Rwenzori Center for Research and Advocacy (RCRA) is a charity organization operating in southern and western Uganda with a mission to accelerate access to information and achieve social change through the use of ICTs – effectively empowering communities (specifically, women and children) through economic development, improved health, clean water and sanitation, and climate resilience.
Each day, almost 800 women around the world die of childbirth or pregnancy-related complications. In Uganda, maternal mortality remains high, at 480 deaths for every 100,000 live births. This is in part due to inadequate access to health care information, lack of a functioning referral system, inadequate capacity of skilled personnel, and poor interpersonal communication in antenatal care. Yet there are tools like mobile phones, community radio FMs, projectors, social media, television, Internet, and desktop computers that have the potential to make a difference. RCRA believes that converging all of these information communication technologies (ICTs) will significantly reduce preventable maternal deaths.
According to the Uganda Communications Commission (UCC), Uganda has nearly 17 million mobile phone subscribers. PricewaterhouseCoopers (PWC) predicts that this number could rise to 25 million this year (approximately 70% of Uganda’s population). With penetration rates still below 40%, PWC contends that there is huge potential for growth.i
In the Rwenzori region where RCRA is based, 95% of Ugandans have mobile phones and 5% can access a phone at neighboring households. Those living in more remote areas without hydroelectricity have solar energy panels to charge their mobile phones, and nearly 99% of households have radios and can listen to broadcasted reproductive radio programs. These statistics reveal great opportunity to converge and leverage ICT.
RCRA kick-started the ‘’Converging ICTs for saving mothers giving life’’ project in November 2014. The initiative’s primary objective is to increase access to ICTs to promote primary healthcare information, improve maternal health and reduce child mortality.
RCRA has attempted to do so by establishing better record keeping processes and facilitating greater communication between health care facilities —from the grass roots level to dispensaries, health clinics and district hospitals.
Outreach at the grass roots level is carried out by village health workers (VHWs), who have basic knowledge on reproductive and maternal health and are equipped with Java-enabled mobile phones. VHWs use the phones to record patient data and follow up with women and children in their communities. They also use the phones to receive information to convey to the community.
An “eLearning” web/mobile system is used to deliver first line support health services (such as basic information and education) through mobile phones, as distance and accessibility were reported as considerable hurdles to accessing health care.
Dispensary level health workers use Java-enabled basic mobile phones to register new patients, confirm visits, and send requests to join the eLearning web platform.
Health center health workers use mobile phones and computers to record new clients, confirm visits, follow-up, and send requests to join the eLearning platform, while district hospital health workers use the web platform through computers as well as GPS capabilities to confirm visits, record additional information, and document further actions taken. They also use this platform to send enrollment requests for eLearning and locate pregnant women and newborns.
Impact to date
The four-month pilot project has improved communication between health facilities and additional avenues to gather information and brought more women and children under the age of five in contact with trained health care professionals.
From November to February, RCRA trained 18 district health workers and community members to improve the availability of health related education among health workers and between health workers and clients.
VWHs were trained on how to use the mobile phones and how to make referrals. They were also educated on basic medical skills, such as how to identify and select number of symptoms and signs of danger during pregnancy. These workers paid 381 visits to pregnant women and increased local clinic attendance by 18%. During the same period, 10 VHWs paid 255 visits to mothers with children under the age of five and increased their clinic attendance by 23%.
While the need for information and education on health issues proved to be substantial, the technical skill and penetration of ICT at the start of the pilot was not sufficient for this material to be delivered via the eLearning web platform.
During the initial visits to the field, it became apparent that VHWs needed guidance on how to approach mothers and children as well as training on reproductive, maternal and child health (especially on how to identify a select number of symptoms and signs to be able to refer the woman to a health facility). This training was done in collaboration with certified health workers from the district hospitals who followed up with VHWs during the course of the project test.
RCRA found that the project’s success relied on the willingness of the beneficiaries to welcome the support of and collaboration with the village health structures. It was also determined that the platform messages alone were not enough. There is need to introduce a direct toll free line to facilitate easy remote communication between the pregnant women and the health workers, as when an SMS sent, there was not sufficient confirmation that the client was reached. When in place, the toll free line will better facilitate referrals, emergency response and remote interaction between patients and health workers.
The success of the pilot suggests that the convergence of communication technologies for behavior change will continue to improve patient attendance at healthcare facilities.
The trainings provided to VHWs have not only increased attendance at health facilities but also underscored the importance of information flow around health care in the communities.
RCRA has developed a full proposal for funding to roll out the project in Kabarole, Kyenjojo, Kyegegwa and Kamwenge, and is currently seeking support from multinational and national maternal, newborn and child health and ICT4D donors as well as the Government of Uganda(GoU)- Ministry of Health(MoH) to minimize the cost of operation and achieve greater impact.
For more information, visit rcra-uganda.org.