Evidence-based, micromedia, SDG3+ database scaled by text/voice messages, reaching last-mile settings and promoting MHPSS/mHealth/telemedicine solutions
Micromedia Modular Database tackles the lack of healthcare and MHPSS (mental health and psychosocial support) infrastructure and service-delivery capacity for underserved populations across Africa.
Beginning in Somalia and with the Somali community in Kenya, we address the weak public health institutions, inadequate public health awareness, and conditions conducive to disease transmission such as low literacy rates, hygiene challenges and crowded living conditions.
We recognize that decades of conflict – combined with displacement, war trauma, poverty, unemployment and substance abuse – has disrupted social cohesion and led to elevated rates of mental health disorders; for example, the UN estimates that nearly one in three Somalis suffers from a mental health condition. Yet mentally-challenged people are often stigmatized, discriminated against, socially isolated and subjected to dangerous and degrading practices such as containment with chains.
We acknowledge the severe shortage of skilled health workers and the fact that medical personnel in the field are overextended and often in danger.
In this context, while some telemedicine and mHealth solutions are in place, uptake is lacking.
In response, Micromedia Modular Database will provide a digital library of evidence-based microlearning material that can be shared via mHealth and telemedicine channels along with being scaled by health institutions, universities, NGOs and others via SMS/USSD distribution. This microlearning material will be in both text and audio form to facilitate scaling (i.e. for populations with literacy issues).
This specific project will begin by creating microlearning material in the Somali language and tailored to a Somali cultural context. Initial content developed will involve COVID mitigation and mental health support.
PILOT PROJECT
Meet the Project Team and Mentors
Dr. Mohamed Abdi
Project Team
Jamal Mataan
Project Team
Khadija Mohamed LLM
Project Team
Dr. Suad Mohamed
Project Team
Kaltuma Noorow
Project Team
Malaika Oringo
Mentor
Les Simm
Mentor
Dr. Gudrun Vater
Mentor
Dr. Hamda Hassan Warsame
Mentor
Heather Wokusch
Founder, Mentor
Norbert Wokusch
Mentor
Team members listed above are uniquely qualified to lead this pilot project:
There is a potential fifth member of this team we are approaching who is a female based in Africa and focused on trauma-informed and healing-centered community approaches.
The intersectional nature of this Team’s skill sets is highly valuable. In addition, they already know each other and, in various cases, have already cooperated on successful projects.
The role of Mentors is to be available to the Project Team for guidance as it develops its solutions.
In that regard, we have an expert in security risk management and capacity building in humanitarian settings (Les Simm), an organizational development consultant with expertise in startups (Dr. Gundi Vater), and a financial expert with a solid background regarding heavily-indebted countries plus decades of experience in IT and database management (Norbert Wokusch).
Additionally, two of the Mentors are young African women:
While both of these experts will provide the current Project Team with valuable advice in specific areas, the additional aim is to familiarize these two women with the Micromedia Modular Database approach as it develops. The goal is eventually to invite them to be on future teams developing content for follow-up related projects for the database, such as in pharmacology, nutrition, and human trafficking prevention.
And finally, as Founder, Heather Wokusch, will work to scale this pilot in the context of a broader global project. As Mentor, she will be available to the current Project Team in areas including psychology, strategic communications and virtual learning.
—
As can be seen in the individual profiles, the Team Members and Mentors have longstanding commitment to environmental protection, gender equality and female empowerment, as well as social inclusion. Those core values will be reflected throughout this entire project.
Read Less
Micromedia Modular Database is a practical solution to a widespread challenge
Demonstrated Need
The Micromedia Modular Database concept is supported by both validated research and the experience of medical/MHPSS personnel on the ground in various countries.
Regarding research: A variety of recent reports indicate that medical/MHPSS personnel on the ground in Africa are overextended, unable to visit last-mile settings often enough (and sometimes endangered when they do), dealing with a lack of basic resources and training, and not supported by an adequate systemic infrastructure.
Further, the widespread poverty of the region combined with weak public health institutions lead to dangerously inadequate public health awareness and that creates conditions conducive to the transmission of diseases otherwise preventable. COVID-related movement restrictions are a further hindrance.
Regarding reports on the ground: Medical and MHPSS professionals working in the field in Somalia and with Somalis in Kenya report that frustration with inadequate training and overwhelming workload lead to their own increased levels of burnout and depression.
So, the need is clear. The issue is how to support medical and MHPSS professionals in reaching more people more easily.
The Micromedia Modular Database is an innovative and effective approach.
Opportunities
New telemedicine and mHealth programs present an opportunity. One example is the 2021 initiative of the Ministry of Health and Human Services (MoH) and the International Organization for Migration (IOM) to support Somali health professionals.
In addition, there is agreed need to promote related awareness. For instance, the African Development Bank’s 2021 report on health infrastructure lists awareness training – for practitioners and the public – as vital to improving telemedicine uptake in Africa.
And finally, there is increased normalizing of e/mHealth. An example is that usage of virtual learning methods such as HINARI, the Global Health e-Learning Center, and OXPAL Medlink is gaining traction among Somali medical personnel.
Sample Problem
Imagine that you are an MHPSS staff member who has been contacted by a mother in a remote Somali village saying that her son has been acting strangely after having experienced a violent situation. The son is very depressed, and you suspect PTSD. But it is impossible for your staff to visit the village for months, and there is no internet available there. A traditional healer on the ground says that the boy is cursed and should be banished or chained. There is no public health treatment facility anywhere nearby, and the boy’s family has no money for private doctors. The boy has a large extended family and they want to help him, but no one knows what to do. None of the stakeholders mentioned above has any awareness of mental health. There is an mHealth option available (the opportunity for the young man to have a few calls with a PTSD therapist based in Mogadishu), but the family does not trust the idea of therapy or of getting direct treatment via mHealth.
However, most members of this large family (including the young man) have mobile phones and are willing to receive information via text or voice messages.
You would like to create a community-based solution emphasizing home-based rehabilitation for the young man. That means sharing specific, evidence-based information on an ongoing basis with a variety of local stakeholders and in the media format (text or audio) each prefers.
Micromedia Modular Database Solution
How can Micromedia Modular Database help? As a registered MHPSS worker, you enter the database and order separate, existing ‘packages’ of information to be sent to different family and community stakeholders (who have agreed to receive that information) for a predetermined length of time. In this case, condensed basics on PTSD causes and mitigation and other areas of related mental health literacy are transmitted to these various stakeholders in their local language and cultural context.
As such, the relevant family members and broader community receive real-time, evidence-based information targeted to their specific needs and on an ongoing basis; the support for the family costs them nothing and setting up the whole process takes you, the MHPSS worker, just a few minutes.
An added bonus is that awareness of and trust for other mHealth solutions is built in this process.
And finally, since – due to funding cuts in your MHPSS work – you do not have access to related in-person or online training, you also decide to send yourself some Micromedia Modular Database material about PTSD to build your own knowledge base at your preferred pace.
This Somali pilot project is one part of a larger group of proposed interconnecting projects with a shared and complementary database.
For example, materials developed in Somali can be repurposed and adapted to Arabic, Swahili and other African languages (and materials developed for those languages in related projects can be adapted to Somali, etc.). This creates the potential to reach hundreds of millions more people in Africa – and globally.
Subsequent microlearning material for the database could cover any range of topic areas (maternal and other areas of health, disaster management, human trafficking, legal information, etc.). For example, in alignment with activities of the World Food Programme, we can foresee adapting the Micromedia Modular Database to providing information on nutrition, supporting food-related rapid emergency response, and other areas of building both capacity and resilience.
Further, the database can be adapted to other languages and cultural contexts – not to mention other digital and technical capacities such as Rich Communication Services (RCS).
As the microlearning material we create can be repurposed cost-effectively to other national, regional, linguistic and cultural contexts, the potential to scale is both global and unlimited.
The business model is quite straightforward: rent access to the database.
Potential clients could be medical centers and hospitals, ministries, NGOs, universities and other training facilities, mHealth and telemedicine offerings, UN entities, telecom companies, etc.
The running costs of this venture are quite minimal since the headcount is low and the product is both digital and evergreen.
Of course, in our hybrid humanity-driven model, database access will also be provided on a complimentary basis to specific, deserving entities lacking in financial resources as well as during situations of crisis (such as environmental disasters, etc.).
The high levels of mobile access and SIM card penetration in Africa facilitate this business model: for example, the World Bank estimates that over 50% of Somalis has a mobile cellular subscription – with actual coverage far higher given shared mobile access.
And even though smartphone penetration is increasing across the continent, basic messaging (such as text and audio) is still the most practical distribution method since most networks are running on legacy 2G and 3G speeds.
This project’s ultimate aim is to have a massive, intersectional micromedia database available in multiple languages and targeted to distinct, deserving populations across the world.
Content developed for mobile phones is the focus given that there are roughly twice as many mobile devices as people on the planet today; in addition, mobile penetration is significant even in remote, underserved areas. For example, it is estimated that more people globally have access to mobile devices than to electricity or clean water.
The Micromedia Modular Database project also plans to seek strategic cooperation opportunities. For instance, in October 2021, Somalia’s Ministry of Health and Human Services announced a joint program with the UN to implement the World Health Organization’s Mental Health Gap Action Program in Somalia. Given the obvious synergies between that project and the Micromedia Modular Database, potential cooperation models would be pursued.
Similarly, synergies could be explored with the Kenyan Ministry of Health in relation to its recently launched Kenya Mental Health Action Plan (2021-2025).
Quite simply, nothing like the Micromedia Modular Database exists yet, so there is no direct competition.
However, the overall ecosystem is highly relevant.
Ecosystem factor: The rise of ‘informal’ mobile systems
‘Formal’ (top-down) mHealth systems have faced significant challenges in Africa, regarding both scalability and sustainability. According to a recent scientific study, issues include ‘the patchy and unsustained nature of formal mHealth provision’ combined with factors such as ‘unsustained funding, insufficient financial/infrastructural support, and equipment failure.’
In contrast, the ‘informal’ model of healthcare staff using personal mobile phones for work-related purposes has dramatically increased. For example, over 97% of healthcare workers surveyed in Africa reported using the ‘informal’ personal phone system but only 15% reported using ‘formal’ mHealth applications.
But while this emergent ‘informal’ health system has the possibility to be responsive to local needs, it is not without drawbacks. Healthworkers in Africa report challenges such as being overwhelmed with calls on repetitive topics, needing to spend their own money on purchasing phone credits to send messages, losing battery power at critical times, etc.
Our competitive advantage: The Micromedia Modular Database empowers ‘informal’ systems in multiple ways. First, it enables healthcare workers to save time by not needing to provide information repetitively on basic topics (that could also be handled by sending pre-determined text or audio messages from the database instead). Second, messages coming directly from a database – rather than from a healthcare worker’s personal phone – handle the issues of phone credits and battery power.
Ecosystem factor: Inclusive, sustainable… or not?
Many digital health innovations in Africa aimed at pursuing Universal Health Coverage goals have in fact proven to be non-inclusive and unsustainable.
The distinction often is whether the goal is to scale towards new international markets or national healthcare systems and populations. This challenge is especially critical in East Africa which has long been characterized by ‘NGOised, fragmented and vertical healthcare systems and heavy dependence on foreign capital.’
An example is the M-TIBA digital platform ‘health wallet’ accessible through a mobile phone, which had originally targeted Kenyans with low-incomes to enable healthcare savings. When that business model did not work, M-TIBA changed its focus to targeting those with higher incomes instead.
In addition, the pandemic has demonstrated that coordination and interoperability of existing solutions can be far more important to healthcare sustainability in last-mile settings than new technology. For example, in East Africa, established methods such as mobile phones and WhatsApp messaging have proven critical in the distribution of COVID-related public health information.
Our competitive advantage: The Micromedia Modular Database does not aim at reinventing the wheel. Rather than creating a technical product which will be largely inaccessible to the disadvantaged and those in last-mile settings, our innovation lies in increasing access to existing information channels and improving the related technical integration.