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Design and mobile technology to reduce mother and baby deaths

Posted on September 29th, 2013 in Fieldwork with 0 Comments

On a frigidly cold Overberg morning, a computer room at the Grail Centre Trust in Kleinmond is heated by vivid red iMobiMaMa prototype health kits (mKits) as well as the intensity of community health workers grappling with the interactive design they’re testing to help reduce mother and baby deaths in South Africa.

The mKits include a mobile tablet, a blood pressure device validated for pregnancy, urine tests for glucose, protein and nitrites, and a scale and tape measure. In addition, they’re equipped with pregnancy tests and small units of health supplements for potential sales. Future kits will also carry portable foetal heart monitors.

For the six health workers who are participants in the design pilot currently underway, using technology to record early pregnancy data – including medical histories, blood pressure and urine tests, and height and weight measurements – has seen them leapfrog their resistance to computers and the thought of using an online iMobiMaMa platform, the mHub, to develop personal online profiles; complete and feed back the online health screening forms with clients; and record their experiences of using the mKits in their daily diaries. All of these are needed to develop a data bank and test the design prototype.

As one of them, Jaquelene Boezak of Riemvasmak township in Kleinmond, says, “Before iMobiMaMa, I’d never even used a computer. Now I’m excited about using it to help women through their pregnancies. I can’t wait for my turn.” Boezak says she’s enjoyed learning about pregnancy and looks forward to giving women information, tests and supplements.

iMobiMaMa, a project initiated by gynaecologist and social entrepreneur Dr Carol Thomas, aims to work with the public health system to leverage widespread cellphone usage to reach and support pregnant women with potentially life-saving support and access.

Child and maternal mortality are major global public health focuses and their reduction are two of the eight Millennium Development Goals set for 2015. A 2012 report by the World Health Organisation (WHO), UNICEF and a range of academics indicates that globally from 1990 to 2010 maternal deaths were halved (from 543,000 per annum to 287,000) and child deaths substantially reduced (from 12 million to 7.6 million).

At 57 neonatal deaths, and 300 maternal deaths, per 100,000 live births, South Africa is considered one of the worst performing on the continent (along with Chad, Cameroon, Lesotho, Somalia and Zimbabwe), having shown no progress in a 20 year (1990 – 2010) World Health Organisation (WHO) study. The significance of South Africa’s lack of progress is underlined by the claims of a 2012 (WHO) and Unicef report that, “An African woman’s lifetime risk of dying from pregnancy-related causes is 100 times higher than that of a woman in a developed country.”

Yet, Thomas points out, the causes are largely preventable ones. “Other than HIV/Aids,” she explains, “the main causes of maternal and neonatal deaths are the effects of developing high blood pressure in pregnancy and bleeding during the birth process without access to adequately trained birthing personnel.”

“These factors,” says Thomas, “are exacerbated by the lack of access to emergency transport to health facilities.”

The incidence of pregnant women who do not book with health facilities early in their pregnancies, is a key factor in the mortality rates, and the national health department has established an mHealth (mobile health) stakeholder group to investigate the use of cellphones to support women with pregnancy-related information and drive early bookings with local clinics. At a meeting with mHealth stakeholders, including iMobiMama, according to Thomas, Dr Peter Barron, advisor to the national Department of Health, expressed concern that, despite maternal and child health being a departmental priority and these services being free at public facilities, only 40% of pregnant women access antenatal care before 20 weeks.

In response to this challenge, iMobiMaMa has taken a design process approach to understand the needs of pregnant women and the contextual realities that contribute to late bookings, before designing a solution.

Working with The Design Cradle, a South African organisation that advances design for social impact, iMobiMaMa has spent the past year conducting field research with community health workers who provide home-based health care in Kleinmond. Here the existence of diverse communities, poverty, unemployment, a lack of public transport and limited health facilities, all reflect the reality for multiple underserved communities throughout South Africa.

The Grail community health workers are previously unemployed lay people who’ve been trained to assist chronically ill patients in their homes in the communities of Kleinmond, Hawston and Betty’s Bay.

Pregnant women are not typically among their target client base. But, during a recent health training workshop in preparation for the design pilot phase, six community health workers were able to identify over 90 pregnant candidates for the pilot. The vast majority of these had not booked with public health facilities; highlighting the need for services like iMobiMaMa.

A number organisations are currently developing cellphone based messaging systems to interact with pregnant women, and iMobiMaMa will use cellphone technology to feed pregnancy data to the iMobiMaMa Hub where this data can be analysed by health professionals. However the project’s unique proposition is the development of a service-based system that will connect poor women, where they live or work, to appropriate the health screening, information, support and products.

Working with community-based health workers, iMobiMaMa’s mission, says Thomas, “is to provide poor pregnant women with the resources to make informed decisions about health choices during pregnancy; encourage them to make early bookings with local health services; and give them access to affordable pregnancy supplements and mother and baby products”.

How pregnant women in marginal communities are reached, has been one of the focus areas for iMobiMaMa and the project’s service design phase has identified the need for trained iMobiMaMa agents made up of local women and unemployed youth who would benefit from incomes while reaching pregnant women in their communities. The Grail Centre Trust’s community health workers fit this profile.

Creating economic opportunities is a shared priority for iMobiMaMa and The Design Cradle. The project is exploring a business model that includes generating commission from the sale of small volume health, pregnancy, mother and baby items in locales where the existence of single outlets for these products means that poor people often pay premium prices.

The tools for the effective delivery of these services are the interactive mKits and the ultimate design of these will be influenced by the findings of the current pilot.

Early concept designs were developed in response to research at the beginning of the project, and took the form of interactive kiosks. The concept designs were used to show pilot participants how designs respond to their input, and local needs and characteristics. One concept design was of a hard shell backpack with wheels for health workers in Mbekweni, Paarl who use taxis and trains. They were designed to be carried and fit comfortably during transportation, and to open up into a stand that housed a computer and a counter with shelves for the medical devices and consumer products.

Another design took the form of a segway and was conceived for the Kleinmond communities where there is no public transport. The idea was that the barrel-shaped front wheel could house the equipment and products, while health workers rode the segway like a scooter. However, while this design might have offered health workers some respite, it was found to be impractical for the sandy, hilly terrain.

A third design was developed to give consideration to privacy for “patients” and allow for a more formal set up in a central location. This one was designed to be towed by a car or bicycle.

Since then, more compact designs have been explored. But ultimately, the design pilot will provide the data and insights necessary to develop a more advanced design.

First published in the Weekend Argus 29 September 2013


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