Using Mobile Technology to Address the ‘Three Delays' to Reduce Maternal Mortality in Zanzibar

Abstract

The hallmark article by Thaddeus and Maine (1994) presented a framework to reducing maternal mortality by addressing the delays: (1) deciding to seek care; (2) reaching care; and (3) receiving adequate care. This project developed a phone-based system used by traditional birth attendants to address the three delays in two districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. 938 mothers participated in the “mHealth for Safer Deliveries” project. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32.0% (NBS and ICF Macro, 2011). This project demonstrated the effectiveness of mobile technology in addressing childbirth's three delays and its potential to impact maternal mortality in low-income countries.

mHealth for Safer Deliveries: A mixed methods evaluation of the effect of an integrated mobile health intervention on maternal care utilization

“…In 2011-2012 began a pilot project with funding from the Bill & Melinda Gates Foundation which successfully reached almost 1,000 women and achieved a facility delivery rate of 75% iii . Based on the success of the pilot and strong evidence that skilled attendance at delivery helps reduce maternal mortality, iv the mHealth for Safer Deliveries program was developed to scale up this intervention in Zanzibar.…”

Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

“…Using existing health management information system (HMIS) data (e.g., service delivery indicators) to inform the supervision approach supported a range of different health system goals, including task shifting of mid-level providers in Uganda [ 17 ]; improved CHW performance and system efficiencies for nutrition services in India [ 18 ]; improved quality of care for private sector and/or community-based health providers in malaria and family planning services across Africa and Asia [ 19 ]; and improved referral systems for CHWs [ 20 , 21 ]. More research is needed to connect the impact of HMIS-informed supervision approaches on service delivery effects.…”

“…HSS outcomes related to data use—better utilization of existing data and increased data generation—were achieved through HMIS and reporting system modalities [ 22 , 23 , 43 , 51 , 56 ], as well as through HR management system improvements [ 19 , 20 , 28 , 57 ], QI [ 41 , 43 , 58 ], recognition systems [ 35 , 36 ], and task-shifting/sharing modalities [ 17 ].…”

“…Eighteen studies (32%) attributed impact on maternal, newborn, and child health (MNCH) to supervision approaches [ 12 , 13 , 17 , 21 , 27 , 36 , 41 , 42 , 49 , 52 , 58 – 60 ]. Of these, four were reported to have been scaled up and sustained: the Safer Deliveries intervention in Zanzibar [ 20 , 21 ], a community-led supervision intervention with traditional birth attendants in Ecuador [ 41 ], a digital health intervention for integrated family health services in Bihar, India [ 38 ], and the MESH-QI approach for supervision and task sharing support for nurses providing antenatal care in Rwanda [ 11 – 13 , 60 ].…”