Abstract
The Last Ten Kilometers 2020 Project (L10K 2020) designed a strategy for piloting, implementing, and scaling a mobile health (mHealth) digital solution to improve the quality of community-level maternal and child health service delivery in Ethiopia. L10K 2020 first conducted a landscape assessment to design a context-appropriate smartphone-based mHealth solution for the Health Extension Workers and tablets for their supervisors and the midwives managing the same clients at the health center level. These applications included multiple modules and packages including client registration and appointment management; follow-up and notifications; digital job aids for each of the maternal and child health program packages (for Health Extension Workers only); and referral and client tracking systems.Findings from the process evaluation of the mHealth app usage and user experience indicated that the application was user-friendly and facilitated real-time information exchange, defaulter tracing, referral, and feedback systems. It improved the timely identification and registration of pregnant mothers. Adherence to treatment protocols also increased in all domains across the pregnancy continuum of care.L10K 2020 has developed a user-friendly model for implementing mHealth solutions at the community level through stakeholder engagement across levels when developing, testing, and deploying the applications, which was critical to effectively cultivating ownership as well as skills and knowledge transfer at all levels. To replicate and scale this model, context-based scoping, resource analysis, and mapping are essential to determine the infrastructure, cost, time, risks, and key stakeholders involved throughout the implementation of the intervention. During implementation, vigilance in consistently mitigating the challenges related to mHealth infrastructure, such as mobile data capacity, electricity, smartphones and tablets, solar chargers, and internet connectivity, is critical for continued success.
Highlights
Mobile health refers to the use of wireless technology and devices to enhance access to information and improve the delivery of basic health care services.[1,2] Over the past 3 decades, a range of digital technologies have emerged for sharing and generating health and medical information, Learning From Mobile Health to Improve Maternal and Newborn Health www.ghspjournal.orgThe initiative aimed to improve delivery, timeliness, and quality of maternal and child health services and to strengthen linkages within primary health care units (PHCUs).and the fields of mHealth and digital health have expanded globally.Real-time access to reliable and accurate information to deliver consistent and high-quality health care is in high demand.[3]
The application of mHealth solutions in the public health sector has contributed to improvements in the delivery of quality health care.[4,5] mHealth applications are widely acknowledged as a way to transform how clients and health providers exchange health information,[4] and they present the opportunity to improve the quality and timeliness of maternal and child health services and strengthen referral linkages, in under-resourced health systems.[4,6,7,8,9,10,11]
Ethiopia achieved most of the Millennium Development Goals for health[12] through wellcoordinated and extensive efforts made by the government, community, and implementing partners through the health extension program (HEP) and the expansion of primary health care services
Summary
Mobile health (mHealth) refers to the use of wireless technology and devices (smartphones and tablets) to enhance access to information and improve the delivery of basic health care services.[1,2] Over the past 3 decades, a range of digital technologies have emerged for sharing and generating health and medical information, Learning From Mobile Health to Improve Maternal and Newborn Health www.ghspjournal.org. The government and its partners have prioritized mobile technology as a potential solution to revitalize Ethiopia’s HEP and the country’s overall primary health care system.[6,13] In collaboration with the Ministry of Health (MOH), the Last Ten Kilometers 2020 Project (L10K 2020), implemented by JSI Research and Training Institute, Inc., designed an mHealth strategy to complement the existing MOH interactive voice response (IVR) system. This system allows Health Extension Workers (HEWs) to call and record information and send/review their activity reports to a centralized database system. The specific objectives included the following: 1. Improve timeliness and coverage of reproductive, maternal, newborn, and child health (RMNCH) services
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