Maternal and child mortality has always been an issue in developing countries around the world. Many pregnant women are exposed to several risks and complications because they lack easy access to healthcare facilities, skilled doctors, or even an ambulance or vehicle to transport them when in labour. This is why each year, reducing infant and maternal mortality is a major part of the millennium Development Goals (MDGs) in many countries.
In order to achieve this MDG, countries have either adopted lifesaving inventions like the Life Wrap, or create ingenious methods like what Rwanda has done with the use of Community Health Workers (CHW) and a simple mobile phone and data collection system called RapidSMS.
In Rwanda, there are about 45,000 CHWs who are helping transform healthcare in the country, with 15,000 workers who are dedicated to improving maternity support. So far, it has been recorded that these volunteers have contributed significantly to the country’s progress in reducing the deaths of mothers and young children. In the space of 15 years, the east African country achieved “the highest average annual reduction in both the under-five mortality rate and the maternal mortality ratio in the world.”
In the first quarter of 2015, Rwanda’s maternal mortality ratio had reduced by close to 80 percent between 2000 and 2013 and stood at 320 deaths per 100,000 births. Under-five child mortality decreased by more than 70 percent as well. According to the United Nations, child mortality in Rwanda has reduced from 50 per 1000 live births in 2010 to 42 per 1,000 births in 2015, saving about 590,000 children. While the figure for maternal deaths is 210 per 10,000.
However this remarkable success is not due to the efforts of CHWs alone, the work of these volunteer health workers are made easier by the UNICEF-supported RapidSMS system which helps to “track pregnancies, report on danger signs during pregnancy, and subscribe to emergency alerts to ensure that women can access emergency obstetric care if complications occur.”
Mode of operation
In an article by the guardian, the author explains how the RapidSMS system works; every health worker own a list containing all the women of childbearing age (15 to 49) in their village. She then recommends that those showing pregnancy signs visit the health centre. Once a pregnancy is confirmed, the CHW sends a text containing the details of the pregnant woman including weight, previous pregnancies and check-up dates to a central database where an individual record is created for all healthcare professionals to share. And when check-ups are due, a message is sent to the health worker who then informs the mother to attend.
Through the use of acronyms, like RED for high risk, and EAR for red alert, CHWs act as eyes and ears for doctors by informing them of complications or health issues that may occur during pregnancy via RapidSMS. Health workers also receive reminders for when expectant women are due, weeks before due date via RapidSMS, once such an alert is received, it is their job to visit and encourage patients to contact them the moment contractions start.
RapidSMS was launched by the Rwandan health ministry in 2009, and since then, the text messaging system has gone through several upgrades to help support expectant mothers. Before then, women in remote communities had their babies at home without proper medical attention and support, thereby causing these women to suffer haemorrhages which often resulted in death. But with RapidSMS and standby CHWs, more women deliver at health clinics. According to Rwanda’s health minister, Dr. Agnes Binagwaho, even though there are still unfortunate instances of death, the text messaging system has helped to make things easier for pregnant women.
However, despite the number of success stories associated with the text messaging system, there still existing challenges like women refusing to participate, the lack of electricity to charge mobile phones in certain parts of Rwanda and the absence of vehicles for transportation to health clinics, which could be many kilometres away. To combat some of these challenges, measures such as increased sensitization and the use of solar panels are being employed.
According to an NGO director, Aaron Oxley, initiatives like RapidSMS are “the result of strong political leadership on health and a system that is most responsive to the priorities of the people…”