Sectors

mLabor (Intrapartum Care)

The CommCare Mobile Partograph app aims to reduce the partograph’s barriers.

CommCare for Intrapartum Care

The primary causes of maternal mortality are prolonged labor and obstructed labor. In order to reduce labor complications, the WHO universally recommends use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. The partograph’s complicated multi-axis graph makes it especially difficult for health workers, such as intrapartum care providers, with limited training to use it, resulting in limited adoption and proficiency among healthcare providers.

Through an iterative process of user-focused design, the CommCare Mobile Partograph app aims to reduce the partograph’s barriers by focusing on improving interpretability, applicability, time, and minimizing complexity. The Mobile Partograph acts as a job aid by prompting intrapartum care providers to report the necessary information at the appropriate time while calculating and producing timely reports on labor status.

Health Clinics and Supervisors

Problem: Health clinics receive partographs that are filled out post-labor; data takes too long to reach decision makers; up to date statistics are not always available.

  • Real-time data reporting enables supervisors to detect data irregularities and observe whether recommended actions were taken, including identifying providers whose clinical practices in labor monitoring and management need improvement.
  • Algorithms are capable of detecting post-labor use, for increased accountability.
  • Live partograph reports enable district health centers and Ministries of Health to view and monitor complete labor records, including the full computer-plotted partograph.
  • Monthly and quarterly reports allow health administrators to assess labor monitoring, timely provision of care for abnormal labors, and maternal and fetal health outcomes.
  • Key alerts on emergency action can be sent to supervisors, and/or referral facilities, who can provide immediate back-up support on appropriate next steps.

Intrapartum Care Providers

Problem: Many intrapartum care providers find the paper partograph challenging to fill in and see it as a burden rather than a job aid, filling it out retrospectively.

  • Easy input of labor monitoring data (e.g., cervical dilation, fetal heart rate, status of membranes, amniotic fluid, etc.) in alphanumeric form improves usability as compared to paper-based form.
  • Data is displayed in graphical or non-graphical format for use by a wide range of health workers
  • Minimal training is needed due to embedded training videos and quizzes.
  • An integrated library of obstetric clinical protocols, such as WHO and national guidelines, prompts information entry at appropriate times.
  • Automatic alerts from data collected during labor and delivery facilitates workflow, and warnings when data entered falls beyond set parameters support intrapartum care providers to maintain data accuracy.
  • Up to date information about available referral facilities informs decision-making to transfer a patient.

Highlighted Projects

Mobile Partograph

India

Key alerts on urgent emergency action are sent to supervisors, staff, and/or referral facilities, who can provide back-up advice on appropriate next steps by making immediate phone calls to providers. Monthly and quarterly reports are generated for health administrators to assess labor monitoring, timely provision of care for abnormal labors, and maternal and fetal health outcomes.

Human Development Innovation Fund

Tanzania

In 2016 Dimagi was awarded an innovation grant from the Human Development Innovation Fund (HDIF) in Tanzania. Building on the success of mLabour in India, Dimagi will leverage the HDIF grant to adapt mLabour to the Tanzanian context and build upon its impact through two tracks: Adaption & Validation and Diffusion. Adaptation & Validation: Dimagi, in partnership with FHI 360 and other local research partners, will conduct focused user-centered design activities and engage a wide range of stakeholders to understand the requirements for scaling mLabour throughout Tanzania. During the first year of the project, Dimagi will conduct an initial 3-month study to validate the safety, usability, and suitability of mLabour. In the second year, additional studies will be conducted to assess how quality of care is impacted through the use of mLabour. Diffusion: Through the Diffusion Track, Dimagi aims to deploy mLabour to five organizations in Tanzania, spanning both the private and public sector. Diffusion activities will include capacity building of two Tanzanian technical organizations to support mLabour, engagement with a range of private and public providers, and engagement with the Ministry of Health and Social Welfare.

Additional Resources