How Rah-e-Maa led to fathers

by Behzad Taimur

Nasir spent his morning sitting in his auto-rickshaw, waiting for a customer. He could certainly use some money today, but he was too preoccupied this morning to think about money. His wife had recently gotten pregnant. As a first-time father, he didn't know much about pregnancy or what would be expected of him. He spoke to a few of his friends but they hadn't been very helpful. They only knew what they had heard from friends and family, and he had questions that they could not answer.

He had been very shy about speaking to a medical professional. "It was not his place to be asking questions about womanly issues like pregnancy", he kept thinking.

His train of thoughts was broken by the ringing of his phone. He took the call. A male voice informed him that a certain Dr. Saba is ready with answers to the questions that he had been fiddling with. Then, a female voice came on. It was Dr. Saba. She provided him with some helpful tips on what he could do to support his wife, including the sort of diet she should be on. She recommended that he take her to a doctor regularly just to make sure everything remains okay. He was, then, told he could ask Dr. Saba anything else he wanted and that he could listen to other parents experiences related to pregnancy. Then, the call tapered off.

Nasir heaved a sigh of relief. He thought about the tips Dr. Saba shared with him and decided to have a discussion about what he learnt with his wife, that evening. Just then, a hand landed on his shoulder. A kind-looking man asked if he would take him to the railway station. Nasir smiled and kicked his auto-rickshaw to a start. In a few moments, they were on their way.

A few days ago, Nasir had heard of a phone number he could dial and ask questions about his wife's pregnancy. He was told the call would cost him nothing and that a very helpful female doctor would listen to his questions and answer them. After toying with the idea, he had finally decided to dial the number. He had done it and got to a hotline which allowed him to record his questions. After he had recorded his question, a voice on the hotline had told him they would get back to him with the answers shortly. And surely, he had received a phone call with the answers soon afterwards.

This phone-based service was Super Abbu, a maternal health-focused service designed and deployed by Information Technology University (ITU) that had helped thousands of other expecting fathers like Nasir before him.

The story of Super Abbu begins in January of 2016. The International Development Design Summit (IDDS) was being held in Lahore and was meant to bring together motivated individuals from various corners of the world with different professional backgrounds to identify key development challenges, develop innovative solutions and prototype them.

Participating at the event was ITU's former Programme Manager, Sacha Ahmad. She and her group members were tasked with addressing maternal mortality in Pakistan using an information communication technology (ICT). Indeed, she could not have been truer in her assessment. Pakistan has the world's highest neonatal mortality rate (44.2 per 1,000 live births), accounting for 7% of the world's neonatal deaths, and has one of the worst maternal mortality ratio in the region (178 per 100,000 live births).

During the summit, Ahmad and her group members undertook extensive research and discovered that men in Pakistan did not feel they had much of a role to play during their wives' pregnancies. In fact, at least to their minds, they felt their duty was limited to providing financial support and arranging transportation. Their research showed that greater male involvement during and after pregnancy went a long way in driving down adverse maternal health outcomes. Ultimately, men remain the primary decision-makers in Pakistani households and wield great influence over their wives, both in terms of what they did and why they did it. The group decided to do something about it. However, the question before them now was - what could they do?

They met with Dr. Agha Ali Raza, who leads the Center for Speech and Language Technologies (CSaLT) at ITU. Dr. Raza saw value in targeting expecting fathers to improve maternal health outcomes and proposed a hotline-like, voice-based service that could get important health-related information to an expecting father over a simple phone call. Soon enough, they were joined by ITU's former employee, Mustafa Naseem, as an ICTD consultant.

Enter: Super Abbu. Dr. Agha, Ahmad, Naseem and their colleagues set up a nonprofit organization within ITU called Rah-e-Maa or "Path of the Mother". The Rah-e-Maa soon developed an Integrated Voice Response (IVR) platform, called Super Abbu. This service was initially led by Ahmad but has since been handed over to Behzad Taimur, who, today, leads the service as its program manager. The Super Abbu service was simple: An expecting father seeking information on some aspect of maternal health could simply dial a number and record a question. The question was transmitted to a specialist doctor who could receive the question on a mobile app that Rah-e-Maa had had designed to support Super Abbu. On receiving the question, the doctor could type or voice-record their answer onto the same app. The answer was, then, transmitted back to the enquirer, who could listen to it on a simple phone.

Interestingly, that was not all. Super Abbu also served as a social media platform. Users could record their experiences with maternal health challenges, listen to others' experiences, comment on them and share them with others! Put simply, Super Abbu was health-focused Facebook on a simple phone! Not only could users get health-related information, but they could also connect with other people who shared their experiences or could add something to them. Since the social media-like features were speech-based and could be navigated merely by pressing keys on a simple phone, the Super Abbu platform was widely accessible. Put another way, users didn't necessarily have to be literate or tech-savvy or fall into an income bracket that could afford more high-end technology, to use it.

And it got better: All of this could be achieved at zero cost to the user!

The pilot of Super Abbu was conducted at ITU and was supported by its then-Vice Chancellor, Dr. Umar Saif, who saw its potential in improving maternal health outcomes. Soon, it was pitched to the UNICEF Innovation Fund, which agreed to fund Super Abbu. At once, the nonprofit, socially-driven Ghurki Trust and Teaching Hospital agreed to furnish services of its specialist doctors for Super Abbu for free! The situation could not have been better and the project immediately took off.

In a 71 day deployment, Super Abbu amassed 21,600 users who made 40,000 calls, and recorded 7,300 questions and stories from across the country. Of the users, 96% were male and had an average age of 27.71 years. Users tended to be low-literate with 21.4% having no education at all and 40.5% having between six and twelve years of schooling only! Similarly, nearly 60% belonged to rural areas. Furthermore, the users put the hotline to good use. Post-deployment surveys showed that 61% of questions were related to gynecology and obstetrics, 24.8% were related to general health and 12.3% were related to children's health.

A high rate of uptake by a very relevant population segment in a way that put the service to good use went to show that there was a pent up demand for such a service. Ultimately, there is a dearth of accurate and reliable health-related information in Pakistan. The situation affects the low-literate and low-income population segments in particular, because they lack necessary means to acquire reliable information, including such basic tools as access to the internet. A low (or no!)-cost voice-based information service centering solely on simple phones can be highly effective in getting important information across to low-literate, low-income persons.

Though, one may ask if this was a one-off success or have other, similar projects also met with success. One may wonder, also, if this success is limited to maternal health-related issues, or do voice-based technologies have more applications across a greater array of fields.

All these are relevant questions which we will be answering in our follow-up blogs. Watch this space!