Change Project Updates

How should we reduce the maternal mortality through digitally-monitored antenatal care?

Dr. Adam Bitunguramye, MBBS, Munini Hospital, Republic of Rwanda

Tel: +250784095552, bitadamson10@gmail.com

ACRONYMS

MDGs: Millennium Development Goals

UN: United Nations

SDGs: Sustainable Development Goals

HMIS: Health Management Information System

RDV: Rendez-vous

ANC: Antenatal care

ICT: Information and Communications Technology

CHWs: Community health workers

Ubudehe categories: socioeconomic categories in Rwanda

HCs: Health centers

MoH: Ministry of Health (Rwanda)

INTRODUCTION

Rwanda is placed among one of the developing nations to have critically reduced maternal mortality through its health system strength. As of 2020, this tiny country in the East Africa has had a maternal mortality rate reduced to 203 deaths / 100000 live births thanks to the constant efforts invested by the government of Rwanda to improve the health of its population.1

It was the fifth MDGs goal; to improve the maternal health which was due to be achieved by 2015, but there was 289’0000 maternal deaths in 2013 worldwide despite a significant improvement from 2000, unfortunately, this was still less than a half of ¾ reduction in maternal deaths which was required by the UN from 1990 to 2015.2,3

SDGs- Goal 3 aims at reducing maternal mortality at less than 70 deaths per 100000 live births. Departing from this target, Rwanda is still approximately three times higher in mortality rate in less than around 10 years to go before 2030.4

However, Rwanda is among the leading countries in Africa and in the region in achieving the aforementioned goal.5 In addition, it has promoted the technology use in all sectors without sparing the health sector. Here I would mention the HMIS and Rapid SMS, Babyl Rwanda and so on.

One of the factor contributing to maternal mortality in Rwanda is a poor antenatal care. Here I would say a scenario where a woman with two previous scars who might miss some of the RDVs because she could have forgotten to check on the handwritten RDVs on her ANC file given by the healthcare providers. This could greatly contribute to the late presentation of the patient to the hospital which would on the other hand lead to either a maternal death or a neonatal death or both.

According to a cross-sectional study conducted in Rwanda, there was no consistency in providing adequate ANC to mother which subsequently ended up in limiting the number of pregnant women requiring a transfer for the danger signs. 6

In this regard, taking advantage of the governance in Rwanda which is decentralized and where most of the Rwandan population use telephones as the means of communication, I would like to introduce the way of reducing maternal mortality through creating a system which will digitally monitor the Antenatal care and the package could be extended to cover more services later probably to cover not only the pueperium and later vaccination with time why not. I would register the mothers whenever they present for the ANC and digitally set the RDV dates from that day on.

The ICT technician would construct that system where SMS would be delivered to the HCs and copies sent to the CHWs to remind the patient to attend the hospital for the antenatal care ahead of time. It is of paramount importance to highlight that the patient shall be directly communicated through that system as well.

Anecdotal findings from Munini Hospital where I was working and I was part of the death audits committee has shown that some preventable maternal deaths are linked to delay one; seeking care and delay two; reaching the right facility.

Yet, several factors are required to be addressed holistically to achieve this SDGs target by 2030 in Rwanda. Therefore in this project;

- We should be able to electronically monitor the high-risk pregnancies. We will be able to track these pregnancies which might end up in maternal deaths thus hindering us from achieving our goal of maternal mortality reduction of less than 70 deaths per 100,000 live births by 2030.

Aim: Digital Antenatal care tracking and follow-ups. We will do a software which would remind both the healthcare provider in the primary care setting; Health post and Health Center when will be the antenatal care date within the range of 7 days ahead of time.

Method: the Software will remind providers at HCs or Health Posts who will then assign the duty to a healthcare provider and then the message will be passed on to the community level through community health workers and the patient of interest if she has got a telephone number.

Those ones who possess the telephone will be contacted and those ones without them will be physically informed.

Logistic supports: It shall be given to women without other means, for instance those in the C, D and E Ubudehe categories for the communication to be effective, however, this goal shall be reached with time or when possible.

The antenatal care will be set in the software as it is recommended by the ministry of health.

ICT support from MoH would help us to build this software above-said.

REFERENCES

1. Survey H, Indicators K. No Title.; 2019.

2. WHO. https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals(mdgs)

3. UN link. https://www.un.org/millenniumgoals/maternal.shtml.

4. #Envision2030 Goal 3_ Good Health and Well-being _ United Nations Enable. https://www.un.org/development/desa/disabilities/envision2030-goal3.html.

5. World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. https://www.who.int/gho/publications/world_health_statistics/2017/EN_WHS2017_TOC.pdf?ua=1.

6. Rurangirwa AA, Mogren I, Ntaganira J, Govender K, Krantz G. Quality of antenatal care services in Rwanda : assessing practices of health care providers. 2018;5:1-10.

Suveksha Shrestha

Clinical Practice Manager, Ghurka Welfare Trust

EVIDENCE BASED PRACTICE AMONG HEALTH CARE PROFESSIONALS IN MANAGEMENT OF DIABETIC PATIENTS IN GURKHA WELFARE TRUST, NEPAL (GWT NEPAL)

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