Improving maternal and new born access to services in Ghana
Grameen Foundation‘s MOTECH
Too many women in Ghana lack access to essential health information and services, impeding progress towards improved maternal and child health outcomes. Despite making some progress, there remains some distance to go if Ghana is to achieve Millennium Development Goals 4 and 5 (1).
Mobile phone technology, available even in remote communities, has proven to be a valuable tool to help bridge the gaps between access to health information and service provision. Grameen Foundation launched the Mobile Technology for Community Health (MOTECH) initiative in Ghana, which is focused on improving maternal and child health. MOTECH uses mobile phones to increase access to and demand for health information and services among rural women, while also providing data on health service delivery and outcomes to the Ghana Health Service.
How MOTECH works
The MOTECH software comprises two applications: Mobile Midwife and the Nurses Application.
Mobile Midwife provides pregnant women and their families with text (SMS) or voice messages that offer actionable information (including alerts and antenatal care reminders) about their pregnancy for each week of gestation in their own language. The Nurses Application helps nurses working in rural health facilities to record and track the care provided to women and newborns in their area.
Each rural health facility is equipped with low-end mobile phones running the MOTECH software.
Nurses enter patient data into forms on a mobile phone and send it to the MOTECH server, which then checks the patient’s health-care information against the schedule of treatments recommended by the Ghana Health Service. When a patient misses an appointment, reminders are automatically sent to the patient and the nurse to ensure follow-up.
Supporting national public health programming
The Ghana Health Service, an autonomous public service agency under the control of the Minister of Health, is committed to achieving Millennium Development Goals 4 and 5.1 The MOTECH platform was developed to test how simple, low-cost mobile technology could contribute to the achievement of these goals. To develop MOTECH, Grameen Foundation worked closely with the Ghana Health Service leaders and front-line health workers to research issues faced by pregnant women and children as well as the health workers who serve them. Systemic challenges were identified, including a lack of accurate health information for women, harmful traditional beliefs and myths, low demand for and awareness of critical care services, fragmented delivery of postnatal care, and cumbersome paper-based patient data systems at health facilities. MOTECH was designed to help address these specific obstacles, and is now tightly integrated into the Ghana Health Service system for delivering care to pregnant women, mothers and children.
Partnerships for support and sustainability
To achieve long-term impact, Grameen Foundation is working to help the Ghana Health Service determine how MOTECH can be scaled up from a pilot project in two districts to the national level,
INNOVATE EVALUATE SCALE UP IMPROVE HEALTH RESEARCH EVALUATE SCALE UP IMPROVE INNOVATE EVALUATE SCALE UP IMPROVE HEALTH
1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www.unmillenniumproject.org/goals/gti.htm)
fully integrated into the national health service delivery system.
This will be achieved using government financing subsidized by revenue from creative business models and contributions from private companies and donor organizations. Through the MOTECH National Steering Committee, a sub-committee on Integration and Transition has been formed, and is now developing the strategy for integration of MOTECH into the Ghana Health Service systems and for the transferral of operational management from Grameen Foundation to the Ghana Health Service. Grameen Foundation has also built a partnership with the leading telecommunications company in Ghana, MTN, to offer a fee-based version of MOTECH’s Mobile Midwife for urban, middle-income women, which will be available nationally. Revenue from this service will be used to cross-subsidize MOTECH services for poor women.
Grameen Foundation is continually exploring opportunities for creative financing strategies, including incorporating advertising and sponsorship into the MOTECH service, and also maternal microinsurance.
IWG catalytic grant for mHealth programme scale-up MOTECH was awarded a grant to scale up its use in Ghana by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance. MOTECH was successful in the grant competition because it employs an effective delivery strategy for evidence-based maternal and child health interventions, combined with creative financing strategies to promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5. Through IWG, MOTECH is receiving assistance from WHO RHR to optimize scale-up while contributing to the mHealth evidence base and best practices on implementation and scale-up.
Assistance: The project receives a grant from the mHealth Alliance; and specialized research assistance from WHO’s Department of Reproductive Health and Research.
Partners: Ghana Health Service, Bill & Melinda Gates Foundation, USAID Saving Lives at Birth, MTN
For more information please contact: Karen Romano, Country Director, Grameen Foundation Ghana (kromano@
grameenfoundation.org), or John Tippett, Director of Mobile Health Innovation, Grameen Foundation (jtippett@grameenfoundation.org)
References:
1. 2008 Ghana Millennium Development Goals Report. Ghana National Development Planning Commission, Government of Ghana and the United Nations Development Programme, 2010.
Credits:
Icons adapted from The Noun Project
Editing, design and layout: Green Ink (www.greenink.co.uk)
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Mobile Midwife
Informative messages, alerts and reminders each week of gestation
Nurses Application
Nurses enter client data and are prompted to provide care according to the schedule of recommended treatments
Clients receive appointment reminders
Clients receive the care they need Improving access for rural pregnant
women, mothers and newborns
Number of facilities (2012) Number of nurses (2012)
Number of pregnant women clients (2012) Pregnant women to be reached (2014 target)
Ghana
Central Region Awutu Senya and Gomao West Districts
38 142 1287 10 812 Greater Accra Region Dangbe East District
90
16 Pending
roll-out 4776
Volta Region South Tongu District
16 55 Pending roll-out 3189 Upper East Region
Kassena-Nankana West District 18 112 3425 3476
