The effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries:Protocol for a systematic review and meta-analysis

Rates of maternal, newborn and child (MNCH) mortality and morbidity are vastly greater in low– than in high–income countries and represent a major source of global health inequity. A host of systemic, economic, geopolitical and sociocultural factors have been implicated. Mobile information and communication technologies hold potential to ameliorate several of these challenges by supporting coordinated and evidence–based care, facilitating community based health services and enabling citizens to access health information and support. mHealth has attracted considerable attention as a means of supporting maternal, newborn and child health in developing countries and research to assess the impacts of mHealth interventions is increasing. While a number of expert reviews have attempted to summarise this literature, there remains a need for a fully systematic review employing gold standard methods of evidence capture, critical appraisal and meta–analysis, in order to comprehensively map, quality assess and synthesise this body of knowledge

Private Enterprise for Public Health: Opportunities for Business to Improve Women's and Children's Health

This guide, developed by FSG and published by the Innovation Working Group in support of the global Every Woman, Every Child effort, explores how companies can create shared value in women's and children's health. The document sets out opportunities for multiple different industries to develop new product and services, improve delivery systems and strengthen health systems that can support global efforts to save 16 million women's and children's lives between now and 2015. It particularly notes that companies need not wait for health services to "catch up" with their economic model, but rather they can work proactively to help accelerate change, by partnering with other industries, civil society and the public sector to create collective impact in a specific location. The aim of the guide is to catalyze these transformative partnerships

Strengthening Primary Health Care Through Community Health Workers: Investment Case And Financing Recommendations

A report released this week at the Third International Conference on Financing for Development found that there is a strong case for investing in Community Health Worker (CHW) programs as part of integrated health systems. The report was released by leaders from the Federal Democratic Republic of Ethiopia, the Republic of Liberia, the U.N. Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, Partners in Health, the Clinton Foundation, the African Leaders Malaria Alliance, and the MDG Health Alliance. The authors encourage domestic governments, international financers, bilateral and multilateral donors, and the broader global health community to finance and support the scale up of CHW programs as part of community-based primary health care through a set of specific recommendations. The authors participated in the crafting of the report and its recommendations as part of a distinguished panel chaired by Ray Chambers, the UN Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, and Prime Minister Hailemariam Dessalegn, President of the Federal Democratic Republic of Ethiopia

A systematic review of digital health tools used for decision support by frontline health workers (FLHWs) in low- and middle- income countries (LMICs)

In in low-and middle-income countries (LMIC), where there are very few trained physicians and nurses, community health workers (CHWs) are often the only providers of healthcare to millions of people. Such LMIC are countries that are classified, based on their geographic region and Gross National Income (GNI), as low-middle income by the World Bank Group, the worlds largest development bank. Research has shown digital health tools to be an effective strategy to improve the performance of frontline line health workers. The aim of this review was to systematically examine the literature on digital health tools that are used for decision support in LMIC and describe what we can learn from studies that have used these tools. As part of a larger parent study the following databases were searched: PubMed, Embase, Scopus, CINAHL, Global Health Ovid, Cochrane and Global Idex Medicus, to find ariticles in the following domains: training tools, decision support, data capture, commodity tracking, provider to provider communication, provider to patient communication and alerts, reminders, health information content. These domains were selected based on the World Health Organisation (WHO) framework for classifying digital health interventions. Content from all seven of these domains informed a series of reviews however this review focuses on how digital tools are used to provide decision support to FLHWs. Included studies were conducted in LMIC in Africa, Asia, North America and South America with the most common users of the tools being CHWs. Most tools for FLHW decision-support used in the interventions described in included articles were in either the pilot or prototype phases, and offered maternal and child health care services. Although decision support was the primary digital health function of all these studies, there was considerable variation in the number of digital health functions of each tool with most studies reporting decision support and data capture as their primary and secondary functions respectively. All the studies found their intervention to have beneficial effects on one or more of the following outcomes: beneficiary engagement, provider engagement, health effects and process/outputs. These findings show great potential for the use of decision support digital health tools as a means of improving the outcomes of health systems through; reducing the work load of FLHWs, reducing the costs of health care, improving the efficiency of service delivery and/or improving the overall quality of care

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation.

INTRODUCTION:Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes. METHODS AND ANALYSIS:This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries. ETHICS AND DISSEMINATION:Ethical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public. TRIAL REGISTRATION NUMBER:ISRCTN83902145

Strengthening the home-to-facility continuum of newborn and child health care through mHealth: Evidence from an intervention in rural Malawi

This paper assesses the impact of a mobile health (mHealth) project on uptake of home-based care for newborn and child health, and investigates the extent to which uptake of home-based care resulted in lessened pressure on health facilities for conditions that can be handled at the household level. It uses mixed methods consisting of cross-sectional household surveys data from a quasi-experimental pre-test post-test design as well as qualitative data. The results show a large, positive effect of the project on the aggregate home-based care for child health, and a sharp, negative impact on facility-based care seeking for fever among children whose mothers/caretakers used the services offered by the intervention. Reasons for using the services mainly relate to the potential of avoiding unnecessary trips to the health facility for care that could be provided at home. The project provides insights on mHealth and community-based programming to improve newborn and child health care delivery

M-health for maternal health- bridging the gaps!!

This article reviews significance, potential and principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology, essentially deploying mobile technology. There are various benefits of such TM clinical applications. The consensus among patients and health care providers is that this technology is convenient to provide needed subspecialty medical care, even when it is not available locally. Such innovations are clinically successful, but economic and cost-effectiveness data are lacking

Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case study

Background After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by confl ict, widespread insurgency, and an infl ow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors infl uencing maternal and child health in Afghanistan. Methods We undertook a comprehensive, systematic assessment of reproductive, maternal, newborn, and child health in Afghanistan over the last decade. Given the paucity of high-quality data before 2001, we relied mainly on 11 nationally representative surveys conducted between 2003 and 2013. We estimated national and subnational time trends for key reproductive, maternal, and child health indicators, and used linear regression methods to determine predictors of change in health-care service use. All analyses were weighted for sampling and design eff ects. Additional information was collated and analysed about health system performance from third party surveys and about human resources from the Afghan Ministry of Public Health. Findings Between 2003 and 2015, Afghanistan experienced a 29% decline in mortality of children younger than 5 years. Although defi nite reductions in maternal mortality remain uncertain, concurrent improvements in essential maternal health interventions suggest parallel survival gains in mothers. In a little over a decade (2003–13 inclusive), coverage of several maternal care interventions increased—eg, for antenatal care (16% to 53%), skilled birth attendance (14% to 46%), and births in a health facility (13% to 39%). Childhood vaccination coverage rates for the basic vaccines from the Expanded Programme of Immunisation (eg, BCG, measles, diphtheria-tetanus-pertussis, and three doses of polio) doubled over this period (about 40% to about 80%). Between 2005 and 2013, the number of deployed facility and community-based health-care professionals also increased, including for nurses (738 to 5766), midwives (211 to 3333), general physicians (403 to 5990), and community health workers (2682 to 28 837). Multivariable analysis of factors contributing to overall changes in skilled birth attendance and facility births suggests independent contributions of maternal literacy, deployment of community midwives, and proximity to a facility. Interpretation Despite confl ict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, aff ecting sustainability. To maintain and further accelerate health and development gains, future strategies in Afghanistan will need to focus on investments in improving social determinants of health and targeted cost-eff ective interventions to address major causes of maternal and newborn mortality