For the last 15 years women in rural Malawi have been experiencing high rates of maternal and new-born illness and death due to preventable complications of childbirth. Three main factors precede the majority of poor maternal and new-born health outcomes: firstly a delay in making the decision to seek care, secondly a delay in getting to an appropriate health facility, and thirdly a delay in receiving appropriate care within the health facility.

Context of ICT implementation at Diamphwe and Mtenthela health centres 

The absence of patient data for decision-making at health facility level remains one of the greatest weaknesses of the Malawian health, which is characterised by antiquated, paper-based systems and a reliance on mothers to hold their own paper-based records, known as ‘health passports’, as well as that of their infants. Implementing electronic health information systems (eHIS) across hospital and community care has potential to reduce birth complications by ensuring that the right information about the right patient is available to the right people at the right time and place. Enabling information to flow between community-based and hospital-based care settings may enable more informed decision-making about high risk cases in need of referral for specialist management, leading to improved maternal and new-born health outcomes. Since 2009, there has been significantly increased commitments to and investments in the strengthening of eHIS at Nkhoma Hospital in Malawi. This is being done through integration of information and communication technology (ICT) in the running programmes of at Nkhoma Hospital and it’s surrounding health centres to increase the quality and effectiveness of development interventions. The ICT solution being implemented is AfyaPro, which has seven (7) modules: patient registration, patient billing, diagnosis and treatment, medical laboratory, reproductive and child health, inventory, and HIV-ART. Beyond installing AfyaPro, efforts have been to strengthen eHIS through a change management process aimed at facilitating ICT ownership, increasing ICT competencies and assisting with institutional integration of ICT at the health facilities. The first stage of implementation involves replacing the paper registers that are currently used in antenatal and delivery care with electronic data capture using AfyaPro. The electronic data is linked to the health passport through a bar code system, as well as being retrievable through name, year of birth and village. Electronic patient data are stored securely in a local and central database and accessible at the referral hospital and the other health centres. In the continuum of care, if a woman is referred from her primary health centre to the referral hospital, or transfers to another health centre, her file is directly available at the referral site, improving quality of patient care.

So far, computers and other hardware have been installed at Nkhoma Hospital and health centres. Health workers have been trained in the use of computers, Afya Pro applications, as well as change management. There is now need to study how the electronic health information system impacts quality of care and health facility management, and ultimately maternal and new-born health outcomes.

Nkhoma Safe Motherhood Scale Up Programme

The main aim of the Nkhoma Safe Motherhood Scale Up Program is to increase family planning and referrals, and the utilization, timeliness, and quality of reproductive health services, while building partnerships and advocating for reproductive health and rights to reduce maternal and new-born deaths in the Nathenje Health Area. Nathenje Health Area’s main referral hospital, Nkhoma Hospital, is surrounded by five health centres: Matapila, Nathenje, Chimbalanga, Diamphwe and Mtenthela and they all work together in this program. The Nkhoma Safe Motherhood Scale Up program covers Traditional Authority (TA) Mazengera in 22 group village heads. To achieve its goal the program uses many activities that have been clustered under the following strategies to address the three delays (delay in seeking health care, delay in accessing health care, and delay in service provision):

Strategies to increase in family planning methods and referrals

1. Strengthening community structures to act on modern family planning
2. Women empowerment
3. Youth empowerment/Mobilization
4. Strengthening community structures to take family planning to communities
5. Strengthening quality assurance in the health facilities

Strategies to increase referrals

1. Empowering the community to organize transport for referrals
2. Strengthening communication systems
3. Strengthening quality assurance in the health facilities

Strategies to increase women using health care facilities for skilled delivery and reproductive health care on time

1. Strengthening community structures to act MCH/MNH/SRHR issues
2. Women empowerment
3. Maternal death audits

Strategies to improve quality and quantity of reproductive health services

1. Improving skills and attitude of health providers
2. Ensuring adequate resources to conduct sexual and reproductive health
3. Improving availability of information

Strategies to build partnerships and advocate for SRHR issues

1. Advocating to church leaders on SRHR issues
2. Lobbying for SRH issues (patients rights, human resources and infrastructure)
3. Developing networks with local/national government and NGOs
4. Mobilizing and distributing information, education and communication materials

Church leaders have been invited to various meetings and have been trained in issues relating to SRHR. There is need to follow up on the advocacy with the church leaders to identify specific actions taken. The project provides a leading role in a local and national network, called Uchembere Network.

There is an exchange programme established for health providers, so they can experience work in the maternity ward of the hospital or another health centre. There is need to further develop this strategy to improve skills and attitudes of the health providers.

Each facility maternal death is audited, yet community-based maternal deaths are rarely reported. There is need to develop a mechanism for capturing all community-based maternal deaths, and subsequently conduct an audit.

A community bicycle ambulance system has been developed and use of bicycle ambulances are being monitored by the community and the project. A wireless communication system set up among the health centres and Nkhoma Hospital is being maintained. There is need to further develop the voice over internet protocol communication system to be able to share document, picture and video among the health facilities. There is also need to evaluate the sustainability and cost-effectiveness of the bicycle ambulance system.

Community structures such as Area Development Committees in the Traditional Areas have been strengthened. Women’s groups in the 22 villages have been set up to empower women. Training of youth from churches in the catchment villages has mobilized them. Community based distribution agents have been trained and are being supported to take family planning methods closer to people’s homes. A quality assurance system ensures a team from Nkhoma Hospital supervises the health centres, and staff from the health centres learn from each other. There is need to evaluate these strategies increase access to family planning methods.

 Paul Kawale 

(Director Community Health,  Nkhoma Hospital, Malawi and PhD Student, University of Edinburgh)

https://www.facebook.com/pages/Nkhoma-Hospital/263372044008

http://www.linkedin.com/pub/paul-kawale/30/787/66

Maternal and infant health in Malawi / Global Health Academy • BLOG by blog administrator is licensed under a Creative Commons Attribution CC BY 3.0