Molave Development Foundation, Inc.
The Ligtas Buntis Safe Motherhood System is an application specific e-Health Promotion and Tracking System for Maternal Health Community Care. It enhances general recording & reporting of maternal health data, and supports the process of maternal health behavior change. It address the current maternal health challenges of the public health sector, especially in recording and reporting prenatal and postnatal registry, in providing health messages to pregnant women, and in increasing utilization of maternal health services of the Rural Health Unit and designated district hospitals & other health facilities.
In the Philippines, where nearly 40% of the population lives below the poverty line, the equity gap is stark and wide. However, the ownership of a mobile phone is one of the few things that has crossed the income divide, making telecommunications relatively affordable and more accessible in this country of 7,100 islands. There are 70 million Filipinos who have mobile phones, compared to only 7 million installed fixed phone lines.
This is the basis for developing a program that uses text messaging to inform and educate pregnant mothers on safe motherhood. Aside from its mass appeal, mobile phones provide the advantage of two-way communication. Mothers are not just passive participants receiving information, but can also ask questions or communicate their concerns if they need to.
Our maternal and child health information system was developed and tested in the municipality of Roxas, province of Oriental Mindoro, with a population of 46,711 people in 8,057 households. The overall provincial mortality rate as of 2010 is fairly high, at 61.88 deaths per 1,000 live births. One huge factor in the high rate are cases of pregnant women opting for home delivery, instead of going for the safer facility-based delivery that accredited hospitals and birthing centers can provide.
This program aims to support the Philippine Government in reaching towards the United Nation’s Millennium Development Goals to reduce maternal mortality ratio by three quarters by 2015.
It addresses the current maternal health challenges of the public health sector, especially in recording and reporting prenatal and postnatal registry, in providing health messages to pregnant women, and in increasing utilization of maternal health services of the Rural Health Unit and designated district hospitals & other health facilities.
SMS, use of free and open source SMS Program such as Frontline SMS, use of USB dongles as SMS modems, Internet, mHealth
The system makes use of an award-winning, free and open source software called Frontline SMS, that turns a computer (PC or laptop) and a mobile phone into a central communications hub for the public health sector. Once installed in a health facility, the “Ligtas Buntis (Safe Motherhood)” System enables users to send and receive text messages to groups of people through mobile phones. The system stores all phone numbers and records all incoming and outgoing information. Messages can be sent to individuals or large groups, and recipients can also communicate back. It is useful for fieldwork or during the conduct of community health surveys.
This involved development and setting up a Short Messaging System (SMS) server, and a content and data management system in the RHU. We also provided training on digital literacy and the use of the system for municipal health workers such as doctor, nurses, midwives, sanitary inspectors and barangay health workers, as this is an integral part of the sustainability of the health information system.
The system features, among others, the following designed functions (as optimized for Maternal Health Care):
• Maternal health reporting (Prenatal and postnatal registry),
• Listing of registered women per barangay for sending broadcast messages
• Broadcasting of needed maternal health information in a TEXT form on areas such as Baby Development, Maternal Nutrition, Pregnancy Care, Pregnancy Complications, Common Problems in Pregnancy, Breastfeeding, Postnatal Care, Baby Care and Family Planning
• Responds to questions asked by mother through TEXT by providing advice
• Promotes complete prenatal visit, facility-based childbirth and postnatal visits.
• Records all sent messages by the System and archive received messages from registered patients
With the Ligtas Buntis System, we were able to increase facility-based births and improve access to health information and data acquisition in a municipality using a simple but effective e- and m-health application that involves all health workers in the municipality, enrolled pregnant women and the maternal health referral system in the province. This is a unique and innovative approach that also focuses on behavior change and capacity building for health workers in the use of technology.
Pregnant women from all over the municipality are recruited and enrolled in the system. Each pregnant woman is sent a total of 125 texts during her entire pregnancy. The topics of the text messages included: greetings/opening, Ang Paglaki ni Baby sa Sinapupunan (Baby’s Development Inside the Mother’s Womb), Tamang Pag-aalaga sa Ipinagbubuntis (Pregnancy Care), Mga Karaniwang Problema ng Pagbubuntis (Common Pregnancy Problems), Tatlong Palatandaan ng Paglalabor (3 Signs of Labor), Tatlong Yugto ng Paglalabor (3 Phases of Labor), Pagpapasuso (Breastfeeding), Pangangalaga sa iyong Sanggol Ilang Linggo Pagkapanganak (Taking Care of your Newborn), and closing message.
The total number of messages each mother received was broken down into the following: 14 during the 1st trimester, 35 on the 2nd, 67 on the 3rd, and 9 for post-partum care. Assuming that each text message costs P1.00, this means that the RHU invests around P 125.00 for every mother enrolled in the system during her entire pregnancy, assuring that she will deliver safely, in an accredited birthing facility.
One important outcome was an increase of 34% in facility-based births, attended by skilled birth attendants (doctors, nurses, midwives) in the municipality. This increase is attributable to the implementation of the SMS Ligtas Buntis Program. This development will also have an eventual impact in terms of lowering maternal mortality rates in the municipality.
When mothers opt to deliver at a facility instead of at home, this means that they will be able to avail of the PhilHealth (socialized health insurance) maternity benefit package. This means more income generation for the Local government unit (LGU) (i.e. PhilHealth will pay the birthing facility at least P1,000 per delivery). With this scheme, it would be easy for the LGU to communicate with all registered pregnant women, thus ensuring a more active and accurate monitoring of their pregnancies, and to better convince them to consider delivering in accredited birthing facilities. With this ICT-enabled tool for behavior change, the LGU can quickly recoup its investment in the SMS Ligtas Buntis System. This will also result in less birth complications, which can lead to more cost implications for the woman’s family, her community and the LGU. Ultimately, this will contribute to lowering of the maternal and infant mortality rates in the municipality and the province, helping to achieve the MDGs for maternal and child health.
Presented in several international and national conferences, such as ICT4H,ICT4D Philippines, eHealth 2011 in Canada, WHO-WPRO, Department of Health, and published on the Web.
Successfully advocated the use of SMS technologies in public health informatics; the Department of Health has used the results of this study to scale up the Safe Motherhood Project in the entire province of Mindoro, under the WOMB project
The commercial applications of this project were successfully pitched to telecommunications companies; because of the impact demonstrated in this project, Smart Communications adopted the approach, and integrated the use of mobile data collection on maternal health in setting up their SHINE Health Information Systems service, which is now being rolled out in various provinces and cities across the Philippines.
Featured in the National Geographic Website: http://newswatch.nationalgeographic.com/2011/05/10/safe-motherhood-mobile-healthcare-in-the-philippines/ MDFI was appointed as the Chair of the Capacity-Builiding Committee that helped developed the ICT4H Roadmap of the Department of Health for 2011-2016.
Dr. Angelo Juan Ramos