Connecting Vietnam’s isolated communities to improve healthcare
Mobile phones are being harnessed to bring vital health information to ethnic minority women in Vietnam. Isolated from mainstream maternal and childcare services by geography, language, education, and poverty, these women experience much higher mortality rates than the majority Kinh population.
Researchers from Vietnam’s Institute of Population, Health and Development (PHAD) piloted an innovative mHealth (mobile health) program to reach these remote populations. Tested in eight communes in the mountainous Dinh Hoa district of Thai Nguyen province in northeastern Vietnam, mMOM has increased women’s awareness, knowledge, and compliance with advice for a healthy pregnancy and newborn care. It has also strengthened the skills and increased the knowledge of village health workers and commune health centre staff, and it has improved the overall district health system.
Although Vietnam has made great strides towards improving the health of mothers and children, ethnic minorities lag far behind. Census data shows that they have higher fertility rates, higher infant and child mortality rates, and lower life expectancies.
Vietnam has made enormous progress in extending mobile phone networks. At the beginning of 2016, an estimated 93% of Vietnamese owned a mobile phone. With IDRC support, a research team from PHAD set out to determine if implementing an integrated health intervention using mobile phones would improve access to maternal and child health services for ethnic minority women.
Researchers chose Thai Nguyen because a health management information system had recently been implemented: all hospitals and 181 communes in nine districts were integrated into an electronic record management system. All commune health centres were also connected by high-speed cable to district and provincial health centres. Health officials and staff at the province, district, commune, and village levels enthusiastically supported the project.
Reaching out to mothers
Initial surveys revealed that distance and lack of time prevented pregnant women in Thai Nguyen from accessing health centres. Some indicated that they were afraid to go. Surveys also showed that health providers did not have the time to spend with patients to fully explain everything they needed to know about pre- and post-natal care. Often, the information they provided did not correspond with the stage of the pregnancy.
To address these problems, the research team established a Maternal and Child Health Information Centre that provides women with crucial information about pregnancy, pre-natal care, birth, and infant care. Some 820 pregnant women and new mothers in eight communes participated in the project.
Each woman received 75 text messages during her pregnancy and the year after giving birth. One-way messages provided vital health information prompts. For example, new mothers were reminded that their babies could be immunized for free at their local health centre. Pregnant women were reminded to take iron and other supplements. The health centre checked up on women who failed to respond to messages and as a result, not a single woman dropped out of the program.
Enhanced knowledge and relationships
All participants across the eight communes said that the text messages delivered valuable information during critical periods of pregnancy and early infanthood. They most valued information about vaccinations, nutrition, ultrasounds, breastfeeding, and when to start feeding solid foods to their babies. Receiving information over mobile phones was convenient, they said, and often eliminated the need for a trip to the health centre.
Women’s increased confidence in their knowledge of pregnancy and new motherhood improved their interactions with health workers. Many health workers reported that women phoned them more frequently, not only about their own health, but also that of other children or family members.
mMOM also changed family dynamics: many women shared and discussed the messages with their husbands, which is uncommon in a society where maternal and infant health have traditionally been considered women’s domain.
Extending benefits to the healthcare system
Community health workers were unanimous in their support of the mMOM project, stating that it had improved their ability to monitor pregnancies and infant health, and had enhanced their technical and health knowledge.
Completed in late 2016, the mMOM project is now continuing with the financial and technical support of the Thai Nguyen provincial health department, which co-managed the intervention. Lessons from mMOM will inform efforts to scale up maternal eHealth efforts across Vietnam. The Ministry of Health has shown strong interest and commitment in introducing the model to other provincial health departments.
The mothers of Thai Nguyen are certainly keen for the program to continue. “I still want to participate next time [next pregnancy], because I may forget the information after raising my child for a while,” said one young mother. Most are even willing to pay for the service despite their economic constraints.