Digital Health for Migrant Mothers Network: Maternal Care in Dadaab Camps

Our Network entitled 'Digital Health for Migrant Mothers' establishes an innovative collaboration between the UN, African and UK-based academics, industry (African-based VR company 'Black Rhino') and midwives to explore how digital tools can be used to enhance maternal care for refugees within camp environments.

The UN has noted that despite improving global trends, maternal and neonatal mortality rates remain disproportionately high for women living in humanitarian settings, such as refugee camps. A central component in this challenge is the lack of trained midwifes with Combating these pressing challenges facing women's maternal health care has been strategically identified as part of the SDGs (5 & 3). Our project builds upon previous GCRF-funded research ('Birthing at the Borders' PI Bagelman) and addresses these challenges in one of the worlds' largest and longest-standing refugee camps: Dadaab camps in Kenya which borders Somalia.

The Dadaab camps currently host over 400,000 refuges (40% of reproductive age) where maternal morbidity and mortality is notably high (Gee et al, 2019). Our project proposes an innovative Network bringing together a diverse but coherent team to co-design a digital health response to the urgent challenges facing migrant mothers in an environment of protracted displacement. Our project is collaborative in nature, employing agile participatory modes of research rather than imposing models from above. Given the urgent need for midwives to have a more empowered role in the digital provision and education of maternal care our project will develop an engaged Network to explore the possibilities of 'training up' midwives, enhancing their digital literacy through the design of digital 'teaching toolkits' for midwifery education supported by UN.

Despite significant international funding spent on reproductive health in Dadaab, maternal and neonatal death rates are disproportionately high as compared to other hardship areas in the region (Gee et al, 2019). Research demonstrates that this discrepancy is due to a systemic disconnect in maternal care within the camp: while most refugee women rely on midwives (as they perceived to provide emotional, culturally-sensitive support) there are only few trained midwives available (Bagelman et al, forthcoming. See CV). Despite the key role that midwives play in supporting refugees in pre to post-natal care, midwifery training remains under-resourced and designed on an ad-hoc basis. While significant resources are earmarked for promoting digital learning and training for biomedical practitioners, midwifery-led health education platforms remain under-supported (WHO, 2016). In particular, digital health tools remain inaccessible to most midwives. For instance, while Virtual Reality (VR) have been well-established within biomedical communities as a productive mechanism for learning and teaching, midwives have little access to such tools. This digital gap is problematic for two main reasons: 1) the absence of digital technology underprivileges women in their ability to provide care 2) and directly impinges upon refugee women in camps who rely - sometimes exclusively - on midwives in receiving care.

In sum, our Network places primacy on African digital expertise, is gendered in its approach and centres those often marginalised in digital debates to promote an innovative, and agile response in emergency camp geographies.

Reference: Gee, S., Vargas, J. and Foster, A.M., 2019. "exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya". Conflict and health, 13(1), p.11.

Our 'Digital Health for Migrant Mothers Network' is vital in developing long-lasting, innovative and interdisciplinary collaborations to advance digital health in emergency camp environments. Our Network brings together key scholars and practitioners with expertise across the intersecting themes: refugee geographies, maternal care, digitality, humanitarian care. Too often these experts remain siloed and our Network addresses this problem. Vitally our Network includes end-users (midwives) and key partners (UN) in all conversations. See detailed 'pathway to impact.'

As an outcome of our Network we seek to design a proposal (to be submitted for second round of funding) which offers a research-led solution (comprising of 3 innovation activities) that will positively impact the DAC regions of Kenya and Somalia. Establishing our GCRF supported Network is a critical first step in the pathway for meeting our key three impacts listed below:

1. Co-design the first midwife-led 'teaching toolkits:' Using VR (virtual reality) this Network will bring together the UN, industry (African-based VR company) academics, practitioners and midwives to produce key simulated scenarios in emergency environments to better equip incoming practitioners. Each of our networking meetings supports this design (see pathway to impact).

2. Integrate curricula into Kenyatta University's Dadaab Centre, which supports our Network (See Institutional Letter of Support). Building upon existing capacity of the Dadaab Centre, which provides refugee training, our Network will embed midwifery digital 'teaching toolkits' (by and targeted at refugee women) into midwifery training programs which will have double impact: a) provide refugee's transferable skills which will empower communities and enhance economic development within the region b) enhance community-based support for vitally needed midwifery care. At present there are no courses designed by refugee midwives, and no training which mobilises digital tools (such as VR). Our Network will have the impact of bringing the proven success of VR simulations (used widely across biomedical fields) to midwifery training - enabling trainee midwives to learn the particular challenges which occur on the ground in emergency contexts.

3. Embed curricula in Dadaab camp, to 'train-up' midwives. With our UN partners we will develop a plan to roll out the digital 'teaching toolkits' (comprising of VR simulations) in Dadaab camps - where there is a dearth of trained midwives providing essential service. These toolkits provide peer-to-peer learning: where midwives teach trainees.

It should be noted that an immediate impact of our Network will be that we enhance Somali refugee midwives' digital literacy. Such actors are often marginalised from digital learning. So too, this project positively impacts digital expertise already present in Africa by supporting and raising the profile of 'Black Rhino' (Nairobi-based VR partner working towards social justice in Africa). During our first proposed workshops we will also develop an element of peer-to-peer learning, employing an online knowledge share platform for midwives and trainee midwives. For this stage sharing will be focussed on Dadaab experiences, but in second stages will be extended to diverse emergency camp contexts.

As indicated my UN Secretariat Lisa Kurbiel (see Letter of Support) our Network is geared towards an urgent problem, and promises tangible positive impact. Kurbiel clearly summarizes the impact of our Network in the following way: "The project is sure to enhance the digital literacies of those who continue to be marginalized; moreover, this project will surely enhance the maternal care challenges we see riven across the global south."