Photo by: Cameron Taylor
“Every system is perfectly designed to achieve exactly the results it achieves.” USAID Applying Science to Strengthen and Improve Systems (ASSIST) Deputy Director Dr. Kathleen Hill shared this quote from W. Edwards Deming with an audience of more than 40 leading experts in technology, health care, and international development that gathered on January 31st in Washington, D.C. for an m/eHealth Health System Strengthening technical working group meeting. The Bridging the Gaps: Leveraging m/eHealth to Achieve Strong Health Systems and High Quality Care in Low-Resource Settings technical meeting considered a working framework developed by the USAID ASSIST project and discussed how m/eHealth solutions can bridge common quality and systems gaps in low-resource settings to augment system strengthening and quality improvement efforts to achieve better health outcomes.
As a gender specialist working for WI-HER LLC, Women Influencing Health, Education and Rule of Law, on the ASSIST project, my interest in m/eHealth is twofold: first, I am examining how technology can be leveraged to transform traditional gender norms to improve health outcomes for women, men, girls and boys. My second interest is in mitigating the negative impact that m/eHealth interventions can potentially have on gender relations. One of the biggest takeaways from the meeting for me was the idea that technology is often developed and packaged as a solution before the problem and its root cause are defined. There can be a lack of discussion and consensus about what the problem is, what response is required to solve the problem and close the gap, and to what extent m/e technology can aid in that. It’s important that the technology solutions benefit the women, men, newborns and children they are meant to serve.
An example is the push in recent years to target women through mHealth interventions, sometimes without sufficiently analyzing whether the problem warrants a response which includes mHealth and targets women exclusively. If the problem identified, for example, is that neonatal mortality is very high, and it is observed that very few mothers in the community receive antenatal care (ANC) or deliver with skilled providers, an mHealth project might provide mobile phones to pregnant women and girls or communicate with expecting mothers through their cellphones to tell them about the importance of seeking care throughout their pregnancy. The reasoning behind this makes sense: mothers who do not receive high-quality ANC and childbirth care are more likely, along with their newborns, to suffer serious consequences of childbirth complications such as pre-eclampsia. But if one of the root causes of pregnant women not attending ANC visits is because the power and decision-making dynamics in households limit women’s and girls’ ability to make health-related decisions, and male partners do not appreciate the value and therefore do not want their partners to attend ANC visits, then the mHealth intervention would not be as effective as it could be. In some cases the receipt of text instruction that challenges a male partner’s authority in the home may even put the woman or girl at risk.
A more appropriate solution which utilizes mHealth would be to design an intervention that also sends messages to male partners about the importance of ANC, appointment reminders for their partners and promoting their participation in education and counseling sessions. This gender-sensitive mHealth intervention would be more likely to lead to increased use of ANC services and skilled delivery care by pregnant women and help to contribute to improved outcomes for mothers and newborns if the quality of care is high. This highlights the importance of m/ehealth projects incorporating a gender analysis and strategies to implement gender-sensitive interventions into the project.
The most moving and powerful part of the meeting was listening to Dr. Hill share the heartbreaking story of Mariama. Mariama is a pregnant woman who arrives at a local clinic with symptoms of pre-eclampsia, and faces a number of health care quality gaps which cause her to not get the treatment she needs: from lack of appropriate diagnosis and transportation to the hospital, a lack of triage to receive care promptly and then finally when she delivers her preterm son Bulakai, who is alive but not breathing and the health care team is unable to locate a bag and mask to resuscitate him. Dr. Hill used storytelling to make this hypothetical case study come alive for all of the meeting participants. Dr. Hill then linked the loss of the life of Bulakai to a system and quality failure which could have been prevented in part by integrating m/e health into MNCH quality improvement efforts.
The “Bridging the Gaps” meeting highlighted the importance of leveraging m/eHealth solutions as part of broader health system strengthening and QI efforts to achieve better health outcomes for women, men, newborns and children. Specifically, experts in the field discussed strategies for leveraging m/eHealth to strengthen essential health system functions related to service delivery and real time care, workforce, commodities and supply chain, and data and information systems in low-resource settings and identified many areas for participant collaboration. The meeting offered a very useful platform for collaboration and learning and the expectation is that m/eHealth HSS/QI technical working meetings such as this will continue in the future.
The Bridging the Gaps: Leveraging m/eHealth to Achieve Strong Health Systems and High Quality Care in Low-Resource Settings technical meeting was jointly organized by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project managed by University Research Co., LLC (URC) with support from the U.S. Agency for International Development (USAID) Office of Health Systems. For more information about USAID ASSIST’s work to leverage technology to improve systems, please contact Allison Foster at firstname.lastname@example.org.