Health Intervention: Technology to boost rural women’s health

Health Intervention: Technology to boost rural women’s health
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Deeply scarred after watching the documentary Kam Agong, a poignant story of severe medical negligence that led to a mother’s painful death in rural Sarawak, Shamala Hinrichsen took it upon herself to drive home the importance of healthcare by establishing Jiwa Ibu, an app accessible to women in East Malaysia.

The 2018 documentary directed by Lawrence Jayaraj, Agnes Padan and Wong Chin Hor, tells the story of Agnes’ mother Kam Agong who bled to death in her village in Long Semadoh a month after giving birth to her eighth son by C-section at Lawas District Hospital, the nearest maternity facility that was five hours away.

The 30-minute documentary revealed the inequalities in the healthcare system, which prompted Shamala to find ways to address the issue.

Then through Hanai — a global healthcare technology provider she founded in 2018 to provide end-to-end digitalisation — she built the Jiwa Ibu app to spread maternal and women’s health awareness via smartphones.

The app, which is available in Malay and English, holds a doctor’s directory, a repository of services for women, the latest in healthcare news, and a health education segment that is focused on maternal wellness, mental health and domestic violence.

The Malaysian-born Shamala, who now lives in San Francisco, points out that the disparity in healthcare access in Peninsula Malaysia to those in Sabah and Sarawak is shocking.

Shamala and her team at Hanai made affiliations with local partners and universities to compile useful resources in an app for women to access in an emergency or just to equip themselves with important health information.

“We decided to target maternal health, mental health and also bring the important resources for our Malaysian mothers, especially when they are in indigenous settings or where they’re not urban [or in] rural and marginalised areas,” she says.

Shamala, who has worked for years in medical communications and is a scientist by training, set up Hanai in November 2019 after spending a four-month sabbatical, mapping the rural healthcare landscape in India, when it dawned on her that there are women who had not seen a single doctor in their lives. “So that sort of launched the idea of Hanai in my head,” she says.

The healthcare technology company, which enables healthcare access and education through mobile phones, regardless of the internet connection, has been serving communities in Mauritania and Kenya for different purposes.

Jiwa Ibu was built in partnership with St George’s University of London, UK-Malaysia Medical Initiative, a bilateral medical initiative that was established between the Malaysia and UK governments, the University of Nottingham and the University of Malaya.

Bridging access

Though Malaysia has a reputation for having one of the best healthcare systems in the world, not all communities within the country are privileged enough to have these amenities. Impoverished and remote areas in rural Sabah and Sarawak are not just devoid of such infrastructure, they also have little access to doctors.

Most of these facilities, such as the health clinics, are served by medical officers who double as health advisers and provide medical support, investigate problems and oversee clinical programmes but lack the expertise to perform certain health-related interventions and surgeries.

“[In] Lawas is where we started the work. The villagers would need to travel six hours to reach the hospital, which has like 10 beds. The closest medical facility is a Klinik Kesihatan (a government health clinic) that does not have a medical doctor but a medical officer. So if a woman shows up needing a caesarean, they (medical officers) cannot do a caesarean [simply because they don’t have the facility and expertise to do it],” adds Shamala.

Technological barriers

During the development stages of the Jiwa Ibu app here, the Hanai team found technological barriers in the form of mobile phones and internet connectivity.

Although Malaysia has a high smartphone penetration, marginalised communities in Sabah and Sarawak are still far behind in comparison to countries in Africa when it comes to utilising smartphones for daily activities, she says.

The Department of Statistics Malaysia (DOSM) reports that the percentage of individuals using mobile phones has increased to 98.7% in 2021 from 98.2% the year before. With most Malaysians having access to mobile phones and 96.5% to the internet, it was not difficult to get people in rural areas to use mobile applications but it had to be user-friendly, says Shamala.

So, they focused on developing an app that could function offline and an interface that works on the simplest of smartphones.

But that was all they could do to help the community overcome the existing technological divide. Shamala hopes that government agencies will soon set up more infrastructure for better connectivity.

For a more cost-effective and economical solution, the Jiwa Ibu app was developed primarily on Android. Another factor that tips the scale in favour of Android is the extensiveness of its customer base and its minimal storage capacity.

“In marginalised areas, there are more Android phone users than iOS (iPhone), simply because of the cost of the devices. Second, Jiwa Ibu is very small [in storage capacity], it’s a maximum of 11MB. And, third, you can download information when you have internet connectivity, and you can still use the app without a connection. And that’s fine because you can continue to read everything that is on the app without an internet connection,” she says.

It was important to Hanai that the app worked well offline because most villagers are not connected to the internet at all times, she adds.

Given the simplicity of the app’s interface, users can locate information and adapt to the app with ease.

“For instance, I have a fever and high blood pressure and my feet are swollen. All of these symptoms are risky indicators during pregnancy. [With Jiwa Ibu] you can continue to access all of that [information] and you can find out the location of the closest hospital on the app.

“That is our primary aim — to educate and raise awareness,” says Shamala. Users can provide feedback and update the app whenever they are connected to the internet.

Health champions extend helping hand

Hanai’s partners — which they refer to as community health champions — play a pivotal role in interacting with users and helping them navigate the app.

Before Jiwa Ibu is rolled out to particular rural communities, the health champions undergo training with Hanai on how the product works and why rural women need to have it at hand.

“First, we hold big launch events and a lot of people from the villages in the area attend [them]. Then, they download the app and start reading through [it] and start finding it beneficial,” Shamala says.

Subsequently, the community health champions will organise visits to these communities once every six weeks or two months to follow up on the progress of those who downloaded the app and those who have not. They then encourage and teach these people on how to use the app, she adds.

Since the product is tailored according to the goals and mission of the partners and affiliated universities, the Hanai team plans and engages with their clients first. They go through a round of extensive context mapping, assessing the needs of the clients and their beneficiaries, in this case — rural women. Additionally, they engage with local stakeholders and design impact measurements before moving on to the next step. They would then develop the product and deploy it to the communities.

The desired goal of the Jiwa Ibu app is to notify women in rural communities to attend their antenatal appointments, as well as to inform them of the importance of inoculation schedules and family planning.

“That’s an actual benefit, rather than just another product that is shoved down people’s throats. So, at [Hanai,] we are trying to make them understand that infant and child mortality is getting better because parents are adhering to vaccination schedules. This is why the app sends them vaccination reminders and more. Second, women [should be] adhering to their check-up schedules to make sure that their babies are healthy,” she says.

At present, the Jiwa Ibu app, which is free, has over 3,000 indigenous users, a majority from Sarawak. The prototype was launched in April 2020 at the height of the Covid-19 pandemic. Hanai is now working on re-launching a newer iteration of the app in Kudat, Sabah.