Preventable, yet wrecking havoc. A woman in Malawi stands a one in 26 chance of dying during pregnancy and in childbirth and the misfortune of dying increases with each pregnancy. Malawi where in local language, pregnancy is described as ‘pakati’ translated as being in the middle of life and death, is a nation where the blissful occasion of giving birth becomes the moment of grief. At the time when maternal deaths are still rampant, technological innovations have started reversing the trends. BRIAN LIGOMEKA writes.
Sitting on the veranda of her grass-thatched mud hut in Mpulula Village in eastern Malawi’s district of Balaka is a 26-year-old single mother, Melise. Despite the apparent signs that she is living in poverty, Melise was beaming with happiness during an interview with this reporter.
She said she would wobble out of poverty in the next five years because her vegetable garden is generating good income, half of which is deposited in her savings account.
Is that the sole reason she is excited?
“My mobile phone is the source of my excitement,” says Melise, whose husband divorced her two years ago when she was pregnant.
Surprisingly, the phone she was excited about is not a state of the art gadget but an old basic small handset, which does not even have internet or whatsap facilities.
“I am excited that I own this mobile phone which I bought at 7000 Malawi kwacha ($10) because it serves as a clinic,” she explained.
Melise’s phone is hooked to a mobile health innovation called Chipatala cha pa Foni (CCPF) or Health Centre by Phone, which is designed to increase access to timely and appropriate maternal, neonatal and child health information, advice and care.
With her home being about 11 kilometres away from the small town of Balaka, Melise is among the thousands of women who registered for the ‘tips and reminders’ service from Health Centre by Phone.
She said she registered for the service when she was diagnosed HIV positive at the time she was pregnant.
“Fearing that I would face discrimination, I decided to avoid disclosing my status to anyone and instead opted for ‘tips and reminders’ service from Health Centre by Phone,” Melise narrated.
She has since then been receiving important maternal and child health information via SMS and explained that sometimes she calls the hotline to ask questions. Through her constant communication with Health Centre by phone service, Melise is excited that she delivered her baby boy safely two years ago.
“A great miracle happened to me. I delivered an HIV negative baby although I am HIV positive,” she said praising an e-innovation which provided her with advice on prevention of mother to child transmission of HIV.
She added: “I am a living example that it is possible to be HIV positive and deliver an HIV-free baby, so long as one follows guidance from the doctors.”
The innovation
Health Centre by Phone, is an mHealth innovation in Malawi designed to increase access to timely and appropriate maternal, neonatal and child health information, advice and care.
Running on a technology platform specifically designed to meet the challenge of low resource communities, the innovation is working wonders in the southern Africa nation of Malawi, one of the countries with high rates of maternal, child and infant mortality. Currently, Malawi’s maternal mortality rate is pegged at 510 per 100, 000 live births while the Under-5 mortality rate is 68 per 1000 live births.
The beauty with the innovation is that it provides women and caregivers with greater control and opportunity to interact with the health system without having to travel long distances to a health facility and at the same time being able to provide access to critical antenatal and postnatal care information.
“The programme also increases appropriate home and facility-based care for pregnant women and children,” says CCPF Programme Coordinator Zachariah Jezman.
According to Jezman, CCPF has two main components namely a toll-free hotline that provides families with information and advice on reproductive, maternal and child health issues and refers callers displaying ‘danger signs’ for further care at a village clinic, health centre or hospital.
The second component is the ‘tips and reminders’ mobile messaging service that provides regular text or voice messages on reproductive, maternal, and newborn health topics.
Courtesy of the project, the queues at many clinics and health centres in districts where the project is implemented are becoming shorter when compared to the time there was no such service. In such districts, mothers no longer rush to the hospital with minor problems which are solved through a phone call.
“Messages are tailored to the client’s week of pregnancy or a child’s age,” says Jezman.
He adds: “Through this service, we are able to fulfill our mission of saving lives and improving health by increasing access to quality healthcare for the most underserved communities.”
Jezman is certainly right because an independent evaluation of the innovation revealed that the innovation has contributed to significant improvements in maternal and child health indicators, through increased use of antenatal care within the first trimester of pregnancy and increased use of a bed net during pregnancy and for under-five children. Furthermore it has also increased early initiation of breastfeeding besides improving knowledge of healthy behaviour in pregnancy.
CCPF has grown substantially from a single district in 2011 to 25 percent nationwide geographic coverage serving a population of over 515,000 women and children across seven districts. A partnership with Airtel, Africa’s largest mobile carrier, has significantly expanded the reach and scope of the service, including zero-rating all calls to the CCPF hotline and helping to expand content beyond maternal and child health.
Meanwhile the Ministry of Health’s Reproductive Health Unit has endorsed CCPF and is supporting its national expansion. With growing interest from the government, private sector and other implementing partners, CCPF is set to reach national scale in a year or two.
The popularity of the innovation has attracted several partners who include Baobab Health Trust, Concern Worldwide, Johnson & Johnson, Support for Service Delivery Integration (SSDI), Malawi’s Presidential Initiative on Safe Motherhood and Vitol Foundation. The reason for this is obvious. CCPF is complementing government’s ambition of reducing maternal and infant mortality as stipulated in Malawi’s Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity. The roadmap, which is a key policy document developed by the Malawi Ministry of Health to accelerate the reduction of maternal and neonatal morbidity and mortality in Malawi.
Through its services, CCPF has contributed to an increase the availability, accessibility, utilisation and quality of skilled obstetric care during pregnancy, childbirth and postnatal period at all levels of the health care delivery system.
Other initiatives
Besides the m-health innovation, Malawi is employing several strategies to reduce maternal mortality.
According to Health Minister Dr Peter Kumpalume one of the strategies is through the improvement of access to care of obstetric emergencies.
“Improving coverage and quality of skilled attendance at birth is also being emphasised,” he said.
He said at the moment all expectant women are advised to deliver in health centres and hospitals instead of relying on birth attendants. “Many traditional chiefs have been sensitised about the importance of clinic birth for rural women and they are the ones encouraging families to deliver at hospitals.”
Kumpalume said that government and other stakeholders are also promoting better reproductive health services for adolescents and improved family planning services which are important ingredients in maternal and infant mortality reduction.
Realising that one major threat to maternal and infant health is the rapidly evolving Aids epidemic, Malawi is co-addressing HIV and maternal mortality challenges at the same time.
One of the strategies used is the implementation of Option B+ programme, which offers anti-retroviral therapy (ARVs) to all pregnant women with HIV, regardless of CD4 cell count.
Within four years, Malawi’s treatment cascade for pregnant women has been transformed so that the proportion of women with HIV who are diagnosed has gone from 49 to 80 percent and those who are virally suppressed has jumped from 2 to 48 percent.
With support from United Nations Children’s Fund (Unicef), Malawi has also been testing the use of Unmanned Aerial Vehicles or drones as means of exploring cost effective way of reducing waiting times for HIV testing results for infants.
The innovation is at a testing stage but if successful, it will compliment other mechanisms such as road transport and use of SMS to communicate results from the laboratories in the cities to the health facilities in rural areas.
Unicef Representative in Malawi Mahimbo Mdoe believes the drones could be the breakthrough in overcoming transport challenges of HIV test results for infants.
“We hope that the drones can be part of the solution to reduce transportation time and ensure that children who need it, start their treatment early,” said Mdoe during the test launch recently.
Touting government’s commitment in the fight against Aids, Kumpalume says, “the implementation of Option B+ programme, the delivery of results from the central laboratory to the health facilities through text messages and the testing of drones are all important innovations.”
Currently, the time taken to get from health facilities in rural areas to the lab is 11 days, and the time taken to return the results by road can take as long as 8 weeks. With the drones, that long wait will become to an end.
Ray of hope
The statistics at the moment are startling. According to World Health Organisation, every day about 830 women die due to complications of pregnancy and child birth worldwide. Almost all of these deaths occur in low-resourced countries like Malawi, and most of them could have been prevented.
While the risk of a woman in a developing country dying from a maternal-related cause during her lifetime is about 33 times higher compared to a woman living in a developed country, there is a ray of hope on the horizon. With new initiatives such as Health Centre by Phone, use of drones to deliver HIV results for infants, promotion of family planning and expectant women deliveries at hospitals, maternal health are being drastically reduced.
The statistics of how Malawi is progressing in improving maternal and child health are now speaking for themselves. Under-five mortality declined from 244 to 68 deaths per 1,000 live births while maternal mortality has declined from 1,100 to 510 maternal deaths per 100,000 live births between 1990 and 2015 in a nation of about 17 million people.
Encouragingly, innovations at the national level are also contributing to global progress. Across the world, the number of women dying due to complications during pregnancy and childbirth has decreased by 43 percent from an estimated 532 000 in 1990 to 303 000 in 2015.
With numerous innovations in the health sector at work, women themselves as is the case with Melise in rural district of Balaka in Malawi are realising that the strategy for reducing maternal and infant deaths is straightforward. Regardless of many women living in poor countries, they too need access to antenatal care during pregnancy, skilled care during childbirth, and care and support after childbirth even if it means getting some of the support through SMS on the phone.
Leave a Reply