Technology in MCH

Extant literature indicates that women with more knowledge have greater likelihood of having better pregnancy and delivery outcomes, says Dr Nayan Kalnad

Technology, MCH, Nayan Kalnad, WHO, World Health Organisation, 2019, Niti Aayog, Knowledge barriers, Behavioral barriers, Access barriers, Cost barriers, Quality of Care

According to the WHO (World Health Organisation, 2019), approximately 830 women die every single day from preventable causes related to pregnancy and childbirth worldwide. And 99% of all maternal deaths occur in developing countries, with India ranking number two on this list. Most of these maternal deaths are preventable. The major complications that account for nearly 75% of all maternal deaths are: severe bleeding (mostly after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications from delivery, or unsafe abortions. In order to prevent these complications, one of the key requirements is that women have access to healthcare and receive comprehensive, evidence-based care. However, this basic requirement is often not met.
Contradictory to what many might think, this healthcare gap is not limited to rural sectors. NITI Aayog’s district level data for Mumbai and its suburbs highlighted that one in two women do not even have folic acid tablets in the first 100 days, a vital determinant of health outcomes for the newborn. In a country where a preventable condition like anaemia is one of the top five leading causes of maternal mortality, an alarming one in two women are anaemic, according to World Health Organisation, 2019.

It is therefore crucial to interrupt the cycle of vulnerability by closing the gaps in antenatal as well as postnatal care. Today, there are four key barriers that subtend the poor utilisation of necessary maternal healthcare services, according to the World Health Organisation, 2010:
1.     Knowledge barriers: Lack of trustworthy knowledge resources on what antenatal care is recommended, and access to information on making the right care choices throughout
2.     Behavioral barriers: Lack of motivation towards healthy behavior.
3.     Access barriers: Lack of access to adequate quality services and a support network.
4.     Cost barriers: Lack of awareness about pregnancy costs, transparency in pricing and /or non-affordability of care.
This is where technology can make a difference. By implementing digital tools in different ways, technology can support closing the gap between mothers-to-be and healthcare providers.

Real-time mother-driven care
In order to achieve positive maternal health outcomes, it is critical to assess and monitor the quality of care being provided. And this is where I would like to give a practical example from our work. In India, most hospitals are not certified, have no formal quality assessment processes and there are no maternal health specific real-time quality metrics that can be used to monitor performance of hospitals. To be able to assess quality in real-time and build a partnership relationship with providers, we established a feedback-based quality mechanism that supports both, the mothers to be and the hospitals.

This is how it works: New mothers rate their delivery experience at the hospital on nine Quality of Care (QoC) indicators: The ratings on these QoC indicators based on WHO guidelines are shared back with the hospital via a digital platform. The review platform allows for pregnant women to search and compare hospitals in their locality based on quality indicators. The aggregated score on the 9 QoC indicators is visible, and an overall 5-point star rating is generated, which is also visible on Google Search. Hospitals and OB/GYNs have access to a dashboard, where they can compare their QoC scores with a local average or over time, as well as see open feedback.
This QoC metric has led to significant improvement in care quality at these hospitals. This review mechanism gives mothers accessing these hospitals a much-needed reliable, real-time, scalable quality monitoring mechanism. It is a very simple, yet very effective tool that has a positive impact for both maternity care providers and mothers.

Access to knowledge & support groups through an app
Extant literature indicates that women with more knowledge have greater likelihood of having better pregnancy and delivery outcomes.  Our mobile app for mothers provides localised and gamified maternal health education in the form of visual flashcards and interactive quizzes. The content was developed in collaboration with doctors and specialists. The app also supports awareness and knowledge through offering access to both the mother’s care group (ObGyn etc.) as well as to a peer to peer mother community through digital chat interfaces in which the mother can type or audio record her messages and seek answers to her questions.

The functions on the mother’s side are not only aiming at educating and informing her but also giving her very functional alerts during her pregnancy. On the mother’s end, the app enables her to:
●      Track upcoming check-ups/test/scans
●      Get reminders for upcoming checkups and tests
●      Access localized knowledge on maternal health
●      Chat through text, audio or video to their doctor or care coordinator
●      Interact with a community of mothers-to be and Together for Her care coordinator
●      Submit feedback on their delivery experience
But it is not only the women who benefit from the app. Technology can also help healthcare providers with relevant alerts and tips and connect them to their patients on a virtual basis. On the providers end, the platform enables them to:
●      View and add mothers that are a part of their care group
●      Confirm completion of health touchpoints offered in bundle and track adherence
●      Communicate with the mothers through the chat interface
Implementing digital tools to connect pregnant women to healthcare providers will ensure that mothers get the healthcare they need when they need it.
Dr Nayan Kalnad is founder and CEO of digital healthcare company-Avegen.