Maternal Health in the Mobile Age

The rapid advance in technology, improved connectivity, and widespread expansion of mobile communications has opened up the potential for mobile technology to become a transformative force for health service delivery. This is especially true in developing countries where health infrastructure is often severely resource-constrained and fragmented. Mobile technology is changing the world as we once knew it, and every industry is attempting to discover high yield interventions that will help them optimize their offerings by reducing cost of operations, improving efficiency, and ultimately, saving lives.

One such application has been in the field of maternal and child health. Despite much public health sector and political attention placed upon Millennium Development Goal (MDG) 5, which aims to reduce maternal deaths, or to be more specific, the maternal mortality ratio by three-quarters by 2015, progress has been slow. Close to 300,000 mothers are still dying each year from preventable causes. Why preventable? Because simple measures like better prenatal care by trained health workers can significantly reduce the number of deaths. Though there have been tremendous improvements on some fronts, there is growing consensus that MDG 5, at present, seems like a far-fetched dream. There is also an agreement, that in the absence of basic health infrastructure in large parts of the developing world, there is a need for an alternative solution.

At Global Health Bridge, we are doing just that. Meet Pushpa -- a well-trained community health worker in rural India who has spent the last twenty years of her life going door-to-door, visiting every pregnant woman in her village of 1,400 people. She checks their blood pressure, provides nutritional information, ensures that the expectant mother visits a health clinic, and when the time comes, safely delivers the baby. During the nine months of providing care for the mother, Pushpa diligently records any necessary details about the mother in her small notebook, sometimes seeking help from a neighboring schoolgirl to help her write, given her limited literacy. She then travels for close to two hours, often walking about five kilometers by foot in the hot tropical sun, to pass this information down to a health facility. Over the years, as the number of families in Pushpa's village increased, she had to walk longer distances, and check on more mothers. Now, Pushpa agrees that her job has become more challenging and that she sometimes forgets. She knows she needs another way to keep track of the numbers, and to make sure that she can still look after every mother. With the help of the Maternal Health Reporter, a mobile-based platform developed by Global Health Bridge, Pushpa is able make this hope a reality.

Now each time Pushpa visits a mother, she uses her mobile phone to dial a toll free number, and enter in information about the mother. This includes the mother's age, expected due date and other important health indicators. This information is then relayed real-time to a remote health center, where the mother's information is processed and timely reminders and health information are sent to Pushpa and the expectant mother. Even though Pushpa was only allowed to study until third grade in her village, this system is simple enough for her to learn the ropes quickly. Our experience from the pilot project shows that sending text messages not only provides necessary information but is also a great tool to engage other key decision makers in the family, including the mother-in-law and husband. Pushpa told us that upon receiving an educational message, one father-to-be called his mother to inform her that his wife must eat "green leafy vegetables for her blood." Improving efficiency in data use can potentially not only improve pregnancy-related outcomes through improvements in antenatal care and nutrition, but also bring about reductions in operational costs as well as costs associated with adverse pregnancy outcomes.

The example of Pushpa's work in her community is not an isolated case. The role of the community health worker in providing care to the poor has now been well recognized in many developing countries, and several governments in Asia and Africa are investing their resources in training lay men and women to provide primary care services at village level. The availability of mobile technology at this level has opened up a new horizon for improvements in healthcare. Training community health workers to use available technology can really help to bring about a paradigm shift in our health information systems. While still in its infancy, the Maternal Health Reporter has shown tremendous promise in its pilot stage. The first and perhaps the most critical factor has been adoption of the technology by the community. When targeting a population with limited literacy, we have found that simplicity in the user interface, accounting for the literacy level and local dialects, can really help create a scalable solution. Working closely with the end users -- the community health workers -- has facilitated an improved understanding of what 'simplicity' is to them, and has, in effect, been critical to adoption. Not enough emphasis can be laid on the value of having the communities become a key stakeholder in the development process.

The field of m-health is burgeoning with new programs across the world, and a constant commitment to simplicity and community partnership will ensure that the poorest in the world can benefit from these developments.