Community Health Worker (CHW) equipment

iMobiMaMa is an mHealth project conceived by gynaecologist Dr. Carol Thomas, and incubated by The Design Cradle. They in turn commissioned me to consult on project management, field-research and design related issues. Of interest, medical related projects frequently contain a depth of expertise from a variety of stakeholders, yet a mechanism to link such knowledge and diverse skill-sets is often missing. Consider the potential for discord between the accredited knowledge of Doctors and supporting staff, with the undocumented, intimate and often discredited community knowledge. Understanding and providing a mechanism to bridge ‘competing’ knowledge bases often results in novel and innovative solutions being identified, particularly beneficial for mHealth projects that work within competitive market dynamics. For more information on the project itself, please see the following text provided by The Design Cradle, and the subsequent links to the concepts which have been developed.

Aimed at assisting to reduce maternal and infant mortality, two of the Millennium Development Goals, iMobiMaMa is a unique, innovative interactive mHealth (mobile technology-based) service which connects poor women in South Africa to the targeted maternal and perinatal information, advice and public health services that help prevent fatalities during pregnancy and childbirth. Conveniently located, mobile iMobiMaMa vendors are equipped with mHealh stations at which pregnant women can test urine and measure blood pressure, height, weight and detect fetal heart rates. The information is fed directly to the iMobiMaMa Hub which registers data and assists women to track their pregnancies for progress and potential complications. The vendors are health entrepreneurs who are trained, supported and monitored by iMobiMaMa in collaboration with partner community-based organisations. At every stage of contact with iMobiMaMa, pregnant women are encouraged to access public health services timeously.

iMobiMaMa’s SMS service engages pregnant women in communication about individual pregnancy progress. Health professionals at the iMobiMaMa Hub record pregnancy data and respond with information relevant to individual gestational milestones. The reduction of maternal and infant mortality are two of the Millennium Development Goals. South Africa, despite free health care for pregnant women and children, is one of the poorest performing countries; recording “no progress” in mortality rates in a 1990 – 2010 WHO/Unicef study. Yet, the major causes, besides HIV/Aids, are preventable ones: untreated hypertension and bleeding during birth. Early pregnancy booking of health services is proven to reduce complications threefold. But according to the national Department of Health 40% of of first bookings are made after 20 weeks. Mobile technology has been identified as an effective tool for encouraging early engagement with public health services. A number of mHealth organisations exist to disseminate information to pregnant women. But their communication model is a one-way one, allowing for little effective measurement of impact. By contrast, iMobiMaMa’s interactive, two-tier model enables targeted support; tracks individual pregnancies; and facilitates the measurement of impact by health and public facility partners.

The iMobiMaMa Project also offers other significant benefits to government. It facilitates an extensive Pregnancy Register, provides information on available public health facilities and the services offered (including access to safe abortion services), and helps to develop a cadre of community health providers that supplements the NHI. It also offers economic opportunities for unemployed youth and women. Future plans for iMobiMaMa include a National Map of Health Facilities' Services, Emergency Transport Links and a Mobile Money solution to facilitate cashless transfers of money. Long-term economic sustainability plans for iMobiMaMa include scaling throughout South Africa and into Africa, vendor franchising, fees for measuring/testing services, Branding, Advertising & Public Service Messaging, and retail of mother and baby items from mobile iMobiMaMa vending stations.

The above concept looks to traditional kiosk vending in public spaces. The community health care consultant uses the kiosk as a means to interact with the community, sell third party product, and in some instances provide a confidential ‘space’. Its collapsible and mobile design allows for transport by bicycle, and also secure storage at the consultant’s home or public venue such as a shopping mall. It can be constructed in roughly twenty minutes, with transport mechanisms and stock being stored within the volume when in use. The counter top allows for a general desk consulting to be carried out, and in the event that a private session is required, a soft mattress and pull-down privacy blinds can be installed. In small communities, where miscommunication and rumour can lead to social divisions, privacy in some cases is of utmost importance.

The above concept caters for a variety of users and contexts, from home based consulting to public awareness campaigns. The modular clam-shell and selective faceted surfaces allow for the initial compact luggage assembly to reassemble into an upright kiosk or consulting desk. In both cases the electronics and touch screen remain accessible to the user, and third-party sales stock are displayed to the consumer. The construction method is such that it can be re/assembled without tools so it can be used effectively by non-technical individuals and those lacking brute strength. The same fixing points that facilitate the kiosk and desk constructions, also allow for straps and handles to be assembled when the product is transported in a luggage format. Importantly, the project in general aims to provide a secondary income to the home care consultants, and as such, the compact size of the unit when transported on public and informal transport does not incur additional costs.

The above concept is specifically designed for home based care visits. The intimate and contextual nature of community health care necessitates that the health workers spend a large portion of their day travelling between patients, and often in areas that do not have public transport. The above concept aims to alleviate the physical stress associated with transporting equipment and products to the patients in a manner that is not restrictive. It uses modular technology / manufacturing processes to allow the user to construct the vehicle of preference. The basic unit is a cylindrical and mobile storage component which removes load carrying. An upgrade to this unit is the inclusion of a scooter styled platform which allows the user to coast rather than walk. The low centre of gravity, two handled operation, large front types, and wide platform allow for an easier negotiation of street hazards, curbs and potholes. Another upgrade is the inclusion of charging technology, which through the uses of regenerative motors, allow for energy to be captured and charge, for example, cellphones. Fold up mechanisms allow for the product to be transported on public and informal transport without incurring additional costs.