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From our team… Dear Dunia Health supporters,

Our first year in operation, as is typical with small start-ups, has been outrageously exciting. In the summer of 2013, Dunia Health conducted it’s first pilot study in the Taybeh health center in Amman, Jordan in conjunction with the United Nations Relief Works Agency (UNRWA). Over the course our study, we met with UNRWA officials, Taybeh health center staff members, and surveyed patients at the clinic to gain an understanding and appreciation for their specific needs. Feedback from all of these groups was overwhelmingly positive and supported the implementation of Dunia Health’s text message alert system to streamline the clinic’s appointment reminder system. Our partners in Jordan agreed that text messages were a simple, effective way to automatically notify patients when vaccines became available, improving the clinic’s communications with patients while simultaneously reducing workload of already overburdened clinicians. This SMS alert alert service, which went online at the conclusion of our 3-week field study, automatically sends a text message to parents of patients waiting for a vaccination appointment, or who have missed or defaulted on an appointment. Since this summer, we have worked with the Taybeh health center staff to manage a batch of 20-30 patients’ mobile phone numbers and have sent them regular text alerts remotely from the United States. All text messages were written in Arabic and were received by the intended patients. This December, UNRWA asked us to expand this alert system to include patients waiting for Vitamin A supplements in the Taybeh camp. While this has been our greatest accomplishment of 2013, we also reached an organizational milestone by presenting at our first global health conference. Our co-founder, Jordan Schermerhorn, tied for 2nd place in the Switchpoint conference’s Silo Busters Lightning Contest. Jordan gave a 90 second pitch about Dunia Health and it’s goals to an audience of global health professionals and students at the Switchpoint conference in April 2013. This is the first of many: you can also find us at the Houston Global Health Collaborative and the Annual Meeting of the Consortium of Universities for Global Health in early 2014. The Dunia Health team has also been invited to attend the Clinton Global Initiative University conference in March 2014 hosted at Arizona State University. We are proud of our accomplishments during 2013 and, with your support, our goal is to continue to grow and expand our services to multiple refugee camp health centers in multiple countries serving a variety of refugee populations. Your support has allowed us to achieve this and strive to do much more, so we thank you for helping us help others. Sincerely, Batoul Abuharb, University of Houston College of Optometry Jordan Schermerhorn, Duke University Cherie Fathy, Vanderbilt University School of Medicine Eman Bahrani, Baylor College of Medicine Matthew Schumann, Princeton University Muhammad Amith, University of Texas Health Science Center

Pilot Results During June and July of 2013, we conducted a 24-day pilot study at the Taybeh Health center in Amman, Jordan. During this field visit, we established a relationship with UNRWA, surveyed participants about their perceived need for vaccine appointment reminders, and began implementation of an appointment reminder service that has continued since. We send SMS reminders for missed vaccination appointments weekly, and reminders for missed growth monitoring and vitamin A supplementation appointments once per month.

86% of patients we messaged ultimately obtained their immunizations with UNRWA.

We faced several challenges during this pilot period. Most notably, we had to become quickly acquainted with the mobile phone landscape in Amman, which is rife with frequent turnover. We identified several reasons a message may not be received by the end user: • UNRWA may have an invalid number stored in the patient value (typically missing a digit or with an extra digit) • The number stored is landline only • Cell phone providers in the region vary in reliability Challenges aside, patients have been responding positively to our reminders based upon feedback from the clinics. Stakeholders at UNRWA have been pleased with the project results and have invited Dunia Health back to conduct a scale-up accompanied by more rigorous impact evaluations.

TOO MANY PATIENTS, TOO LITTLE TIME In summer 2012, we conducted preliminary research in the refugee camps in the Gaza Strip, where availability of basic vaccines is often unpredictable. During a 3month shortage of the vaccine against measles, mumps, and rubella in the Nuseirat clinic, we discovered: • 25 nurses and doctors serving a catchment area of 85,000 patients • 150 phone inquiries about vaccine availability each day • 2 nurses moved from caring for patients to answering phone calls • Subsequent outbreaks of preventable infectious diseases

Percentage of SMS Text Alerts

Appointment Reminders Successfully Received by Patients per Month, n = 305 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% June




% received

% failed


*Jul-Aug 2013: No numbers received due to holiday

Patient Surveys


FUTURE PLANS Summer 2014: Randomized Control Trial •

• •

Track immunization defaulters in two groups: • 4 clinics receiving SMS reminders • 4 clinics with no reminders • Compare total default time between groups Hold focus groups with Palestinian and Syrian-Palestinian mothers on barriers to health access Conduct qualitative assessments of immunization access under unusual circumstances, such as emergency campaigns and during Ramadan Publish our results in an open-access academic journal and the UNRWA Health annual report

LEARN MORE Website: Twitter & Instagram: @duniahealth

Pledge your support: The Dunia Health team would like to thank our sponsors and partners:

Dunia Health 2013 Annual Report  

Learn about our work improving immunization access for Palestinian refugees in Jordan.