Maternova is pleased to share the first of a 3 part blog series created by Medic Mobile.
The Maternova Haemoglobin Colour Scale is one of the core supplies the team used recently in Bangladesh, as they focus on antenatal care and improving patient outcomes.
By Nadim Mahmud and Priyanka Pathak of Medic Mobile.
Nadim is the organization’s Co-founder and Chief Research Officer. Priyanka is the Regional Director of South Asia.
As outlined by the United Nations, MDG 5 is an ambitious goal that organizations around the globe have tried to tackle in recent years. When we at Medic Mobile decided to apply our tools to this challenge, we were faced with the same questions that many before us have encountered: where do we start, and how do we go about impacting such a hopelessly complex issue? Our proposition is to start small, stay focused, and pay attention to the details. Take antenatal care (ANC), for instance:
Throughout the developing world, we know that good ANC improves maternal (and infant) health. It reduces rates of preterm labor, improves perinatal infant survival, prevents infection, and is associated with higher birth weights. ANC can also detect maternal anemia, identify and treat sexually transmitted diseases (STDs), and triage women who are at high risk for obstetric complications. Finally, women who attend ANC appointments are more likely to give birth in the presence of trained health professionals, actors essential in managing post-partum hemorrhage and performing neonatal resuscitation.
In Bangladesh, only 21% of women receive the full complement of ANC visits. 49% do not attend even a single session.
On a foggy December morning, we took a flight to the country's beautiful southern coast, Cox's Bazar, to try to understand why. We spoke with village health workers (VHWs), locally-hired women trained to connect families with what few health resources are available. We spoke with doctors, nurses, lab technicians, and researchers. We spoke with mothers and their families. The explanations we gathered were multifactorial and, in many cases, utterly unanticipated. Many did not understand the role or importance of ANC. Others were aware but routinely forgot about their follow-up appointments. Many lived at a distance and were unwilling or unable to make trips to the health center. Almost all reported a deep fear of Caesarean section if they were to attend an ANC appointment. An astonishing 90% delivered at home.
One of our core beliefs at Medic Mobile is in the power of information – the idea that with access to knowledge, anyone has the potential to change their life for the better.
This belief is why our tool set, built on SMS-based applications that can run on virtually any mobile phone, focuses on quickly and efficiently bringing information to the fingertips of those who need it. Combined with the realization that 95% of the world’s population has access to a mobile signal and that the next billion mobile subscriptions will be in developing regions, connecting people with once inaccessible health resources seems in the very least possible. Medic Mobile now works with more than 30 partners across 16 countries in Africa, Asia, North America, and South America. 6,000 health workers using our tools serve over 600,000 patients annually, covering catchment areas with 6 million individuals.
Our insightful visit to Cox’s Bazar moved us to action. We established an on-the-ground partnership with the Hope Foundation for Women and Children of Bangladesh, who agreed to work with us in developing a new kind of ANC. If mothers were not able to make the trip to the clinic, we would bring its resources to them. If they were fearful about C-sections, we would allay those fears with education about the indications, risks, and benefits involved. The VHW would be a key component in this model, requiring extensive training and support in the field. With a cell phone in hand, we could send targeted educational messages and follow-up/appointment reminders. With a simple java application, the VHWs could return structured patient data for each ANC visit, with automatic triggers defined to identify concerning findings and triage patients to higher-level care. Inverting the delivery model would also necessitate the ability to perform certain laboratory tests at patients’ homes, and we were fortunate to come across Maternova’s unique products. For example, their Hemoglobin Color Scale will enable VHWs to perform quick anemia screens at the point of care, thus minimizing access barriers, promoting health worker efficiency, and reducing the burden for distant lab technicians.
Our plan to impact MDG 5 is through a one-year pilot to test the effectiveness of our SMS-supported VHW network in increasing the rate of ANC delivery and promoting deliveries in the presence of trained health professionals.
Over the next few months our 2012 Fellows, Faye Maison and Zahra Bhimani, will live in Cox’s Bazar and spend time with Hope’s doctors, nurses, VHWs and, most importantly, the future mothers we plan to help. We will work together to design, test, fine-tune, and ultimately implement our SMS system in the hopes that it will improve maternal health outcomes in Cox’s Bazar. In the coming months, we will contribute a multi-part blog series describing our system, discussing challenges and barriers to implementation, and hopefully concluding with a success story of simple tools with big potential.
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