MANTRA: Increasing maternal and child health resilience before, during and after disasters using mobile technology in Nepal

In emergency situations, women of childbearing age do not stop becoming pregnant or giving birth. However, humanitarian emergencies often negatively impact health care systems, through damaged or destroyed critical infrastructure which restrict perinatal women and their newborns access to reproductive and maternal health care. This is particularly the case in rural remote regions, such as mountainous areas of Nepal, where frequent earthquakes and landslides pose significant hazards to an already limited healthcare infrastructure.
Understanding the needs of perinatal women and newborns in emergencies and developing adequate interventions to increase their resilience (i.e. their capacities to protect themselves and recover), should be part of any Disaster Risk Reduction (DRR) planning or response and yet these needs are often unmet. In such crises, Female Community Health Volunteers (FCHVs), who generally support mothers and encourage them to seek care in the perinatal period, may themselves be cut off from the health facilities that they serve and may be struggling to cope in the same way as other community members. Urgently needed information and knowledge may exist but be inaccessible for a number of reasons including: inappropriate use of technical language, text-based information inaccessible to those with low or no literacy, denigration of local knowledge, restrictions on the freedom of movement or access to communications of women and girls, and infrastructure damage that obstructs travel to and from healthcare services.
Empowering women to improve their health has been successfully implemented by UCL IGH, in partnership with Nepalese NGOs, by training FCHVs to run participatory learning and action women's groups focused upon maternal and newborn health. This community-based intervention was found to reduce mortality in the first month of life (i.e. during the neonatal period) by 30% in Nepal (Manandhar at al 2004) and has been effective in reducing neonatal and maternal mortality (Prost et al 2013). However, to date this approach has not been oriented towards resilience during emergencies, and neither has it been adapted to take advantage of the rapid growth in access to mobile technology in developing countries.
Therefore, this project investigates how to improve access to information and communications to support maternal and child health before, during and after a disaster. It aims to do this by developing mobile technology to support and expand existing participatory learning public health interventions and social protection mechanisms, especially in rural areas of Nepal. By doing so, this initiative addresses some of the priorities highlighted in the UN Sustainable Development Goals, and the Sendai Framework for Disaster Risk Reduction 2015-2030 to support maternal, newborn and child health, as well as sexual and reproductive health.
This research combines geosciences (e.g. scientific knowledge of natural hazards and risk assessments based on satellite imagery), social sciences (e.g. attention to gender, vulnerability and health in the context of disasters), technology (e.g. mobile apps) and arts (e.g. through participatory learning, and visual and textual health care communications) to devise new ways of rapidly deriving data from satellite interpretation and fieldwork that can be developed into a meaningful risk interpretation for local communities. Through adding a mobile phone 'app' the objective of this project is to make evidence-based information (e.g. oral survivor accounts, locally-generated photographs, drawings, videos, stories, and historical recollections) and learning wider-reaching and accessible, especially when paper booklets or picture cards might be unavailable or damaged and when disasters have cut off lifeline infrastructure.

In 2015, Nepal has suffered a devastating earthquake that killed nearly 9,000 people, injured 22,500 and left 800,000 in need of shelter. The Health Research and Social Development Forum (HERD) has been working with rural women and FCHV communities during and after the 2015 earthquake to assess the risk and deliver health services. Dr Hearn who worked in Nepal port earthquake also identified there is little or no information available to guide communities as to the hazard posed by slopes during and after disasters making perinatal women who need access to healthcare extremely vulnerable. Further, maternal health and especially perinatal women are often overlook in disaster planning. However, 20% of women of childbearing age are likely to be pregnant during emergencies (UNFPA 2012). Perinatal women and newborns are particularly vulnerable during and after emergencies when critical infrastructure may be damaged, destroyed or otherwise difficult to access (Menendez et al., 2015; Mupapa et al., 1999; Kobayashi et al 2016).

Based on this context and demand, the project intended impacts aim to support:
1. The Nepalese government, NGOs, HERD, MIRA and other organisations dealing with health, maternal and newborn populations and environmental hazards and resilience. They will benefit through promoting their economic development and welfare by building resilience based on new knowledge about environmental hazards, better understanding of rapid landslides risk assessment using satellite imagery and the use of mobile technology for communication risk and grass root support. Combining scientific evidence, local informal knowledge and experience with a new mode of delivery - mhealth - has proven useful in remote areas where the availability of functioning health systems is minimal (Gray, 2013). Novel, original, scientific interdisciplinary results, from the data collected and the methodologies developed and tested will be documented through publications, workshops and exhibitions.
2. Women, newborns, FCHVs, communities in rural and high risk areas who will be actively involved in this project from collection of images, co-authoring of the technology app and evaluation of the pilot. A follow up proposal is planned to develop the approach and scale it up across Nepal to increase women's resilience, in particular the vulnerable perinatal group and newborns, to environmental hazards.
3. The UK's government and NGOs dealing with building resilience to environmental hazards and gender issues. They will benefit through ensuring that ODA has a significant and positive impact on the economic development and welfare and through the collaborations and partnerships built during this project.