A mobile phone intervention on maternal care in Zanzibar

In our recent visit to Zanzibar, Tanzania from July 10th to August 20th, 2016, we spoke with many experts regarding improvement in maternal care in Zanzibar. One person whom we spoke to was Poppy Farrow, the Zanzibar Program Coordinator for the mHealth for Safer Deliveries Program of D-tree International. Farrow was responsible for assisting to manage Zanzibar’s first emergency transport service specifically for pregnant women. According to Farrow, despite high rates of antenatal care and good access to healthcare facilities, maternal and neonatal mortality remain high in Tanzania—at 310/100,000 live births and 23/1000 live births, respectively, and almost half of all deliveries are performed at home without a skilled attendant.

With mobile phone usage growing rapidly in Africa, mobile technology is being recognized as a tool to improve access to and utilization of healthcare services. Thus, Farrow’s program— the mHealth for Safer Deliveries program— was initiated from January 2013 to December 2014 to address the three delays in receiving skilled care at delivery: (1) the decision to seek care; (2) reaching skilled care; and (3) receiving adequate care once at the healthcare facility. A secondary goal was to increase rates of postnatal care, which have also been historically low in Zanzibar. The program supported community health workers (CHWs) who were trained to use a mobile phone with a user-friendly decision-support application so that the CHWs could: (1) register women and develop personalized birth plans based in medical and obstetrical history; (2) counsel the mother and family on healthy behaviours and recognizing danger signs; (3) record permissions from family members agreeing to a facility-based delivery; (4) screen women and their babies for complications from pregnancy up to a week after delivery and refer them to the healthcare facility as needed; (5) use mobile banking to pay for transportation to the healthcare facility; (6) use text or voice communication to notify the health facility that a woman is in transit.

At the end of the program, of the 13,231 women who delivered in the program, 75% did so at a facility and 78% under skilled care compared to a baseline of 35% according to the Demographic and Health Survey of 2010 (DHS). Among those women in the program whose previous delivery was at home, more than 65% intended to deliver at a health facility. Overall, the rates of postnatal attendance were as high as 88% among women in the program. This is a significant increase when compared to the Zanzibar Annual Health Bulletin 2012 and Tanzania DHS 2010. Qualitative data including surveys of mothers, CHWs, and health workers also pointed to the success of the program.

This assessment shows that the mHealth for Safer Deliveries program is a success as to having reached over 13,000 pregnant women in Zanzibar with unprecedented rates of both facility delivery and postnatal care attendance. The program encouraged CHWs to more effectively reach out to women in remote communities with accurate information and education and connect them to facilities. However, the evaluation faced a number of limitations, the most significant being the lack of a control group for the quantitative findings. Hence, although the rise in facility deliveries and postnatal attendance was evident, the lack of a randomized design did limit the conclusiveness of the results. Nonetheless, the significant difference from DHS data does support the claim that this program made a difference and suggestive of a positive impact of the program on rates of facility delivery in Zanzibar. Even though the program ended in 2014, it was invigorating to learn that there are many programs that share the same goals as our program: to improve maternal care.

3. “Staff – D-tree International.” D-tree International. N.p., n.d. Web. 30 Aug. 2016.