By Homan Mohammadi
Maternal health has been a key priority in the global health agenda for decades, as its issues, despite their persistence, are largely preventable. Despite efforts, however, death during childbirth remains one of the leading causes of mortality among women worldwide; according to a 2008 study published in The Lancet, 342,900 women die annually during pregnancy or childbirth. The vast majority of maternal deaths in the developing world, however, are avoidable with timely prenatal and postnatal care.
Recently, there has been a surge in the use of mobile devices to improve healthcare in the developing world – a practice referred to as mobile health or mHealth. Since mobile phones are abundant in developing nations, governments and leading NGOs have enthusiastically supported their application to maternal health issues.
Two global health programs, mothers2mothers (m2m) and Mobile Technology for Community Health (MoTeCH), have employed mobile health technologies to improve the provision of maternal healthcare.
The successful integration of mobile phones in these programs has expanded their opportunities for conducting health interventions and improving access to care. Yet, these organizations face the key challenge of reducing the barriers that prevent mothers and health professionals from fully utilizing these potentially beneficial resources.
m2m, which has over 700 sites in nine African countries, has integrated maternal health services in communities to prevent mother-to-child transmission of HIV. They hire and train Mentor Mothers living with HIV to work in health facilities alongside doctors and nurses. The Mentor Mothers offer psychosocial support and health advice to pregnant mothers who are also HIV-positive.
m2m recently began using cell phones to provide information to pregnant mothers, as well as to receive their feedback. Mentor Mothers and site coordinators have been communicating with mothers through cell phones to collect and share health information. m2m is currently collaborating with Johnson&Johnson on the Mobile Alliance for Maternal Action (MAMA), a new partnership that leverages mobile technology to help prevent death during childbirth.
Dr. Mitch Besser, founder and medical director of m2m, stated in an interview with HCGHR, “[m2m] is currently considering the role of incentives to have mothers return to clinics, and is thinking about using a grant from Vodafone to give mothers cell phone airtime. This could serve as an incentive.”
m2m expands upon currently existing mHealth initiatives like the MoTeCH program. Launched in Ghana in 2010, MoTeCH is comprised of two integrated services: the Mobile Midwife Application and the Nurses’ Application.
The Mobile Midwife Application focuses on providing weekly, time-specific updates and reminders for pregnancy-related concerns, including required vaccinations and awareness of transportation costs to nearby health facilities. The Nurses’ Application is utilized by community health workers at rural health facilities to log information about patient visits into mobile phones.
Thus far, MoTeCH has only had the time to gather preliminary results from qualitative interviews to evaluate the efficacy of these programs. Initial feedback for the Mobile Midwife Application has been very positive. Feedback for the Nurses’ Application, on the other hand, has been mixed, with some nurses complaining about the length of time involved in entering data. Ms. Allison Stone, the Project Manager of MoTeCH, stated in an interview with the HCGHR, “To our knowledge, there are very few mHealth projects that encompass all that is included in MoTeCH: data capture by health workers, data feedback to health workers, information services for clients, and data reporting for supervisors, managers, and policy-makers.”
Despite its comprehensive approach, MoTeCH has faced difficulties such as incomplete data entry by nurses and lack of access to text messaging amongst mothers. With regard to the last concern, Stone indicated that MoTeCH is considering various new tactics. “We expect that solutions might include loaning phones to women during pregnancy and their child’s infancy, providing extra training for women in the use of phones so that they will be able to confidently access their messages, or making the procedure for accessing MoTeCH messages simpler,” said Stone.
The inventive solutions considered by MoTeCH to improve access to messaging underscore the importance of innovation within mHealth. Recently, users on Open IDEO, a website for devising new solutions to social problems, submitted numerous ideas about how mobile technologies can improve maternal health globally. One winning idea was a program that, unlike m2m’s hiring and training model, allows pregnant mothers to choose a mentor via text from a list of qualified, experienced mothers who are volunteering their time in the community. Rather than serving in health facilities, mentor mothers can meet with their mentee in a public location such as a local market and share their personal experiences in an informal setting.
Such creative approaches hold much promise for the future of maternal health. Initiatives that encourage the establishment of personal connections in the community may transcend the simple utility of the mobile phone itself. Regular updates from phones would not be needed to sustain these projects; instead, mobile technology can simply act as a social trigger that sparks new connections and ultimately improves health outcomes. In this manner, mHealth can reach beyond simple delivery and feedback technologies, allowing for sustainable solutions that are in tune with social and cultural contexts.
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