Using mHealth to Improve Timeliness and Quality of Maternal and Newborn Health in the Primary Health Care System in Ethiopia

The use of mobile health (mHealth) in Ethiopia’s primary health care system offers a potential solution to improve timeliness and quality for maternal and newborn health care services. It is user-friendly and fosters communication between health care workers and health extension workers to provide quality services across the pregnancy continuum of care. Key Findings The Last Ten Kilometers 2020 Project (L10K 2020) designed a user-friendly mobile health (mHealth) solution that bridged communication gaps between health care workers and health extension workers and improved quality services for women across the pregnancy continuum of care delivery in Ethiopia. Findings from routine monitoring and usability assessment showed that the mHealth application facilitated real-time information exchange with supervising health facilities in the primary health care system, as well as timely identification and registration of pregnant women, thereby increasing uptake of maternal health services across the continuum of pregnancy, childbirth, and postnatal stages. Key Implications Engaging with health sector stakeholders at all levels when developing, testing, and deploying the mHealth solution can effectively cultivate ownership and ensure skills and knowledge transfer at all levels. Using a cocreation strategy to develop an mHealth solution will help ensure the smooth handover and scalability of the model and build local capacity. Vigilance in consistently mitigating the challenges related to mHealth infrastructure, such as mobile data capacity, electricity, and internet connectivity, will reduce usage disruption, and bolster users’ confidence in the app’s capabilities. 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.