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

在紧急情况下，育龄妇女不会停止怀孕或分娩。然而，人道主义紧急情况往往对卫生保健系统产生负面影响，因为关键基础设施遭到破坏或摧毁，限制了围产期妇女及其新生儿获得生殖和孕产妇保健。这在偏远的农村地区尤其如此，例如尼泊尔的山区，那里频繁的地震和山体滑坡对本已有限的卫生保健基础设施构成了重大危害。了解围产期妇女和新生儿在紧急情况下的需求并制定适当的干预措施以提高其复原力（即他们保护自己和恢复的能力），应该是任何减少灾害风险（DRR）规划或应对措施的一部分，但这些需求往往得不到满足。在这种危机中，通常支持母亲并鼓励她们在围产期寻求护理的女性社区卫生志愿者自己可能与她们所服务的卫生设施隔绝，并可能像其他社区成员一样难以应对。迫切需要的信息和知识可能存在，但由于以下几个原因无法获得：不恰当地使用技术语言，识字程度低或没有识字的人无法获得基于文本的信息，诋毁当地知识，限制妇女和女孩的行动自由或通信自由，以及基础设施受损阻碍了往返于保健服务机构的旅行。伦敦大学学院妇女权利中心与尼泊尔非政府组织合作，成功地实施了增强妇女权能以改善其健康的工作，培训妇女保健工作者管理以孕产妇和新生儿健康为重点的参与性学习和行动妇女小组。研究发现，这种基于社区的干预措施使尼泊尔出生后第一个月（即新生儿期）的死亡率降低了30% （Manandhar等，2004年），并有效降低了新生儿和孕产妇死亡率（Prost等，2013年）。然而，迄今为止，这种方法并没有面向紧急情况下的复原力，也没有经过调整，以利用发展中国家移动技术获取的快速增长。因此，本项目调查如何改善获取信息和通信的机会，以支持灾前、灾中和灾后的妇幼保健。它的目标是通过开发移动技术来支持和扩大现有的参与式学习型公共卫生干预措施和社会保护机制，特别是在尼泊尔农村地区。通过这样做，该倡议解决了联合国可持续发展目标和《2015-2030年仙台减少灾害风险框架》中强调的一些优先事项，以支持孕产妇、新生儿和儿童健康以及性健康和生殖健康。这项研究结合了地球科学（例如，关于自然灾害的科学知识和基于卫星图像的风险评估）、社会科学（例如，在灾害背景下对性别、脆弱性和健康的关注）、技术（例如，移动应用程序）和艺术（例如，通过参与式学习）。以及视觉和文本卫生保健通信)设计新的方法，从卫星解释和实地调查中快速获取数据，这些数据可以发展成为对当地社区有意义的风险解释。通过添加手机“应用程序”，该项目的目标是使基于证据的信息（例如幸存者口述、当地生成的照片、图画、视频、故事和历史回忆）和学习更广泛地传播和获取，特别是在纸质小册子或图片卡可能无法获得或损坏以及灾害切断生命线基础设施的情况下。

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.