Wekebere pregnancy monitoring system

In low-resource settings, most hospitals are overcrowded, understaffed, and ill-equipped. Vulnerable expectant mothers suffer most from this strain, and often die from preventable causes. With our first product, currently in development, we are targeting the problem of high maternal and infant mortality. Nearly three million mothers do not survive during pregnancy and child birth in low-resource settings. 80% of these deaths are preventable; the primary causes are complications of preterm birth, birth asphyxia, and infections. Although these conditions can be treated with known interventions, many expectant mothers do not receive the attention they need because facilities are understaffed and under-equipped. Midwives in these facilities rarely have necessary tools needed to provide high quality neonatal care. As a result, vulnerable expectant mothers are suffering- avoidably. Many initiatives have focused on preventing or treating the primary conditions, but there is an unmet need for tools to help overburdened healthcare workers better manage high volumes of patients. Midwives’ current standard of care for monitoring fetal being is to periodically count heartbeats or breaths manually, and share a thermometer or pulse oximeter if one is available. Without proper equipment or staff to routinely monitor vital signs, high risky mothers in distress often go unnoticed, their health deteriorating and likelihood of effective intervention declining. Gold standard monitors used in high-resource hospitals are prohibitively expensive and inappropriately designed--if donated to a low-resource environment, they often end up in the “equipment graveyard” within a year

Wekebere is one of the proposed solutions. Wekebere (meaning ‘check yourself’ in the local language) is a phone-based Application that is attached to a hard-ware device that enables mothers to self-monitor the status of their foetus. This innovation uses an AI-powered wearable home-based device and android application to monitor and collect maternal and fetal health (parameters) information to predict pregnancy-related complications and provide personalized risk assessment and early referral. It builds in the natural curiosity by mothers to ‘listen’ to their unborn babies. When these devices are strategically placed at maternity centers, they can attract mothers to ‘hop-in’ for check-ups. As mothers check on their foetal well-being, data on other important parameters related to the pregnancy can be collected, using question prompts from a mobile phone device. For mothers who are at highest risk, the device can be taken to their homes, enabling their physicians to receive 24 hour tracking of the mother’s health, an enabling appriproate decisions to be taken.
Our solution improves women and girls' wellness through a targeted approach on pregnancy monitoring in expectant mothers to detect high risk pregnancies and promote timely medical intervention,averting the risk of death for the mother and the baby. Our solution works to tackle downstream factors to allow women and girls to live more fulfilling lives. Good health is a cornerstone to productivity, with poor health often resulting in lost work output.

Our customers are rural and peri-urban healthcare providers. Across Uganda and similar African markets, they serve over 70% of patients seeking care. They operate in areas suffering from weak access to urban centers and whose residents make $50-$200 a month. These areas have a high concentration of medical facilities but sub-optimal care quality, with limited clinical and diagnostic support. With the right tools, these facilities can bolster the entire healthcare system and play a critical role as the first, and often only, health access point. Strengthening existing primary care will enable millions of individuals to access appropriate care and timely treatment locally. Our research period, which involved 1300 small and mid-sized medical facilities, demonstrated that providers feel unable to meet their patients’ diagnostic needs as they don’t have access to the right tools, technology, and specialized skills. We are working with them to understand how telemedicine and affordable pricing models for new diagnostic technologies can help bridge this need and have jointly piloted this solution in our existing peri-urban facilities. These discussions have encouraged us to scale this product suite to more remote communities to reach millions of ugandans, and later East Africans, who currently can’t access advanced ANC screenings.

Founded in 2017, wekebere is social enterprise developing sustainable and impactful medical solutions. Co-founders Stephen, Daisy and gerald began wekebere as undergraduate students in software Engineering at Makerere University, after witnessing firsthand the massive opportunity to sustainably improve health outcomes for vulnerable mothers in low-resource settings. We have raised over $80,000 and have been recognized  in innovate for life and Young Ict Visionaries Award, selection as a top 10 Company using technology  Changing Africa (2017) We have also participated in accelerators including Up accelerate,and Innovate for life .

We believe Solve’s mission to promote the health of pregnant women and newborns directly aligns with what we are seeking to achieve. To this end we seek help from Solve to help overcome the following barriers:

Scaling, Partnerships, and Regulatory Support: We are looking for experts and potential partners in our target markets who can support and guide us through new market entry, local partnerships, and the regulatory landscape as we scale. As we move into more rural areas, we are looking for partners who can support us in building out a distribution model that will work for the last mile. We are also looking for other health companies build our network of health stakeholder partners on a global level. 

Software Development: We are seeking support in developing our tech platform and associated software solutions. As we intend to move into remote care and automated care, we are seeking further technical support in making sure our solutions work seamlessly and ensure patient trust. 

Grant Funding: We’re also looking for in-kind contributions that will allow us to subsidize the wekebere device so small facilities can access these devices at lower up-front costs.

Training: We are finally seeking support to operationalize our telemedicine strategy, building a network of remote midwives and implement training programs geared towards facilitating gynacologist uptake of basic wekebere fetal monitoring system.

We leverage the exponential developments in smart wearable devices to bridge the pregnancy diagnostic gap across rural and peri-urban markets, and bundle these devices with smart financing packages to tackle the two fundamental issues hindering higher uptake of ANC services: high specialization needed to operate legacy equipment and significant upfront capital costs needed to purchase such tools.
Our solution allows for non-specialized expectant mothers to pair with trained midwives to deliver ANC services, and our flexible monthly payments minimize the financial burden placed on these low income earners. Moreover, this model allows for these services to exist locally, mitigating patients’ need to travel long distances. Our solution brings advanced fetal monitoring to these patients’ communities, so pregnant mothers can enjoy improved maternal health outcomes at home

The feedback systems of our solution are designed to be easily understood by different care providers with different levels of experiences. To address the needs of the users with hearing problems, decreased vision and color blindness, Wekebere provides the heart rhythm in three different feedback channels; as a number on the display, a LED over the display flashing in sync with the heartbeat and a speaker that plays the fetal heart sounds. To better guide the user on which number and beat is good or bad, the visual feedbacks changes color in relation to the child's heart rhythm and appear in green (normal heart rhythm), yellow (abnormal heart rhythm) and red (abnormal heart rhythm over time). These color contrasts were adjusted to be distinguishable even by colorblind users. Wekebere is suitable for all health workers related to maternity care, from highly trained doctors to midwives with more limited education

We plan to target markets where obstetric care and key diagnostics are currently unaffordable or inaccessible to patients, making all underdeveloped markets needing tools for better quality care potential targets for our products. By Q3 2022 we are targeting 1000 Ugandan mothers , and 5 key priority health areas. By Q4 2022 we plan to expand our services to 1,000 similar healthcare outlets in Rwanda and kenya serving an average of 10,000 patients annually. 

By 2025, we see Wekebere as a pan-continental, decentralized prenatal monitoring network present across 10,000 medical clinics and pharmacies, in Kenya, Uganda, Nigeria, Tanzania and Ethiopia. Our network will support thousands of pregnant mothers and provide ANC services. 

Our theory of change includes several steps to measure impact. In the short term, in our pilot studies we are tracking outputs such as number of pregnant women monitored and hours of monitoring logged, and looking at improved care for expectant mothers through intermediate outcomes such as how often a midwife responds to aberrant vital signs, how often she adjusts treatment, and how a midwife’s workload is reduced by saving time manually measuring vital signs. In the long term, we will be looking at how implementation of our device improves maternal and infant mortality and morbidity rates.

We will use the following impact indicators to measure success and to compare data from a comparison group, such as an adjacent Doppler’s intervention area receiving standard maternal care at labor and in the last two months of pregnancy. We expect a difference (effect size) between the two groups of at least 15– 20 percent in the achievement of these indicators, as follows: 

1. Reduction in neonatal mortality rates at study sites (assessed within 28 days of life) 2. Reduction in the incidence of neonatal asphyxia because of early detection of fetal distress by wekebere solution and the resulting improved antenatal and intrapartum management (assessed within 28 days of life) 3. Reduction in the incidence of infant developmental delay (assessed periodically within the first year 

of life) 4. Improvement in feeding behaviors and breastfeeding rate and quality (assessed during the first six 

months of life) 5. Improved infant cognitive and behavioral indicators at one year using standardized assessments. 

Indicators 3, 4, and 5 are based on the premise that prematurity leads tolong- term morbidities. Early identification and prediction of premature labor through wekebere, and effective labor monitoring through wekebere system, will lead the clinician to attempt to prolong the pregnancy (for example, by administration of tocolytic drugs) or provide appropriate obstetric intervention (for example, providing steroids for fetal lung maturation) to reduce newborn morbidity (commonly from asphyxia) and improve short-term and long- term infant health and developmental outcomes. 

If we deliver affordable, telemedicine-enabled, obstetric ultrasounds linked to remote midwives via local primary healthcare providers, we can enable pregnant mothers to access essential ANC  in order to identify risks of pregnancy-related complications early and improve maternal health outcomes.

We spoke with healthcare providers in 2021 to understand pain points in providing care to their communities. They voiced that most women missed critical ANC visits due to lack of key services such as obstetric ultrasounds which led to high patient leakage. Facilities also indicated that they did not have the financial resources or technical skills to provide these services to pregnant women seeking ANC care at their facilities. These realities were backed by researchers at makarere university who showed that wealthy women had 2x higher odds of receiving ultrasounds when compared to poor women, even across high-risk groups. Thus for women living outside of urban centers, the acute risk of pregnancy complications and resulting morbidity and mortality persists.  Additionally, a study by peter waiswa etal shows how demand generation techniques (such as those used by wekebere) can significantly increase patient volumes. Demand generation led to a 6x increase in patients visiting clinics in Uganda to receive antenatal care services, shifting health seeking behavior to promote life-saving screenings that were previously undervalued.

Our logical framework is outlined below:

Activities/Inputs: We provide affordable, telemedicine-enabled, fetal monitoring devices to local small peri-urban primary care providers, combined with flexible financing, and linked to remote specialists for accurate obstetric scans during pregnancy.  

Outputs: New local primary care facilities are recruited. Pregnant women receive obstetric ultrasounds at ANC supported by local staff and remote specialists. This increases patient trust of telemedicine services as their local providers are integrated into their care.

Outcomes: Maternal and neonatal complications are identified and patients are able to receive appropriate treatment more quickly. Clinics see an increase in patient numbers. 

Impact: Identification of pregnancy-related complications leads to improvements in maternal health outcomes and decreases rates of maternal morbidity and mortality and improves infant health outcomes. 

Our system leverages simple, cost-effective sensor technology to measure crucial health parameters. The wearable’s listens to electrical activity to obtain the fetal heart rate and uterine contractions. The system also utilizes Bluetooth Smart for a local centralized monitoring system. Furthermore, our solution collects valuable frontline health data in areas where data is a major challenge; the backend data are invaluable to stakeholders, such as NGOs and ministries of health, as we work towards large scale maternal health initiatives.

 Our key mandate is intrinsically women focused given that the Wekebere device is built and customized to serve the women as a niche market.Our current hiring process on product validation and refinement is giving priorities to women with the current 10 recruited midwives having over 80% being women

Our lead advisor who has a background as a biomedical engineer,Philippa Makabore is a woman and we are looking to recruit more women to join the leadership roles in the business as we gradually grow

Business- to- consumer (B2C): Direct engagement with pregnant women. Because wekebere is portable, wireless smartphone– connected devices, we might make them available through an appropriate market channel to engage pregnant women directly and offer them consultation by allowing them to select a doctor. 

Business- to- business (B2B): Government and developmental organizations. We target government and developmental organizations for large sales with the initial pilot. The B2B model will involve direct sales of devices and an annual contract for software maintenance and updating. We also plan to experiment with a service model, in which our solution is paid for every test performed and there is no capital investment. This model can be implemented through nongovernmental organization champions who work or wish to work with the government. It can increase the scalability of the solution. 

B2B/ Business- to- business- to- consumer (B2B2C) in private hospitals: Wekebere will be offered to private hospitals on a subscription basis. There will be fees for enrolling in the system and recurring costs on a monthly basis, which will also include maintenance and software. We do not plan to position our system only as a fetal heart rate diagnosis device or a labor monitoring tool but more as a solution for fetal well- being, and we expect to extend additional services. For example, the results obtained our solution can be auto- interpreted and a prediction algorithm developed to correlate them with neonatal outcomes. This solution can link midwives, doctors, and gynecologists in low- resource settings with doctors and gynecologists in the urban segment or with medical experts for additional online (and remote) consultation.

We plan to achieve scalability through the following growth model. We want to present and market the solution differently in the private versus public and urban versus rural health segments. In the private sector, we want to enable monitoring of high- risk mothers, both in clinics and remotely supervised by health workers. First, we will collaborate with the most influential urban midwives, gynecologists and obstetricians and promote the solution through local midwives and nurses union and conferences. Meanwhile, we are establishing a collaboration with the Association of Obstetricians and Gynecologist of Uganda (AOGU), which includes 15000 gynecologists. Auto- interpretation of data will provide more objective and frequent results for remote monitoring. In the rural segment, where there is an acute scarcity of health professionals, we will enable physicians to conduct nonstress testing and monitoring of uterine contractions. The system’s auto- interpretation of data and the grade of severity flagged by the prediction algorithm will reduce dependence on the doctor. We can also extend fetal monitoring services through ground- level health workers, to enable nonstress testing at home or at nearby sub centers, during home visits, allowing patients with any anomalies to be promptly referred to secondary or tertiary facilities. Our solution also aligns with the objectives of the government of Uganda and ministry of health to reduce maternal and infant mortality. When used at a facility, it can increase the rate of institutional deliveries, a key objective of the government’s National Health Mission to reduce maternal and neonatal mortality.