The Project for Rapid Prevention of Maternal Mortality and Obstetric Fistula

The Project for Rapid Prevention of Maternal Mortality and Obstetric Fistula

Organization type: 
nonprofit/ngo/citizen sector
$100,000 - $250,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Using a community-based catalyst approach and organizational tools from successful disease eradication programs, it ought to be possible to deal effectively with selected diseases that are not biologically eradicable. The idea works. Obstructed labor, main cause of birth-related deaths in a remote area, went to zero within 4 months and no woman has died of this since May 2008 in a pop. of 100,000.

About You
HDI Inc (Health & Development International)
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Section 1: About You
First Name

Dr. Anders R.

Last Name



, AK

Section 2: About Your Organization
Is your initiative connected to an established organization?


Organization Name

HDI Inc (Health & Development International)

Organization Phone


Organization Address

23 Middle St, (3rd Floor), Newburyport, MA 01950-2716

Organization Country

, MA

How long has this organization been operating?

More than 5 years

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Your idea
Country your work focuses on
What makes your idea unique?

As many women die in childbirth yearly as in the 1960s, an estimated 500-600,000 in spite of much money and many long-term prevention initiatives. Organizational disease eradication tools have never before been applied to rapidly prevent women from dying in childbirth or to protect their dignity by striving to rapidly prevent obstetric fistulas. The idea's conceptual uniqueness led to it being resoundingly criticized from a number of points of view, including for its being so focussed. But it works. Uniquely, it has even strengthened health-system utilization indicators like the number of women going for prenatal consultation (up 63% in 2 years) and the number of women giving birth assisted by a health professional (up 70% in 2 years), in a multiethnic population of 100,000 nomads and subsistence farmers who speak 4 languages and live spread across 4,650 sq. kilometers with only one road (unpaved), 8 nurses, a single midwife and no doctor in the project area. The size of the terrain where the project is being tested is also pretty unique, and implementation is about to be expanded to cover a total of 263,000 people on more than twice the area in 2010, to further test the idea for scalability. We are unaware of any similar initiative. Nor do we know of any other type of initiative with this aim but using other methodology, that has been tested so thoroughly over such a large, remote, and difficult project area. With modest additions, the idea/approach may also be able to rapidly prevent deaths from post-partum bleeding and eclampsia. That has yet to be tested; having received ethics clearance, we await government permission to similarly test rapid prevention of bleeding-deaths using the same community-based system. Using the same ORGANIZATIONAL tools to prevent three major, quite different causes of birth-related death would also be unique. That has never before been done on this scale in this kind of remote developing-country setting using mostly existing resources

Do you have a patent for this idea?

Tell us about the social impact of your innovation. Please include both numbers and stories as evidence of this impact

Having aimed to reduce the number of women dying in obstructed labor by 75% within 2 years, that number was down 100% within 4 months. As of January 2010, no woman had died of obstructed labor since May 2008 in the project area, for 21 months and counting. Obstructed labor was previously reported to be the main cause of birth-realted maternal deaths, as in other geographically remote areas. While the aimed for 50% reduction in new obstetric fistula cases has not quite been achieved yet, total birth-related mortality may have been reduced by 30% in the project area the 2nd year, in a country where 1 of every 7 women sooner or later dies in childbirth, the worst such statistic in the world. To me, a story that tellingly illustrates the project's impact is about the woman who threatened divorce in her strongly male-dominated society if her husband would not go for his annual re-training as a village volunteer. He had things to do in his fields, he said. She was livid. When he puzzled asked why, she said, essentially, "Don't you remember when our youngest child was born, and I was having difficulty? Those people came even in the middle of the night, and six people lifted me into that ambulance! And they didn't even charge us money! I and our baby boy survived in fine shape. And you want to go to your field when these people invite you for training???!!!??? Go right ahead!! But I won't be here when you return!" It was the husband himself who told us. He had chosen to attend the 3-day training course in the spring of 2009 after all. When mothers survive, existing children also survive better. The impacts on many levels when preventing women from becoming socially outcast and economically unproductive for the rest of their lives are myriad, as many as one can imagine and then some! Preventing obstetric fistula means preventing women from leaking urine and/or intestinal content day and night, even in their sleep after a birth that lasted too long, almost always a birth where the baby dies.

Problem: Describe the primary problem(s) that your innovation is addressing

The primary problem that this innovation addresses is the fact that, in spite of all of the money and effort thrown at the problem since then, about as many women and young girls in puberty die in childbirth today as during the late 1960s, roughly 500.000-600.000 of them each year. Most prevention interventions have had a long-term horizon for efficacy (such as "educate all girls", "a midwife for all", and "upgrade all hospitals everywhere", etc), all of which are important, even essential things to do. But the question remains as to whether the international community must per force sit idly by until these long-term interventions have effect, or whether one can apply relatively modest additional funds in a strategic manner to achieve a much faster effect, whether one can maximize the efficacy of what limited resources actually already exist in developing country settings, even while doing those other good things. Has the world really no choice but to kill another 14 million women or more, while waiting for the long-term solutions to have effect???

Actions: Describe the steps that you are taking to make your innovation a success. What might prevent that success?

To make the innovation a success, I first got together with the US Centers for Disease Control (CDC) and then also the UN Population Fund (UNFPA) with partial Canadian (CIDA) funding. We organized a global policy retreat of reproductive health experts to consider the idea, the innovation, in 2005. Then I worked with the government of Niger to plan and then implement the innovation in a remote rural, multiethnic, multi-language population of about 100.000 nomads and subsistence farmers, where health indicators and infrastructure were no better than the national averages. Having proven the innovation works on that scale, we are now extending it to cover an estimated 263,000 people in geographically areas that are non-contiguous. And I organized a successful international meeting at The Carter Center March 9-10, 2010 so "the international community" could consider whether this and selected other initiatives, using different approaches, may be ready for scaling up. Based on that meeting we are now also exploring whether it may make sense to implement the innovation in a specific East African country as an additional next step. And we continue to seek Niger's government approval to expand the program to also prevent women from bleeding to death at birth, through the same infrastructure, the same organizational approach.

Results: Describe the expected results of these actions over the next three years. Please address each year separately, if possible

The "official" aimed for result, chosen in advance, is to reduce obstructed labor deaths by at least 75%, to reduce obstetric fistula incidence by at least 50%, and to prevent at least 50% of post partum hemorrhage deaths, each within two years, in every area where this innovative approach is introduced, and to achieve further improvements from there on. Having reduced obstructed labor mortality by 100%, to zero new cases within four months, thus surpassing the aimed for or "expected" result for that parameter, one has of course raised the bar for that outcome in subsequent implementation areas. We will nevertheless stick to the initially aimed for or "expected" results goal as being the "official" one, partly because the project was severely criticized for having chosen goals that were much too ambitious and presumed to be unrealistic. If obstructed labor mortality is reduced very quickly in subsequent geographical implementation areas, one will adjust the "expected" results in an even more ambitious direction.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your innovation seek to have an impact on public policy?


If your innovation seeks to impact public policy, how?

This innovation seeks to influence public policy by first showing that women's lives can be rapidly saved and their dignity protected, to a degree that makes it politically and policy-wise unacceptable for the international community and national governments to stand idly by as one waits for longer-term interventions to bring the number of maternal deaths and obstetric fistula cases down. One organizational tool that the innovation uses is to regularly share outcomes information (the good news and the bad) with policy makers, so they align their policies in ways that speed the prevention of birth-related deaths and speeds the rapid prevention of obstetric fistulas.

What stage is your project in?

Operating for 1‐5 years

Does your organization have a board of directors or an advisory board?


Does your organization have a non monetary partnerships with NGOs?


Does your organization have a non monetary partnerships with businesses?


Does your organization have a non monetary partnerships with government?


Please tell us more about how partnerships could be critical to the success of your innovation

Partnerships not only could be critical, but they already are critical to the success of this innovation. HDI has collaborated with corporate partners previously but has not yet done so on this project. Partnerships with a UN agency (UNFPA) and CDC led to policy-acceptance in late 2005 for the idea to be tried out. To implement the project, partnerships with local and traditional leaders, regional leaders, national government officials, UN agencies, and other NGOs have been key. In other projects, HDI's main partner has sometimes been a corporation. On this current initiative, we have not yet found a commercial corporation to work with, though we would love to. Partnerships will be of utmost importance if this innovation is to be scaled up, because as a very small NGO there is no way we could manage to implement the program in a long list of countries alone.

We would like to learn more about how your initiative is financially supported. Please explain your business plan/revenue model

The initiative is supported by both HDI Inc (an American 501 (c )(3) public charity) and HDI-Norway with funding from the Norwegian government (NORAD), several Norwegian foundations, individuals in the US and Norway, and modest grants from US-based foundations such as The Conrad N. Hilton Foundation, One By One, and The Roth Family Foundation. It was one family's fundraising event in their home in California that raised the $152,000 that allowed the project to get off the ground, thanks to private individuals, corporate leaders, and foundation representatives whom they assembled for that occasion. A different HDI project receives USAID funding, and that may become relevant for this project too, at some future date. At this early stage, the revenue model for testing this innovation is based on the idea of mobilizing support from individuals, foundations, corporations, and UN-agencies.

The Story
What was the defining moment that led you to this innovation?

HDI Inc was having a strategic review at a board meeting in November 2003, which included presentations from CDC (US Centers for Disease Control and Prevention) about possible new things to take on now that guinea worm was almost eradicated. A board member attending her first meeting, former US ambassador to Niger who had listened the whole time without a comment, asked, "Does it have to be a disease? Can it be a condition?" Intrigued to learn what she was thinking of, we heard her describe obstetric fistula and all of its horrors in survivors of obstructed labor. Before she was done, it seemed crystal clear to me that this was what we were looking for in response to a question board member Dr. Hopkins of the Carter Center and I had batted around a bit, "Can we use tools and approaches from successful disease eradication programs to also effectively address a disease that is not biologically eradicable?" It seemed completely clear to me that the answer was "YES!" and that disease eradication approaches are ideally suited to rapidly preventing obstetric fistula. If women don't even get fistula at childbirth, they also don't die of obstructed labor because it is the survivors of obstructed labor who get obstetric fistula. Essentially the whole picture for how this could be done seemed clear to me then and there.

Tell us about the person—the social innovator—behind this idea.

I am a Norwegian country doctor (family physician practicing rural medicine) who was in Boston for Master of Public Health studies when a classmate saw me in a basement hallway (in October 1987) and suggested I might like to hear a guest lecture in a course I was not taking. Dr. Donald R. Hopkins spoke about the Guinea Worm Eradication Program, then in a nascent stage. I talked with him afterward to discuss ideas his lecture had given me. By graduation day in June 1988, the group working on that initiative agreed it might be useful if I pursued some of the ideas upon my return to Norway. HDI was incorporated in Massachusetts in September 1990 and has since then been one of just two NGOs that have supported guinea worm eradication efforts all along, along side The Carter Center which is the main driver of the Guinea Worm Eradication Program.

Looking back, I suppose one could say this fits into a pattern. For example, while a medical student I had a leadership role among those who worked to launch Norway's first program for Care of the Dying.

How did you first hear about Changemakers?

Through another organization or company

If through another source, please provide the information

I have heard about Changemaker for some years and cannot honestly say who it was that first mentioned them to me.

Does your project address any of the following barriers to women’s technology access and use?

If you checked any of the boxes above, please explain how.

Approximately 250 words left (2000 characters).

Does your project involve women in one or more of the following stages of the technology lifecycle? Identification of the problem the technology will solve:

If you checked any of the boxes above, please explain how you will ensure women’s involvement in each relevant phase of the technology lifecycle.

Approximately 250 words left (2000 characters).

If women are a focus of your project, how did this focus evolve?

The project focused on women from its conception..

Which type of women will your project reach directly?

Rural, Peri-urban, Urban, Low income.

In what ways does your project team/leadership involve women?

The core project team includes women., The core project team includes women from developing countries..

Has your organization formed any new partnerships in response to this challenge? If so, with what type/s of organization/s?

Multilateral/bilateral, Non-profit/NGO/community-based organization, Government, Women's organization.

Has your project leadership had prior experience with the following?

Working on innovation.