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Co-innovating for antenatal care in fragile environments

A collaborative initiative by the International Committee of the Red Cross (ICRC), Philips Design and Philips Foundation



    Driven by the notion that 94% of all maternal deaths occur in low and low-and-middle-income countries, the International Committee of the Red Cross (ICRC), Philips Design and  Philips Foundation joined forces to help both volunteers and professional healthcare workers in providing better services to pregnant women with complications in fragile environments*. 

    This has resulted in the development of a High-Risk Pregnancy (HRP) toolkit, consisting of several solutions to support healthcare workers to recognize and explain the signs of high-risk pregnancies. In this way, high-risk women in fragile sociocultural settings can understand the importance of using the referral system for necessary help. It also involves raising awareness of healthy pregnancy habits and the importance of regular antenatal check-ups and safe delivery in healthcare facilities.


    *The ICRC defines fragile environments as conflict zones, post-conflict zones, displacement areas and areas affected by natural calamities.





    The co-created toolkit consists of:


    High risk pregnancy referral cards a portable set of tear-resistant cards to help:

    1. Recognize and explain the signs of high-risk pregnancies to women living in ICRC operation settings.
    2. Educate and raise awareness on practices for healthy pregnancy, as well as encourage antenatal check-ups.


    The referral cards are easy to understand for audiences with different levels of literacy. The visuals respect local cultural sensitiveness, and the content can be easily adapted to different languages to respect their use in different contexts.


    ‘Heart for 2’ fetoscope a double-heads, battery-free device to support:

    1. Training of assistant midwives and healthcare workers in finding and listening to fetal heart beats for timely referral pregnancies at risk.
    2. Simultaneous listening of fetal heartbeat by healthcare worker and pregnant woman (and family), improving experience of antenatal care visits.



    ICRC trialed and validated the HRP Cards in two facilities in South Sudan over a 3-month period. Subsequently, ICRC distributed 2,350 sets of referral cards in 6 African countries - Cameroon, CAR, Mali, Niger, Nigeria, South Sudan - reaching approximatively 1,800 traditional birth attendants (lay healthcare givers). Based on the results, ICRC has made the cards accessible in its primary healthcare resource centers for use by all ICRC health delegates.


    Following the validation in fragile settings, Philips Foundation and the Kenya Red Cross have also deployed and studied the benefits of the cards in more stable environments with high maternal and child mortality.


    The Heart for 2 fetoscope is currently being field tested in a trial with the Kenya Red Cross.

    Learnings and next steps


    Quotes with feedback and observations reported from ICRC health field officers (HFOs) and traditional birth attendants (TBAs):


    ICRC Health Delegate in Nigeria: The cards are very useful for the TBAs, as we can see from the data they are able to identify the various risks demonstrated in the cards and offer timely referrals. In fact, some of the TBAs come with their cards with the mother they have identified to have a certain condition


    TBAs in Central African Republic (CAR): With the HRP cards it is easier for me to convince the mother and the family about the importance of being referred to a health facility. I can show them the pictures and because it has the logo of the ICRC, the community has more trust.


    ICRC Health Delegate in South Sudan: It is much easier to train the TBAs with HRP cards because the pictures are very well done and adapted to South Sudan. They can bring this tool back home and discuss with the women showing them the cards.


    Quotes from stakeholders involved in the co-creation process and validation of the tools in the field:


    Ms. Sigrid Kopp – Former Supra Regional Midwife, International Committee of the Red Cross:Earlier risk detection in pregnancy will lead to earlier referrals from the community to first level of care, and from primary healthcare to hospitals. This time factor plays a crucial role when working on the high number of maternal morbidity and mortality in areas where the access to quality healthcare is hampered due to low coverage of healthcare services, war, displacement, insecurity, lack of infrastructure, lack of skilled healthcare providers and lack of awareness and knowledge.


    Esperanza Martines, Head of Health, ICRC: The HRP cards are the result of a simple, yet meaningful, co-creation process. Following feedback from both staff and communities, the cards have been updated and now can be seamlessly integrated into ICRC’s primary health care resource center and be made available to all health delegates to leverage in operations.


    The HRP toolkit has been awarded 8 prestigious design awards.


    2015 - 2018




    Cameroon, Central African Republic, Mali, Niger, Nigeria, South Sudan

    Middle-East & Africa, African Countries Map

    Care to collaborate, or want to learn more about this project?  
    Do not hesitate to contact us.

    In line with Sustainable Development Goal 17 (partnerships for the goals), we believe we can make a real difference in providing access to quality healthcare if we work together.

    Project report


    [1] Philips Foundation video: Philips High-Risk Pregnancy Toolkit: The need explained

    [2Conversation between Peter Maurer (former President ICRC) and Ronald de Jong (Chairman Philips Foundation) about the toolkit during the Global Good Summit 2017

    [3High Risk Pregnancy Toolkit selected as Fast Company – World Changing Ideas finalist

    [4] Book: Organizing for Sustainable Development – Addressing the Grand Challenges (expected 14 April 2022). Chapter 10 – Value co-creation through multi-stakeholder collaborations for health in fragile settings: the case of the high-risk pregnancy referral tool. Simona Rocchi et al. 

    [5Double Headed Fetoscope description

    [6] Leopold Manouvre Poster: steps for abdominal palpation and fetal auscultation.

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