saving mothers giving life (smgl) smgl-sms : applying mobile phone-based system to reduce maternal...
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Saving Mothers Giving Life (SMGL)
SMGL-SMS : applying mobile phone-based system to reduce maternal mortality in Kalomo District, Zambia
Outline • Background• SMGL and aims• mHealth in Maternal Health• SMGL-SMS + Methodology• Achievements• Challenges• Lessons learned• Next step
Background
• Zambia is the first country to launch Saving Mothers Giving Life,
through the Global Health Initiative (GHI), funded by US
Government and aiming at reducing maternal mortality (by 50%
at the end of year one) in the four chosen districts (Lundazi and
Nyimba, Mansa, Kalomo)
Maternal Mortality ratio in Zambia since 1996
MGD Target
1996 2002 2007 20150
100
200
300
400
500
600
700
800
649
729
591
162
MMR
Rationale • barriers associated to the 3 delays leading to most
pregnancy-related mortality to health care prevent women to benefit from life-saving interventions
Delayed decision to seek medical care
Delay of getting to the health center
Delay of receiving adequate care when a facility is
reached
Lack of proper Post-partum follow-up
Place of delivery and Assistance during delivery (ZDHS 2007)
• More than 90% of Zambian women receive some antenatal care• Only 48% of women deliver in health facilities• 47% have assistance of a skilled health provider.
47%
25%
23%
5%
skilled health worker
Relative
Traditional birth attendant
No one
48%52% Health Faciliy Delivery
Home delivery
Maternal health inequalities
• ZDHS did not disaggregate MMR
data below national level
• But MMR is worse in rural areas
where access to health services is
much poorer
• 83% of women giving birth in
urban areas were assisted by
skilled people, compared to
31.3% in rural areas (ZDHS 2007)
Figure: Births Attended by Skilled Personnelby Province, Zambia (ZDHS 2007)
Making pregnancy and childbirth safer
• Key Operational Strategies:
– Access to a continuum of care, including appropriate
management of pregnancy,
– Enable access to life-saving emergency obstetric care
(EmONC) when complications arise
– Improving referral system
– Delivery in health facility by skilled birth attendant
– Monitoring during post partum period
SMGL
• 5-year effort intends to help mothers during labor, delivery,
and postpartum
• SMGL has begun with select districts in Uganda and Zambia,
(among the countries with the highest maternal mortality
ratios in the world)
• In Zambia, the initiative will focus on the Lundazi, Nyimba,
Mansa, and Kalomo districts.
• SMGL-SMS : Sub-project applying mHealth to maternal
health care delivery
What is SMGL-SMS?
• A mobile phone SMS-based system
• Using RapidSMS open-sourced platform
• Designed and developed by mHealth team at
ZCAHRD Lusaka Office
• Enable dynamic data collection and sharing
• Currently being piloted in 9 health facilities in Kalomo
district, Zambia
SMGL-SMS Aims
• To contribute to the reduction of delays (1) associated with
transport to the referral facility; (2) associated with timely
intervention when the mother reaches the referral facility.
• To provide real-time information regarding maternal health in
Kalomo District through routine SMS-based data collection
methods.
• To increase the number of women who attend the WHO
recommended four antenatal care (ANC) visits and the number
of facility deliveries through SMS reminders
Rationale for using mobile phones
• The number of mobile phone subscribers in
Zambia rose from just 464,000(2004) to over 5
million (2011) following market liberalization
• Continued growth in coverage of mobile
networks
• Mobile phone penetration rate in Zambia is
expected to reach 51% by end of 2012
Why mHealth?
• Mobile phones have the potential to reduce delays that often
result in maternal death: Delayed decision-making added to
delayed transport
• Mitigate information-sharing problems between Health
centers and Hospitals
• Improve transportation and referral for maternal health
• Mobile phone can promote continuity of care: follow-up at
community level and information sharing for effective referral
SMGL-SMS system
Health facility Routine MCH
data collection
Community Registered Pregnant women are
followed in the community by CBAs Reminders, Postpartum
Referral System - Automated notification of referral
center during emergency- Ambulance Notification
Web Based User’s interface
Real time data visualization, report generation and progress monitoring
SMGL-SMS
SMGL-SMS workflow
Web user interfaceSMGL-SMS Server
Pregnancy registration and follow-up
SMGL-SMS Server
Pregnancy is registered in the SMS system
Mother’s details are recorded into Safe motherhood register CBA is
notified of a new mother being registered in her zone of operation
CBA keeps a record of the pregnant woman in a logbook
System features Level of operation System functions Responsible
Facility Level
Registration o Pregnancyo Follow-up visitso Birth o Death
Data Clerk
Referral o Emergent /non-Emergent referral
o Notification of referral centero Dissemination of outcome
Data ClerkFacility Staff
Community Level Registration o Birth o Deatho Reminders
- Follow-up visit- Expected delivery date- Non-Emergent referral
CBA
District Level Monitoring And support
Monthly reports District mHealth Supervisor
Overall SMGL Result chain
*Output that will be obtained through mHealth system. The three above outputs (1.1, 2.1 and 5.1) will constitute outcomes for SMGL-SMS in result chain below.
SMGL-SMS result Chain
SMGL-SMS Goal:Applying mHealth technology to contribute to the reduction of Maternal mortality by 50% in targeted facilities in Kalomo District, Zambia by 2013
Outcome 1:Improved referrals
communication
Output 1.1:Functional SMS-based
system application customized for SMGL
Output 1.2 :Facility and community staff
are trained and have the capacity to effectively use
the SMS system
Outcome 2:Improved antenatal, postnatal
care and record keeping
Output 2.1:Increased number of ANC
visits and Facility deliveries
output 2.2:Better management of
postpartum care
Outcome 3: Evidence generated through
mHealth system
Output 3.1Web User interface
showing selected maternal health indicators
Methodology
System design and development
• Functional SMS-based system application customized for SMGL
• - Phase I• - Phase II
Implementation in 9 facilities in Kalomo
• Recruitment and training of data entry clerks, Community Based Agent
• Training of Health care worker
Monitoring and evaluation
• Ongoing system Monitoring• Evidence generation• Evaluation
Achievements
SMGL-SMS launched July 24th 2012
Phase I system developed and fully operational in 9 health
centers in Kalomo
Recruitment and training of
- 9 Data entry Clerks
- 78 Community Based Agents
Training of 33 Health workers
Registration and follow-up of over 1500 pregnant women over
a 2-month period
Challenges
• Non availability of baseline data necessary
measure change over time
• Limited mobile network coverage in certain areas
• Limited availability of emergency vehicle in
Kalomo
• Inhospitable terrain leading to poor
transportation
Lessons learned
• A thorough facility and community assessment is required to
build mHealth system that meet the needs of intended
beneficiaries
• Involvement of trained Safe Motherhood Action Groups
(SMAGs) or Traditional Birth Attendants (TBAs) in community
based interventions/activities
• A bigger impact on maternal health will be achieve if
communication and transport is improved at community level
Next Step
• Phase II: Development of web user interface
and System enhancement
• Undertaking community based assessment of
communication and transportation system
• Documenting lessons learned
• Generating evidences and evaluating the
impact of the SMGL-SMS system
Conclusion
mHealth applied to maternal health has the potential to:
• Enable monitoring, follow-up and referrals of pregnant
women along a continuum of care from the start of
the pregnancy all the way through her post-partum
period
• The use of mobile phones will reduce delayed
decision-making and transportation during childbirth
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