In many countries where Muslim religion and culture is prevalent, sex if often a very taboo topic. Such is the case in Bangladesh. Formed in 1971 following the Liberation War where it gained independence from Pakistan, Bangladesh is one of the poorest countries in the world. According to the UNICEF, it has the highest rate of child marriage, with 29 percent of girls married before 15. Given high poverty levels and the serious health consequences associated with early pregnancy, each year about 600,000 women die from complications related to pregnancy or delivery. The cultural stigma associated with sex education makes it very difficult, especially for young girls, to talk about sex and health problems. As a result, various types of health, social and legal problems go unsolved.
Furthermore, less than 10 per cent of births take place in health centers, the remaining done at home, attended by relatives or traditional birth attendants. This explains why Maya Apa, an e-health platform, has been a blessing for many women who often had questions and problems that no one else was willing to discuss in such a conservative society. Leveraging the fact that over 50 million women owned a mobile phone, with close to 80% expected to be internet enabled, the app has been developed with basic features in mind in an effort to reach the masses, especially rural women.
In under a minute and from the privacy of their phones, Bangladeshi women can sign in, create an anonymous profile and post a question in English or Bengali. The legal, medical and other relevant professional experts address the questions pertaining to their field and find solutions within 48 hours. The app also serves as a platform for the community to engage in the Q&A thread, allowing for peer-to-peer information exchange and constructive discussions to take place on matters women generally shy away from discussing openly. The previously asked questions remain available to the public, including unregistered members, avoiding repetition and allowing the professional staff to best utilize its time and answer the maximum number of questions on a daily basis.
For an anonymous interviewee, the Maya Apa app also provided a platform to also talk about domestic violence and seek legal advice on how to get a divorce and retain custody of her child. “No one in my family was willing to help me – they didn’t want me to leave my abusive husband. They kept on telling me: What would people say about a divorced daughter! Learn to adjust … At last, I heard about this app and posed my question, not really expecting much. But then I was surprised at the support I received. In addition to providing me a step-by-step answer, Mapa Apa also connected me to a legal aid organization which helped me through the process.”
Essentially, Maya Apa managed information flow between many women in need of answers and the health professionals eager to help with the limited infrastructure available. In many hospitals, nurses and doctors are embracing the platform and instead of waiting for patients who often have to come from far away, nurses and doctors can now answer questions remotely. Furthermore, the app is used to deliver prevention and awareness information via text message to pregnant young mothers, allowing for healthier prenatal care and a reduction in birth mortality. Fundamentally, this app has revolutionized the Bangladeshi health care space by improving access to information and increasing patient engagement.
Although this is a great start in solving the country’s myriad of social issues, additional steps can be taken to improve its social impact.
- For fatal chronic diseases such as AIDS and malaria or for children vaccinations, push notifications can be sent as reminders to comply with medications
- The app could scale up in infrastructure (such as additional servers) and serve as a platform to gather data as part of a larger integrated plan to implement eHealth services for women and children.
- Similarly, the Maya Apa app can be leveraged as an important tool for patient management. The patient’s entire medical history could be stored and easily accessible to doctors when in an emergency intervention or to provide treatment.
- The team at Maya Apa could set up drives to rural areas to train those that may not have the skill set to use the website or mobile app. While some may have the skills and aptitude to use a smartphone, many do not.
- The app can also be developed to serve as a training interface for traditional nurse attendants. According to the WHO, Bangladesh has 5.8 physicians, nurses and midwives per 10,000 habitants. Through the app, traditional birth attendants could access to knowledge and training online, thus increasing the supply of healthcare providers and improving mother and child survival rate at birth.