Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda

Global Health Research and Policy, Volume 4, No. 1, Year 2019

Interpretation

Background: In an effort to improve access to proven maternal and newborn health interventions, Rwanda implemented a mobile phone (mHealth) monitoring system called RapidSMS. RapidSMS was scaled up across Rwanda in 2013. The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda. Methods: Using data from the 2014/15 Rwanda demographic and health survey, we identified a cohort of women aged 15–49 years who had a live birth that occurred between 2010 and 2014. Using interrupted time series design, we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care (ANC), health facility delivery and vaccination coverage. Results: Overall, the coverage rate at baseline for ANC (at least one visit), health facility delivery and vaccination was very high (> 90%). The baseline rate was 50.30% for first ANC visit during the first trimester and 40.57% for at least four ANC visits. We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC (level change: -1.00% (95% CI: -2.30 to 0.29) for ANC visit at least once, -1.69% (95% CI: -9.94 to 6.55) for ANC (at least 4 visits), -3.80% (95% CI: -13.66 to 6.05) for first ANC visit during the first trimester), health facility delivery (level change: -1.79, 95% CI: -6.16 to 2.58), and vaccination coverage (level change: 0.58% (95%CI: -0.38 to 1.55) for BCG, -0.75% (95% CI: -6.18 to 4.67) for polio 0). Moreover, there was no significant trend change across the outcomes studied. Conclusion: Based on survey data, the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda. In most instances, this was because the existing level of the indicators we studied was very high (ceiling effect), leaving little room for potential improvement. RapidSMS may work in contexts where improvement remains to be made, but not for indicators that are already very high. As such, further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.

AI Digest

Study Justification:

The study aimed to evaluate the impact of a mobile phone monitoring system called RapidSMS on the utilization of maternal and newborn health services in Rwanda. This was important because improving access to these services is crucial for the well-being of mothers and infants. The study aimed to determine if RapidSMS could effectively increase the uptake of services such as antenatal care, health facility delivery, and vaccination coverage.

Highlights:

– The study used data from the 2014/15 Rwanda demographic and health survey.
– RapidSMS was implemented in Rwanda in 2013 to improve access to maternal and newborn health interventions.
– The study focused on women aged 15-49 years who had a live birth between 2010 and 2014.
– The study used an interrupted time series design to estimate the impact of RapidSMS on the uptake of health services.
– The coverage rate for antenatal care, health facility delivery, and vaccination was already very high (>90%) at baseline.
– The implementation of RapidSMS did not lead to a significant increase in the uptake of the studied health services.
– The lack of impact may be due to the high baseline coverage, leaving little room for improvement.
– Further research is needed to understand why RapidSMS had no impact on indicators where improvement was possible.

Recommendations:

Based on the study findings, the following recommendations can be made:

1. Further research should be conducted to understand the factors that contribute to the high baseline coverage of maternal and newborn health services in Rwanda.
2. Future interventions should focus on areas where there is still room for improvement in service uptake.
3. The effectiveness of RapidSMS should be evaluated in contexts where there is a need for improvement in maternal and newborn health indicators.

Key Role Players:

1. Ministry of Health: Responsible for overseeing and coordinating the implementation of health interventions.
2. Community Health Workers: Play a crucial role in delivering maternal and newborn health services at the community level.
3. Health Facility Staff: Provide essential care and support during antenatal care, delivery, and vaccination.
4. Researchers and Academics: Conduct further research to understand the factors influencing service uptake and evaluate the effectiveness of interventions.

Cost Items for Planning Recommendations:

1. Research Funding: Budget for conducting further research to understand the factors influencing service uptake and evaluate interventions.
2. Training and Capacity Building: Budget for training community health workers and health facility staff to improve the delivery of maternal and newborn health services.
3. Monitoring and Evaluation: Budget for implementing a robust monitoring and evaluation system to track the impact of interventions and identify areas for improvement.
4. Communication and Awareness: Budget for raising awareness among the community about the importance of maternal and newborn health services and the available interventions.
Please note that the cost items provided are general categories and not actual cost estimates. Actual budget planning would require a detailed analysis of specific needs and resources.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some limitations. The study used data from a national survey and employed an interrupted time series design, which is a robust method. However, the study found no evidence of an immediate increase in the uptake of maternal and newborn health services after implementing RapidSMS. The high baseline coverage rates and the lack of significant trend change suggest a ceiling effect, indicating little room for improvement. To improve the strength of the evidence, future research could consider conducting a randomized controlled trial or exploring other potential factors that may have influenced the lack of impact.

Abstract

Materials

N/A

Innovations

The study titled “Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda” evaluated the impact of a mobile phone monitoring system called RapidSMS on the utilization of maternal and newborn health services in Rwanda. The study used data from the 2014/15 Rwanda demographic and health survey and employed an interrupted time series design. The results showed that implementing RapidSMS did not lead to an immediate increase in the uptake of maternal and newborn health services such as antenatal care, health facility delivery, and vaccination coverage. The study concluded that RapidSMS may be more effective in contexts where there is room for improvement, as the indicators studied in Rwanda were already at a high level. Further research is needed to understand why RapidSMS had no impact on indicators with potential for improvement.

AI Innovations Description

The recommendation to improve access to maternal health based on the study is to further research and understand why the implementation of the RapidSMS mobile phone monitoring system did not have a significant impact on the utilization of maternal and newborn health services in Rwanda. The study found that the baseline coverage rate for antenatal care, health facility delivery, and vaccination was already very high, indicating a ceiling effect. This suggests that the RapidSMS system may be more effective in contexts where there is room for improvement in these indicators. Therefore, further research is needed to identify the factors that contributed to the lack of impact and to explore other potential innovations that can address the specific challenges faced in improving maternal health in Rwanda.

AI Innovations Methodology

In order to improve access to maternal health, one potential recommendation could be to implement a community health worker (CHW) mHealth monitoring system. This system would involve equipping CHWs with mobile phones and using a mobile application to monitor and track maternal and newborn health services.

The CHWs would be responsible for visiting pregnant women and new mothers in their communities, collecting data on their health status and service utilization, and entering this information into the mobile application. The data collected could include information on antenatal care visits, health facility deliveries, and vaccination coverage.

The methodology to simulate the impact of this recommendation on improving access to maternal health could involve the following steps:

1. Baseline data collection: Before implementing the CHW mHealth monitoring system, collect baseline data on the utilization of maternal and newborn health services in the target population. This could be done through surveys or existing data sources.

2. Intervention implementation: Introduce the CHW mHealth monitoring system, providing training to the CHWs on how to use the mobile application and collect data. Ensure that the system is properly implemented and functioning.

3. Data collection during the intervention: Monitor the utilization of maternal and newborn health services using the CHW mHealth monitoring system. Collect data on the number of antenatal care visits, health facility deliveries, and vaccination coverage recorded by the CHWs.

4. Data analysis: Analyze the data collected during the intervention period to assess the impact of the CHW mHealth monitoring system on improving access to maternal health services. This could involve comparing the utilization rates before and after the intervention, as well as comparing the intervention group (where the CHW mHealth monitoring system was implemented) to a control group (where the system was not implemented).

5. Evaluation and interpretation: Evaluate the findings of the data analysis and interpret the results. Determine whether the CHW mHealth monitoring system had a significant impact on improving access to maternal health services. Consider factors such as the level of utilization before and after the intervention, any changes in trends, and any potential limitations or challenges encountered during the implementation.

By following this methodology, researchers can simulate the impact of implementing a CHW mHealth monitoring system on improving access to maternal health services. This can provide valuable insights into the effectiveness of such an innovation and inform future efforts to improve maternal health access.

Authors & Co-Authors

Statistics:

Citations: 8

Authors: 3

Identifiers:

DOI: 10.1186/s41256-019-0098-y

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Technology and Innovations

Study Countries:

Rwanda

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female