What is the role for Mobile Operators in MDG 4? A look at Etisalat’s Mobile Baby service

Last week I presented various mHealth initiatives that are helping to achieve MDG 5, which is to improve maternal health. This week I will present the role of mobile operators in helping to achieving MDG 4, with a focus on Etisalat and their Mobile Baby service.

MDG 4: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

Child deaths are falling, but not quickly enough to reach the target – United Nations

According to a recent report released by UNICEF, while global under-five mortality rate dropped from nearly 12 million in 1990 to an estimated 6.9 million in 2011, the situation is still worrying: Under-five deaths are increasingly concentrated in Sub-Saharan Africa and South Asia. In 2011, 82% of under-five deaths occurred in these two regions, up from 68% in 1990. Additionally, half of the global under-five deaths in 2011 occurred in just five countries: India, Nigeria, the Democratic Republic of Congo, Pakistan and China. As well, annual deaths of children under five in the Democratic Republic of Congo, Chad, Somalia, Mali, Cameroon and Burkina Faso rose by 10,000 or more in 2011, as compared with 1990.

WHO states that up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life; and almost 3 million of all the babies who die each year can be saved with low-tech, low-cost care.

Most women, especially in low-income countries, continue to deliver at home for a variety of reasons including cost, preference, culture, and lack of information [1]. Home deliveries could be made safer by reducing the “3 delays”:

1. the decision to seek care
2. arrival at a health facility
3. the provision of adequate care

One operator is addressing these three delays through the usage of mobile phones. Etisalat, a mobile operator with its operations in various African and Middle East countries, has developed and commercially introduced Mobile Baby in partnership between Qualcomm, WHO, D-Tree International and Great Connection Inc. The service was successfully deployed in Saudi Arabia, Tanzania, the United Arab Emirates and Nigeria in 2011, and is expanding to Afghanistan and Ivory Coast soon.

The Mobile Baby programme supports a seamlessly-integrated combination of:

• mobile phone-based decision support
• step-by-step protocols to identify and report danger signs during labor and delivery
• data storage
• remote diagnosis
• ultrasound-based remote monitoring of pregnancy evolution communication
• messaging for new mothers and mothers-to-be
• communication with referral facility indicating emergency transfer and requirements on arrival
• mobile payments for emergency transportation

There are five reasons why Mobile Baby is a great example of a mobile service addressing MDG 4:

1. Educational and training programmes by local NGOs and government agencies to train birth attendants and midwives on the Mobile Baby service functionalities and provide feedback from the birth attendants, trainers and medical practitioners to be proactively used during on-going application optimisation.
2. Vertical integration of various m-services: primarily mHealth and mobile money
3. Eco-system creation and close collaboration with various stakeholders as also government engagement from the early stage of product development
4. Given importance to localisation: the user can use the Mobile Baby service in English and Arabic, as well as  Swahili, Hausa, Ibo, Yoruba and soon in Urdu and Pashto. In addition, local cultural preferences and sensitivities were taken into account during the application development process. Tools such as Ethnio, WebSAT, UserVue, OpenHallway and Google Analytics where utilised during the User Interface optimization process.
5. Self-sustaining proposition: As a self-sustaining proposition, the Mobile Baby service creates revenue for all members of the ecosystem, including birth attendants and medical practitioners, emergency transportation owners and drivers, equipment manufacturers and MNOs financed by the mix of NGO/governmental schemes, insurance and direct patient payments.

Since the service launched in 2011, over 500 birth attendants and midwives have been fully trained on the application and over 10,000 pregnant women have been registered with the programme. All birth attendants are provided with required mobile equipment and seven major hospitals and 26 regional health facilities are actively participating in the program in four countries. In Tanzania, in Etisalat-supported regions (Zanzibar and Pemba), there has been a steady 70% facility deliveries rate is demonstrated, which is huge increase from the baseline of 40% facility deliveries rate in Tanzania.

If you are interested in various other mHealth initiatives, please have a look at the mHealth Tracker here.  If you are aware of any other mHealth initiative that we are not listing on our mHealth tracker we would be very keen to learn more about it. In addition you can have a look at the GSMA report published at Mobile Health Summit: Using mHealth to Support Universal Health Access.