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. In addition: Curamericas Global, Inc. (formerly Andean Rural Health Care), is a non-profit organization located in Raleigh, NC. Curamericas Global was founded in 1983 by Henry Perry III, M.D., Ph.D., MPH, with the goal of establishing primary health care programs that are responsive to the health needs of the community while building the local capacity of health service providers. Curamericas Global’s Child Survival projects in Bolivia, Haiti, Mexico and Guatemala have consistently met or exceeded project goals, cumulatively serving over 350,000 beneficiaries, and managing $6.7 million of USAID funds since 1987 without audit exceptions or questioned costs. Other grants and sub-awards from CARE, Rotary, and the Mexican Desarollo Integral de Familia (DIF) also met or exceeded their goals.  Curamericas Global’s signature methodology, the Census-Based, Impact-Oriented Methodology (CBIO), developed in Bolivia and further refined in Haiti and Guatemala, has empowered hundreds of poor communities to improve their health. Like Liberia, the area served in Guatemala was a post-conflict indigenous region devastated by a long civil war. In both Bolivia and Guatemala, Curamericas Global succeeded where earlier programs had failed, launching local PVOs to execute the programs; these PVOs and their programs are now fully sustainable, largely due to the social capital and community ownership generated.  These PVOs derive their funds from contracts with local Ministries of Health, and donations from private foundations and individuals.

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