Yagiten Pvt. Ltd
The life of people in the remote mountain village is tough because of the absence of basic services such as communication, health and education. Comparing with others life of pregnant mother and infant baby is much vulnerable. The pregnant mothers are often put under a great deal of pressure from their own family both directly and indirectly. Maternal mortality is high because of lacking knowledge and sincerity level during prenatal, natal, and postnatal periods in community members. According to Nepal demographic profile 2012 the infant mortality rate in Nepal is 43.13 deaths per 1000 live births and it is ranked in 53rd position where this value is higher than Bhutan and Sri Lanka. This problem is not only lack of infrastructure or services but also lack of knowledge of family members and the community is a factor enforcing unsporting behavior to the pregnant women. Pregnancy process is not related only with pregnant mothers but also simultaneously her husband should be responsible and be aware and educated about the process during prenatal, natal, and postnatal periods. Lots of risk and dangerous can be minimized if husband and wife discussed enough about their pregnancy process and baby.
Due to the difficult topography, villages are scattered and distance between house hold with local health post and birthing centers are in quite far distance. Birthing centers and local health post does not have enough data about numbers of pregnant women in their service area. This is the reason that birthing centers and health post could not make proper preparation during the emergency.
Internet and smart phone application such as Android can overcome most of addressed problem in such area. Now most of the villagers whose family members are in abroad are carrying smart phone device and accessing internet to use Facebook, Viber and Skype. “Amakomaya” pregnancy mother’s related android application has open new way of using mobile for rural women. With the help of Female Community Health Volunteer (FCHV) and local health workers pregnant women can register their name and telephone number with their last menstrual period (LMP) date, health post code and respective FCHV code. According to the LMP date the application presents the periodic weekly audio, video and text content and reminder notification for ANC visit. The application can be accessed by health workers, FCHV and Nepal government district health officers (DHO) according to their access level and permission. From the application health workers can know about numbers of possible pregnant women who are nearby delivery and can do essential preparation in the birthing centers accordingly. FCHV, local health workers, DHO and pregnant women themselves are end users of application.
At the moment there are more than 400 pregnant women has been registered and downloading “Amakomaya” android application. More than this the audio, video content have been copied and shared more than 3000 people by using mobile external SD card.
The life of people in the remote mountain village is tough because of the absence of basic services such as communication, health and education. Comparing with others life of pregnant mother and infant baby is much vulnerable.
According to Nepal demographic profile 2012 the infant mortality rate in Nepal is 43.13 deaths per 1000 live births and it is ranked in 53rd position where this value is higher then Bhutan and Sri Lanka. This problem is not only lack of infrastructure or services but also lack of knowledge of family members and the community is a factor enforcing unsporting behavior to the pregnant women. The pregnant mothers are often put under a great deal of pressure from their own family both directly and indirectly. Even though it is not an intention of putting mother in hurt or pain, but lack of awareness and sincerity of possible risk and dangers during pregnancy period.
[Case study 1] Devi Purja 35 years old, a pregnant mother from village Ramche-2. said- 3 years ago I had delivered dead baby son on its 8 months of time. At that time I did not know how it happened and what was it’s cause. Again now I am pregnant and running in 6 months. I do not know what I have to do next. Just wait and see. If it is my luck I must have to accept it.
(This statement has been collected during case study collection before developing preganency support web-application in 2011)
[case study 2 ] Ram Maya Pun, Female community health volunteer (FCHV) worker from Nangi village said- Most of women in village are shy and does not easily share pregnancy related issues. We have to use many direct and indirect people to get the information about who are getting pregnant in the village. Some time they come with us when cases are in critical situation. (This statement has been collected during case study collection before developing pregnancy support web-application in 2011)
So there exist various types of problems for example most pregnant women are informed, and understand the information regarding pregnancy but due to the surrounding environment they are not able to act according to the necessarily for them. So the problem is not only related with pregnant women but also other members and partners who are having a lack of understanding during the involvement in the prenatal, natal, and postnatal periods. Due to cultural issues the man (specially husband) rarely has a place in the prenatal, natal, and postnatal phases. If he shows affection for the child and partakes in the care and upbringing he is often viewed as a “girlieman” by the community. Husband don’t feel they need to be involved in the whole prenatal to postnatal phase. It is the behavioral and cultural change we need to tackle. Husband believes it is “a household chore” to take care of a baby. The value system encourages this behavior. The men don’t have a role during the natal or postnatal periods. They don’t clean the baby, feed the baby, and change the diapers and so on. If they do these chores the rest of the community reacts negatively towards him. It is all because of lack of education, awareness in both man and women. In February, 2011 we have done one focus group discussion with women from 3 different villages to explore the issues related with pregnancy and behavior performed by women specially married.
Topics of discussion
1- What they (mother) feel about pregnancy process?
2. How they like to improve their life quality during pregnancy period. (food, Relation, Work, rest).
3- With whom they want to keep relation during their pregnancy period?
4- what sort of food are the take during pregnancy period?
5- How they like to be treat (relation and behave by others) during pregnancy.
6- Are pregnant women they like husband to be around her during pregnancy and in delivery time?
7- How frequently do husband and wife talk about their baby and pregnancy?
8- Will they be interested to receive pregnancy content in computer via internet?
9- Are they frequently discussing with FCHV about pregnancy before it?
[Findings:] Most of the women responded that pregnancy process is accidentally happen. They do not have proper plan for child. They do not change any food behavior. Just do what they were eating before and work is similar what they are doing before. If there is work in home they have to do it and complete it. Since they like similar age friend from neighboring house or sister. They believe husband, mother in-law, father in-law and brother in-law are not best friend during pregnancy for them. Also they do not keep that much of concern about her pregnancy. But all women miss their own mother during her pregnancy period. This is not possible for all. Because they already coming far from to their husband house. All women agree that it is not easy process and always having difficult and others does not understand and feel it. From some corner of heart they miss their husband, but he needs to go outside home to make money for the better future of new baby. So they do not have other choice also. Even though husband is in home they do not frequently talk about baby and pregnancy related issues. Because both are shy to each other. Some women knows there are FCHV in village but they do not like to directly talk still they have shyness with them too. But they will be happy if they can get such pregnancy content in Radio and TV and computer so they can access it when they are alone.
[Problem address:] So from above discussion and some external report it is clear that the maternal mortality is high because of lacking knowledge and sincerity level during prenatal, natal, and postnatal periods in community members. Since the first priority should be given to pregnant women her self. But pregnancy process is not related only with her so simultaneously her husband should be responsible and be aware and educated about the process during prenatal, natal, and postnatal periods. There are lots of risk and dangerous can be minimized if husband and wife discussed enough about their pregnancy process and baby. Now most of the family members are carrying mobile and chatting or listening music or enjoying ring tone from there mobile. With the same device we are delivering pregnancy related content in audio, video and text mode for the registered husband and wife. It is not only delivering the content but also connecting FCHV, local health post and doctors by one application. Once the data are centralized in a server health post doctor, DHO can access and analyze the data and accordingly make plan and preparation for safe pregnancy delivery process.
Unlike many other development based project “Amakomaya” project was not started by a NGO or INGO or the government at the beginning. It was started with the small fund US 4,000 and support of university IT intern students from the very basic level. Initially the dream was only to deliver audio/video content to aware pregnant women from tele-centers or information centers. Although fund was not available the program was continuously moved ahead with the motivation from villagers, health workers, intern students with small secretarial support from Yagiten Pvt. ltd. After successfully receiving ISIF 2013 grants the project has jumped to next steps to develop Android application and plan to distribute 20 sets in 10 villages. But project has been admired and accepted by local people and local government in such way that now most of the Village development committee them self are motivated to spend for Android mobile devices and internet connection. Sustainability, community participation and ownership is always challenges for the donor agencies funded project. “Amakomaya” is one which is highly accepted and owned by local people and do not have future problem in sustainability. This is the main cause to deserve the prize for this project.
The goals and objectives of the project have evolved over time. At the initial stage of the project, the goal was to make aware pregnant women about their pregnancy situation by delivering audio and video content to their simple mobile device. We did not dream how far we will able to move ahead and how this “Amakomaya” (In English “Mother’s Love”) can be used by pregnant women, their family members and other concern stakeholders. New objectives and ideas have gradually emerged, changed and improved during 3 years of working experiences with pregnant women, local health post workers, and application developers. The objective now is not limited to delivering multimedia enabled content to pregnant women in the rural and remote areas but maximizing the benefits of Internet services and mobile application by connecting all the concern stakeholders such as Female Community Health Volunteers (FCHV), Local health post doctor, family members (specially HUSBAND of pregnant women) and government District Health Officers (DHO) and making them aware about the situation of each pregnant women and make them responsible to better plan for safe and institutional delivery in rural and remote areas.
At the moment the project “Amakomaya: saving life of pregnant women and infant baby” doing its best effort to seriously involve and empower all the related stakeholders (family members, FCHV, local health workers) on using Internet and smart phone devices to save the life of each pregnant women and infant baby in remote area of Nepal. Using “Amakomaya Android Apps” over Internet connected smart phone, we hope to make the pregnancy process more joyful, fearless, and pleasurable and self-respect to pregnant women including her family members and local health workers.
At the beginning stage, “Amakomaya” project has used PC based website developed by PHP programming language. Then after android apps developed in Java programming language to deliver audio, video and text content over android based mobile devices. Animated video has been taken from the baby centers and dubbed in Nepali language. For weekly purpose the project has developed separate videos by interviewing with gynecologist.
To access the internet in village we have used broadband wi-fi network those are connected in health post. 3G also have been used for the registration of pregnant women and data upload. Since 3G is still expensive so “Amakomaya” project is recommending to use ADSL, broadband wi-fi or Wi-Max to access the internet in mobile devices.
“Amakomaya” (The Mother’s Love) project was informally started by Rajendra Prasad Poudel, as a team leader with his college IT (Information Technology) interns students after successfully completing his Internet Society (ISOC) E-learning course under Next Generation Leaders (NGL) program and Internet Governance and ICT policy capacity building online course from Diplo Foundation. After successful completion of the online e-learning course from Internet society and Diplo Foundation Rajendra Prasad Poudel has received US $ 4,000 as ISOC Next Generation Leaders (NGL) Laureates Grant in September, 2011. Initially the fund has been used to develop web-based application to show the audio, video content for the pregnant women residing in the village those have been connected by Nepal wireless Networking project. Rajendra Prasad Poudel and his team has visited to 7 villages and started to give a three days of training to the rural pregnant women and other general public to access the web-application they have developed in March 2012. Unfortunately the training could not able to bring all the pregnant women from the village to the computer training center. Although the initial fund from ISOC NGL grant was fully spend the team was not stopped. Immediately Rajendra Poudel and his one Intern students downloaded all the collected audio and video content from the amakomaya.com website in their laptop and started to visit again village by village, health post by health post and home by home to explore pregnant women and show them those videos content and together do need assessment survey in 300 households of 7 remote villages from Kaski and Myagdi district. After the analysis of the need assessment survey data it has been identified that more then 60% of village women has been carrying multimedia enabled mobile (mobile having camera). Again the team has brain storm among the team members and local health works and decided to produce the existing video content in mobile play able format and distribute by using external micro-SD card or Bluetooth. In December 2012, the team have again visited to all the 7 villages of Kaski, Myagdi and Rasuwa district and copied those videos to 3000 mobile devices within a month of time. It was very much encouraging for the team and other concern people. Since the team was not satisfied and try to think about how many women has been watching those videos?, how they are watching?, are they properly using these content ? .
After the long discussion the team has decided to develop the localized Android Apps to solve all queries in their mind. Fortunately ISIF Asia has decided to provide the funding to “develop Mobile based Application to support pregnant women of Nepal” in early 2013. The aim of the ISIF awarded grant is to develop Android Apps that is useful for pregnant women and other concern stakeholders such as FCHV, health post doctors, City hospital based gynecologist, and Nepal government District Health officers. By access Amakomaya Android Apps the pregnant women can register their, name, last menstrual period (LMP) date, telephone number, respective health post code, and respective FCHV code. The application needs internet connection during the registration of the pregnant women. After successfully registration of the pregnant women she can access all the audio, video and text content in weekly basis. Also application gives notification for antenatal care (ANC) visit.
Also the project has provided 20 android wide screen sim based mobile to the local health post to use the application and serve pregnant women in 10 health post. Now the project has been successfully implemented in 10 VDCs of four districts (Kathmandu, Makwanpur, Chitwan, and Rasuwa) . The technical team has been getting regular feedback from the grassroots community as a end user of the application on the improvement of the application to make more effective for the pregnant women and concern stake holders.
The most relevant outcomes of “Amakomaya” project are as follows.
1. Developed localized Amakomaya Android Apps to support pregnant women.
2. Distributed weekly audio/video content to more then 3000 smart phone in 7 villages of Nepal.
3. More than 450 pregnant women have already registered in the application and continuously monitoring by FCHV and Health workers.
4- Distributed 20 sim based wide size screen mobile has been distributed to 7 Village Development and 1 set for Patan Academy of Health and Science (PAHS)
5- Organized 18 trainings programs to use “amakomaya Android apps” targeted for pregnant women, FCHV and health works in 7 villages.
6. Nepal government Makwanpur District office have officially accepted “Amakomaya” program and proposed for 2014/15 year plan to expand in 10 other VDCs by their own budget.
7. Bajarabarahi VDC of Makwanpur district and Bachcheuli VDC of Chitwan District have purchased 14 Android mobile devices by them self.
(after 17.8- 28.8 (11 minutes of coverage)
(after 20.8 -26.6 (6 minutes of coverage)
Rajendra Prasad Poudel