In Jombo, a village located in the Chikwawa Diocese (in the remotest part of the southern region of Malawi), villagers must walk 10 kilometres to the nearest health facility – Montfort Hospital. There is an extensive road network but, during the rainy season, villages such as Jombo suffer from unusable road conditions. Furthermore, communication services within and outside Jombo remain a challenge. These bottlenecks create delays for pregnant women in reaching vital healthcare in time. Such delays contribute to Malawi having one of the highest maternal mortality rates in the world: 675 per 100,000*.
IICD, as part of the Connect4Change consortium (C4C), is overcoming these challenges and increasing access to maternal healthcare by improving the quality of home-based maternal care for the most isolated mothers in Malawi.
Through a series of human-centered design practices and IICD’s design thinking methodologies (Round Table and Solution Design workshops), better communication with health workers, improved data management and reduction of maternal deaths, were all identified as key targets. After testing potential solutions together with IICD's local technical partner UltiNetS, over 100 community health workers (CHWs) were trained in using the mHealth application, ‘CommCare’. With this Java application, the CHWs register pregnant women, and follow up on their antenatal care visits. Subsequently they register the newborns with the same application, and follow up on their first two years vaccinations. Complicated cases can also be registered and followed by the CHWs. The mobile platform is used for reporting, referral of patients to health facilities and to receive feedback from central health facilities, such as hospitals.
“This allows users to track patient data both on mobile devices and on the web. This helps health workers keep track of their clients over time and manage the entire life cycle of a case without the need for network connectivity,” said Stuart Winga, Operation Manager at UltiNetS.
Improved communication between health workers and health facilities can have multiple effects, for instance on patient referrals to hospitals. It has proven difficult for home-based care workers and CHWs to arrange appointments with hospitals for the patients they visit. Doing this digitally, with the use of mobile phones, reduces delays and increases reliability. The project in Malawi achieves this in a number of ways. Firstly, by providing real-time communication between different agents in the community health structures, including health centres and front line workers. Furthermore, electronic reports are sent from community health structures to computers at the hospital.
But not everything went off without a hitch. At the outset of the project, some users experienced difficulties to analyse and generate reports using CommCare at health facility level. Due to the importance of data analysis and report generation to monitor progress, identify imaging problems and make decisions, IICD advised to complement this application with a Hospital Management Information System (HMIS). This will allow to capture more data at hospital level, which can help in interpreting the CommCare data. The hospital is in the process of implementing an HMIS, which will improve the analysis of the generated data and help in decision-making. Decision makers can adapt policies based on timely and reliable data.
Results in maternal healthcare
In the Chikwawa Diocese, where over 2,000 pregnant women and infants have been registered as of November 2014, the project is showing promising signs towards the reduction of maternal and child mortality rates, from 4 to 1 and 70 to 40 deaths per year respectively. These ICT-enabled maternal and child health interventions have the full support of the Malawian government. Such alignment of policy has facilitated progress towards shared goals including the increase of timely pregnancy referrals to Montfort Hospital, the promotion of active male involvement in maternal healthcare and the increase of children under five attending monthly clinics.
The Women Health Project in Mangochi Diocese has been targeting women and men of reproductive age and young children in 22 villages under the catchment of Koche Health Centre. Similarly to Chikwawa, the results have shown real progress towards the overarching aims of improving maternal healthcare. More knowledgeable front line workers are providing improved health service delivery and, through the use of mobile phones, women are reminded two weeks before delivery to encourage births in Koche Health Centre.
Community sensitisation: motivating men to participate in women’s health
For IICD, the importance of formulating context-specific solutions and multi-stakeholder involvement, including local leaders, is crucial to advocate for the services and assist in mobilising the community. The work of safe motherhood committees and male champion groups has contributed to health promotion and behavioural change in health seeking, and active involvement of men in decision making about women and child health issues. The project has demonstrated that it is possible to motivate men to participate in women’s health in a culture where this is regarded as almost impossible. Male involvement has improved throughout the project with more men now escorting their wives to the health clinics. Men have formed male champion groups where they discuss issues of safe motherhood. In Chikwawa there are nine male champion groups, each group consisting of 20 men.
The forum, organised by the Food and Agriculture Organization of the United Nations (FAO) and the World Association of Community Radio Broadcasters (AMARC), set a number of recommendations in relation to enabling policy and institutional frameworks, investments and partnership opportunities, and capacity development.
Participants of the FCCM agreed that sustainable social and economic development begins when farmers, communities and people are empowered to make decisions for their own lives. “We all shared experiences on how ComDev, ICTs and community media can help family farmers to drive innovation and social change in rural areas, “ said Francois Laureys, representing IICD at the FCCM advisory group.
Some of the FCCM recommendations to overcome family farmers’ challenges associated with limited access to information and communication services are:
- Build cross-sectoral alliances to promote and implement law and policy reforms in respect to communication and family farming.
- Urge governments to invest in reinforcing community-based communication services and up scaling good practices.
- Engage in multi-stakeholder partnerships, to embed communication in development initiatives/programmes.
- Develop the capacity of rural actors at all levels, applying a diversity approach, to engage effectively in rural communication processes.
- Develop mechanisms and tools for coordination and partnerships ensuring that communication for development principles are evident and operational
‘Farming For The Future: Communication Efforts To Advance Family Farming’
A recent publication by FAO and AMARC, which has referenced some of IICD’s latest publications and documented experiences in the use of ICTs in Agriculture, aims to “inspire reflection on the role of communication in advancing family farming”. The document provides examples of communication for development (ComDev) approaches applied to farming and rural development “with special attention to the experiences generated by farmers’ organizations”.
Entitled ‘Farming For The Future: Communication Efforts To Advance Family Farming’, the publication explains that “smallholder family farmers and rural communities require access to information and communication to make their voices heard and change their lives for the better. This implies including communication for development (ComDev) as part of agricultural and rural development policies in order to promote dialogue and participation.”
“The FCCM represents the launching of a consultation process around mainstreaming ComDev principles, methods and initiatives within relevant policy frameworks to advance small stakeholder agriculture and rural livelihoods.”
ICT solutions and their proven effects on farmers’ inclusive development
Citing some of IICD’s evidence-based practice examples of how ICT solutions can positively affect the inclusion of family farmers, the FCCM supported some of their recommendations.
“Our experience with the farmers’ association CRCR (Cadre Regional de Concertation des Ruraux) in Mali shows that a holistic integration of communication media -for and by farmers- can strengthen the position and voice of family farmers,” said Laureys, “and providing farmers with access and means to better communication is crucial for this empowerment.”
CRCR is a lobby and advocacy organisation run by farmers in the province of Sikasso. It is comprised of 240 farmers’ and pastoralists’ organisations in an area of approximately 450 km2, with about 1 million inhabitants, of whom 70-80% live off (family) farming. Due to its poor road infrastructure, large parts of the province are very isolated and/or very difficult to reach.
“IICD supported CRCR in 2004 to set up a communication system based on a decentralised network of ICT-equipped information centres owned by local farmers, and agreements were signed with local and community radios in the province. Farmers were trained on basic ICT skills and maintenance, and over the past years this cascade capacity building methodology has trained at least 500 farmer leaders and thousands of individual farmers – both men and women.”
In recent years, CRCR has also adopted more sophisticated ICT tools, from SMS-based data collection platforms and web-enabled databases to map family farmers and monitor their production, to the use of social media for networking and knowledge exchange.
“In a few years’ time, CRCR has become a driving and federating force of the farmer movement in the Sikasso province, and it has developed solid relationships with local, regional and national authorities and agricultural bodies making it potentially replicable in other parts of Mali and West-Africa,” said Laureys.
- FAO’s publication ‘Farming For The Future: Communication Efforts To Advance Family Farming’
- FAO’s FCCM final conclusions and follow-up actions.
- Policy Brief (available in English, French and Spanish) based on the e-Agriculture forum discussion “Communication for Development, community media and ICTs for family farming and rural development”
- IICD’s ICT Solutions for Inclusive Agricultural Value Chains.
“I am very pleased that Suzanne is taking over", said Figuères. “Next year IICD will turn 20 years, and with a renewed strategy but keeping and embracing our vision and values, IICD will continue as a more entrepreneurial organisation. I am very proud for having contributed and laid the groundwork for this important transition in the history of IICD.”
Suzanne van der Velden
With a background in International Development, Journalism and New Media, Suzanne van der Velden’s (1979) professional career includes her role as IICD’s Community Relations Director responsible for international partnerships, programme development and impact management of IICD’s work, from 2011 to 2015. Prior to that, she served as Chief Content of VARA New Media and served various functions at international agencies in the areas of research, publishing, and management.
“IICD is one of few international organisations with a true sustainable impact in ICT-enabled development, and therefore I am very honoured to be appointed to lead this organisation. At the same time I am conscious about the challenges lying ahead of us”, said van der Velden. “The landscape we are working in has changed, and continuing our good work requires a strong focus and adaptive approach. With almost 20 years of in-depth ICT4D expertise, IICD is dedicated to continue serving disadvantaged people in developing countries with digital technologies. As long as we see that our work contributes to improving the living conditions of millions of people in difficult circumstances, there is indisputably a raison d'être”.
Speaking on behalf of IICD’s Board of Trustees, Chairman Karel de Beer said: "We are delighted that Suzanne van der Velden will be the next Managing Director. She brings all the drive, vision and talents that IICD needs in these challenging times. We explicitly want to thank Caroline Figuères for her leadership and strategic thinking over the past seven years".