Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda

Abstract

BackgroundIn an effort to improve access to proven maternal and newborn health interventions, Rwanda implemented a mobile phone (mHealth) monitoring system called RapidSMS. RapidSMS was scaled up across Rwanda in 2013. The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.MethodsUsing data from the 2014/15 Rwanda demographic and health survey, we identified a cohort of women aged 15–49 years who had a live birth that occurred between 2010 and 2014. Using interrupted time series design, we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care (ANC), health facility delivery and vaccination coverage.ResultsOverall, the coverage rate at baseline for ANC (at least one visit), health facility delivery and vaccination was very high (> 90%). The baseline rate was 50.30% for first ANC visit during the first trimester and 40.57% for at least four ANC visits. We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC (level change: -1.00% (95% CI: -2.30 to 0.29) for ANC visit at least once, -1.69% (95% CI: -9.94 to 6.55) for ANC (at least 4 visits), -3.80% (95% CI: -13.66 to 6.05) for first ANC visit during the first trimester), health facility delivery (level change: -1.79, 95% CI: -6.16 to 2.58), and vaccination coverage (level change: 0.58% (95%CI: -0.38 to 1.55) for BCG, -0.75% (95% CI: -6.18 to 4.67) for polio 0). Moreover, there was no significant trend change across the outcomes studied.ConclusionBased on survey data, the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda. In most instances, this was because the existing level of the indicators we studied was very high (ceiling effect), leaving little room for potential improvement. RapidSMS may work in contexts where improvement remains to be made, but not for indicators that are already very high. As such, further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.

Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

“…A study conducted by Hategeka et al [46] in Rwanda on the impact of the RapidSMS program on the use of MCH services showed divergent results. The lack of impact of RapidSMS on ANC services uptake was attributed to the infidelity in the implementation of the program.…”

New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China

“…A burgeoning literature has consistently demonstrated strong evidence for the feasibility, effectiveness, and efficacy of mHealth [ 4 - 9 ]. For instance, a recent literature review shows an overall retention rate of 92% (95% CI 82%-98%) in mHealth among PLS, as well as a range of potential benefits and satisfaction reported by users [ 4 ].…”

Adoption of Mobile Phone Messages for Delivery and Newborn Care in Bangladesh

“…There has been continued investment in health infrastructure, medical equipment, capacity building in formal healthcare, improved health systems governance and monitoring, demand-side-financing schemes and an extensive door-to-door health worker campaign strategy by the Government and NGOs (El Arifeen et al, 2013;Ministry of Health and Family Welfare, 2015;MOHFW, 2018). Research elsewhere suggests that mHealth interventions are less likely to show significant improvements in outcome indicators in high-performing health areas (Hategeka, Ruton, & Law, 2019) and that targeted messages may increase awareness and readiness around delivery and special care for premature babies among pregnant women who have an increased risk of preterm births (Olivia Kim et al, 2019).…”