Facilitating the Implementation of MNCH Protocols through mHealth: Tanzania

Dunstan Bishanga, MD,MSc Chief of Party-MAISHA, Jhpiego/Tanzania 05 October 2013

MAISHA: Mothers and Infants, Safe, Healthy, Alive

Duration: October 2008 May 2014 Scope: National program, > 250 health facilities Funding: USAID Partners: Save the Children, D-Tree Program objectives:

Reduce maternal mortality due to major direct causes Reduce newborn mortality through timely newborn care Eliminate mother to child transmission

A phone-based tool for Maternal Care

mHealth for Quality MNCH Services

Jhpiego is working with the MoHSW in collaboration with Dtree International to implement the use of a phone based tool for maternal care in communities and facilities in:

Morogoro Zanzibar

mHealth for Antenatal and Postnatal Care: continuum of care

Goal: To ensure delivery of high-quality care to pregnant mothers following MOH guidelines in a format that is easy to understand and use.
To strengthen facility/community linkages To serve as job aids for service providers and community health workers To track individual client records for individualized care To consolidate monthly records and streamline reporting

Scope of the Project

The project includes both Facility and Community based tools that focus on:
Electronic registration ANC, PNC, PMTCT and PPFP Follow-up for appropriate visits. Referral linkage between community and facility.

Design and Implementation Process for the mHealth Application

Design Field Refinement Training and Pilot prep Pilot Assessment

Review of Train small Train larger guidelines group of group of workers workers Observe patient flow Weekly Complete meetings to central server Develop collect feedback set-up protocol Incremental Develop application prototype refinement based on HCW feedback

Monitor use of Data analysis field Measure applications effectiveness of Regular application and meetings with interventions HCWs Lessons learned Validate reports for larger scaleup

The Application

The application includes: Identification of risk factors Screening for danger signs and complications Monitoring lab results to ensure all tests are done (BP, Hb, protein in urine, etc.) Encouragement for facility delivery Comprehensive counseling including individual birth planning, nutrition and family planning.

Use of the Application: examination

Results to date
28 health facility workers from 5 facilities trained in mobile application (from July 2012)

3,429 women registered from July 2012 to present

12 community health workers trained in mobile application (from February 2013)

436 women registered and visited by CHWs in Mafiga and Gairo catchment areas from February 2013 to present

Early Data: Promising PNC

Indicators for Post Natal Care
Pre-mHealth (January With mHealth (January July 2012) July 2013)

# of women attended for PNC within 48 hours

# of women that delivered outside a health facility

51%
35%

63%
26%

# of mothers coming for revisits

42%

48%

# of children checked for HIV using PCR

# of children give CTX # of children delivered by skilled personnel

1.9%
0.74% 44.4%

2.3%
3.4% 51.5%

Early Data from ANC:

Increase in Anaemia Detection/Recording
Cases reported at the Baseline 2012 January February March April 0 0 0 0 Cases reported with use of mHealth Application in 2013 6 4 5 4

May
June July

0
0 4

1
1 1

Early Data from ANC:

Increase in High BP Detection/Recording
Cases reported at the Baseline in 2012
January

Cases reported with use of mHealth Application in 2013

February
March April May June July

0
0 1 1 0 4

12
16 13 7 7 8

Lessons Learned
Data generated using the mobile phone application is more complete than paper forms. Danger signs are more frequently recognized resulting in higher number of referrals to higher level facility Nurses report that while using the mobile tool takes more time they believe they are giving more thorough care. Mothers report they have come to the clinic because they have heard about the phone and believe they get better care.

CHWs and mobile phones

Success story from Gairo Health Center We received a client who was referred by one of
the CHWs who is using a phone she detected that the client was not feeling fetal movement, so referred client to the facility. The facility nurse confirmed the fetal distress and then referred the client to hospital. The client was operated and they managed to save the lives of baby and mother. (reported by Grace Ngallya, CHW supervisor)

PARTNERS

Ahsanteni Sana!

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