Trained midwife Heaven Workneh remembers a time when she was called out to help a relative who was about to give birth in a town just outside Bahir Dar, in Ethiopia. The mother was in the late stages of delivery and confused about the medication she had been told to take. Workneh too, though medically proficient, was not familiar with the specific drug and its maximum dosage or complications.
It’s a situation many midwives in remote locations can find themselves in during complicated deliveries, and with little access to information on location there’s an increased risk for making the incorrect decision that could impact the health of the mother and child. Fortunately, this was not the case for Workneh who had access to life-saving technology right on her smartphone.
“During that time, what came to my mind was the Safe Delivery App [downloaded onto my phone], and I quickly referred to my phone for advice and all the necessary information for that postnatal mother. It really is a life saver.”
Every day almost 900 women die from complications due to pregnancy and childbirth – according to the World Health Organization (WHO) most of these avoidable deaths happen in the developing world, particularly Africa. Many of these deaths are preventable and with the right training and access to essential information at the right time, birth attendants working even in the most remote areas can save many of these lives; here, access to new technologies could be the key to accessing these critical resources.
Many birth attendants, or midwives, working even in the remote areas of the developing world have medical training and access to a smartphone – but what they don’t have is the niche training and skills necessary to prevent the leading causes of maternal and neonatal death like hemorrhage, infection, eclampsia/ pre-eclampsia, obstructed labor and newborn asphyxia. Add to that, many skilled midwives lack up-to-date, guideline-adherent, easy to understand, practical job aids to help them deal with obstetric and newborn emergencies. And for skilled birth attendants in areas that experience fewer deliveries, emergencies do not happen often for them to become experienced in managing the complications. This is where training tools like the Smart Delivery App (SDA) are proving to be effective.
The SDA is the brainchild of Denmark-based Maternity Foundation, the University of Southern Denmark, and Copenhagen University. Conceptualized as a basic, easily accessible tool it leverages the ubiquity of smartphones in Africa to help make childbirth safer for women by providing skilled birth attendants with direct and instant access to up-to-date, life-saving information and guidance that can be used even in the most remote areas as an on-the-job reference tool.
The app contains four basic features: animated instruction videos; action cards; an updated drug list; and practical procedure instructions. All the features are designed for low-literacy, low-income settings and work completely offline once downloaded.
Yane Ababaw, a midwife working in Gimbi in western Ethiopia, also recalls how the SDA helped her save a mother and her newborn twins. During a complicated delivery, the mother was unconscious when the second of her babies was delivered, and the newborn seemed lifeless. Ababaw quickly consulted the SDA on her smartphone, diagnosed the problems, and used emergency procedures to save both the mother’s life and that of her child. “I [was] confident that from what I have learned from the app, I can stop [a mother] bleeding,” says Yane Ababaw. “I can save her life.”
Workneh now trains midwives with the SDA in Ethiopia, the first country in Africa to receive and clinically trial the new technology. It has already proven to critically enhance a birth attendant’s ability to access knowledge and apply these new skills to complex problems like resuscitating a newborn and handle postnatal bleeding.
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,” she says. “Most midwives, if not all, have a mobile phone, so accessibility is very high… the app is easy to use because it is supported by animations and videos [and also] uses local languages.”
Trial results showed that within 12-months the SDA-trained birth attendants’ ability to handle postpartum hemorrhage (PPH) and resuscitate a newborn more than doubled. It also shown significant improvement of access to information to health workers on the periphery of the healthcare system, working in the most remote parts of the country. This was enough to dramatically boost the rollout of the SDA which is now being used in 40 countries and has more than 20,000 downloads.
Maternity Foundation CEO, Anna Frellsen says the goal is to reach 10,000 health workers with the SDA by the end of 2017, and 20,000 by the end of 2018. “We believe that the Safe Delivery App will reach its full potential not as an isolated tool, but as an integrated part of health system strengthening efforts carried out by governments, non-profits, professional organizations and other actors,” says Frellsen. “In order to reach as many skilled birth attendants as possible with the Safe Delivery App, we are working with ministries and implementing partners in more than 15 countries.”
Tanzania and Ghana are already testing the SDA in their communities, with the app being further supported by a website compiled of resources to bolster the implementation of the app by both institutions and individual healthcare workers. The new site will include a toolbox with tips and guidelines, presentations on midwifery training, examples of real user scenarios, and testimonials from current app users. The addition of this new virtual knowledge hub is just one more milestone aiming to get the app into the hands of as many healthcare workers as possible.