Maternal and child health goes digital

Over the past two decades, Africa has experienced an incredible boom in the use of mobile phones and other digital technologies. Many countries have seized the opportunities these technologies offer to tackle the barriers that geography and scant resources pose to both access to and provision of services and at a relatively low cost.

Healthcare is one of these services. As of March 2020, at least 42 of Africa’s 54 countries had developed national eHealth policies. Mobile health, or mHealth, is an integral part of the eHealth package.

The US National Institutes of Health define mHealth as “the use of mobile and wireless devices (cell phones, tablets, etc.) to improve health outcomes, healthcare services, and health research.” Research projects supported by the Innovating for Maternal and Child Health in Africa (IMCHA) initiative have shown that mHealth can help reach those aims. They have done so through relatively simple solutions, from text message appointment reminders to more complex interventions such as case management and referral tools, data capture and management systems, and staff training, monitoring, and support.

Reducing barriers to care

Many primary healthcare facilities in sub-Saharan Africa are underfunded, poorly equipped and understaffed. This makes providing essential lifesaving care difficult. Furthermore, unsatisfactory, low-quality care deters women from using the services available, such as prenatal visits or delivery in a health facility. IMCHA research projects have shown that mobile technologies have the potential to address this supply-and-demand double bind.

In Tanzania, for example, a research team tested and implemented the use of mobile phones to register pregnancies and births, advise pregnant women about danger signs, and monitor stocks of medicines, supplies, and workflows. This innovation was part of a package of interventions to improve how community health workers (CHWs) assess and treat women and infants and to extend healthcare to rural areas. Building on insights gained through the research, the team has worked with a mobile company to design software that helps measure the quality of maternal and newborn care. More precisely, this tool monitored shortages of medicines and equipment at health facilities to inform management of the supplies needed for providing maternal and child health services. That tool will now be integrated into Tanzania’s existing Health Management Information System.

Also, in Tanzania, a research team tested the use of mobile phones to improve healthcare providers’ awareness of pre-eclampsia and eclampsia ― the second highest cause of maternal mortality in the country ― and improve their management of the condition. The project provided education and practical skills to CHWs to help them detect women at risk. Provided with smart phones and access to a tailored smart phone application, the CHWs automatically fed real-time test results to a central site for monitoring women’s health. In turn, they were prompted for follow up with pregnant women in need of care and referral to a higher-level facility. Government of Tanzania officials are now assessing the potential of this mobile health solution for the real-time management of antenatal care.

Boosting health workers’ skills

The projects mentioned above include a strong training component to enhance healthcare delivery. Others, focusing on more formal education, have shown that eLearning strategies have the potential to boost caregiver skills in remote rural areas.

For example, a combination of face-to-face training and mobile platforms has helped train primary maternal care providers in diagnosing and treating pregnant adolescents and new mothers in Nigeria suffering from depression, a condition that brings long-lasting consequences for both mother and infant. The training was delivered through face-to-face sessions, and mobile phones were used for patient follow-up to encourage compliance with treatment, as well as to remind them of homework to be completed and of appointments. These measures improved detection of depression from a pre-training level of about 2% to 40%. Almost all adolescents rated the phone support as a favourite aspect of the intervention.

In Tanzania, the lack of personnel to deliver obstetrical and neonatal care in health facilities is a major barrier to reducing maternal, newborn, and child deaths. To address this challenge, an IMCHA project helped improve the country’s program for associate clinicians in comprehensive emergency obstetrical and newborn care.

To reinforce the knowledge and skills of the program’s 42 trainees, the project also designed and developed six eLearning modules on key causes of post-partum illness and death to be integrated into their three-month professional training program. Based on the success of the modules in enhancing skills, the government has decided to establish a national eLearning platform.

Feeding into policy and research

The capture and use of real-time data using digital tools is proving invaluable for health providers, decision makers throughout the health system, and health planners, allowing for a greater depth of analysis related to maternal and child health.

In Ethiopia, for instance, an IMCHA research team trained doctors and hospital administrators to use mobile phones and tablets to record causes of maternal, neonatal, and child deaths ― information that is sorely lacking. The project provided Ethiopia with its first-ever representative dataset on the causes of deaths, helping to better identify gaps in health services for women and children. To complement this data collection, the research team developed a simple innovative e-platform to capture cause of death information at health facilities as well as accounts of deaths gathered through interviews with household members of the deceased ― verbal autopsies.

IMCHA projects have also generated useful insights to help refine innovations and enhance future research.

In Nigeria, for example, home visitors educating communities about the causes and consequences of short birth spacing used GPS-enabled android handsets to show video docudramas to pregnant women and their spouses. They also used the same handsets to collect data from the households and send it to a central server, allowing remote monitoring and quality control of the visits. In the early phase of home visits, the IMCHA research team detected about 16% invalid records in the dataset. Quality assurance was further secured when the research team programmed the handsets’ technology to block invalid records from being submitted, ensuring that 100% of the records were valid.

mHealth is a powerful tool

These and other IMCHA projects have provided evidence on how mHealth can complement and enhance health services. In Tanzania, for example, using mobile health applications to educate women and adolescents about family planning (FP) options led to more than six times as many women using FP methods than anticipated at the start of the project.

mHealth innovations developed by IMCHA research teams have also found applications in treatment compliance, in data collection, and in managing the supply of essential supplies, such as contraceptives. Health systems have benefitted from better trained staff. Many of these innovations are being replicated by health authorities and have led to system changes, such as the creation of a mental health desk in Nigeria and eLearning platform in Tanzania.

It is certain that challenges remain, and technology cannot solve all the problems within a health system. But it can become part of an evolving solution.

The Innovating for Maternal and Child Health in Africa initiative seeks to improve maternal, newborn, and child health outcomes by strengthening health systems, using primary healthcare as an entry point. It is funded by Global Affairs Canada, the Canadian Institutes of Health Research, and IDRC.

For more information

• Learn about the Innovating for Maternal and Child Health in Africa initiative

• Watch the IMCHA Legacy Video Series

• Read the IMCHA Impact Briefs