Zero Mothers Die - Presentation to the Government of Ghana
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Zero Mothers Die was presented to the Government of Ghana and the UN system in Ghana on November 22, 2013. Ghana has been chosen as the first implementation country for Zero Mothers Die, a global multistakeholder partnership project focusing on improving maternal health through the systematic use of ICTs and mobile health.
![PROBLEM:
Unacceptably High Maternal Mortality
• In 2010, 287,000 women died during and following pregnancy
and childbirth.
• Each day, 800 women die from preventable causes related to
pregnancy or childbirth complications.
• 99% of these maternal deaths occurred in developing countries,
with more than half taking place in sub-Saharan Africa.
• 24% of these deaths are attributable to HIV in SubSaharan Africa.
• Most of these deaths could have been prevented.
[source: WHO Maternal Mortality Fact Sheet]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Zero Mothers Die - Presentation to the Government of Ghana
- 1. A commitment to saving the lives of pregnant women with ICTs and mobile health
- 2. PROBLEM: Unacceptably High Maternal Mortality • In 2010, 287,000 women died during and following pregnancy and childbirth. • Each day, 800 women die from preventable causes related to pregnancy or childbirth complications. • 99% of these maternal deaths occurred in developing countries, with more than half taking place in sub-Saharan Africa. • 24% of these deaths are attributable to HIV in SubSaharan Africa. • Most of these deaths could have been prevented. [source: WHO Maternal Mortality Fact Sheet]
- 3. SOLUTION: Zero Mothers Die A global and innovative project to save the lives of pregnant women and new mothers through the systematic use of information and communication technologies (ICTs) and mobile health.
- 4. ZERO MOTHERS DIE A Multistakeholder Public-Private Partnership
- 5. Global Plan [source: UNAIDS 2013 Progress Report on the Global Plan]
- 6. GHANA: First Implementation Phase Ghana, one of the UNAIDS Global Plan target countries, has been chosen in consultation with the partners as the first implementation country for Zero Mothers Die. The initial implementation phase will take place in Greater Accra.
- 7. Target Beneficiaries In Greater Accra Pregnant Women & New Mothers 2,700 Local Healthcare Workers 570
- 8. GHANA CONTEXT: [source: UNAIDS 2013 Progress Report on the Global Plan]
- 9. GHANA CONTEXT: Great Progress Has Been Made… [source: UNAIDS 2013 Progress Report on the Global Plan]
- 10. GHANA CONTEXT: But there is still more to be done… [source: UNAIDS 2013 Progress Report on the Global Plan]
- 11. GHANA CONTEXT: Maternal Mortality Declared National Emergency Under-five mortality rate 72 1,000 Maternal mortality rate 350 100,000 The lifetime risk of death for pregnant women is 1 in 66. [source: UNFPA 2011 report State of the World’s Midwifery]
- 12. WHY MOBILE HEALTH? “ Mobile phone networks cover 96% of the world's population. 77% of all mobile subscriptions are held by nearly 90% of the population in low- and middle-income countries. The impact of mobile phone technology on health, including maternal health, can be farreaching, cost-effective and replicable. ”
- 13. MOBILE HEALTH for MATERNAL HEALTH Mobile health initiatives cover a wide range of activities, including: • • • data collection disease surveillance health promotion • • • diagnostic support disaster response remote patient monitoring Mobile health initiatives targeting MDGs 4 and 5 are reaching over 140 million women. See:
- 14. Zero Mothers Die tackles the MDGs
- 15. PROJECT OBJECTIVES 1 Reducing maternal mortality and maternal health complications 2 Accelerating mobile phone ownership and use by pregnant 3 Education and capacity-building of local health workers using through increased access by pregnant women to appropriate healthcare information, via mobile voice and text messages in local languages and dialects. women to increase access to healthcare, empower women with information, and reduce the mobile phone gender gap. This includes facilitating connections with healthcare workers through allocations of free airtime restricted to calling assigned local healthcare facilities and workers. tablets preloaded with up-to-date and tailored training materials and content in local dialects and languages to improve maternal and child health in their communities.
- 16. PROJECT COMPONENTS MumHealth, a mobile messaging service delivering health information to pregnant women and new mothers in local languages and dialects. 100,000 mobile phones per year to pregnant women. 36,000,000 minutes of free airtime per year to pregnant women to enable their communication with local health workers and facilities. Capacity-building and education of local health workers using ICTs and localized content. Mobile money savings scheme to help finance and increase access to skilled care during childbirth. Solar power business generation scheme to bring financial empowerment to pregnant women and provide sustainable energy to support the charging of their mobile phones.
- 17. MumHealth & MumHealth is built off of the evidence-based Mobile Alliance for Maternal Action (MAMA) mobile messages library. The messages will be tailored and localized by UniversalDoctor for the Ghana context. Culturally sensitive and stage-based messages created by BabyCenter according to UNICEF and WHO guidelines, and vetted by WHO. Used by 266 organizations in 61 countries. The messages are built around key health behaviors and interventions which evidence shows can improve health outcomes. Topics: antenatal care, nutrition, vaccination, PMTCT, infant feeding, oral rehydration, use of insecticide-treated bednets, and post-partum family planning.
- 18. KEY RISKS: 1 Discrimination due to HIV stigmatization PROPOSED SOLUTION Zero Mothers Die will target all expectant and new mothers, instead of only HIV-positive pregnant women, by employing a comprehensive approach to improving maternal, newborn and child health, while maintaining the prevention of mother-to-child-transmission of HIV (PMTCT) and systematic use of ICTs as key elements. This strategy will also ensure women who would become HIV seropositive during pregnancy will not be lost by the project.
- 19. KEY RISKS: 2 Language and illiteracy barriers PROPOSED SOLUTION • The MumHealth repository of mobile messages will be developed in key languages/dialects in the area of implementation. • The messages will be tailored and localized for target beneficiaries. • Regarding illiteracy and disabilities, Interactive Voice Response (IVR) technology will be used to develop voice messages as an alternative solution by offering prerecorded audio information in different languages/dialects.
- 20. KEY RISKS: 3 Low mobile phone ownership levels PROPOSED SOLUTION • Local intelligence gathering suggests there is no mobile phone gender gap in Greater Accra. • • According to local partners, it is almost 100% certain that women will own at least one mobile phone. Spouses controlling the mobile phones and restricting access by the women is an unlikely risk in Greater Accra. • In any case, Zero Mothers Die endeavors to equip at-risk, low-resource pregnant women who do not own a mobile phone.
- 21. KEY RISKS: 4 Misuse or resale of the mobile phones PROPOSED SOLUTION • The mobile phones distributed through the project* will be uniquely designed with limited (i.e. non-smartphone) functionality to avoid this. • If this is a significant risk, the project can restrict the numbers that can be dialed through the mobile phone. *Zero Mothers Die will ensure the mobile phones acquired and distributed by the project to the pregnant women will come from responsible mobile phone manufacturers who are reliable in providing quality mobile phones.
- 22. GUIDING PRINCIPLES Sustainability Scalability This will be achieved through concrete actions: Engaging local Ministries, agencies and stakeholders in the project processes (design, implementation, evaluation, etc.) to promote buy-in and local ownership. Seeking alignment with the Ministry of Health’s national health priorities and plans and the National eHealth Strategy. Ensuring Zero Mothers Die is integrated with local health services and health information management systems, and thereby within local health ecosystems. Establishing an inclusive business model to ensure long-term sustainability and limit burdens on budgets.
- 23. For any questions or requests for more information on Please contact: Jeannine Lemaire Zero Mothers Die Project Coordinator at: Lemaire.Jeannine@gmail.com http://www.millennia2015.org/Zero_Mothers_Die http://www.adaorganization.org/index.php/projects/zero-mothers-die
Notas do Editor
- The critical problem that Zero Mothers Die aims to tackle is Unacceptably high maternal mortality, due to mostly preventable causes and HIVI’m sure you are all familiar with these figures…In 2010, 287,000 women died during and following pregnancy and childbirth, with 800 women dying each day from preventable causes related to pregnancy and childbirth complications.99% of these maternal deaths occurred in developing countries, with more than 50% taking place in sub-Saharan Africa.And 24% of these deaths are directly attributable to HIVBut the most important fact here is that most of these deaths could have been PREVENTED…
- and that’s where Zero Mothers Die hopes to make an impact.What is Zero Mothers Die?In broad strokes, it’s a global and innovative project to save the lives of pregnant women and new mothers through the systematic use of information and communication technologies (or ICTs) and mobile health.
- Zero Mothers Die is also a major multistakeholder partnership, initially formed with 6 major partners. It is led by 3 organizations: Advanced Development for Africa, Millennia2025 Women and eHealth Foundation, and UniversalDoctor, in partnership with key partners UNAIDS, Airtel and The People’s Vision.We are very glad to know that now the First Lady and the Government of Ghana, together with the UN System in Ghana are joining to complete the partnership for the implementation in Ghana.
- Zero Mothers Die takes its foundations from the UNAIDS Global Plan, an initiative towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. UNAIDS has identified 22 priority countries for the Global Plan. The 2 overall targets are: 1) Reduce the number of new HIV infections among children by 90%, and 2) to Reduce the number of AIDS-related maternal deaths by 50%.Within these targets, there is the main goal of reducing mother-to-child transmission of HIV to 5%.
- As one of the target countries of the UNAIDS Global Plan, Ghana was carefully selected as the first implementation country for Zero Mothers Die – with the initial implementation phase taking place in Greater Accra.
- Across the global project, our target beneficiaries will be 1) pregnant women and new mothers, and 2) local healthcare workers.In the initial implementation phase in Greater Accra, we aim to reach 2,700 pregnant women and new mothers, and 570 local healthcare workers.
- Let’s look at the Ghana context briefly, in terms of progress made according to the UNAIDS 2013 review of the Global Plan countries…From 2009 to 2012, there has been a 76% decrease in the number of new HIV infections among children, with 850 new infections in 2012.Less than 1 out of 10 women living with HIV did not receive antiretroviral medicines to prevent mother-to-child transmission of HIV, with 1 out of 10 women or their infants not receiving ARVs during breastfeeding.
- Those figures indicate that great progress has been made…In most of the Global Plan priority countries in sub-Saharan Africa, the number of children newly infected with HIV has declined from 2009 to 2012, although at varying rates. When the Global Plan initially launched in 2011, Ghana had a 31% decline in new HIV infections among children. According to the UNAIDS 2013 Global Plan Progress Report, Ghana has now achieved a 76% decline, the largest decline in the rate of children acquiring HIV infection in sub-Saharan Africa.
- But there is still more to be done to reach the targets of the Global Plan…1 out of 4 eligible pregnant women are still not receiving ARV therapy for their own healthThere is a 36% unmet need for family planning, which could further reduce the number of new HIV infections among children and improve maternal health8% of pregnancy-related deaths are still attributable to HIV…
- In addition, maternal mortality has been declared a national emergency in Ghana – with the lifetime risk of death for pregnant women being 1 in 66.
- Essentially, Zero Mothers Die is a comprehensive mobile health project. Why was mobile health chosen as the key element?Mobile phone networks today cover 96% of the world’s population, making it one of the most ubiquitous technologies around the world. 77% of all mobile subscriptions are held by 90% of the population in low- and middle-income countries.Therefore, the impact of mobile phone technology on maternal health and health in general can be far-reaching, cost-effective and replicable.
- Mobile health initiatives are increasingly focusing on maternal health issues, particularly MDGs 4 and 5 of reducing infant mortality and improving maternal health. These initiatives tackle a wide range of activities, including disease surveillance, health promotion, diagnostic support and remote patient monitoring…Mobile health initiatives tackling maternal health are reaching over 140 million women around the world thanks to effective initiatives such as WazaziNipendeni and MOTECH, and thanks to technology and resources provided by the Mobile Alliance for Maternal Action (or MAMA) and Text to Change.
- Zero Mothers Die initially tackles 2 MDGs in particular – MDG 5, improving maternal healthMDG 8, creating a global partnership for development… and specifically target 8F of MDG 8, which focuses on making the benefits of new technologies more available in cooperation with the private sector, especially ICTs, as Zero Mothers Die seeks to leverage mobile phones to deliver pre- and post-natal information and services to underserved women in low-resource settings.
- Zero Mothers Die has 3 main project objectives…The first is Reducing maternal mortality and maternal health complications……
- There are 6 main components of the Zero Mothers Die global project…The first is MumHealth, which is a mobile messaging service delivering healthcare information to pregnant women and new mothers in local languages and dialects via both SMS as well as voice to ensure women with low literacy levels and disabilities can benefit from MumHealth.The second is the distribution of 100,000 mobile phones per year to pregnant women – with the aim of providing healthcare information and services to 1/3rd of pregnant women at risk of maternal deaths each year.The third is the provision of 36,000,000 free airtime minutes per year to pregnant women. For specifically the Ghana implementation, this is made possible thanks to Airtel. This component is key to enable the women to communication when needed with local health workers and healthcare facilities.The fourth focuses on capacity building and education of local health workers through the use of tablets preloaded with localized maternal, newborn and child healthcare information, with a special focus on PMTCT (prevention of mother to child transmission of HIV). One of the main applications on the tablet will be UniversalWomen Educator, a tool built specifically for this project by UniversalDoctor.The fifth component, which covers a mobile money savings scheme, will help pregnant women to finance their access to skilled care during childbirth – which is one of the key factors for saving women’s lives during childbirth.The final component is a solar power business generation scheme to bring financial empowerment to pregnant women and provide sustainable green energy for the charging of their mobile phones, which is made possible thanks to the technology of The People’s Vision, one of our key partners.
- I’d like to go more in-depth on the first component of Zero Mothers Die,MumHealth. As I mentioned, this is a mobile health messaging service reaching pregnant women and new mothers. It will be built off of the MAMA mobile messages library, which will then be tailored and localized by UniversalDoctor for the Ghana context.- The MAMA messages library was created by BabyCenter according to UNICEF and WHO guidelines, and vetted by the WHO.- Their messages are being used in maternal mobile health projects by 226 organizations in 61 countries around the world.Most importantly, the messages are evidence-based – meaning they are built around key health behaviors and interventions which evidence shows can improve health outcomes.The topics of the messages include: antenatal care, nutrition, vaccination, PMTCT, infant feeding, oral rehydration, use of insecticide-treated bednets and post-partum family planning.
- So what are the key risks that Zero Mothers Die could face?First of all, as Zero Mothers Die has a key focus on PMTCT and the UNAIDS Global Plan, there is the risk of engendering discrimination due to HIV stigmatization.For this reason, Zero Mothers Die will target all expectant and new mothers, instead of only HIV-positive pregnant women. By generalizing our target beneficiary group, yet maintaining PMTCT as a key element of our project, we hope to avoid engendering any discrimination against participating women.Furthermore, this strategy will ensure women who would become HIV seropositive during pregnant are not lost by the project.
- Another key risk we face is language and illiteracy barriers.For this reason, MumHealth will be carefully tailored and localized in key languages and dialects in the area of implementation, and according to local cultural sensitivities.Furthermore, we have adapted our mobile messaging service MumHealth to include voice messages via Interactive Voice Response technology so that women with low literacy levels or disabilities related to vision can still benefit from this service.
- The third main risk to a mobile health project such as Zero Mothers Die is low mobile phone ownership levels among our beneficiary population.Regarding the initial implementation phase in Accra – this should not be an issue as local intelligence gathering performed by Airtel indicates that it is almost certain women own at least one mobile phone and that the issue of spouses controlling the phones and restricting access by the women is an unlikely risk in Greater Accra.In any case, Zero Mothers Die endeavors to equip at-risk, low-resource pregnant women who do not own a mobile phone through our mandate of distributing 100,000 mobile phones annually.
- And finally, the misuse or resale of the mobile phones provided by the project has been raised as an issue.The proposed solution is that the project’s mobile phones will be uniquely designed to be closely connected to pregnancy and maternal health issues, and they will have limited non-smartphone functionality to avoid theft.If an implementation area poses a significant risk of theft or misuse or resale, the project will work with its technology partners to restrict the numbers can be dialed through the phone.It is important to note that we are also addressing the issue of fake phones entering the country – Zero Mothers Die will ensure the mobile phones acquired and distributed by the project will come from responsible phone manufacturers who are reliable in providing quality mobile phones.
- Finally, I would like to present to you the guiding principles of the project: Sustainability and Scalability.Zero Mothers Die aims to achieve these through concrete actions, including:Engaging local Ministries, agencies and stakeholders in the design, implementation, evaluation and other processes of the project, to promote buy-in and local ownership.The project will carefully seek alignment with the Ministry of Health’s national health priorities and plan and the National eHealth Strategy.The project will also ensure that it is integrated with local health services and health information management systems, instead of running parallel systems, and thereby integrate within local health ecosystems.Zero Mothers Die will establish an inclusive business model to ensure long-term sustainability and limit the burdens on partners’ budgets.
- On behalf of the Zero Mothers Die Consortium, thank you for attending the presentation. For any further information or queries on the project, please feel free to get in touch with myself – Jeannine Lemaire, the Zero Mothers Die Project Coordinator – using the email address you see on the screen.