AMREF results follow up 2018

The project aims to apply mobile health to improve Maternal and Child Health Service and utilization of the available health resources.
The project “Mobile Health for Improved Maternal and Child Health Services Utilisation” that is implemented by AMREF Ethiopia aims to apply mobile health to improve Maternal and Child Health Service and utilization of the available health resources. A baseline study was carried out on the project in the North Shoa zones of Ethiopia’s Amhara Region where the project is piloted. Data was randomly selected from 430 women (from 430 households) of reproductive age who had a child of less than one year at the time the study was carried out (November 2017 – December 2017). Data was collected using face-to-face interviews and included reviews of service statistics from 39 health facilities.
A literature review conducted by the baseline study indicates that, in Ethiopia, direct obstetric complications account for 85% of maternal deaths.


Maternal deaths caused by direct obstetric complications

These complications include abortion (32%), obstructed labour (22%), sepsis (12%), haemorrhage (10%) and hypertension (9%). Maternal health is directly impacted by economic, social and institutional factors. For example, limited access to health care during pregnancy, lack of maternal health education and sensitisation, lack of care during delivery and female genital mutilation are some of the factors highlighted in the report.
  • Abortion 32% 32%
  • Obstructed labour 22% 22%
  • Sepsis 12% 12%
  • Haemorrhage 10% 10%
  • Hypertension 9% 9%
Therefore, the project will support and increase utilisation of maternal, new born and child health services through use of ICT. The baseline found that ICTs such as mobile phones were used by 57% of the respondents. For those who use mobile phones, 82% use them every day. Among many functionalities, women indicated that they use mobile phones for voice calling (94%), text messaging (58%), e-learning (4%) and money transfer (2%). The baseline also found that health workers have access to ICTs. Among the health facilities that were visited 66% have mobile network coverage. Majority (90%) of health care providers own mobile phones i.e., feature phones (22%) and smart phone (78%), and 52% of them perceived they have very good knowledge on how to us mobile phones. 90% of health care providers had experience of using text messages for health related services while 10% mothers preferred to receive text message feedback from health facilities using mobile phones as opposed to paper based feedback and phone calling.

Most midwives and health extension workers (HEWs) who participated in the baseline survey perceived text messaging through mobile phones as a means of ensuring good follow up (75%). At the same time 73% perceived text messaging as a good accountability tool for providing evidence that they have provided care to patients.

Only 57% of pregnant women were told about the need to have ANC follow-up and it was the HEWs (59%) who did most of the informing according to these mothers. Facility delivery assisted by skilled health professionals was only 54%, postnatal care coverage was 23%, and among these 23% only 7% had four or more checks.

Challenges in using cell phones were: frequent interruption in network connections and electricity for charging, as well as inability to comprehend the language the message was constructed in (reported language barrier when the message is in English).

Of those with cell phones, 24% reported no problem in using them, and for other respondents who experienced problems, the problems included language barriers (51%), network problems (37%) and shortage of electricity to charge (21%). The major source of health information was health development armies and health extension workers who account for 36% and 43% respectively. Some of the respondents’ expressions can be summarised with the quote below:

Mobile phones reduce the burden of travelling long distances to inform the mothers, improve the data management practice both in the Health Post and Health Centre [Zonal level health service point]. Mobile phones also help health workers to maintain proper recording of information about mothers and to have uniform information across health facilities.

Community volunteers carrying an expectant mother with traditional ambulance (KAREZA). Image: AMREF
There are some instances where the system has continued to communicate obsolete messages and these can be a source of irritation to the mother as in the case below:
We have been experiencing a problem with the server which was sending wrong and old messages. For instance, a message was sent to us to remind a mother to attend ANC visit. The same message was sent frequently after the mother gave birth even which was a challenge during the implementation of the pilot mHealth project.

The findings from the baseline report were shared with the project implementation team to capture them in implementation activities. Which means that system errors such as the above experience can be dealt with in a timely manner. The research will continue to carry out results follow up exercises until the project ends in 2019.