Mobile Maternal, Newborn, and Child Health (MNCH) with BRAC in Bangladesh

Urbanization is happening rapidly in Bangladesh and by 2015, it is estimated that out of 50 million, 21 million people will be living in slums1. Although healthcare is available, neonatal deaths are higher in slums than in non-slum areas.1: “Newborn care practices among slum dwellers in Dhaka, Bangladesh” BMC Pregnancy Childbirth. 2009; v9: 54.

In this photo: The bird’s eye view of slum from the BRAC building in Dhaka.

In this photo: Maternal health awareness billboard in Dhaka by BRAC, the world’s biggest NGO. Maternal, newborn and child health (MNCH) has been a major

challenge to overcome in Bangladesh, and the figure is significantly worse in slum areas. A study showed that between 2002 and 2006, neonatal mortality was 43.7 per 1000 live births in slums compared to 20.1 per 1000 live births in non-slum areas2. 2: Bangladesh Urban Health Survery (UHS). Volumes I and II. 2008.

In this photo: A community health worker (CHW) makes her daily round to slum households.BRAC has been combating the issue of maternal, newborn and child health in urban slums through Manoshi program since 2007, funded by the Bill and Melinda Gates Foundation. CHWs are trained to keep track of all birth records, provide essential newborn care, and refer mother and child to pre-selected health facilities in the case of complication.

CHWs walk door to door and visit 30-45 households daily. They had been manually recording all pregnant related information on the register book or health card. Patient information then waited until the end of each month to be collected and submitted.

In this photo: A BRAC community health worker manually fills out a patient data form.

In this photo: Mridul (CEO), Maya (Program Manager), Rubayat (Chief of Operations) from ClickDIagnostics discuss the mHealth training module for CHWs with Taku (far left) from the Alliance Forum Foundation, our project partner.

ClickDiagnostics has partnered with BRAC Manoshi to integrate mobile-phone based healthcare system for a more cost-efficient, resource optimizing and financially sustainable healthcare model. We launched our first pilot project in July 2009 for the duration of 7.5 months. We were able to alleviate several bottlenecks in the BRAC Manoshi prject through reengineering their healthcare system.

Our model provides CHWs with simple JAVA script enabled mobile phones with built-in medical algorithms. Once patient information has been inserted using mobile phones, they are digitally sent to the centralized medical information system (MIS) in real-time.

In this photo: ClickDiagnostics’ management team leads the training of pilot group of CHWs.

Using mobile phones to collect data can significantly cut the time it takes for a CHW to fill out a paper form, which can take well over 30 minutes for each household.

In this photo: Using mHealth application for the first time at a training, CHWs were able to comfortably navigate through the medical algorithm on mobile phones within just a couple of hours.

ClickDiagnostics’ automated risk assessment algorithm keeps track of pregnant mothers and assess the level of their risks, enabling CHWs to prioritize their tasks and visits. A specialist can also access the real-time data from CHWs to monitor conditions of risky patients and address them in a timely manner.

In this image: A screeshot of the central medical information system (MIS).

In this photo: A CHW takes a snapshot of the patient with the built-in camera in her mobile phone.

ClickDiagnostics’ mHealth mechanism has empowered CHWs in several ways. It increased their work efficiency, minimized mistakes commonly made in manual recording on paper, and elevated the level of credibility CHWs receive from patients as an effective medium of health services.

ClickDiagnostics will continue to work with BRAC Manoshi to monitor the program’s on-going success. Stay tuned for the upcoming news (August 2010) on scaling up the current project in Bangladesh to 64 branches nationwide, aiming to cover more than 5.7 million people in the slums of 6 metropolitan cities in next 2 years.

In this photo: In a slum on the banks of the Buriganga River, Dhaka. (Photo credit: Jessica Mudditt)