A few months ago, we met Elizabeth Davies at a health facility in Bombali District in Sierra Leone, where she works as a nurse midwife. Sierra Leone has some of the highest maternal and newborn mortality ratios in the world, a lot of it due to poor accessibility and low utilization of services by skilled birth attendants.
Elizabeth told our partners at UNFPA about a time she used her mobile phone to manage a case of bleeding after birth.
“There was a case of a woman with post-partum hemorrhage and I followed the step-by-step instructions on my phone and was able to stop the bleeding and send her safely to the regional hospital the next day,” she explained.
The app on her phone was the Safe Delivery App, a mobile training tool for skilled birth attendants that the Maternity Foundation is rolling out in Sierra Leone in partnership with UNFPA.
“The App not only improved my skills, it helped me to save women’s lives,” said Elizabeth.
Although maternal and newborn mortality rates have decreased drastically since 2000, more than 800 women and 7000 newborns still lose their lives every day from causes related to pregnancy and childbirth – with the vast majority happening in developing countries, not least sub-Saharan Africa.
But can an app save lives in childbirth?
The Safe Delivery App has boiled down global clinical guidelines on the most common childbirth complications into simple, visually animated instructions. It includes instruction videos, essential practical procedures, action cards for emergencies, drug lists, and an individualized e-learning experience, MyLearning, which takes the user through different levels of learning and quizzes and a final certification exam.
One thing is to put all this great content down to an app – but does it work? To answer this question, we conducted a randomized controlled trial back in 2014, which revealed that over a 12-month period the health workers using the app more than doubled their skills and knowledge in key obstetric complications. Based on these results the Maternity Foundation launched the App in 2015 and made it free to download, and since then we have worked with partners to implement it across sub-Saharan Africa and South Asia. Today, it has been downloaded more than 90,000 times and supports midwives in both more stable and in humanitarian settings.
What have we learned from developing, testing, and scaling a digital training tool for nearly five years?
It’s not about technology
An app on Google Play or App Store will not make a difference in itself. It is easy to get carried away in terms of what is possible technologically, but lasting results often come from a simple, focused innovation that can easily be integrated with existing practices or trainings on the ground. In short: It’s not about the technology itself – it’s about how it can be used to fill gaps and support existing activities on the ground. In our case, it is about how it is integrated into existing health systems and midwifery training programs in the countries we work in.
Make collaboration part of your DNA
The strength lies in how you work with partners on integrating your tech solution. Don’t assume you have all the answers yourself. You need to collaborate with strong partners and let go of a bit of control and linear planning. We work with partners on the ground in about 15 countries to roll out the Safe Delivery App, and there is no one-size-fits-all model. We bring a technical solution and a lot of programmatic know-how – and our partners bring
the country-specific expertise, networks, and experience.
Think beyond pilots
How do you make your innovation sustainable and scalable? One thing is to get strong evidence that your solution works – that is the first essential stepping stone for building credibility. The difficult part is scaling up app usage, because it requires quite a different model than traditional program work. Originally, we developed the Safe Delivery App as a stand-alone job aid supporting midwives in their everyday work, but in time, we have increasingly started working with partners on integrating it with existing training and mentorship programs. Because we learned that integration is what works in the long run.
80% standard – 20% customization
The real ownership of implementation needs to be in our partner countries. For that to work, it is critical that the solutions are adapted in terms of language, clinical standards, and visuals. Building a strong, validated, and scalable backend system requires massive investments, so in order to be cost-effective and harvest synergies between your tech solution and the context you work in, you need to find a good balance between customizing your solution and having a solid, standardized back-bone. We call it 80% standard, 20% adaptation.
So, to answer the initial question: Can an app save lives in childbirth?
No, it cannot. But strong midwives and skilled birth attendants like Elizabeth can – especially when given the right support. And that’s where technology and innovation can make a critical difference.