DAWA Mobile Health
Dawa Mobile Health
Dawa Mobile Health is a last mile health care solution. Its aim is to deliver effective, affordable, and sustainable health care services to rural communities in Chad. Dawa works as an add-on to existing health care infrastructure for rural communities by travelling to the villages, collecting samples and returning with treatment.
The Dawa Model
Dawa Mobile Health is a last mile health care solution. It’s aim is to deliver effective, affordable, and sustainable health care services to rural communities in Tchad.
Dawa works in collaboration with the existing health care infrastructure, such as hospitals and health care clinics to reach rural patients dispersed in different communities.
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Dawa Mobile Health has different concepts for delivering services based on the competencies and equipement needed in each case.
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Dawa Agent is the most basic unit where and agent can collect non-invasive samples, such as urine samples, and take fever, blood pressure or similar tests. Dawa Agent can also deliver prescription medicine.
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Dawa Van can be staffed with a nurse, midwife, or technician who can perform more advanced tests such as take blood samples or give ultrasounds.
Areas of Health
Dawa was founded to address bilharzia, a water-transmitted parasite, which is still at the core of the work. Once launched, Dawa saw the needs in other areas and now Dawa works with multiple health conditions including chronic illnesses, maternal health and more, as well as research and knowledge development.
Bilharzia
The core service of Dawa is testing and treatment of bilharzia´, which neither require advanced equipment or skills, but without an untreated bilharzia can lead to severe long-term health consequences such as cancer, infertility, urinary problems.
Bilharzia affects millions of people but remains one the neglected tropical diseases that receives little attention. There are significant gaps in knowledge that could facilitate more effective treatments.
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Dawa’s program for bilharzia is based on three steps: awareness-raising, testing and treatment, and research.
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Awareness-raising is based on the Dawa agent establishing a trust-based relationship with the community and informing about the disease including symptoms and transmission. This becomes a two-way conversation where the community also shares their behaviors around water, previous efforts etc, which allows the agent to better understand the specifics of this community which can guide the other steps.
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Testing and treatment starts with prevalence testing in a new community to understand the rate and if bilharzia is already endemic to the community or not. Positive cases in prevalence testing are of course treated. After this, the members of the community contact Dawa’s agent when they identify symptoms of bilharzia. The Dawa agent comes to take the urine samples, brings to the laboratory for testing, and then returns with treatment.
Research has become its own prioritised component since we continue to have surprising results in our work in the field. Many results have merited academic journal article to contribute to improving the work around bilharzia. An initial learning was finding much higher rates in adult populations than expected in Torrock, without obvious signs but severe long-term complications. Others include finding low effect of clean water in households for prevention. And most recently that some cases can even be diagnosed ocularly due to cloudy urine samples. By using a scientific approach in our regular work, we can efficiently contribute to the body of knowledge and develop more efficient treatment schemes.
Chronic Illnesses
Millions or people living in rural environments suffer from chronic illnesses that benefit from regular check-ups and treatment. Unfortunately, the inaccessibility of healthcare services means that most people cannot maintain the necessary level of care and risk having severe complications that require more and urgent care instead. Travelling and staying in the regional town for several days is simply not feasible and many chronic illnesses are neglected.
Dawa piloted a partnership with the regional hospital in Ngouri to deliver anti-tuburculous medications to affected people in the rural areas. The treatment is currently offered for free, but the distance to collect is too much of an obstacle.
Dawa is also exploring to work with diabetes, chronic heart illnesses, where the illnesses can be managed with simple tests for follow-up.
Maternal Health
The maternal mortality rate in Chad is the second highest in the world. The main causes are preeclampsia, gestational diabestes, and hemorraging during labor. While these are common pregnancy complications that could be managed, they become fatal when the women continue their pregnancy without proper follow-ups and then give birth at home, too far to travel for help once problems arise during labor.
Dawa can help reduce maternal mortality rates by identifying high-risk pregnancies so they can be monitored appropriately and high-risk labors can be scheduled at the hospital.
Dawa has begun this work on a small scale in the Lac Tchad region due to clear need. UNDP had conducted an aware-raising project in partnership with the regional hospital in Nguiri. The project informed women about the risks with preeclampsia and gestational diabetes. This led to pregnant women turning to the local health clinic for testing. However, the health clinic did not have capacity for these kids of tests so they asked Dawa to assist. While Dawa isn’t yet performing blood samples in Lac Tchad, these complications can be indicated with urine samples. So Dawa collected urine samples from 109 pregnant women and for those that indicated risks, the women were adviced to go to the regional hospital for formal diagnosis and closer follow-up.
Dawa aims to develop the area of maternal health further during 2025 to be able to offer a follow-up program for all pregnancies in addition to testing to identify high-risk pregnancies.
Since Dawa worked with pregnant women, a natural continuation was to facilitate the birth registrations. Without any specific focus, Dawa helped registered 53 babies who would otherwise not have had official papers. This is an easy add-on to the maternal health services.
Data Collection and Research
Dawa Mobile Health operates in an environment which significantly lacks in data statistics and research. Dr Didier Lalaye noticed already in 2014 how most available knowledge on bilharzia did not match the realities he saw in the field in Torrock. The prevalences were higher than expected, the complications were more severe than previously studied, and the risk behaviors previously identified did not correlate with the positive tests.
Dr Lalaye decides to pursue his PhD to further study the disease, including its transmission, complications, diagnostic methods, and prevalence.
Dawa aims to contribute to knowledge development through data collection and research. By publishing scientific articles on the finds from the field work, Dawa can contribute to the collective knowledge around bilharzia, and other health issues, and develop new methods for diagnostics and treatment.
During the launch project in the Lac Tchad region, Dawa noticed that many positive urine samples were visibly cloudy, which means that ocular inspection could be sufficient to diagnose and treat some cases. Another example of learnings is that established understandingsof risky behaviours do not explain differences in prevalence. In the Torrock as well as Lac Tchad regions, Dawa has seen that positive tests does not correlate with self-reported use of risky water for domestic use. This means that efforts to increase access to clean water for domestic use has not had an impact on rates of bilharzia. The risky behaviors that correlate with positive tests are rather contact with risky bodies of water to urinate or to simply cool off and play. This behavior, especially among children, has proven harder to limit which might suggest that large scale treatments rather than behavioral campaigns might be the key to irradicating bilharzia.
Dawa aims to further develop the are of data collection and research together with university partners in the Netherlands and Chad.
Drone Mapping
Climate change has greatly impacted many bodies of water in the Sahel region. Previously free-flowing rivers have had their inflows dried up and have become stagnant bodies of water.
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Tracking the characteristics of bodies of water can greatly help identify areas that are at greater risk for high prevalence.
Drone technologies combined with AI analysis can allow for large scale risk mapping which can help allocate resources where needed most urgently.
Dawa is planning a research project with partners in the Netherlands and Chad to initiate drone mapping and analysis of bodies of water.