Healthcare is difficult to access in Nepal, especially in low-income, rural areas. The country's mountainous terrain makes travel to health centers strenuous for all and often impossible for sick, injured, disabled, or pregnant people.
Decades of political instability have resulted in an unevenly developed national health system, with a newly emergent private sector catering services of varying quality and price to privileged Nepalese. With more than twenty different governments established since the 1990s, Nepal has nonetheless worked impressively to improve access to healthcare for marginal communities, declaring healthcare to be a basic human right in 2007 and offering many primary care and preventative services for free. Ranking 115th out of 162 countries in the Gender Inequality Index, Nepal has struggled to support women's health and wellbeing, but has been making steady improvements.
Since the early 2000s, Nepal has worked to increase access to maternal, antenatal, and neonatal care. Introducing programs such as the 2005 Maternity Incentive Scheme, the government offered financial recompense for women to travel to deliver in health facilities and for healthcare providers to assist in births. In 2008, the government made deliveries in government health centers free of charge and in 2009, a program was developed to financially incentivize pre- and postnatal care. Networks of local healthcare workers began to be trained to fill in the gaps: Maternal and Child Health Workers, Village Health Workers, and Female Community Health Workers. With these programs, maternal mortality has plummeted, declining from 539 per 100,000 live births to 239 per 100,000.
Despite these extraordinary improvements, there are large gaps to fill in maternal and child health. Around 70% of deaths in children occur in the first 28 days after birth. And while government initiatives have assisted in reducing reliance on traditional rather than medically trained birth assistants from 11% to 5%, over 40% of women in Nepal still give birth at home.
Amakomaya is a free web and mobile application that aims to fill these gaps in healthcare access.
Administered by a diverse team of medical, sociological, financial, and public health professionals, the application delivers medical information via pre-recorded video content. The videos explain the stages of pregnancy, inform mothers what to expect, provide medical information about warning signs of health problems, and assist women in maintaining the wellbeing of themselves and their babies.
The application contains platforms for pregnant women as well as their healthcare providers. Women can enter information about their health and receive advice and reminders for care. The interface also engages women's support networks, offering outreach to husbands and mothers-in-law about best practices for care during pregnancy.
The provider-focused elements of the application allow for digitization of health data, allowing for robust follow-ups during and after the pregnancy and increasing insight into maternal health in a country that still overwhelmingly relies on paper medical records.
Amakomaya is a donor- and grant-supported public health service that began as a team of volunteers. Funded initially by a 2011 $4,000 ISOC grant, the program also received funding in 2013 from ISIF Asia. Content was contributed by the Patan Academy of Health Sciences, which provided medically sound information about pre- and postnatal health accessible to rural populations.
The application currently serves 1,500 women across 11 remote regions across Nepal. It has engaged dozens of Female Community Health Volunteers to support application users to seek medical care at local health clinics.
Use of the application requires a certain level of awareness about the benefits of medical support for health issues surrounding pregnancy. Many people in rural communities in Nepal are accustomed to family-based delivery practices and these closely held traditions around birth and childcare require compassionate reframing by trusted sources.