Every year, around 300,000 women die from complications in pregnancy or childbirth, 2.5 million babies die during the first 28 days of life, and just as many are stillborn. That is over 800 women and 14,000 babies losing their lives every day. 99% of maternal deaths and the vast majority of newborn deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa and Southeast Asia.
The majority of these deaths are preventable through access to skilled and quality care during pregnancy and childbirth. One key element is to build the capacity of health workers when managing childbirth emergencies. The Safe Delivery App, a smartphone application developed by Maternity Foundation in partnership with Universities of Copenhagen and Southern Denmark, aims to do just that. Through simple, intuitive animated instruction videos, drug lists, and quizzes, the Safe Delivery App guides health workers in how to handle the most common childbirth emergencies, including the seven signal functions of Basic Emergency Obstetric and Newborn Care (BEmONC). All features and functions are designed for low-literacy, low-resource settings, and function offline once downloaded. The App has been adapted into numerous languages and aligned with national clinical guidelines including in India, Ethiopia, Ghana, Myanmar, and Laos.
Digital Birth Attendant
Picture this scenario. A woman in rural Ghana goes into labour in the middle of the night. When she arrives at the clinic, the on-call midwife is on duty alone. The delivery is quick, and both the baby and the mother seem healthy. Suddenly, the baby breaks into a fever, stops crying and refuses to breastfeed.
Under normal circumstances, the midwife would refer the newborn to the nearest hospital, but it is the middle of the night, there are no ambulances and she needs to act fast. The midwife opens the Safe Delivery App, follows the instructions in the videos and drug lists and manages to bring the baby’s temperature back to normal. After a few hours, the baby is doing well, and the mother can bring her home.
The above is a story from midwife Fareedah Tinorgah Yelgie, who works at Tolon Health Centre in the northern region of Ghana. There are only two midwives working at the clinic where they deliver an average of 80 babies every month.
“Because of the Safe Delivery App, I was able to manage the complications, and I observed the mother and baby until the next day. Both mother and baby were fine, the stress on me came down and I felt happy. Thanks to Safe Delivery App, I was the hero of that night,“ Fareedah explained when we met her in Ghana.
Is an App an efficient tool to improve quality of care? Evidence shows that health workers using the Safe Delivery App significantly improve their skills, knowledge, and confidence in identifying and managing obstetric and newborn complications. A 2014 randomized control trial conducted in 73 rural health facilities in Ethiopia, for example, showed how the Safe Delivery App more than doubled midwives’ ability to handle specific post-natal and newborn complications. More recently, a 2018 study conducted in eight rural health facilities in central Democratic Republic of Congo revealed similar results. In the 2018 study, both confidence and knowledge scores on the same complications increased significantly after skilled birth attendants had used the App for three months.
To date, the Safe Delivery App has been downloaded more than 60,000 times in over 40 countries worldwide. To ensure that the Safe Delivery App supports existing maternal and newborn health activities, Maternity Foundation works through partners such as ministries of health, UN organisations, and local and international NGOs to roll out the App within existing activities on the ground. It can be used as a stand-alone job aid for midwives, but it is also increasingly being integrated into in-service training curricula as well as in midwifery schools.
For Maternity Foundation, one of the key learnings when using an App to improve quality of care for mothers and their babies is this: Technology can only take you so far. It is how you integrate and correlate your digital tools with existing activities and priorities on the ground – and do it through strong partnerships – that will ultimately secure its reach to support health workers in their daily work. That is when it holds the potential to save lives.
As midwife Nicola Zewge put it when we met him at the maternity clinic in Nguenyyiel Refugee Camp in Ethiopia: “Our work is risky – we have the lives of mothers and their babies in our hands every day. The Safe Delivery App makes it easier for us to manage. I think all midwives should use it.”
For more information on the Safe Delivery App, visit www.safedelivery.org.