Main Highlights
- Significant Impact on Maternal Health: The Text4Life mobile app has successfully enhanced maternal health outcomes in rural Nigeria by addressing transportation challenges that prevent pregnant women from accessing emergency care.
- High Success Rate: 91% of women who reported complications using the Text4Life system were successfully transported to health facilities. Notably, there were no maternal deaths among participants during the study period.
- Community Engagement: The program’s success was largely a result of active community involvement, which included collaborations with nearby taxi drivers and healthcare providers.
- Scalable and Replicable: The Text4Life initiative demonstrates the potential for mobile technology to be scaled up and integrated into national health strategies, offering a replicable model for other low-resource settings.
Background
This policy brief summarizes key insights from an article and presentation by Professor Friday Okonofua at a DIMA Health Webinar, addressing the persistent challenge of maternal mortality in Nigeria, particularly in rural areas with limited access to healthcare. In 2017, Nigeria accounted for 23% of global maternal deaths, with rural women being at the greatest risk due to inadequate healthcare infrastructure and socio-cultural barriers. Although the government has made efforts to improve maternal health services, transportation remains a significant obstacle, preventing many women from reaching healthcare facilities in time.
To address this critical issue, the Text4Life mobile app was developed. This innovative solution connects pregnant women in rural Nigeria with emergency transportation and healthcare providers, aiming to reduce maternal mortality by ensuring timely access to medical care in these underserved regions.
Intervention Overview
Text4Life is a mobile application that enables pregnant women to request emergency transportation when they experience complications during pregnancy. The system alerts community leaders and healthcare providers, who then coordinate transportation with pre-registered local taxi drivers. This approach ensures that women in rural areas can quickly and safely reach primary healthcare centres or be referred to higher-level facilities if necessary.
Key Findings
During an 18-month study conducted in 20 rural communities in Edo State, the Text4Life system registered 1,620 pregnant women. Of these, 56 women (3.5%) used the app to report complications. The program achieved a 91% success rate in transporting these women to healthcare facilities, with 46 women treated at primary health centres and 5 referred to higher-level facilities. Remarkably, no maternal deaths occurred among the participants during the study, highlighting the app’s effectiveness in preventing maternal mortality.
Policy Implications
The success of Text4Life illustrates the potential of mobile technology to address critical barriers to healthcare access in rural areas. The program’s integration with community structures and its high success rate in ensuring timely medical intervention offer a compelling case for scaling up the initiative across Nigeria. Furthermore, the Text4Life model could serve as a template for similar interventions in other low-resource settings globally.
Recommendations
- Nationwide Expansion: Expand the Text4Life program to cover more rural areas across Nigeria, aiming for nationwide implementation to maximize its impact on maternal health.
- Integration into National Health Strategy: Embed the Text4Life system into Nigeria’s national maternal health strategy and primary healthcare framework to ensure long-term sustainability.
- Enhance Community Training: Invest in capacity building for community health workers and volunteers to manage and sustain the Text4Life intervention effectively.
- Strengthen Public-Private Partnerships: Collaborate with local transportation providers and telecommunications companies to ensure reliable network coverage and transportation services in rural areas.
- Support Larger-scale Studies: Conduct larger-scale evaluations to assess the long-term impact, scalability, and cost-effectiveness of the Text4Life system, providing data to inform future policy decisions.
- Develop Sustainable Funding Models: Establish funding models that involve government, NGOs, and private sector stakeholders to secure the financial sustainability of the Text4Life program.
Conclusion
The Text4Life mobile app represents a transformative approach to improving maternal health outcomes in rural Nigeria by addressing the critical issue of transportation. The program’s success in preventing maternal deaths and its potential for scaling up nationwide underscore the need for broader adoption of mobile health solutions within national healthcare strategies. By expanding and integrating such innovations, Nigeria can make significant progress in reducing maternal mortality, particularly in its most vulnerable rural populations.
Main Reference
Okonofua, F., Ntoimo, L., Johnson, E., Sombie, I., Ojuolape, S., Igboin, B., Imongan, W., Ekwo, C., Udenigwe, O., Yaya, S. and Wallis, A.B. (2023). Texting for life: a mobile phone application to connect pregnant women with emergency transport and obstetric care in rural Nigeria. BMC Pregnancy and Childbirth, 23(1), 139. https://doi.org/10.1186/s12884-023-05424-9
Other References:
National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Abuja and Rockville: NPC and ICF; 2019.
Ntoimo, L. F. C., Okonofua, F. E., Igboin, B., Ekwo, C., Imongan, W., & Yaya, S. (2019). Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria. BMC Pregnancy and Childbirth, 19, 1-13.
World Health Organization. (2019). Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary (No. WHO/RHR/19.23). World Health Organization.