By Avantika Pathak

As of last year, the number of those forcibly displaced worldwide currently stands at approximately 80 million people and continues to increase. 67% of all refugees come from just five countries, of which 6.6 million are attributed to the Syrian refugee crisis, the largest refugee and displacement crisis during this time. Turkey currently hosts the largest number of Syrian refugees with 3.6 million people.

Women and girls make up approximately 50% of all refugees, while children below 18 years of age comprise 44% of Turkey’s Syrian refugee population. These women and children face a number of challenges including family separation, psychosocial stress and trauma, physical harm and injury, and health complications, particularly antenatal and pregnancy-related complications. Recognizing the increasing lack of access to fundamental health services such as women’s health and vaccinations, HERA inc. designed a digital health platform to bridge these gaps.

Caitlyn Hoeflin, HERA’s program manager, affirms the app lays critical groundwork to support refugees’ access to crucial health services. A former business consultant with scientific research experience, Caitlyn joined HERA inc. to pursue her passion for human rights activism and helping refugees. She was inspired by Aral Surmeli, the founder of HERA, and Surmeli’s idea to use cell phones to disseminate preventive health services to refugees. For refugees, mobile phones are a lifeline that enable them to stay connected with family, news, employment opportunities, and healthcare. Leveraging this ubiquitous technology to communicate critical information and expand access to vital services can have an enormous impact on migrant populations. As the population of displaced people continues to grow due to catastrophic events such as climate change and conflict, Caitlyn sees HERA as a solution with great potential to play a pivotal role in the lives of many refugees worldwide. 

HERA’s Unique Solution 

For HERA inc., the namesake of the Greek Goddess representing women, marriage, family and childbirth, the primary mission is to empower women to protect and improve their own health and that of their children. This mobile health intervention built in continuous collaboration with Syrian refugees aims to increase access to prenatal care and childhood vaccinations and, ultimately, decrease maternal and infant mortality and morbidity. By providing information on both the Turkish health and legal system in the refugees’ native language, the app actively addresses five key barriers Syrian refugees encounter in accessing healthcare services: registration procedures to access free health services, navigation of a new health system, language, fear of adverse treatment, and cost. Some of HERA’s distinguishing features include:

• Push notification reminders for prenatal and vaccination appointments

• Secure electronic health record keeping allowing users to store their medical information

• Health facility location finder

• Emergency service call to help users call emergency services

• Access to health education and information about the health and legal system

HERA Milestones

Originally an NGO, and now a social enterprise, HERA’s positive impact has already been felt through the results of its pilot trial conducted last year. One of HERA Inc.’s biggest achievements has been the trial’s use of the app to vaccinate an additional 476 children and connect 300 additional women with necessary prenatal care. Although the data could not predict how many deaths and disabilities were prevented from increased access to these services, the team calculated an estimated 237% return on investment (ROI). Moreover, given that prenatal services and vaccinations are critical to maintaining a healthy pregnancy and minimizing the morbidity and mortality of certain diseases, with time and expanded access, this digital health platform will have exponential impact. 

For HERA, its biggest obstacle has also been its biggest strength: establishing contact with a population that is highly mobile and whose primary focus is survival. Given that many of the operators in the region speak Turkish, both language and trust pose additional barriers to initial adoption. To address these challenges, HERA established community workshops in Arabic, the Syrians’ native language, to introduce refugees to the app and help them understand how to use it. 

Caitlyn believes that the benefits the app provides in helping users navigate a foreign health system and access health information in their native language will automatically translate to word-of-mouth marketing once they reach a certain number of users.

Adapting in the Time of COVID

The app’s focus on preventive health services has also helped them pivot to respond to refugee needs arising from the COVID-19 pandemic. The HERA team recognized that this population was at an even higher risk for community-wide spread for COVID-19 due to language barriers and a potential lack of information. It reached out to current users of the app to disseminate information in the form of educational modules on hygiene and sanitation, symptoms of COVID-19, and how the disease spreads. 

The app also provided users a short survey to help them gauge if they were experiencing symptoms and urge them to seek help accordingly. For Caitlyn, the ability to add on modules catered to the COVID-19 pandemic has been a powerful proof of concept. She expressed that although HERA is focused on maternal care and vaccinations, there is a very real potential for its application to more chronic conditions such as diabetes and even mental health. 

HERA – Winners of the 2020 Women’s Health Tech Challenge

HERA was selected to participate in the HITLAB Women’s Health Tech Challenge (WHT) from a pool of 125 applicants representing over 20 countries. The mission of the Women’s Health Tech Challenge is to identify and accelerate technologies that address unmet needs in women’s health. The Challenge is an essential element of The Women’s Health Tech Initiative, which aims to drive women’s health innovation through events, mentorship, networking and thought leadership.

“The WHT Challenge was an invaluable experience, it was inspiring to meet all the fellow female entrepreneurs at various stages in their ventures!” Caitlyn enthusiastically added. She reflected on how the HITLAB team and Susan Solinsky, WHT Director and Chief Growth Officer at Ellipsis Health, helped HERA hone their pitch and message to effectively communicate their mission, what they care about, and how they are going to change the world. “The HITLAB team also distilled our message down to its essence making it even more impactful when we present it to potential stakeholders, investors, and anyone wanting to get involved with the project,” Caitlyn recalls.

She and her team were also thrilled to have gained a partnership with Horizon Government Affairs through the WHT Challenge. “Allison Wils, Horizon’s Vice President of Strategy, is excited to talk with us about HERA’s narrative and how we can portray ourselves to effectively meet our goals in helping women and children,” Caitlyn shared. Through this partnership, they are looking forward to exploring other applications for HERA and mapping out potential new places where their app can help people.

What We Can Expect from HERA in 2021

HERA cares deeply about the women they help. Even though the pandemic has limited their ability to be out in the field, the team continues to work remotely on their next steps. This past year, they published scientific papers for other actors in global health and worked with the Boston Children’s Hospital and HITLAB to further HERA’s goals. They are also in the midst of completing their next study on maternal health and prenatal care in Istanbul. Additionally, the team is currently developing HERA 2.0 based on initial user feedback. Some of the changes include streamlining services, improving usability and accessibility for non-smartphone users, and addressing users’ data usage and storage limitations.

Finally, the team continues to remain focused on increasing the demand for crucial preventive services, like childhood vaccines and prenatal visits to save lives, reduce hospitalizations, and lower healthcare costs for refugees worldwide. They are diligently pursuing the expansion of their user base through the exploration of use cases in other countries like Pakistan, Bangladesh, and Greece. 

Engage with emerging innovators and leaders in women’s health tech by joining HITLAB’s Women’s Health Tech Initiative. Join the initiative and contribute to the revolutionary world of FemTech by being a Sponsor, Ambassador, or Applicant. Tune in every Wednesday for another episode of HITLAB Women’s Health Tech Wednesdays, a free webinar series highlighting Women’s Health leaders. Caitlyn Hoeflin will be joining the show later this year.

References:

1. Refugee Data Finder. UNHCR The UN Refugee Agency. Accessed February 26, 2021. https://www.unhcr.org/refugee-statistics/

2. Reid K. Syrian refugee crisis: Facts, FAQs, and how to help. World Vision. Accessed March 3, 2021. https://www.worldvision.org/refugees-news-stories/syrian-refugee-crisis-facts

3. Karasapan O. Turkey’s Syrian refugees – the welcome fades. Brookings. 2019 Nov 25. Accessed March 3, 2021. https://www.brookings.edu/blog/future-development/2019/11/25/turkeys-syrian-refugees-the-welcome-fades/

4. Women. UNHCR The UN Refugee Agency. Accessed February 26, 2021. https://www.unhcr.org/en-us/women.html

5. Women refugees and migrants. UN Women Europe and Central Asia. Accessed March 3, 2021. https://eca.unwomen.org/en/news/in-focus/women-refugees-and-migrants

6. El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health. 2019 Jun 27;13:31.

7. Alawa J, Zarei P, Khoshnood K. Evaluating the Provision of Health Services and Barriers to Treatment for Chronic Diseases among Syrian Refugees in Turkey: A Review of Literature and Stakeholder Interviews. Int J Environ Res Public Health. 2019;16(15):2660. Published 2019 Jul 25.