A mobile health project in Ethiopia gives any health worker with a smartphone access to the information they need to deal with emergencies during childbirth. Now it’s being scaled up to reach 10,000 health workers across Africa and Southeast Asia by 2017.
A midwife at Gimbi Health Center in West Wellega, Ethiopia, uses the Safe Delivery App to help her carry out an examination on a patient. Photo by Mulugeta Wolde
For Ethiopian mother Mitike Birhanu, the birth of her twins almost ended in tragedy. She was unconscious when the second of her babies was delivered, and the newborn seemed lifeless. But her midwife quickly consulted an app on her smartphone, diagnosed the problems, and used emergency procedures to save both Mitike’s life and that of her child.
Every year, over 300,000 women globally die from pregnancy-related causes, and over 5 million babies die during birth or within the first weeks of their lives. Yet the vast majority of maternal and newborn deaths could be prevented if health workers attending births had better emergency skills and knowledge.
Many health workers in low- or middle-income countries work in environments where there is no electricity or running water. But one thing they do have is smartphones.
The Safe Delivery App (SDA) was created as a simple tool for health workers such as midwives and nurses to access basic emergency obstetric and neonatal care skills. Developed by Danish NGO Maternity Foundation in collaboration with the University of Southern Denmark and the University of Copenhagen, the app aims to train and instruct birth attendants on how to manage potentially fatal complications during pregnancy and childbirth.
Based on global clinical guidelines, the SDA contains four basic features: animated instruction videos, action cards, a drug list and practical procedure instructions. The five- to seven-minute videos teach lifesaving skills such as how to stop a woman bleeding after birth or how to resuscitate a newborn. When there is no time to watch the full video, the action cards give clear, essential recommendations and immediate care information – such as how to mix an alcohol-based hand rub.
The SDA is free to download from Google Play and the App Store. And it can be preinstalled on phones, so once it’s downloaded, users don’t need a network connection or internet access to view the videos or other features.
Meaza Semaw, project coordinator at the Ethiopian Midwives Association, says the app is ideal for places like Ethiopia, where women’s access to quality maternal health services is challenging, especially if they experience complications in birth. “The Safe Delivery App is a great tool to improve maternal health in Ethiopia. Most midwives, if not all, have a mobile phone, so accessibility is very high,” she says. “The app is easy to use because it is supported by animations and videos. In addition, it uses local languages.”
With the support of the MSD for Mothers program, the first four of the app’s 10 videos were tested in a one-year, randomized controlled trial across 78 facilities in Ethiopia during 2014. Results show users’ skills in handling most common complications such as postpartum hemorrhage and newborn resuscitation more than doubled after 12 months of using the app.
The app was officially launched in April 2015, and a year later was chosen by the Women Deliver conference as an example of how a partnership-based innovation can help end maternal and newborn mortality. SDA is now currently in use in Kenya, with plans to roll out to Guinea, Sierra Leone, Myanmar, Laos and India in the coming months.
So far, the app has been funded with help from over $50,000 in donations through an Indiegogo crowdfunding campaign, and Maternity Foundation is working with partners in individual countries to fund the translation and rollout of the app. The hope is to be able to fulfill the commitment Maternity Foundation made to the U.N.’s Every Woman Every Child to reach 10,000 health workers with the app by the end of 2017, so ensuring a safer birth for 1 million women.
At Wollega University in Ethiopia, student midwives use the app during training. (Mulugeta Wolde)
Maternity Foundation CEO Anna Frellsen says the organization is working in partnership with governments, midwives’ associations and larger NGOs to achieve its goal. “We really want to see the app integrated as part of the existing health system in countries, and we are starting to engage with the [health] ministries and stakeholders in each country to find out how it can be used and adapted,” she says.
The Ethiopian Midwives Association is currently working on integrating the SDA into its ongoing training program. Frellsen hopes other health organizations in participating countries will do likewise.
There is also a new version of the app in the works, which will feature quizzes and a test (rewarded by a certificate) to “push” learning to the user and make the experience more interactive.
Frellsen says one of the key components of Maternity Foundation’s “backbone” support for its partners will be disseminating learning around the SDA and mobile health in general. “We are looking at how we can publish some of the learning for sharing with others who would like to use the app, but also more broadly as a case for how to scale up an mHealth [mobile health] tool,” she says.
In western Ethiopia’s Gimbi rural district, the midwife who saved Mitike’s life says the Safe Delivery App has already made her better at her job. “I am confident that from what I have learned from the app, I can stop [a mother] bleeding,” says Yane Ababaw. “I can save her life.”