MoTeCH: A Mobile Approach to Maternal Health Care

Posted by AnneryanHeatwole on Feb 10, 2010

In an effort to bridge the gap between community health workers and patients, the Grameen Foundation is in the midst of a two and a half-year project called Mobile Technology for Community Health (MoTeCH). MoTeCH, a joint initiative between the Grameen Foundation, Columbia University’s Mailman School of Public Health and the Ghana Health Service, is working to determine how best to use mobile phones to increase the quality and quantity of antenatal and neonatal care in rural Ghana.

The project is two-fold.  One service targets what Tim Wood, director of the Grameen Foundation’s Mobile Health Innovation and ICT Innovation divisions calls “pregnant parents,” and another targets community health workers.

Said Wood about the pregnant parents, “there’s this recognition that it’s not just the mother that has the phone – oftentimes it’s the male in the household that has the phone or has access to the phone. So we think about the messages that we want to send to the pregnant parents. And the idea here is to engage the pregnant parents more during the course of the pregnancy so that they will seek more antenatal care.” According to Wood, it’s common in Ghana for a woman to go to her first antenatal care visit and then never return. And over the course of a pregnancy, it’s ideal to see the woman at least four times. MoTeCH encourages women and families to seek more regular health care.

For example, a woman might come in for a health check-up when she’s 12 or 14 weeks pregnant, at which point she would be registered into the MoTeCH system. She would then be on track to receive two kinds of messages: informative texts and action texts. The informative texts simply tell the parents what to expect (i.e., developmental stages) during a pregnancy, while the action texts encourage parents to make clinic visits based on their personal histories (such as needs for shots or follow-up appointments). 

The other target audience of MoTeCH is community health workers who provide the vast majority of primary care in much of the developing world. The workers use mobile phones to enter data such as when they have seen a patient and what kind of treatment these patients received. Data is then compiled to more easily track patients.  

The idea behind MoTeCH is to link the two systems so that the messages can be more specifically targeted and tailored to the needs of the individual parents; for example, if a pregnant woman misses a tetanus shot, the community health workers’ records will show how many weeks along she is and she can be easily sent a reminder. Similarly, messages can be sent to village community health workers alerting them to patients who are in need of specific services in order to locate the patient and encourage him or her to get treatment. “It gets community health care workers out of the clinic and seeking patients who need care a little bit more immediately,” said Wood.

Wood pointed out that a big asset of MoTeCH is the time saved for workers, adding that much of the community health workers' time is taken up by manual data entry. “We hope that by entering patient encounter information by mobile phone we can get the nurses out of the business of spending three or four days at the end of the month manually tallying that information. We hope that the MoTeCH platform will enable the nurses to spend more of their time doing actual health care work and less time doing manual data tallying and recording,” he said. 

Although funded by the Gates Foundation, MoTeCH is focused on keeping costs low in order to be a long-term, sustainable project. As such, it is designed to run on the mobiles that are already in users’ hands – no need for technology upgrades. “We’re not distributing mobile phones to patients; there’s a high enough mobile phone ownership and penetration even in these remote, rural parts of Ghana that we think we can reach people without handing out mobile phones.” 

The project has done short field tests, but so far MoTeCH has not yet been fully deployed – full deployment is slated for June 2010 in two distracts in the Upper East region of Ghana, Kassena/Nakana and Kassena/Nakana West. A few months after that, MoTeCH plans to expand to Dodowa in the Greater Accra region in order to test and demonstrate the supportability and scalability of the project. 

Although the first true deployment isn’t taking place until June 1, the project has been underway for nearly a year. The first phase included research for an "mHealth Ethnography" report in August of 2009.  Patricia Mechael, author of The mHealth Ethnography report, said that the report used interviews with community members and health workers to assess the state of antenatal and postnatal care in the region. She noted that Ghana is particularly well suited for the MoTeCH project. “We went to a place where the government is becoming a bigger user of mobile tech solutions. Now we’re starting to see a much more active role of the government to define and drive home how technology can be applied for health. And that’s an incredibly positive change,” she explained.

The content development team also conducted field research, starting with a “the pregnancy question box.” Researchers visited three communities and provided villagers with mobile phones and the ability to ask any question they might have regarding pregnancy. Users could either text a message in and get an answer from a trained midwife, or they could use a voice call to talk to a professional. In this way, the organization was able to gather data about common concerns and questions about pregnancy in the communities, and shape the content of their text and voice messages to known concerns of pregnant parents. 

Since the release of the mHealth Ethnography Report, MoTeCH has worked to build the groundwork for the project – developing the content of the messages, customizing the software platform, working with community health workers to test the accessibility of programs, and implementing and testing software.

MoTeCH uses OpenMRS, an open source medical record system as the basis of the medical records management, while the rest of the software is uniquely designed for MoTeCH by developers at the University of Southern Maine.

Columbia University and the Grameen Foundation are working together closely to implement the system. Columbia has taken the lead on the simplified register development and is monitoring the evaluation plan. And all of the work is linked to the Ghana Health Service since the work involves close interaction with the nurses and community health workers in the region, from developing the register to deciding on the protocols for how to bring the MoTeCH service into the regions.

MoTeCH did run into challenges, especially in developing a program that can work around the language and literacy barriers in rural Ghana. To combat this, the system was developed to deliver messages in two forms – either text messages or voice messages that have been pre-recorded in local languages. When users register for the system they have the option of specifying which format they would like to receive their messages in. Wood anticipates that most patients will register for the voice message service while nurses will use the text message format. On the patient side, users do not have to pay to receive text or voice messages. The Gates Foundation grant covers the community health workers’ use.

The project's ultimate aim is to increase the number of antenatal care visits and, subsequently, to increase the number of healthy births in the regions in which MoTeCH is deployed. Wood said that the project is already off to a good start, “In general we’re seeing tons of enthusiasm, both from the pregnant parents and from the community health workers who are very quick to understand the potential of the service and the system.”

Photo Credit Grameen Foundation

MoTeCH: A Mobile Approach to Maternal Health Care data sheet 10903 Views
Countries: Ghana

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