Mobile Health Around the Globe: mHealth and Social Networking in Rural Tanzania

Marc Mitchell

EXCLUSIVE POST – I first heard of Marc Mitchell and D-Tree International when I spoke with Jorge Fernandez about his conference, Apps on Health for a post in the Mobile Health Around the World series. Jorge mentioned MobileBaby, the app that D-tree was using in Tanzania to help pregnant women be more aware of the options and support available to them and their newborn babies.  The mHealth group on LinkedIn commented on the post and a discussion ensued.  Marc picked up on the discussion and we then corresponded by email. 

D-tree International is a non-profit organization committed to changing the way health care is delivered to developing countries.  D-tree uses innovative technology to provide accurate and effective point-of-care diagnosis and treatment to the world’s underserved.

Currently, Marc and D-tree are working in the rural areas of Tanzania and Malawi on several projects in numerous focus areas including malnutrition, HIV/AIDs triage, maternal and child health and IMCI. 

Home-Based Care 

Home Based Care Providers play a vital role in serving poor and rural populations, but often they are not given the tools needed to do their work, and they have limited access to medical training or mentorship.

Together with partners, D-tree developed a phone-based tool to improve the effectiveness of home-based care programs in Tanzania.  The application has the following levels of functionality:

• Household visit tracking – records every household visit
• Household visit support and data collection – checklist of activities for visit
• Follow-ups – reminds care-giver to follow up on recommendations given previously
• Record keeping – maintains records of household members and equipment (mosquito nets, etc)
• Health protocols – step by step guide through relevant health protocols
• Day planning – helps health workers plan their days
• Data exploration – used to explore trends in activity and compare data with other providers

D-tree also worked with BRAC Tanzania to create videos for use on mobile phones to assist the Community Health Workers with health education.  Read a wonderful post about this project by Arturo Morosoff.  The videos featured nurses, doctors, BRAC staff and members of the community. Only head and shoulder shots were used and the videos were short (1 – 3 minutes per topic) and covered the following topics:

• Video 1:  Introduction to BRAC
• Video 2:  Tuberculosis and HIV (since these often occur together)
• Video 3:  Malaria and Diarrhea (since these often occur together)
• Video 4:  Immunization
• Video 5:  Family Planning
• Video 6:  The BRAC / CHV Process
• Video 7:  Safe Drinking Water
• Video 8:  Entrepreneurship

All videos are in Swahili and are available here.

Integrated Management of Childhood Illness (IMCI)

D-tree has been working in the area of child health to improve the use of IMCI protocols by using a eIMCI protocol app on mobile phones.  The software guides healthworkers step-by-step through the full IMCI assessment, classification and treatment plan.  The healthworkers are enthusiastic about this plan and initial results show that they more closely adhere to the protocol when using this eIMCI version.

Mobile Baby and Reducing Maternal Mortality

D-tree, with seed funding from the Bill and Melinda Gates Foundation and in partnership with the Etisalat Group, Qualcomm and Great Connection Inc, developed a mobile
application to provide critical healthcare to pregnant women.  Mobile Baby won the 2012 GMSA Award for the Best Mobile Product or Service for Women in Emerging Markets.

In Zanzibar, half of all births still take place at home, far from skilled care.  Further, only one third of Zanzibari mothers and newborns receive timely post-natal checkups.  D-tree has developed a mobile phone app for midwives that will help them and pregnant mothers to identify risks, find the closest health center and find the means to get there.  It also uses mobile banking to pay for the transport and alerts the clinic that the patient is on her way.

Maternal and newborn mortality could be reduced if all deliveries were done in well equipped health facilities.  Regardless, most woment in low income countries continue to deliver at home for a variety of reasons including cost, preference, culture, and lack of information.  D-tree’s mobile application addresses all of these.

The mobile phone based algorithm assists midwivew to quickly and accurately identify obstetric emergencies and arrange transportation for the pregnant woman to a health facility where she can receive appropriate care.  This tool includes 

1. A step-by-step protocol to identify danger signs during labor and delivery
2. The phone number of vehicle owners who can transport the patient on an emergency basis
3. Access to money on the phone to pay the vehicle owner for transportation
4. A record of permissions needed from the family or local decision makers to transport mother and infant in case of emergency
5. The ability to contact the referral facility indicating emergency transfer so they can be prepared for the patient’s arrival

What is creative about this idea is the combination of mobile decision support, data storage, on-line banking and communications on a single device at the point of care to improve maternal health outcomes.  Most mHealth applications focus on one of these elements, but in the case of maternal health it is the combination that has the potential to save lives.  This project is an example of healthcare social networking at its best – used to promote safety and wellness and reduce fatalities.

In the initial five months of this project, D-tree has seen facility deliveries increase from 30% to 70%.

“The purpose of our project is to reduce maternal deaths by providing a safety net for mothers who deliver at home through the use of mobile technology.  The sooner that risks and/or danger signs are recognized and discussed with family members, the sooner that necessary resources can be mobilized for referral during labor, immediately after home delivery, or in the days after childbirth – resulting in healthier maternal and child health outcomes and saving lives”.

D-tree is on a mission to raise $10,000 from 50 donors by April 30th at 11:59pm EDT.  They need $4000 by that time to earn a permanent spot on Global Giving.  Please go to the Safe Delivery website to learn more about this project and to donate.

The Following video provides additional information on The Safe Delivery project:

Be sure to visit our Mobile Health Around the Globe page to read more posts in this series