Simple Sehati tool will help deliver women from perils of pregnancy in Indonesia

Mothers and children in Indonesia face a far less precarious journey through pregnancy and delivery thanks to an innovative tool developed by a domestic start-up, Sehati.

The company’s simple TeleCTG hardware and online application is bringing quality maternal healthcare to women in the remotest parts of Indonesia. Before Sehati’s solution, delivering affordable, accessible healthcare, especially maternal care, to a population scattered widely across more than 17,000 islands spanning 5,200 km has proven a significant challenge.

Among other obstacles, maternal health care in Indonesia is confronted by high infant and maternal mortality rates and a disproportionate ratio of patients to obstetricians. Add a lack of access to skilled professionals, costly or nonportable equipment, and necessary ante- and post-natal knowledge and the perilous path through pregnancy and delivery for Indonesian mothers and children is quite clear.

TeleCTG is a low-cost, easily-transportable tool allowing remote midwives to collect and transmit maternal health data via smartphones to obstetricians in major cities. As the first diagnostic tool of its kind developed in Indonesia, TeleCTG can increase the number of healthy, live births by addressing risk factors early and providing invaluable information for pregnant women in areas with scarce resources.

Indonesia is the second-most populous country in Asia and the world’s fourth-largest geographically; the majority of its 240 million people live in rural settings.[1]

Training and education of healthcare workers are national priorities of the Ministry of Health. But the reality is that rural Indonesians have long depended on community-based healthcare, often provided by local non-professional workers. For them, the dedicated health centers and medical professionals in cities are often difficult to access. There is a stark disparity between urban and rural care in terms of ante- and post-natal care, institutional deliveries, and the presence of skilled attendants at birth.[2]

These key indicators of maternal and infant health have long gone unaddressed, due in part to a disproportionate ratio of patients to obstetricians. In 2016, only 3,500 specialists were trained and available to treat more than five million mothers in Indonesia.[3] Moreover, the cardiotocograph (CTG) technology required to monitor and evaluate maternal health properly has historically been bulky, expensive, non-transportable, and difficult to interpret by staff who are not trained obstetricians.[4]

For many Indonesian mothers, the scarcity of helpful information and maternal educational tools represents as big a problem as the lack of access to physical resources. A 2012 UNICEF study on maternal health in Indonesia found that poorly educated mothers were much less likely to deliver in a healthcare facility or in the presence of a skilled attendant. Those mothers also failed to receive postnatal care for newborns or have access to vaccinations.[5] These factors contribute to the striking fact that newborns with less educated mothers are more than three times as likely to die within one month as those in other categories.[6]

In one innovative swoop, TeleCTG remedies the physical, financial, and informational difficulties faced by Indonesian mothers. A set of sensors attached to a small handheld device identifies fetal heart rate and movement. Data is collected and transmitted to the remote midwife’s smartphone, then sent via Bluetooth to servers in command centers located in major cities. Certified obstetricians then access and evaluate the data, consult with the remote midwives, and offer clinical advice about the patients’ treatment and care. The process means expectant mothers can rely on experts to identify and address potential complications early on in pregnancy. A simple design makes the device inexpensive to produce, easily portable, and ideal to assess the health of mothers for whom hospital visits are impossible.

Figure 1. A handheld TeleCTG device and Sehati’s online application work to create links between remote midwives and obstetricians in major cities / Sehati TeleCTG

As an Indonesian company, Sehati is well-equipped to understand the specific needs of the country’s resource-scarce communities. Alongside its TeleCTG hardware, two more applications, Ibu Sehati and Bidan Sehati, provide important obstetric information to mothers and midwives. The extensive education they provide to midwives boosts their competence and prospects of being hired in healthcare settings.[7] The apps also record and monitor pregnancy data based on three preset parameters. Paired with the TeleCTG device, the Sehati educational and monitoring tools provide the physical and informational resources necessary for safe pregnancies and deliveries.

An innovation-friendly public sector contributed to Sehati’s success. BEKRAN, the Indonesian Government’s Creative Economic Agency, chose the startup to represent the nation at the 2019 South by Southwest festival in Austin, Texas, where it garnered international attention and financial support.[8]

Back in Indonesia, the Ministry of Health permitted Sehati to deploy its technology on a trial basis in 14 subdistricts in Jakarta in 2018, before granting it a license as a health care product. Sehati TeleCTG’s status as a government-backed, Indonesian-made medical device mandates all government-owned healthcare facilities to use it.[9] The technology is now in use at close to 10,000 community health centers and over 2,000 hospitals, engaging a community health network of around 400,000 midwives.[10]

Sehati applied for and was granted a patent for its TeleCTG technology in June 2017, leading to a substantial profit on sales of its device sales, which accelerated its expansion plans.[11]

Co-founder Abraham Auzan said the patent process is imperative for the success and profitability of start-ups, especially in the health technology sector.[12] Disruptive innovations in healthcare are often geared toward lowering prices and increasing access to resources. Patents protect the intellectual property behind new designs. They allow companies to earn margins on their technology and maintain affordable prices for consumers, without the anxiety of being copied or challenged by competitors. For countries like Indonesia, where 95 percent of medical devices are imported, patents protecting locally designed and produced health technology are crucial to usher in greater self-sufficiency and economic stability. Moreover, they support domestic innovations that are best equipped to address the specific needs of the local population.

Armed with their 20-year patent, TeleCTG’s founders can license the novel technology and generate revenue through partnerships with manufacturers at home and abroad. The patent has acted as a beacon to draw attention and investment from international partners at events like South by Southwest, who can be confident their investments will be protected.

Indonesia is working to create a more fertile and robust environment for innovation and intellectual property in healthcare technology. A Ministry of Health regulation passed in 2017 bolstered the legal basis for online training available to health workers, protecting qualifications provided through Sehati’s apps.[13] The Ministry’s National e-Health Strategy (2015–19) prioritizes the strengthening of infrastructure to protect electronic health services. It also triggered the establishment of telehealth interventions to accelerate the delivery of care in remote communities.[14] Since 2014, the Ministry has sought to digitally consolidate all health data to make it more accessible for mHealth ventures.[15]

Indonesia is recognized by the United States Chamber of Commerce Global Innovation Policy Center (GIPC) as using a number of mechanisms for IP protection; its copyright enforcement regulation is seen as among the strongest in Southeast Asia.[16] These laws, including hefty financial fines and imprisonment, deter potential poachers of intellectual property and incentivize innovators to drive their developments onto the market. However, the GIPC also notes that Indonesia’s IP mechanisms lack coordination or the power to enforce laws between agencies.[17]

Indonesia has a long road ahead to reach a truly innovation-friendly legal landscape or make quality healthcare the norm for its most remote and resource-scarce populations. But, crucially, it recognizes the link between the two as pivotal to achieving both.

The support, exposure, and financing Sehati has received from the Indonesian Government has enabled the startup to expand and plan its next steps as a global innovator. With its firm foothold in the Indonesian healthcare system and plans to expand into 15 African countries soon, Sehati and its novel TeleCTG technology is a flag-bearer for indigenous ingenuity made stronger by a supportive public sector.

[1] Joint Committee on Reducing Maternal and Neonatal Mortality in Indonesia; Development, Security, and Cooperation; Policy and Global Affairs; National Research Council; Indonesian Academy of Sciences. Reducing Maternal and Neonatal Mortality in Indonesia: Saving Lives, Saving the Future. Washington (DC): National Academies Press (US); 2013 Dec 26. 4, The Indonesian Health Care System. Available from: https://www.ncbi.nlm.nih.gov/books/NBK201708/

[2] United Nations Children’s Fund (UNICEF), Maternal and Newborn Health Disparities: Indonesia (New York: UNICEF, 2015). Available from: https://data.unicef.org/resources/maternal-newborn-health-disparities-country-profiles/.

[3] Fahmi Ramadhan, “This startup boosts maternal health in Indonesia”, GovInsider, November 2, 2016, https://govinsider.asia/innovation/meet-anda-and-abraham/

[4] Ibid.

[5] UNICEF, Maternal and Newborn Health Disparities: Indonesia, 3.

[6] Ibid.

[7] Anda Waluyo, “A Different Approach for Maternal Health through Telehealth & Ecosystems”, Social Innovations Journal 47, June 2, 2018, https://socialinnovationsjournal.org/regional-ecosystems/argentina/75-disruptive-innovations/2813-a-different-approach-for-maternal-health-through-telehealth-ecosystems

[8] Agustinus Mario Damar, “Sehati TeleCTG Ready to Target the Global Market After Attending SXSW”, Liputan6, March 23, 2019, https://translate.google.com/translate?hl=en&sl=id&u=https://www.liputan6.com/tekno/read/3924020/sehati-telectg-siap-sasar-pasar-global-usai-hadiri-sxsw&prev=search

[9] Anda Waluyo, “A Different Approach”.

[10] Ibid.

[11] Republic of Indonesia, Intellectual Property Database (“TELE CARDIOTOCOGRAPH (TELECTG)”, accessed Jul 2 2019), https://pdki-indonesia.dgip.go.id/index.php/hakcipta/TFVNK3BlQkV0RUxOMTVnRzQ5VEFWUT09?q=C00201702451&type=1.

[12] Salsabila Bratandari Nazief, “Abraham Auzan’s Disruptive Innovation”, Outro/Intro, September 23, 2018, https://www.outrointro.com/blog/abraham-auzan.

[13] “Infrastructure Provided, Sehati TeleCTG Optimizes Reach”, WartaEkonomi Online, April 23, 2019, https://translate.googleusercontent.com/translate_c?depth=1&hl=en&prev=search&rurl=translate.google.com&sl=id&sp=nmt4&u=https://www.wartaekonomi.co.id/read222789/produk-anak-bangsa-sehati-telectg-hadirkan-inovasi-bagi-ibu-hamil.html&xid=17259,15700002,15700022,15700186,15700191,15700256,15700259&usg=ALkJrhjPbojWgSY1bCaWLC8M8zh9fWXsNQ

[14] Daryo Soemitro, An overview of the Indonesia e-health development plan, (Jakarta: Republic of Indonesia Ministry of Health Center for Data and Information). Available from: https://www.academia.edu/34678858/An_overview_of_the_Indonesia_e-Health_development_plan.

[15] Ibid.

[16] Dian Septiari, “Indonesia languishes in intellectual property index”, The Jakarta Post, March 14, 2019, https://www.thejakartapost.com/news/2019/03/14/indonesia-languishes-intellectual-property-index.html.

[17] Ibid.