 Okay, thank you Linda and thank you Anita. I hope you are back on. First of all, I would just like to thank the amazing organizers of this event and of course all the midwives who are participating and attending this conference and also of course I would like to wish you all a very happy International Day of the Midwife. My name is Ketrina Kjellf and I work at Maternity Foundation as head of the clinical development team. I'm a Danish midwife and I have a master of public work and I've worked with the Maternity Foundation for almost the past five years. And I will be presenting together with my colleague Pearl. So Pearl, would you just like to introduce yourself shortly as well? Thank you, Ketrina. So a very happy International Day of the Midwives to all the participants who have joined us today. So I'm Pearl. I'm an Indian nurse midwife with a doctoral degree in nursing and midwife free. I'm working with the Maternity Foundation as a clinical coordinator for nursing and midwife free education. Thank you. Over to you, Ketrina. Thank you, Pearl. If I can go to the next slide here. Okay, so this is the agenda for today's presentation. We will give you a very short introduction to our organization, Maternity Foundation. So primarily how we work with digital health and how we use digital health tools for capacity building of healthcare workers who work within maternal and newborn health. And then we'll talk a little bit more specifically about our digital health tool, the safe delivery app. And then finally, which is a little bit of a surprise thing for this event that we would like to introduce you to our newest clinical module in the safe delivery app, our digital health tool, which is on perinatal mental health. And then we'll have a short Q&A session at the end. So first, I would just like to take you through how Maternity Foundation started out with an NGO. And how also our journey as an NGO working to improve maternal and newborn health begun and where we are today. So Maternity Foundation was founded in 2005 as a traditional sort of smaller NGO working in Western Ethiopia where the focus was on capacity building of the health system through clinical trainings and also empowering the community through health education. But in 2015, Maternity Foundation launched the safe delivery app after having published a randomized control trial, which significantly showed improved skills and knowledge for health care workers in handling complications in obstetric and newborn care for the health care workers using the safe delivery app. Between 2015 and 21, we have worked really on scaling this digital health tool, the safe delivery app. And we have reached more than two, by 2021, we have reached more than 200,000 healthcare workers with national scale in both India and in Ethiopia. And sort of our target for 2025 is leveraging our safe delivery plus global program, which builds on the safe delivery app as a digital tool but also includes online learning and these clinical trainings. And the aim for us is to reach more than 600,000 healthcare workers primarily midwives by 2025. So the safe delivery plus program is really a digital sort of modular learning and training universe. So safe delivery plus is one sort of connected and integrated learning experience at sort of the intersection between our initiatives, programs and tools. So it consists of the safe delivery app. It consists of online learning and clinical trainings, which are both online and offline. And the safe delivery plus is also has the advantage of being powered by data science to sort of continually improve and personalize the user experience. And with the safety, the idea is that with the safe delivery plus healthcare workers are able to receive quality training and the learning that they need to ensure safe deliveries for women and newborns. This next slide is just a little bit in terms of our reach. So we estimate that our work so far has reached more than 390,000 healthcare workers to date, and we have trained more than 100,000. We have users of our safe delivery app, our key tool in more than 40 countries, which as you can imagine has given us really a wealth of insights and experience about how the app can be implemented in different programs, projects and settings. And then finally, we know that it works because the use of the app has been subjected to a number of studies, as I mentioned before. So including two randomized control trials, which have shown that the app is effective in increasing knowledge and skills around safe delivery. Okay, so one of the most important things to highlight about our work with the safe delivery app and the same delivery plus program is that it is not a standalone tool or a program. We work with multiple partners, both in service and pre service. In some countries, the self directed gamified learning platform, which is built into the safe delivery app, which is called My Learning, has been accredited for CPD points. This is the case in both India and Tanzania and Cambodia and other places as well. And this has primarily been done in collaboration with their nursing, the National Nursing and Midwifery Councils. Another example is pre service education. So where we have, as an example, work with, for example, the Indian Nursing Council to integrate the app into the curricula of new midwives. So the app has been integrated into specific units and students are required to work through the content of the safe delivery app during their sixth and seventh semester. And then 10 marks are assigned for the safe delivery champion certificate for the internal assessment. And the certificate completion has been added to the coursebook as well. So that means if you go through the learning component of the app, that is the requirement through the sixth and seventh semester. When you're studying in nursing with life in India. We also, in addition to this, we have also seen, we also see faculty members at some of the colleges that they have already started using the safe delivery app and integrated as an integrated component to support their teaching. And then we also have examples of more sort of loose integration of implementation. So, for example, in Ghana, the Ghana Midwifery Association and other partners supported the wide sort of dissemination of the app through national events. Well, you're taking it. That's right. One was fake and one was a scouting. There's a little bit of background noise. You could turn your microphone off please. Thank you. Through national events, regional dissemination and captured feedback for further tech developments and improvements of the app. Another thing we also do is clinical trainings with the app as a sort of core element, both remote and underground. We also have this sort of open system for linking and sharing with other digital platforms and tools. So, for example, the content of the safe delivery app is also available on the World Continuing Education Alliance platform. And we have developed additional e-learning and content specifically for a learning management system in India to support the learning of nurse midwife students in the country. So this next slide, this is sort of just a summary of some of our partners that we have worked with at very different levels. Again, really just to reinforce that we are all about strengthening the existing work of partners. Okay, so now just let us dive a little bit deeper into the safe delivery app. It's a digital health tool developed to support healthcare workers, primarily midwives, improving their knowledge and skills in BMUNC, so basic emergency obstetric and newborn care, and other selected topics within maternal and newborn health. It's free and it works offline once it has been downloaded to the device. And it can be downloaded both for Android phones and iPhones. So you just have to go to App Store or Play Store or Google Play to find it and just write safe delivery app and then it will appear. It's very simple and intuitive and engaging with animated instructions. So as I mentioned before, there's a gamified learning component also included where the user can test her or his knowledge on the clinical content. And also a very important thing about the app is that it's specifically designed to reach the most remote healthcare workers. And the pictures here, this is how it looks. So this is just a slide to show you what the content of the safe delivery app is. We also have additional besides these modules that are mentioned here. We also have a module in selected versions on FGM. So when we first started out, we had eight modules that were built on BMUNC. But since then, we have been sort of widened our scope and continue to build new modules for the safe delivery app. So one of the newer ones is also the normal labor and birth module, which as a midwife, I thought was probably the most important one to include in the app as well. So the app consists of five different features. There is instructional animated videos, which will show procedures that are needed during labor and birth in an animated simple way in a step by step approach. We also have action cards, which is a written card within the app where you can quickly, it's sort of a quick reference. So you can quickly look up what you need to do if a baby isn't breathing or if a woman is bleeding and so on. Then we have our practical procedures, which can be something like how to insert a urinary catheter. And we also have a fairly comprehensive drug list, which you can find in the top right corner of the app with all the drugs that are needed to perform BMUNC. And finally, we have the My Learning component at the end, which is a self-directed learning platform where you can test your knowledge in the different topics. So another really great thing about the app is that it is customizable and it's modular, which means when new global clinical guidelines are released, we can relatively easily and quickly update the safe delivery app. We have many different versions of the app. We have different languages, as well as clinically adapted versions. And we also have, as you can see on the side here, adapted the animated visuals as well to the different regions. When I say clinically adapted, I mean that we have actually adapted the content for specific versions so that it fits with the national guidelines in the country. And lastly, we also have, use a very modular structure in the app, so we're able to add new relevant content to the app. So new topics, for example, which was the case during COVID-19, where there were lots of information coming out about COVID-19 and what to do as a midwife and how to prevent COVID-19. And this information we relatively quickly were able to add into the Safe Delivery app and we did that in collaboration with UNFPA and ICM. And because so many people had already downloaded the Safe Delivery app, they actually had access to the information through the app relatively quickly. And also because the guidelines changed quite often also in terms of vaccinations, for example, we were able to get that information out to them very quickly. So this year we are particularly busy because we are working on these new clinical modules for the Safe Delivery app. As you can see, we're planning on widening our scope from being just focused, very focused on BIMA as I said before, to also including new modules such as modern contraceptives, safe abortion, antenatal care and postnatal care. And then we also have released the Pyrinator Mental Health module in 2023 and it is available also when you download the Safe Delivery app. If you download the English global version, yeah. Now my wonderful colleague Pearl will take you through this new module and the Safe Delivery app, the Pyrinator Mental Health and also a little bit about the background of why it was developed. Thank you, Pearl. Thank you, Katrina, for letting us know about the work of Maternity Foundation and the significance of Safe Delivery app. So taking forward from there, I would just like to explain to you about the Pyrinator Mental Health module. So can I have the next slide, please? So Pyrinator Mental Health here, it means that it's the time during pregnancy and the first 12 months in the postpartum period. And as we know, during this period, the woman's body and the mind undergoes a lot of changes which predisposes her to complications such as anxiety, postnatal depression, Pyrinator depression and birth-related post-traumatic stress disorders. So when we see the studies, we can see that more than 20% of women, that is one in five women, develop mental health condition during the Pyrinator period. If the woman is poor, the condition is still worsened. That is up to 50% of women living in poverty will develop a Pyrinator Mental Health condition. So that is a huge number. Normally women, even men, the partners are affected and studies show that one in 10 partners may experience Pyrinator Mental Health problems. So these conditions are caused by a combination of changes in biology, psychology and the environment and competent, respectful and supportive care is required to identify and support women who suffer from such health conditions. As we can see, one in five women in the low and middle income countries experience anxiety and depression while one in 10 women in high income countries experience anxiety and depression. And most women require only light mental health support to overcome these issues and maternal health, child health services are in a unique position to support women in their mental health. And we have to remember that everyone has the right to good mental health and appropriate treatment. So the Pyrinator Mental Health, so poor mental health during the Pyrinator period may affect the well-being of the woman and her infant as well as the family. And it predisposes her to higher risks of obstetric complications like preeclampsia, PPH and low birth weight including stillbirth. It is a tragedy if a woman loses her life after she gives birth to a life. So suicide is an avoidable preventable condition that can be handled well by maternal health workers if only we identify the Pyrinator mental health issues early and care for the women. So when healthcare providers are trained to identify symptoms of mental health conditions during contacts in the Pyrinator period, they can make a huge difference in the lives of women. So now let's just look into why this module was included in the, we just looked on why this module was included in the safe delivery app. Now let's see what all are present within this app. So this app includes basic practical information about Pyrinator mental health, the risk factors, barriers to seeking care, diagnosis and symptoms and screening tools. Many times we think that we have to go search for the screening tool but here we have the Edinburgh postnatal depression scale, the generalized anxiety disorder scale, all placed under the practical procedures. So any screening can be immediately done with the help of these screening tools. Not only that we have prevention and treatment methodologies, medications in the drug list are also available. The action cards in the Pyrinator mental health module contains the details about conditions such as Pyrinator depression, anxiety disorders, bipolar disorders, Pyrinator and pupil psychosis also. There are details on infant outcomes and also a note on violence against women which is very important. The practical procedures, they contain details on various treatment options such as counseling, trauma informed care, psychoeducation, cognitive behavioral therapy, psychological first aid and so on. And we have a very interesting my learning platform which is in the form of a quiz which helps the learners evaluate themselves and move on from the level of being familiar with the module to being an expert in the Pyrinator mental health module. So all these are included within the module in the safe delivery app. And what we hope through this module, so this through this module we hope that there would be an increased focus on Pyrinator mental health, midwives and other healthcare workers will be able to identify women because identification is the first step in supporting such women and helping them. So midwives feel more confident in providing mental health support and reducing stigma for mental health conditions, enabling an environment where women can voice out their needs so that their needs are met, ensuring respectful care and promotion of mental health and prevention of mental health disorders. Caring for carers, we can see that it is stressed here again. So we emphasize on this because providing care for women experiencing Pyrinator mental health conditions can be stressful for the healthcare provider. And so this app talks about professional support and self care techniques for the carers so that they will be able to address such issues if they are suffering from any illness also. I would just like to conclude by saying we in maternity foundation firmly believe that it should never cost life to give life and the joy of motherhood should be experienced to the fullest extent by every woman. So let us as midwives on this international day of the midwife still promise ourselves that we will update our knowledge and sharpen our skills by utilizing the digital tools that are freely available that are widely available so that we are ever ready to provide a positive childbirth experience for all the women that we encounter. So with this, I would like to close our session and open up for the Q&A session. So thank you. So I can see I wanted to know if this was hospital based or out of hospital evidence from hospitals or home. So the initial randomized control trial that was done with the safe delivery app was done in Ethiopia also and that was on in the health facilities, smaller health facilities with midwives. And so the concert of the app really what we have done is taken global guidelines, WHO guidelines and sort of boiled them down to these sort of 10 minute, approximately 10 minute animated videos with the most important information to save life so that you don't have to run through a lot of pages of guidelines that can be complex. And also the fact that you have it in your pocket is also an advantage. So what we what the idea really was to sort of boil down lengthy guidelines into something that's easy to understand and also with the very visual components that you can see how to do bimanual compression when a woman is bleeding, for example. And I can see Shannon is saying we don't have national guidelines and that's the US is not the only place we have. What we've done really is that we have sort of five global versions of the safe delivery app, which primarily builds on WHO guidelines, but then we have them in different languages. So we have it Spanish will be coming out very soon but we have Portuguese, Arabic, French, and English out as it is right now. Did I forget any pro and those are all the same based on the same guidelines and then we have a lot of other national versions with them with and language versions where the content has been aligned with the national guidelines if there are any. Maybe I can also I can see this one comment about difficulties downloading the app. It should be possible, but on that note, it is good if you are in a place when you have to download it to your eyes where there's sufficient internet connection because it does have these animated videos included. And that means it does require sufficient internet to get it downloaded to the app. But once it's on your device, it doesn't require internet at all, which is one of the assets of the app really. I believe Maxine has a question. She has a hand up. I've enabled you to turn on your sound if you want and speak Maxine or write it in the chat. Ah, there you go. Very good question that as well. I'm all for that one. We deliver pizzas, not babies. I think we haven't actually considered changing the name just because sometimes that's difficult when you're already out there with a name that a lot of people know. But I do hear your reflection to thinking about something less medical. And also you're also right for because we are actually widening our scope quite a bit at the moment. So it might not be the right name. We haven't thought about changing it for now, but I'll have that in mind. Then there's also a question on do the animated videos come to your country of work? So we have actually animated videos with different visuals for specific versions. In the my learning section, the digital learning component where you can sort of quiz, it's a quiz component where you can test your knowledge. We have mixed all the different visuals in the supporting sort of the questions in the app. Interesting question there about China. I know there are a lot of limitations with China. I also want to share this out with my students, but I'm not sure it can be used in China. So I don't know if it can be used in China. We don't have a specific version for China. So I actually, I don't know. I'm sorry. A question from Latisha. Thank you, Merron. So Merron says that Latisha was asking if you update it as and when use things pop up in the field. Yes, so we do update it. And then of course to get the updated version of the safe delivery app, you do need to go in actively and update it. But usually there's built in sort of a pop up notification, which will state what has been changed or what has been added to the app. So if you have internet connection where you are, it should be fairly easy to get the updated version of the safe delivery app. But we quite often say if you're not in a place where there's sufficient internet connection, then always remember to think about updating it if you're using the safe delivery app when you do actually come to a place where there's sufficient internet connection. And please let us know, Yang, what the answer is. Is it accessible in China? We would love to. I think it's a fabulous app, to be honest. Thank you. Thank you, Linda. And I will surely follow up on that. So how is the sustainability from your side as an organisation? Yeah, so the app is free for all users and that's how we would like it to continue to be. That's the basis of what we do. But we have sort of built in what we call sort of a freemium business model that has sort of enabled us to reach healthcare workers across the globe. The app is not, as I mentioned, a standard loan tool. So we work through partners as an integrated component of bigger systems and complementing already existing programs in countries and so on. Whether it's educational program or a humanitarian response or a development project, but really to ensure sort of our financial sustainability, we started to build up this freemium model where, so it's kind of known from other apps as well. So the solution is free itself, but there's add-on services that can be purchased at a premium. But in our case, we decided to make the app free for the users. But we do require in-country partners when we work to implement an app in the country. And they will often co-finance these premium services, which can be these clinical national adaptations so that it's a collaboration with maybe a governmental institution, Ministry of Health. And then they will help us in paying for the premium services, which can be national app adaptation, it can be trainings, and it can be implementation support. And we also have a lot of data coming out from the app on usage, which is also something that we quite often share with partners so that they can see, okay, do we need to, we can, for example, see in which regions the app is being used in a country. And so we can share with partners if there's a specific area where the implementation efforts could be improved. That was in another room again. Have you answered Marcus's question? Is the app integration for free? So that is something. We haven't done it with a lot of other digital tools, but I think I will refrain to, I don't think it's for free. We haven't done it, but it's often been a collaboration with other apps because it's an asset for both, right? So it's something that our technical team works on in larger projects usually. There's also a question from Maxine again. Who funds Mutility Foundation? Is your future secure? So we have, so it differs quite a lot. We have quite a lot of donors and so we have a lot of donors and we also have collaboration with, as I said before, government. So what we do is we are only, as an NGO, we only have country offices in India and in Ethiopia. So we are 100% dependent on implementing partners in country. And we always, it's always a collaboration with implementing partners, ministries of health and so on. And quite often we work together with, for example, UNFPA, who has also been supporting us in developing this new appearance of mental health module. But also with regional and national UNFPA, for example, they also support us in implementing in countries. But it can also be other governmental institutions like JICA or GI set from Germany. So it differs quite a lot who our partners are. And also it differs quite a lot to what extent the app is implemented in the country. As I mentioned before, in India and Ethiopia, we have actually scaled the app quite significantly in other countries. We might only have been doing some trainings and it has sort of taken off by itself. Okay, well, I think we'll have to leave that there because we don't have, we don't have any more time left. So if anybody's got any more questions, please take note of Catherine's email address which is on this slide before I move it on. And we will just complete here. Lots of great questions. And I, again, I heard about this app a couple more years ago. I have it on my phone even though I'm not practicing as a midwife anymore, been retired for a long time. And it was, I do think it is a published resource and I do share about it quite often. Okay, so I'm just going to move on to the final two. So thank you both. First of all, Catherine and Pearl for a fantastic innovation and presentation.