Abstract
BackgroundGlobally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania.MethodsTeleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning.ResultsIn 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18–21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43–89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users.ConclusionsE-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.
Highlights
IntroductionThe skills that the care providers reported to have acquired through the eLearning included active management of third stage of labour, better ways of performing caesarean section, use of condom tamponade for controlling postpartum bleeding, proper preparation of pregnant women before caesarean sections (CS) and proper positioning of a pregnant woman during and after provision of anaesthesia
Teleconferencing and mobile teleconsultation platforms A total of 33 teleconferences were conducted in 2015 and 40 health care providers from 14 supported facilities took part
The facility recording the highest level of participation was Kibiti Health centres (HC) in Pwani region, which participated in 82% (27) of the teleconferences (Table 1)
Summary
The skills that the care providers reported to have acquired through the eLearning included active management of third stage of labour, better ways of performing caesarean section, use of condom tamponade for controlling postpartum bleeding, proper preparation of pregnant women before CS and proper positioning of a pregnant woman during and after provision of anaesthesia. Advanced level associate clinician is defined as a professional with advanced competencies to diagnose and manage the most common medical, maternal, child health and surgical conditions, including obstetric and gynaecological surgery (e.g. caesarean sections). Evidence shows that mid-level care providers can perform related tasks, task sharing must be aligned with broader strengthening of knowledge and clinical skills, mentorship and support if sustainable provision of quality health care is to be achieved [7]. Tanzania’s eHealth strategy 2013, through its well-articulated strategic objectives, emphasizes the need to improve quality of health service delivery in rural settings through eHealth solutions [3]
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