Using mHealth to Improve Timeliness and Quality of Maternal and Newborn Health in the Primary Health Care System in Ethiopia

Abstract

The Last Ten Kilometers 2020 Project (L10K 2020) designed a strategy for piloting, implementing, and scaling a mobile health (mHealth) digital solution to improve the quality of community-level maternal and child health service delivery in Ethiopia. L10K 2020 first conducted a landscape assessment to design a context-appropriate smartphone-based mHealth solution for the Health Extension Workers and tablets for their supervisors and the midwives managing the same clients at the health center level. These applications included multiple modules and packages including client registration and appointment management; follow-up and notifications; digital job aids for each of the maternal and child health program packages (for Health Extension Workers only); and referral and client tracking systems.Findings from the process evaluation of the mHealth app usage and user experience indicated that the application was user-friendly and facilitated real-time information exchange, defaulter tracing, referral, and feedback systems. It improved the timely identification and registration of pregnant mothers. Adherence to treatment protocols also increased in all domains across the pregnancy continuum of care.L10K 2020 has developed a user-friendly model for implementing mHealth solutions at the community level through stakeholder engagement across levels when developing, testing, and deploying the applications, which was critical to effectively cultivating ownership as well as skills and knowledge transfer at all levels. To replicate and scale this model, context-based scoping, resource analysis, and mapping are essential to determine the infrastructure, cost, time, risks, and key stakeholders involved throughout the implementation of the intervention. During implementation, vigilance in consistently mitigating the challenges related to mHealth infrastructure, such as mobile data capacity, electricity, smartphones and tablets, solar chargers, and internet connectivity, is critical for continued success.

FIGURE 1

Proposed Technology Architecture for mHealth Initiative in Ethiopia Abbreviations: IVR, interactive voice response; mHealth, mobile health.

FIGURE 2

Health Extension Workers CommCare-Based mHealth Application in Ethiopia for Client Registration and Tracking, Screenshots Abbreviations: HDA, Health Development Army; HEW, Health Extension Worker; mHealth, mobile health; L10K 2020, Last Ten Kilometers 2020 Project.

FIGURE 3

Sample Screenshots of the Electronic Job Aids Included in the CommCare-Based mHealth Application in Ethiopia Abbreviations: HEW, Health Extension Worker; mHealth, mobile health; PLW, pregnant and lactating women.

FIGURE 4

Health Service Modules Prioritized by the Ethiopia Ministry of Health (Left) and the CommCare Platform (Right) Abbreviations: ANC, antenatal care; CBNC, community-based newborn care; ENC, essential newborn care; EPI, Expanded Program for Immunization; GMP, growth monitoring and promotion; HEW, Health Extension Worker; iCCM, integrated community-based case management of common childhood illnesses; IMNCI, integrated management of newborn and childhood illnesses; MDSR, maternal death surveillance and response; PNC, postnatal care; PMTCT, prevention of mother-to-child-transmission (of HIV); PSPI, possible serious bacterial infection.

FIGURE 5

Health Extension Workers (HEWs) Supervisor/Focal Person mHealth Application Screenshots Abbreviations: ANC, antenatal care; HMIS, health management information system; mHealth, mobile health; PNC, postnatal care.

FIGURE 6

Increased Early Pregnancy Registration as a Result of the App at L10K 2020 mHealth Pilot Project Sites in Ethiopia, July 2017–June 2018 Abbreviations: mHealth, mobile health; L10K 2020, Last Ten Kilometers 2020 Project.

FIGURE 7

Trends of Delivery and Postnatal Care in mHealth Pilot Sites in Ethiopia, 2017–2018 Abbreviations: mHealth, mobile health; PNC, postnatal care.