Industry: Intrapartum Care
Purpose: In 2016, The Human Development Innovation Fund (HDIF) awarded Dimagi a grant to address gaps in quality of facility-based care in Tanzania using the mobile-based application, mLabour. Over the past few months Dimagi has worked with several local partners to adopt this mobile solution to the Tanzanian context and this September the team, along with our research partner, FHI 360, launched an evaluation of the use of mLabour in three facilities.
mLabour Innovation Blog Series: As part of this project, the Dimagi mLabour team started a blog series to track the progress of the app in Tanzania and beyond. Part One will cover the beginning stages, including insights from local nurses and patients. Over the next 12 months check back in for Parts Two, Three, and Four as we discover more about the app’s effects on Intrapartum Care in Tanzania and India.
mlabour Innovation Blog Series
Part 1: Adopting mlabour to the Tanzanian Context
Screenshots of the mLabour tool.
Intrapartum Care in Tanzania
The global health community has made significant strides in reducing maternal and neonatal mortality, with maternal mortality rates falling by 34 percent between 1990 and 2008 (WHO, 2010). Despite these reductions, mortality rates remain inexcusably high in low-income countries, where 99 percent of these deaths occur. Poor quality of facility-based care is one of the highest contributing factors, especially in countries like Tanzania, where the maternal mortality rate has stagnated at 410 deaths per 100,00 births (WHO, 2014). Poor quality of care has also impacted neonatal mortality. One-third of stillbirths happen during delivery in Tanzania, 40 percent of which are associated with insufficient tracking of vital indicators such as fetal heart monitoring.
mLabour: From India to Tanzania
The mobile-based application, mLabour, was initially developed by Dimagi in India to build on the paper partograph. Despite evidence that, when used correctly, the paper-based partograph can reduce maternal mortality and morbidity, the complexity of the tool, as well as the time it takes to complete, remain barriers to uptake.
In Tanzania, the paper partograph is often approached as a means of retroactive data collection rather than as a tool that can aid in decision-making and the identification of obstructed labour, as well as other emergencies that can occur in the intrapartum period, such as fetal distress. mLabour seeks to address the challenges of the paper-based partograph by automating the multiple graphing components of the partograph, as well as providing real-time decision support from the time a woman is registered at the facility to the time she and her newborn are discharged.
Adopting mLabour in Tanzania
Over the last several months, the Dimagi team has worked alongside midwives and obstetricians through the Private Nurses and Midwives Association Tanzania (PRINMAT) and the Association of Private Health Facilities in Tanzania (APHFTA) to appropriately adapt the mLabour prototype developed in India to better align with Tanzanian protocols. This included additions such as integrating printing capabilities and new postpartum counseling content covering Kangaroo Mother Care, family planning, early and exclusive breastfeeding, and HIV.
With the completion of the adapted tool, and in close collaboration with FHI 360 and CSK Research Solutions, on September 1st, 2017 Dimagi launched an evaluation of mLabour at three facilities: Kairuki Hospital in Dar es Salaam, FACGBF Maternity Home in Bagamoyo, and Waebrania Maternity Home in Gongo La Mboto. 26 nurses and midwives were trained on how to use the tablet and integrate it into their existing work. Over the course of nine months, FHI 360 will evaluate mLabour’s impact on adherence to clinical protocols and patient satisfaction, as well as the overall usability of the tool.
The First Six Weeks of mLabour in Tanzania
In the first six weeks of this study, 75 births have been registered on mLabour and use has sustained excitingly high levels. Valentina Msechu, the Manager of Nursing Services at Kairuki Hospital, shared her excitement about being among the first to pilot mLabour in Tanzania. “mLabour has made it so easy to identify when there may be an emergency,” she shared with me on my last trip to Dar es Salaam.
There were so many challenges with the manual partograph, but mLabour is easier to use, less disruptive to our work, and the midwives are more comfortable.” – Valentina Msechu, Manager of Nursing Services at Kairuki Hospital
Several nurses at Kairuki Hospital sited that mLabour makes it easier for them to determine which patients to prioritize based on stages of labour and danger signs, and highlighted the exam reminders built into mLabour were among their favorite features. “It took some time, to get used to,” a young nurse, Elizabeth, added, “but now that we have been using the tool, it is simple.”
Anecdotally, patients at both Kairuki Hospital and FACGBF Maternity Home have expressed that they too have directly felt the benefits of mLabour. Asnat Mchopa, the director of FACGBF Maternity home, shared that one patient commented that she “felt happy and more attended to.” Beatrice and Elizabeth, midwives at Kairuki Hospital, added that mLabour “facilitates improved communication between nurses and patients.”
What Does the Future of mLabour Look Like?
We are just six weeks into this nine-month study, which will ultimately inform the overall adoption and scale of mLabour within Tanzania, as well as a more global strategy for the product. Beyond the questions around adherence to clinical protocols, patient satisfaction, and usability addressed in the formal evaluation, the Dimagi team will be exploring the factors that contribute to a successful mLabour implementation and the environments in which mLabour may have the greatest impact on patient care and health outcomes.
Stay tuned for further updates regarding Dimagi’s work on mLabour.
If you are interested in learning more about mLabour, please contact mLabour@dimagi.com.