Country: Ethiopia

Wako Gutu Foundation (WGF) as Lead Applicant

Contact e-mail:wakogutufound@yahoo.co.uk
Addis Ababa
Ethiopian Midwives Association as Co-Applicant
Contact e-mail:Yeshitila.tesfaye@ethiopian-midwives.org, yeshi444@ymail.com
Concern for integrated Development (CFID)as Co-Applicant
Contact e-mail: seife10@gmail.com
Education for Development Association (EFDA) as Co-Applicant
Contact e-mail: efhda@ethionet.et
Shalom Humanitarian Development Association (SHDA) as Co-Applicant
Contact e-mail: jiregnashalom@gmail.com
Orphans and Girls Assistance Association (OGAA) as Co-Applicant
Contact e-mail: ogaa.ethiopia@gmail.com, amare356F@yahoo.com
Light Ethiopia as Co-Applicant
Contact e-mail: lightethiopia2012@gmail.com
Youth and Cultural Development Foundation (YCDF) as Co-Applicant
Contact e-mail: ycdfoundationethiopia@gmail.com, zenayenehg@yahoo.com
Project Title: Scaling-out mobile enhanced maternal and child health in hard-to-reach areas of Afar, Oromia and
Somali National Regional States of Ethiopia, 2019-2021/22
Developmental Objective:The overall objective (impact level) of this project is to contribute to reduced maternal,
neonatal & infant mortality. Issues to be addressed are home-based and facility-based antenatal care, postnatal care,
institutional delivery, and emergency obstetric care.
Description of Project Intervention
The project is expected to directly benefit 50,000 pregnant and lactating (recently delivered) women and infants of
one year or younger. Among the targeted beneficiaries, 85% pastoral communities with the remaining 15% being
highlanders; in parapasu with the call, the priorities of interventions for this project include:
Gauge partnership: Wako Gutu foundation gathers and formalizes partnerships with the co-applicants for effective
engagement. Besides, the foundation extends partnerships with relevant government health offices (regions, zones
and districts, nearby hospitals) and private service providers particularly content development consulting firms
through series of discussions.
Functional Platform Setup:A domestic ICT firm will undertake upgrading, expanding and re-galvanizing of the
existing hard ware equipment and facilities of the foundation’s platform.
Content development: using its experienced digital health specialists, the project will develop localized content/
interoperable, locally adapted and user-generated content platform with translation in to local languages (Afar, Afan
Oromo and Somali languages), formatting and usability testing of content.
Community mobilization using print/publications like local language translated leaflets, user manuals, logos,
banners. The project employs community edutainment using Digi-soft and smart projectors (solar operating
projectors) and edutainment vans (vehicles attached to loud speakers) during community sensitization campaigns.
Cascade Training: The project will provide capacity building training sessions in phases for community health
volunteers, government health extension workers, public health professionals, midwives, nurses and physicians
including refresher trainings.
Action-based Studies and Research: This involves both operations researches and formative researches for
reinforcing implementation.
Reach of target population/access to information: This encapsulates project promotion, enrollment, message
content identification, message design, message production and delivery of messages. In this work component, the
project identifies, register, and stage a pregnant woman, monitor ANC attendance, send pregnancy messages, alerts
/reminders. A broad swath of promotion and encouragement actions on home-based and facility based MNCH care
behaviors including use of bed nets& consumption of IFA tablets, danger signs during pregnancy, like hemorrhage,
excessive bleeding, labor, hypothermia /fever, age when complementary feeding should be initiated, vaccination, and
immunization, minimum gap between two successive pregnancies, when to call a baby as low birth weight,
breastfeeding a child within one hour of birth, attendance of ANC within the first trimester, PNC check-ups within two
days of birth, drinking more water, minimizing strenuous lifting, increased knowledge of some traditional practices as
harmful like pre-lacteal feeding, continuing of breast feeding at one years of age.
Monitoring, Evaluation, Accountability, and Learning: The project will regularly collect, track and analyze data
from service delivery databases, phone surveys and annual field surveys on customer acquisitions/registrations,
content delivery status, customer satisfaction and impact on knowledge and behavior of users regarding ANC and
postnatal care visits, exclusive breastfeeding, and vaccination programs for service improvement and reinforcement.
Description of Methodology
The Lead Applicant (Wako Gutu Foundation) is currently in the middle of implementation of the project titled as
“Mobile-Phone Enabled Agricultural Livelihoods & Health Extension for Agro-pastoralists Life Transformation in
Hinterlands (MEAL & HEALTH) Project” in three districts (Gindhir, GuraDhamole of Oromia Region) and Tulu Gulid
district of the Somali Region which delivers maternal and child care through channels of SMS, IVR, and USSD. The
foundation is currently the leading digital health implementer in Ethiopian Pastoral areas. Currently, the foundation
has garnered huge experience dovetailing through its four distinctive big servers of high quality. The platform is also
the latest which isease for content migration, hubs creation and displacement with appropriate telecom and computer
hardware equipment and front-end and back-end services connected to IVR equipment, SMS equipment, and
accessories like speakers, video fans, etc. and content aggregators.
The co-applicants have long histories of community based and community driven changes in the maternal and child
health sector with some of the for instance CFID and Ethiopian Midwifery Associations of community health
champions and affiliation groups. The Ethiopian midwives association has strong connection with government and
non-government network organization networks and individuals.
This project will scale-out the existing Mobile Health (mHealth) component of the project at Wako Gutu Foundation to
other districts and broadens the stacks of the content in-scale through this GFF fund.
The foundation decided to galvanize these existing efforts and expand to other districts using the following service
delivery methodology.
The project adopts a high-touch, low-tech approach to care using a combination of IVR through outbound
message/dialing/voice (50%), text message (30%), and USSD (5%), and community web portal (15%) as described
below.
A toll-free hotline (which is open seven days a week) provides pregnant and lactating women with information and
advice on maternal and child health issues and refers callers displaying danger signs for further care at nearby
hospital or higher clinics, health center. A “tips and reminders” mobile messaging service provides regular text/voice
with video and pictograms mediations for those with android/smart mobile phones. The project provides age- and
stage-based information to pregnant and lactating women meaning messages will be tailored to the women’s week of
pregnancy and child’s age. This service delivery will be managed by two different servers (the hotline server which
handles the users’ hotline application and a notification application, and the communication server which handles a
hub application and the interactive voice response (IVR)).
The project will identify and recruit community health volunteers in each village and give a low-cost phone to provide
those pregnant and lactating women without personal phones access to the service. Besides, providers at referral
zonal/district hospitals such as the midwives, nurses, doctors, and ambulance driver will be provided with phones. In
this framework, the project provides mobile voucher system for two-way/interactive communication of pregnant or
lactating mothers directly with their community health volunteers and to access emergency obstetric care. Thus, each
beneficiary woman will be given a phone voucher with a modest credit in Ethiopian Birr and a card with the phone
number of her local community health volunteer which allows the woman to make a short call after which the
community health volunteer could call them back.
For a normal pregnancy, the system will send automated reminder at a specific date for clinical appointments,
including delivery. In case of danger signs like labor, hemorrhage, etc. the community health volunteer sends an
emergency alert to the system, and then an emergency alert system is triggered which provides immediate feedback
to the community health volunteer, advising on immediate action. Ambulance requests will be forwarded to the
nearest ambulance vehicle point to ensure that the mother/infant has been transferred for emergency obstetric and
neonatal care.
Specially designed software automatically generates and sends voice/text messages according to the women’s
gestational age, until 12 months after delivery. The information required for the platform, e.g. gestational age, date
and mobile phone number will be gathered during the first antenatal care visit ( mostly by government health
extension workers, and health office records), assisted registration and self-registration of targeted women. The
registered phone numbers will be either the women’s own phone or an access phone number of a
husband/friend/mother who could relay the messages. The content and frequency of the message will vary
depending on the stage of the pregnancy. Early in the pregnancy, a woman will receive two messages in the month,
but after a gestational week 36, the intensity increases to two a week.
The project will also augment an automated web portal with user-friendly forms for online promotion.
Almost 90 % of the intervention communities are located in tumultuous areas in which ethnically motivated resource
based conflicts highly prevail, and there are numerous make-shifts exacerbating the health challenges. The
foundation has tested and proved from the former similar digital health project that it is the most efficient, accessible
and suitable for such dire environments like displacement, migration, and violent skirmishes.
To maintain service quality and ensure message delivery(process monitoring) the project applies preferred
timeslots, creating jingles, and returning missed calls to ensure that the program is being implemented and received
as intended. Besides, the help-desk has capabilities to handle 100 simultaneous in-bound/out-bound calls, in-coming
call, out-going call, internal calling, caller line identity (CLI), caller line identification presentation, call transfer, three-
way calling, ring group (hunt groups), multiple IVRs and auto attended, multiple music on hold, multiple queues, call
recording, time based announcement/IVR, pickup group, call forwarding, abbreviated dialing, conference room,
incoming call screening, call monitoring, call recording, auto dialer, BLF (Busy Lamp Field), and echo suppression
and cancellation.
The system reports on key variables like total number of answered calls, answered calls in a queue, answered calls
by health specialists, abandoned calls, abandoned calls in a queue, talk time of health specialists, answered calls of
health specialists, hold time &hold time of calls that remained in a queue unless it was attended and average hold
time for all calls landed in a queue, hourly, daily, monthly and yearly base call log of health specialists, all in hourly,
daily, monthly andyearly basis.
Geographic Scope
The project will be implemented in the following selected hard-to reach districts
Oromia Region (Arero, Dillo, Dubuluq, Dirre, Chinaksen, Fedis, GolaOda, Babille, GidaAyana, JarteJardaga, Jaldu
districts), Somal Region (Meiso, Erer, Harshen, shinille, Ayisha, Adigala, Dembel), Afar Region (Gewane, Galala’u,
Awash fentale, Amebara, Dulecha)
Project Budget
The budget has been estimated using the current Ethiopian birr to US Dollar exchange rate, and it includes cost
items: updating and upgrading the foundation’s former platform, content development, outreach, partnership, air-time
fee), human resources, equipment& furniture.Thus, the total required budget is $5 million (five million dollar).
Expected results
 Improved access to antenatal, postnatal care, institutional delivery, and emergency obstetric care for 35,000
pregnant and lactating women
 Increased uptake of home and facility based MNCH care practices among 15,000 pregnant and lactating
women
The project has an anticipated impact on the community to generate demand for access and quality maternal,
neonatal and child health services.
It also keeps the physicians/nurses, midwives, and health extension professionals in different health offices stay
abreast of the latest developments in digital health and make use of opportunities to engage in digital health
programming and research.
Project Sustainability
Project sustainability will be ensured through gradual transformation of free toll to subscription/sign up business
model. It is also sustainable by ensuring high-performing partnership constellation, and enduring behavioral change
through champions. This in turn will encourage the government to take it as a mainstream programme in the health
sector.