This report by the International Telecommunication Union provides practical information on the variety of information and communication technology (ICT) solutions available that could help support countries in improving information and accountability for maternal and child health, as advocated by the Commission on Information and Accountability (CoIA). The report firstly provides an overview of the status of different ICT services available in CoIA focus countries before presenting examples of the role that ICTs can have in implementing CoIA’s 10 recommendations. The report also highlights key governance, policy, and human resources considerations for the successful implementation of ICT projects at national scale.
The Evidence for Action programme has developed a structured literature review of how information communication technology (ICT)/mobile technology have been used in low and middle income countries for monitoring and improving the quality of maternal and newborn healthcare in general, as well as in the context of vital event registration and/or maternal death reviews.
The review identified a total of 24 projects covering four thematic areas:
- data management including collection, transmission, and analysis of information
- point of care support by assisting decision-making and diagnosis
- training and disseminating knowledge to healthcare workers (e.g. latest research and guidelines)
- improving communication and networking between healthcare workers and health facilities, patients or other healthcare workers
The review found that these technologies could have greater potential in improving and monitoring quality of maternal and newborn care if the following factors are considered:
- ensuring the deployment of technology that can be installed and maintained locally
- deploying devices and infrastructure that is low cost and can be integrated within the health system
- ensure the buy-in and commitment of key stakeholders
The paper concludes that the future of ICT to contributing to quality of care improvements is promising; however it must be complemented by other inputs such as adequate infrastructure and human resources to maximize its potential.
The article by Mosa Moshabela and colleagues in the BMC Health Services Research presents a case study of community-level surveillance in Senegal as part of the Millennium Villages Project (MVP). The mobile technology based (mHealth) platform Childcare+ was used to identify pregnancies, births and deaths. Once this information is entered into the surveillance system, this then prompts a verbal and social autopsy to be conducted. Verbal Autopsy and Social Autopsy (VASA) data was collected using a standardised tool based on the WHO’s Verbal Autopsy questionnaire but with some modifications on questions related to social contributors to mortality (e.g. accessing transport). The VASA data was collected either by hand or using a mobile device and then uploaded to a central database where a pre-set algorithm was used to calculate the likely cause of death and any contributory social factors.
The case study highlights how the routine community-based surveillance system identified inefficiencies at a tertiary level of care as the main contributor to the five maternal deaths in the area. The study concludes that mHealth data collection tools are able to detect small changes in community-level mortality in real-time, can help facilitate rapid-cycle quality improvement interventions when linked with accountability structures such as mortality reviews.
This article by Chittaranjan Purandare and colleagues in the International Journal of Gynecology and Obstetrics describes the process that led to the development of an electronic Maternal Death Review (MDR) system in India. Users were positive about the software, finding it simple to use, secure, and useful to generate reports for planning. Key lessons learned include:
- Ensure alignment of the country’s objectives and strategies into software development plans
- Have a clear implementation road map and project management system to ensure that timelines are followed
- Have an action plan for both intended and unintended problems that arise
- Involve programme “champions” who will see implementation to its end
- Establish public-private partnerships for guidance and support from key stakeholders
- Share regular updates on progress to ensure help is provided when needed and that team-members are motivated to provide high-quality work