12 September 2017

Africa: Bridging the Maternal Healthcare Divide With Mobile Technology

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Every day, about 830 women die due to complications related to pregnancy or childbirth around the world. The suffering is completely unnecessary.

Every day, about 830 women die due to complications related to pregnancy or childbirth around the world. For each death there are many more women who suffer traumatic, life-changing injuries due to pregnancy and childbirth. These figures are tragic, particularly when you consider that the majority of the cases occur in developing countries and almost all of them are preventable.

The suffering is completely unnecessary. In most instances, access to basic maternal healthcare would secure the wellbeing of these women and their babies. It's not just about the number of hospitals and healthcare workers either, sometimes the healthcare is available, it just doesn't reach the women who need it, particularly in rural communities. This is where mobile technology can help.

Take Tanzania as an example. About 70% of Tanzania's 56 million people live in rural areas with limited access to healthcare. As a consequence, the Government of Tanzania Demographic and Health Survey estimates that in 2015 556 women died for every 100,000 live births, which is one of the highest maternal mortality rates in the world. The number of Tanzanian women seriously injured because of traumatic deliveries is even higher: every year there are an estimated 3000 new cases of obstetric fistula alone.

Obstetric fistula is directly linked to a major cause of maternal mortality: obstructed labour. Untreated, fistula is not only distressing and painful, but many of the women are marginalised, isolated and no longer regarded by their communities as productive members of society. In 2016, the scale of the problem prompted the UN Secretary General at the time, Ban Ki-Moon, to call upon the world to end fistula within a generation, putting it at the same level as HIV and polio.

Many women with obstetric fistula don't even know it can be treated. Even if they are aware, they have no way of getting to hospital, nor do they have the money to pay for treatment. With no hope of a cure, they suffer in silence, hidden away, making it extremely difficult for the health system to reach them.

For example, when the Comprehensive Community Based Rehabilitation Treatment (CCBRT) in Dar Es Salaam started offering free treatment to women with obstetric fistula in 2009 it only treated about 200 women a year - well below its capacity and a relatively small number compared to the total number of women in Tanzania suffering with the condition. It had the surgeons, facilities and money, but it couldn't get the message to women that free treatment was available or have any way of sending them the funds to travel to hospital.

This is where mobile technology offered a lifeline. CCBRT partnered with the Vodafone Foundation to establish a pioneering new service called "Text to Treatment". It enabled CCBRT to use text messaging to raise awareness and communicate with patients. They could also send women the money for them to travel to hospital via M-Pesa, a mobile money transfer service developed by Vodafone with support from the UK's Department for International Development. In the first year of the service, the centre saw a 40% increase in the number of women treated. In 2016, 94% of the 1012 patients treated used the M-Pesa service.

Since then, USAID and the Vodafone Foundation have established a broader programme called "Mobilising Maternal Health" in Tanzania. Building on the work fighting obstetric fistula, its goal is to find ways that mobile communications can improve access to healthcare and help educate women in rural areas about pregnancy and childbirth.

A central pillar of the programme is a "ambulance taxi" service. A toll-free number in the Sengerema and Shinyanga districts connects emergency calls 24 hours, 7 days a week from expectant mothers to a network of 100 taxi drivers who will take them to the nearest, most appropriate health facility according to their condition and the fare is paid using M-Pesa. In one year the service played a critical role in reducing the number of maternal deaths by almost 30%.

If we are serious about achieving the UN's Sustainable Development Goal of reducing the global maternal mortality rate to less than 70 per 100,000 by 2030, there is so much more to do.

Bridging the rural-urban healthcare divide is pivotal, and the programmes in Tanzania, which have helped about 440,000 women in total, are a demonstration of the role mobile technology can play. The onus is on governments, donors, private companies, and international organisations to continue working together to harness the power of mobile technology to give every woman and child around the world access to quality healthcare.

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