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Nehnwaa Child Survival Project

Challenges Entered: 

Liberia's civil war devastated its roads and health care system. Dire shortages of health workers and roads claimed by jungle or turned mud in the rainy season condemn thousands of women to die unnecessarily at home from obstetric complications, giving Liberia the world's third highest maternal mortality ratio (994).   Lifetime risk of maternal death is 1 in 12.  Husbands haul wives with obstetric complications to health facilities 5 to 10 kilometers away in wheelbarrows.  Curamericas Global has launched the USAID-funded Nehnwaa Child Survival Project with in-country partner Ganta United Methodist Hospital (GUMH) in north-central Liberia to improve the health of women and children in one of the worst-hit regions, Nimba County, by training and deploying mobile Primary Health Care Teams, Community Health Workers (CHW), and Trained Traditional Midwives (TTM), and by deploying an obstetric emergency (OE) response system, utilizing cell phones and renewable energy technology, Freeplay Energy's solar/hand-cranked cell phone charger.    There is no published evidence of projects that explicitly use cell phones for OE response in the developing world- this project breaks vital new gound. Lack of electricity in the villages has impeded cell phone penetration; the Freeplay Energy chargers solve this problem. CHWs and TTMs trained to recognize obstetric emergencies equipped with cell phones and chargers will call in obstetric emergencies, or signal when a high-risk pregnancy goes into labor.  GUMH staff will respond with a 4WD all-terrain vehicle (for patient transport to GUMH) or motorcycle (for home-based treatment) and/or emergency coaching via cell phone.  The system will have 24/7 coverage with trained GUMH staff to answer, assess the situation following clear  question and answer algorithms, and, if necessary, have the nearest available vehicle take the patient to the closest health facility. This system will be field-tested with drills and assessed for CQI via debriefing after each use. A rigorous M&E system will document efficacy.

Project Details
Project video: 
Project Assessment
Financial support: 
Project has financial support
Sustainability Model: 
The project will serve as a pilot for the Liberia Ministry of Health and Social Welfare (MOH&SW) as it rebuilds the Liberian health infrastructure and responds to immediate health needs. If it proves a successful model, the MOH&SW will support its further roll-out over the entire country in partnership with the country's main cell phone service providers, Lonestar and Cellcom. Current USAID funding and contributions from the Free Play Foundation will sustain the pilot through 2013.
Expertise needed: 
Technical Expertise: <span style="font-size: 12pt; color: black; line-height: 115%; font-family: 'Times New Roman','serif'">The Project needs capacity-building in the overall deployment, maintenance, and technical management of an emergency response system, including selection, maintenance, and optimum use of infrastructure (cell phones, chargers, response vehicles), logistics, staffing, scheduling, staff training (at both village and GUMH level), triage and algorithm development, deployment of back-up systems, system stress testing, CQI, and M &amp; E, including the development and measurement of output and outcome indicators. </span>
Project goals: 
January 2008 Curamericas Global staff visits GUMH and designs the Project. Feburary 2008- project proposal written and submitted to USAID. June 2008- USAID awards $1.25 million for the project. July October 2008 design of project fiscal and management systems, recruitment and hiring of project staff. November 2008 capacity-building and pre-service training of GUMH staff. December 2008 formative research (focus groups using Designing for Behavior Change framework and baseline KPC survey).
Identified Obstacles: 
Equipment (cell phones chargers) loss, breakage,  misuse, or exposure to weather (esp. rain). Abuse/misuse of equipment for personal uses. Gaps in cell phone signal coverage. Bridge wash-outs in rainy season impeding access of response vehicles. Staff training inability of village level workers to recognmize OEs or ability of GUMH staff to follow response algorithms. Maintenance of 24/7 coverage by GUMH. Vehicle maintenance and repair due to rugged road conditions, and increases in gasoline/diesel prices.

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