With only 500 days remaining for the Millennium Development Goals, there is much excitement for the progresses in maternal, newborn, and child healthcare (MNCH) in developing countries. Successes include a 45% reduction in maternal mortality since 1990, yet there is still much work to be done. According to the UN nearly 300,000 women died from complications due to pregnancy and childbirth worldwide in 2013. There are over 250 programs in the CHMI database working to accelerate improvements in maternal health. 64 of these MNCH programs use technology to combat maternal and child mortality, and increase availability and reduce healthcare costs for the poor.
Today, doctors in Nairobi can speak to women in rural Kenya over the phone about their pregnancies. Community health workers going door to door in Bangladesh can organize patient records and ask the right questions concerning symptoms of disease with mobile tablets linked to a central system. The abundance of devices, applications, and phone centers has generated hope for the impact of technology on Maternal, Newborn and Child health. Below, we investigate some of the innovative ways that health programs are using technology to provide better care for mothers and newborns.
Mobile Applications for Data Collection and Patient Communication
One of the most common ways that technology is used in MNCH care is to enhance health workers’ abilities to record data and follow up with patients. In recent years mHealth has emerged as a major solution to increase geographically isolated communities’ contact with doctors. Access to vital health information can have a significant impact on a mother’s pregnancy and child, and proper data and communications is necessary for a CHW to refer a dangerous situation to a local health facility. Out of the 64 programs analyzed for this post, 46% use technology “to improve data collection, organization, or analysis.” (Figure 1)
ChildCount+ is used for data collection in the Millennium Villages Project in 10 countries across West and East Africa. This mHealth platform relies upon SMS data entry and a centralized database to track and monitor maternal and child health. ChildCount+ has the ambitious goal of registering every pregnant woman and every child under the age of five in the Millennium Villages. By providing important health information via SMS to mothers and health workers, ChildCount+ has reduced maternal mortality by 22% in the Millennium Villages locations. 
In Pakistan the Micro Health Franchise System Umeed Say lowers maternal health costs and improves midwife services with technology. UmeedSay has developed multiple mHealth systems for midwives, including a clinical decision support system, electronic medical record access for doctors and midwives, and a system for registering, monitoring, and evaluating the work of community midwives . Midwives can use the mobile application to send SMS messages on pre- and post-natal data. This data is relayed to a central clinic where it can be reviewed by specialists, who can also facilitate diagnosis of complications. Umeed Say’s mobile app also allows access to patients’ background information and lab tests, and can connect midwives to emergency services.
Hotlines and Voice Response Technology
While mobile platforms allow community health workers to reach remote populations, certain regions do not have the same direct access to these services. Many programs rely on hotlines to solve this lack of access. 8 programs in the CHMI database that use hotlines for MNCH care. In the Democratic Republic of Congo PSI DRC operates Ligne Verte, a popular hotline with information on HIV and STD protection, family planning, and basic child health. Ligne Verte partners with Vodafone to provide calls toll-free, and in 2009 received 78,000 calls on maternal health and family planning. In Sierra Leone the Fistula Hotline links women to experts to discuss concerns of fistula, an all-too common side-effect of prolonged labor in developing countries. The hotline nurses determine whether women are eligible for fistula treatment, and then connect them with more resources.
Meanwhile, Baby Monitor in Kenya bridges the gap between a hotline and a mobile phone application by linking pregnant women with health clinics through interactive voice response technology. As many phone applications and SMS information services require patient literacy, illiterate populations are often left out of this segment of innovations. Baby Monitor is a low-cost screening service that pre-records clinical decision trees in local languages. Mothers who call the hotline have access to health information they can understand, and are easily referred to local or regional health centers for further diagnosis or emergency care.
MNCH programs that rely upon technology do so not only to enhance individual interactions between patients and doctors, but also to enable access to wider networks of services. Out of the 64 MNCH programs using technology, 14 programs combine ICT with innovative delivery services including franchises, health service chains and networks. Djantoli targets children and mothers in Mali and Burkina Faso through health monitoring, health insurance, and preventative education services delivered by mobile phone-equipped community agents. These agents are linked to local doctors who provide remote monitoring and disease detection. Through home visits, mobile monitoring, and health education talks, Djantoli has treated and prevented diseases among 3500 children since 2010. A wide network of health clinics and community health workers are linked through their technology and health insurance scheme, ensuring that mobile methods and local resources work hand-in-hand.
Mat Troi Be Tho promotes exclusive breastfeeding to combat malnutrition in Vietnam. The social franchise relies upon social media and a mobile phone counseling service to share educational campaigns. Their online platform also includes a live chat feature for counseling with expert health workers. The Mat Troi Be Tho website hosts videos and educational resources, manages an active forum for new mothers, and offers training courses for health workers. With over 700 facilities throughout the country, this franchise has used technology to expand its services and increase the poor’s access to health education.
While mHealth has taken off in the maternal and child health space over the past 15 years, the overall effects are still being captured. To fill the gaps in evidence and impact, programs that use technology to address MNCH are encouraged to report their results and share knowledge in the CHMI document library. As we follow more innovations and trends of how technologies impact healthcare in developing countries, our team will continue to update our database and reports. Until then, stay tuned for our next database at a glance!
Photo: A clinical officer at Access Afya. © 2013 CHMI