UHC Blog Series
Digital Solutions for Maternal Health in the Era of COVID-19
By Brielle Dojer
October 15, 2020
Eight months have passed since Africa’s first confirmed coronavirus case, and the continent has now seen over 1.5 million cases of COVID-19, with over 37,000 deaths. In addition to the illness and death caused by infection with SARS-CoV-2, overburdened health systems, lockdowns, and fear of infection have disrupted critically needed non-COVID health services, including maternal health care. During the 2014-2016 Ebola outbreak in West Africa, the region saw a decline in access to care for pregnant women, and a subsequent increase in maternal mortality. The coronavirus pandemic has already impacted maternal health in a similar way, and this will only worsen if steps aren't taken now to provide this necessary care. Recent modeling from Johns Hopkins predicts that, over a period of six months, the coronavirus pandemic could result in 12,200 - 56,700 additional maternal deaths in 118 low and middle income countries. A response that ensures mothers continue to receive the care they need during this time is necessary, and digital solutions are a critical component of this response.
Given the challenges and constraints of the pandemic, digital solutions have emerged as a way to meet the unique healthcare needs of this era. Many of these solutions are part of the COVID response, providing trustworthy sources of information regarding COVID-19 symptoms, prevention, and response for frontline and community health workers. However, utilization of digital tools has also helped maintain existing services, like primary and maternal health care, which have faced disruption during the pandemic. Especially during the early days of the pandemic, supply chains were disrupted and health systems were overburdened. Additionally, lockdowns made traveling to seek care difficult, some clinics closed, and widespread misinformation and lack of communication led to fear and confusion around seeking care. Digital tools have helped to address some of these difficulties.
Source: Moses Adejo/Jhpiego
The Jhpeigo-led RICOM3 Program
In Nigeria’s Lagos State and Federal Capital Territory, The RICOM3 (Reducing the Indirect Causes of Maternal Morbidity and Mortality) Program, implemented by a consortium and funded by MSD for Mothers, has been utilizing digital tools since before the pandemic - providing a digital platform for mothers to track important health information like blood pressure and blood sugar level, communicating with mothers and health facilities via SMS and WhatsApp, providing mothers with a nurse or “coach” to communicate with via SMS and WhatsApp, and creating WhatsApp groups for mothers in the same trimester of their pregnancies, or with the same health concerns, for example. According to Chibugo Okoli, deputy country director for Jhpiego Nigeria, when COVID hit and lockdowns began, their patients faced “a lot of confusion about which services were open [and] which were not” as well as questions about where to go for antenatal care, who to call, how they would travel to the hospital in the case of an emergency, and anxiety about contracting COVID-19 should they seek care.
While the full extent of how care was impacted during the initial COVID surge has yet to be revealed, RICOM3 sites saw dramatic decreases in women registering for antenatal care (ANC) (-45%), frequency of ANC visits (-50%), and returns for postnatal care (-40%). Deliveries, however, remained stable. Their existing digital tools allowed the RICOM3 consortium, and the health facilities they are working with, to navigate these challenges and minimize service disruption. RICOM3 was able to continue communicating with women registered on their platform, acting as a go-between for information between partner health facilities and mothers. They also encouraged partner health facilities to call women not registered on the digital platform, and to set up helplines for women to call and ask questions. Additionally, virtual ANC clinics and ECHO sessions allowed RICOM3 to relay critical information to women regarding COVID, misinformation, and pregnancy, as well as concerns about COVID while breastfeeding or dealing with hypertension and diabetes. For women without access to android phones (16% of those registered on their platform), they communicated via SMS messaging.
In Zanzibar, D-tree International and The Revolutionary Government of Zanzibar have also successfully used digital tools to improve Zanzibar’s health system through Jamii ni Afya, Zanzibar’s national digital community health program that was launched prior to the coronavirus pandemic. These digital tools also assisted community health workers in maintaining existing health, nutrition, and early child development services during the initial surge of COVID-19. Now, the digital health experts at D-tree are reiterating the critical need for digital health solutions that the COVID-19 pandemic has exposed, and sharing lessons on how to develop digital systems that can effectively respond in pandemic situations.
Digital solutions for maternal health have the potential to be useful and effective during this time because they address many of the factors impacting access to care. These solutions circumvent the fear of contracting coronavirus while seeking care in hospitals and clinics, as well as the actual danger of doing so, and communication and facility accessibility issues due to lockdowns. Digital solutions allow women to receive critically needed care and information while remaining safe at home. It is necessary for regions without such solutions to develop them, in order to meet the needs of mothers during this uniquely difficult time. While health systems around the world fight the pandemic, we must also remain focused on mothers, and cannot allow the pandemic to undo recent gains made in maternal health - digital tools are revealing themselves as our best weapon in this fight.
Thank you to Chibugo Okoli, Deputy Country Director for Jhpiego Nigeria, and Rachel Hofmann, Regional Program Director at D-Tree International, for informing this piece.