Health Workers (CHWs), addresses the “three delays” that contribute to maternal mortality in rural communities: delay in seeking care; delay in reaching a facility; and delay in provision of adequate care. We are combating these in the following ways:

Delay in seeking care: Many women in our communities prefer to deliver at home, with a traditional birth attendant--women who have been providing health care to their families for generations. We identify influential TBAs in the community and recruit, train, and pay them as professional CHWs. CHWs find every pregnant woman in the community they were, track their case via a mobile app, and introduce them to the formal health system by encouraging them to seek services at a facility. As a result, women seek antenatal care earlier in their pregnancy, and are more likely to deliver at a facility. In Lwala, this has resulted in 78% of women completing at least 4 antenatal care appointments.

Delay in reaching a facility: Even if a pregnant woman in our community has been convinced to deliver with a skilled clinician, rather than at home, once she goes into labor she still needs to get to a facility. Our CHWs secure emergency transport and accompany a laboring mother to the facility. As a result, we have achieved a 97% skilled delivery rate.

Delay in provision of adequate care: Once a pregnant woman reaches a facility, she may still encounter a complication that requires more advanced care at a tertiary facility, including postpartum hemorrhage. The NASG buys a hemorrhaging mother up to 72 hours to be transported. The Kenyan MOH has recognized the potential of this intervention and has called upon Lwala to lead the first county-wide scale-up of this device. Since 2018, four medical doctors, five clinical officers, and 29 nurses from 15 facilities have been trained on this low-cost and efficient intervention. 

Potential: We believe that by professionalizing a previously-stigmatized group of caregivers, TBAs, we are transforming them from the health system's greatest competitor to its greatest advocate. Utilizing this approach and combining it with a low-cost, high-potential technology like the NASG has the potential to greatly reduce maternal mortality in a variety of rural settings.

Traditional-birth attendants are a group of caregivers who have been greatly stigmatized by the formal health system, but have tremendous buy-in from the communities they serve. By professionalizing them as formal CHWs, and further bolstering their efforts with low-tech solutions that effectively treat some of the greatest complications experienced by those laboring mothers they refer, you are addressing all three delays that contribute to maternal mortality in a rural context. 

TBAs-turned-CHWs find every pregnant woman and are digitally enabled with a smart phone, loaded with our mobile application, Comcare. CHWs access and input information about their clients in real-time, and the data is automatically entered into a sophisticated Salesforce database. This allows us to track progress on our key indicators and provides guiding information for our team to provide high-quality care for mothers in real-time. The NASG works by providing efficient, simple, and safe circumferential counter pressure of the abdomen and legs, reducing the volume of blood in the compressed area, while expanding central circulation in vital organs.

We will utilize this growth stage to collect more data on the NASG's effectiveness, so we can advocate for its inclusion in national standards as part of collaboration with the MOH and the national Maternal and Neonatal Health Working Group.

As a result of our success in improving child and maternal health outcomes, the Kenyan Ministry of Health invited us to expand our community-led health approach throughout Migori County. This will influence how one million Kenyans access health care and develop a “model county” to transform the wider health system.

We are training facilities and trainers-of-trainers. 

We are currently serving a catchment area of ~70,000 people, and training facilities in Migori County (~1,000,000).

We will directly serve ~70,000 in the next twelve month as we continue our expansion throughout Migori County (population ~1 million).

Through our internal data systems and partnership with the Vanderbilt Institute for Global Health, we are constantly evaluating and improving our programs. VIGH brings 12 years of experience implementing research, training, and capacity-building grants programs in LMICs. VIGH includes 16 experienced faculty & staff who have operated numerous grants from NIH, CDC, USAID, and HRSA. We have 2 academic papers in the publishing process & are in the middle of a rigorous impact evaluation.

We are advocating for policies that support community led-health models (including transforming TBAs into CHWs, and providing them with payment) at the government level, and ensuring that they are included within sub-county, county, and national strategic planning and budgeting documents, to ensure this approach is sustainable. Expanding throughout Migori County to start is the right unit for scale, as constitutional changes recently devolved health care to the county-level and supporting a county to successfully replicate this model county-wide will pave the way for national expansion. 

As we seek to advance community-led health models, we recognize the importance of aligning ourselves with organizations and thought-leaders that we can learn from. The important role that CHWs play in strengthening health systems has been widely championed, but national roll-outs have not demonstrated the impact we know we can have. We are eager to combine efforts with other systems-changes leaders in global health, as we continue to advocate for community-led health models and policies that support them at various levels. We believe MIT Solve and its cohorts could be an excellent partners in helping us achieve this.

A key barrier is demonstrating that community-led health models have the potential to not only scale, but complement effective technology solutions that address some of the greatest health challenges facing rural communities. We believe that MIT Solve can help by introducing us to other leaders who have effectively been able to combine the two (community-led health, and technology), and scale both their model, as well as the innovative technologies they utilize.