Teletriaging to give moms virtual support during COVID-19

60% of our ANC clients reported that COVID-19 is influencing their decisions on where and when to seek care. We already have over 150,000 women enrolled on our Propmpts digital health platform, and have recognized that scaling up the service would empower more women to seek care at the right time and place during the pandemic. The  free,  two-way text messaging capability connects mothers with clinically-trained helpdesk agents, to ask questions and share concerns. These insights allow us to provide dynamic and real-time guidance to mothers during the pandemic, especially in response to service disruption.

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Teletriage – additional Prompts support for mothers who cannot attend their appointments: How do you support a mother who was asked to seek care elsewhere for her appointment, or is hesitant to take public transport to get to her clinic? We have rapidly built, tested and launched a “teletriage” to support mothers with remote, ‘virtual’ ANC appointments. The goal of teletriaging is not to replace in-person care, but to identify those mothers in need of urgent attention.

The triaging begins at our help desk: any user sending messages about missing ANC appointments or being turned away from care is prompted to engage with a bot that walks her through a number of standard clinical profiling questions. The responses are then packaged and shared immediately with our clinical help desk for review.

Lucy, a nurse by profession and one of our clinical help desk agents, reviews the files and holds a follow-up call with each patient to identify danger signs and immediately manage any clinically urgent matters. Many mothers only require general advice: identifying danger signs, supplement use, diet, signs of labour, and navigating the dusk-to-dawn curfew. However, Lucy has also been able to support mothers who need additional attention. For example, a first time, potentially high-risk, mother hadn’t received important blood tests and shots during her last appointment and was advised on the importance of these, and where she could seek the appropriate services.

 Finding a facility can be a challenge: Lucy will go through alternative options, including private or NHIF facilities, or traveling to a facility in another area, however, the financial  burden of these options are often not feasible for our moms. We have been actively tracking the challenges raised by these mothers and are sharing across our mentorship program; nurse midwives at public hospitals and their facility managers act as an additional touch-point to respond to issues raised and offer potential solutions and referrals. We are also sharing weekly data updates with our health system managers, using the information to close the feedback loop and create a more dynamic response system for maternal healthcare provision.

Post-COVID tele-medicine: Teletriaging is in demand from our County partners who run public hospitals. They recognize that mothers may miss their in-person appointments due to the ongoing circumstances, and will now have the opportunity to interact with a clinical expert through their phone, and be referred to care if needed. In limited resource settings, telemedicine can offer additional, personalized support and advice to ensure continuity of care. We and many other partners are working to create these solutions to bridge gaps in quality of care.

About the Author

Liz McNeil, Communications & External Relations Manager: Liz McNeil recently joined the Jacaranda Health team to expand the reach of Jacaranda Heath's work and learnings through strategic communications and collaborations. She has previously worked as Regional Business Development & Partnerships manager for East/Horn of Africa at AFRIpads and led a social enterprise in Tanzania dedicated to improving the lives and livelihoods of rural families. She holds a BA in Political Science with a Business Admin. Option from Sir Wilfrid Laurier University in Canada and an International Development Project Management certification from Humber College. Sathy Rajasekharan, Executive Director (Africa):  Sathy Rajasekharan is the Executive Director (Africa) at Jacaranda Health, and oversees the organization's mission of delivering low-cost, sustainable solutions through public hospitals to improve maternal and newborn health outcomes. Prior to joining Jacaranda Health, Sathy was a Senior Program Manager for Health Systems Strengthening at the Clinton Health Access Initiative (CHAI), Eswatini. He has held previous positions in the commercialization and translational research space, as Associate Director of the McGill University Centre for Biomedical Innovation and the Associate Director of Experimental Therapeutics at the Montreal Neurological Institute. Sathy has a Ph.D. in Neuroscience. Rachel Jones, Senior Research & Design Manager: Rachel M. Jones is originally from the United States and has been working with Jacaranda Health in Nairobi, Kenya since 2016. Rachel manages the Research & Design unit of Jacaranda Health, where her team uncovers client insights, develops and pilots new ideas for efficiency and impact, and oversees evaluations for the organization. Her team also leads research projects and new initiatives with academic and private partners. Rachel holds an MPH in Global Health from Emory University and a BA in Religious Studies from William & Mary. She has previously worked with Emory's Global Health Institute on the topic of HIV key populations and religion and the US Peace Corps in Morocco empowering youth.


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