Leveraging Technology to Improve Women’s Health in Somalia
A new telehealth platform brings innovation and equity into Somalia's health care system.
Written by Sahra Noor and Sumeya Ali of Hello! Caafi
“waxaan ahay hooyo geel raacata ah oo aad ugu faraxsan in uu jiro barnaamij sidan oo kale ah. Illaahey Qeyr ha idin siiyo”
I am a nomadic mother, and I am delighted to have access to such a service., May Allah bless you", a 45-year-old mother in Harwanaag, a rural town in Puntland. This is one of many messages we receive daily on our telehealth platform from patients across Somalia. Samira (not her real name) continues to inform us that she is two hours away from the nearest health facility and appreciates the convenience of the healthcare we provide.
Our name Caafi is a Somali word for "to wish upon Healing" to someone, and it's commonly used to wish someone good health and wellness, and serving patients like Samira and many others is why we founded Hello! Caafi, Somalia's first telehealth service provider.
What is telehealth?
Telehealth is a term used interchangeably with telemedicine, Mobile Health, or E-Health. It is defined as delivering health care, health education, and health information services via remote technologies [1].
The COVID-19 pandemic has made telehealth an increasingly vital tool to the wellbeing of people across the globe. The pandemic has dramatically changed how patients communicate and visit their healthcare providers and receive information and medication. Telehealth services offer a safer alternative for healthcare professionals and patients by reducing the risk of exposure to disease and illness. It can reduce the burden of patient care in health facilities and decrease the use of expensive PPEs. Using telehealth methods to create demand for routine and preventative care helps avoid negative health consequences in the future.
Somalia's health care system primarily relies on brick-and-mortar hospitals, clinics, and pharmacies mainly found in major cities and towns for health care provision. Unfortunately, this system is inaccessible for the 50% of Somalis who live in rural pastoral, fishing, or agricultural communities.
The lack of alternative care delivery models combined with an extreme shortage of health professionals (Somalia has four health care professionals per 10,000 people[2]) has caused a growing inequity in access to healthcare, especially for the most vulnerable members in those communities, including girls, mothers, and children. Consequently, 1 in 20 women aged 15-49 die due to pregnancy or birth-related complications every year [3].
Hello! Caafi addresses this inequality in healthcare and stewards the limited workforce by harnessing the power of technology, the country's high mobile penetration, and Somalis' oral speaking tradition.
We believe telehealth is particularly well suited for Somalia because of its low population density and poor road infrastructure, making traveling for health care a costly and challenging endeavour for many patients.
Telehealth also addresses unique barriers to care that Somali women and girls face regardless of their geographic location and economic status. Women are the primary breadwinners and caregivers in most households, yet health facilities often operate during school or work hours and require queuing. Household, childcare, work, and school commitments make it difficult for many of them to get the essential health services they need. Telehealth provides women and girls of reproductive age an opportunity to receive confidential and convenient maternity and primary care in the comfort of their home, school, or at work and avoid travel, queuing, and the awkwardness associated with in-person visits.
How does it work?
We have set up a national toll-free 3-digit phone number linked to our telehealth platform with personalized digital health record management. Patients who call us are connected to Somali-speaking health providers remotely and on-demand. Somalia is primarily a cashless economy, and patients pay their fees through their local mobile money transfer service providers.
Our services include medical and mental health consultations, health screenings, prescriptions, and other necessary advice to keep patients well. For patients we determine to require in-person care, tests, or physical examinations, we remotely coordinate referrals to public and private health facilities and providers of their choice or those closer home. Our work is possible thanks to our partnerships with our growing referral network of health facilities and major telecommunication networks in the country.
Hello Caafi co-founders Sahra Noor and Sumeya Ali
Our Approach
Hello Caafi emerged from our personal experiences as Somali mothers, health and development professionals, and users of health services. Throughout our start-up journey, from market research to design to proof of concept and operationalization, we have been keen on designing a platform that addresses Somalis' cultural and social norms and some of the inherent challenges patients face when accessing health care. For example, we decided to offer a toll-free number instead of a mobile app to help patients who can’t read, write or live in rural communities and don't have access to 3 or 4 G mobile phones and cellular networks.
Self-funding and bootstrapping Hello! Caafi has given us creative freedom and flexibility to iterate and pace the development and roll-out of the platform. Although it’s not easy, we recommend this autonomy for other female innovators. Somalia’s health innovation ecosystem is still in its infancy, and few policies and networks exist to guide or support female entrepreneurship or health technology in general. For us, getting external funding and investors early on would have brought unnecessary pressure and constrained our ability to be responsive, nimble, and agile as an organization.
As a nurse and female-led social enterprise, we are laser-focused on building a patient-centered and user-friendly telehealth platform that is inclusive, culturally appropriate, and meets the growing demand for tech-driven health care. As we release our mobile telehealth application in the coming weeks, we plan to continue to provide the toll-free feature to ensure no one is excluded from accessing our providers. Beyond care provision, we want our platform to provide digital health education and guidance every Somali needs to live healthy, prosperous lives.
Our Impact
Since we launched in 2021, we have reached thousands of Somalis across 70 locations in small, rural towns throughout the country with limited marketing. Serving as the initial point of entry to the health system, providing primary health care, and facilitating referral pathways remotely, we aim to advance Universal Health Access (UHC) in the country. Watch Our Story
While we are pleased with how quickly the community has embraced our service model, this new concept is still hard to grasp for many. We are constantly educating people on its usage, benefit, and limitations. Some of our patients lack the literacy skills or necessary cellular data to access our full spectrum of services. Although we charge 70% less than most private health facilities, cost remains a barrier for most patients. In a country where three-quarters of the population lives under $2 per day, financial hardship is understandable. We are committed to offering our services regardless of the inability to pay, and we continue to explore partnerships to subsidize the cost of our telehealth service.
UN’s Sustainable Development Goals 3 and 10 address the importance of fighting health inequalities and promoting good health and wellbeing, and telehealth is crucial to both. Health technology platforms and locally-led health innovations like ours can make a substantial dent in reducing Somalia’s high maternal and child health mortality rates and overall disease burden, making these SDGs and UHC coverage less far-fetched and more attainable.
For more information on Hello Caafi!
Their story: Our Story https://youtu.be/aUZyfVPX-LM
Their website: Hello Caafi https://hellocaafi.org/
About the authors:
Sarha Noor is Co-Founder and CEO of Hello Caafi! She is a nurse and health care executive with over 15 years of experience leading clinical services, including call center operations and virtual care programs. Sahra is passionate about harnessing the power of mobile and digital technology to promote wellness and increase access to high-quality health services. She holds a BSc in Nursing from St. Catherine University (USA) and an MSc in Nursing and Health Systems Administration from the University of Minnesota.
Sumeya Ali is Co-Founde and COO of Hello Caafi! She is an optimist who believes in people’s ability to build a brighter future. She is passionate about Africa’s advancement in the areas of health, technology, and innovation. She has extensive experience in research and communication in the development sector in Africa, She has dedicated the last ten years to lead and inspire change as a leader and mentor. She has a degree in International Relations and Excutive Masters in Management and Organization Development.
Footnotes
[1] What Is Telehealth? https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268
[2] According to WHO, Somalia also falls far below the minimum global expectation of doctor/patient ratio. Currently, there are only four doctors, nurses, or midwives for every 10 000 people in Somalia.” https://reliefweb.int/report/somalia/who-and-somali-government-roll-out-process-deliver-quality-health-services-all