Malawi: Combating maternal deaths with innovations

Malawi is combating maternal deaths with innovations

BALAKA, Malawi – Sitting on the veranda of her grass-thatched mud hut in Mpulula Village in Malawi’s district of Balaka is a 26-year-old single mother, Melise. Despite the apparent signs that she is living in poverty, Melise is a happy woman.

“My mobile phone is the source of my happiness,” she said.

Surprisingly, the phone she is excited about is not a high-tech gadget but a basic handset.

“I am excited to own this phone because it serves as a clinic,” she said explaining that her phone is hooked to a mobile health innovation called Chipatala cha pa Foni (CCPF) or Health Centre by Phone.

The service, which she registered for when she was diagnosed HIV positive during her pregnancy, gives her access to timely maternal, neonatal and child health information, advice and care.

“Fearing that I would face discrimination, I never disclosed my HIV status to anyone and instead I opted for ‘tips and reminders’ service from Health Centre by Phone,” Melise explained.

She has since then been receiving important maternal and child health information via SMS and she sometimes calls the hotline to ask questions. Through her constant communication with the service, Melise delivered an HIV-negative baby two years ago.

“A great miracle happened to me. I delivered an HIV negative baby although I am HIV positive,” she said praising the innovation which provided her with advice on prevention of mother to child transmission of HIV.

She added: “I am a living example that it is possible to be HIV positive and deliver an HIV-free baby, so long as one follows guidance from the doctors.”

The innovation

Health Centre by Phone, is an mHealth innovation in Malawi designed to increase access to timely and appropriate maternal, neonatal and child health information, advice and care.

Running on a technology platform specifically designed to meet the challenge of low resource communities, the innovation is working wonders in Malawi, one of the countries with high rates of maternal, child and infant mortality. According to World Health Organisation (WHO), Malawi’s maternal mortality rate is pegged at 510 per 100, 000 live births while the Under-5 mortality rate is 68 per 1000 live births.

The advantage with the innovation is that it provides women and caregivers with greater control and opportunity to interact with the health system without having to travel long distances to a health facility.

“The programme also increases appropriate home and facility-based care for pregnant women and children,” says CCPF Programme Coordinator Zachariah Jezman.

According to Jezman, CCPF has two main components namely a toll-free hotline that provides families with information and advice on reproductive, maternal and child health issues. The service also refers callers displaying ‘danger signs’ for further care at a village clinic or nearby hospital.

The second component is the ‘tips and reminders’ mobile messaging service that provides regular text or voice messages on reproductive, maternal, and newborn health topics.

Courtesy of the project, minor problems are solved through a phone call resulting in queues at clinics in districts where the project is implemented becoming shorter.

“Through this service, we are able to fulfill our mission of saving lives and improving health by increasing access to quality healthcare for the most undeserved communities,” explained Jezman.

The innovation, according to Jezman, has contributed to significant improvements in maternal and child health indicators, through increased use of antenatal care within the first trimester of pregnancy and increased use of a bed net during pregnancy and for under-five children.

CCPF has grown substantially from a single district in 2011 to 25 percent nationwide geographic coverage serving a population of over 515,000 women in seven districts. A partnership with Airtel, one of Africa’s largest mobile carrier, has significantly expanded the reach and scope of the service, including zero-rating all calls to the CCPF hotline and helping to expand content beyond maternal and child health. With growing interest from the government, private sector and other implementing partners, CCPF plans to roll-out nationwide.

Other innovations

Besides the mobile health innovation, Malawi has employed several strategies to reduce maternal mortality.

According to Health Minister Dr Peter Kumpalume, one of the strategies is through the improvement of access to care of obstetric emergencies.

“Improving coverage and quality of skilled attendance at birth is also being emphasised,” he said.

He said at the moment all expectant women are advised to deliver in health centres instead of relying on traditional birth attendants.

Realising that one major threat to maternal and infant health is the rapidly evolving Aids epidemic, Malawi is addressing HIV and maternal mortality challenges concurrently.

One of the strategies used is the implementation of Option B+ programme, which offers anti-retroviral therapy (ARVs) to all pregnant women with HIV, regardless of CD4 cell count.

Malawi National Aids Commission says within four years, the country’s treatment cascade for pregnant women has been transformed so that the proportion of women with HIV who are diagnosed has risen from 49 to 80 percent.

The Commission’s executive director Davie Kalomba said Malawi has managed to initiate and retain alive on treatment over 600,000 clients as at December 2015.” An estimated one million Malawians are living with HIV, according to WHO.

Drones in Malawi

With support from United Nations Children’s Fund (Unicef), Malawi has also been testing drones as means of exploring cost effective way of reducing waiting times for HIV testing results for infants.

The innovation is at a testing stage but if successful, it will compliment other mechanisms such as road transport and use of SMS to communicate results from the laboratories in the cities to the health facilities in rural areas.

Unicef Representative in Malawi Mahimbo Mdoe believes the drones could be the breakthrough in overcoming transport challenges of HIV test results for infants.

“We hope that the drones can be part of the solution to reduce transportation time and ensure that children who need it, start their treatment early,” said Mdoe during the test launch.

Touting government’s commitment in the fight against Aids, Kumpalume says, “the implementation of Option B+ programme, the delivery of results from the central laboratory to the health facilities through text messages and the testing of drones are all important innovations.”

Ray of hope

While WHO says the risk of a woman in a developing country dying from a maternal-related cause during her lifetime is about 33 times higher compared to a woman living in a developed country, new technologies are offering a ray of hope. With new initiatives such as Health Centre by Phone, use of drones to deliver HIV results for infants, promotion of family planning and expectant women deliveries at hospitals, maternal health are being drastically reduced.

Unicef states that between 1990 and 2015, maternal mortality declined from 1,100 to 510 maternal deaths per 100,000 live births in Malawi.

With several innovations at work, women like Melise are realising that access to antenatal care, skilled care during childbirth, and support after childbirth even if it means getting the support through SMS is what is needed is to reduce maternal deaths.

Melise is not her real name.