Pregnancy should be an exciting time, but for some women in Kenya it can be a dangerous experience. Women in sub-Saharan Africa have a one in 38 chance of dying in pregnancy or childbirth, compared with one in 3,700 in developed countries. It’s a situation exacerbated by limited access to quality, affordable healthcare for many low-income families, the geographical remoteness of some communities, which often means there is a lack of infrastructure, and a culture of mistrust for medical professionals, in favour of untrained community “midwives”.
When maternity-care provider Jacaranda Health was first established in Kenya in 2010, it was these women whom the organisation wanted to reach, running mobile clinics in tents before building more permanent facilities. Today, it runs an 18-bed hospital in Kahawa West, Nairobi, where it has provided maternal care to more than 30,000 women and delivered more than 3,000 babies. In 2016, the hospital reported that it had 66% fewer maternal and newborn complications than nearby facilities.
While chief innovation officer Sathy Rajasekharan does not consider Jacaranda a tech company, technology has played an important role in the facility’s success, and its ability to keep costs low. Prices are around a fifth of those of other private hospitals, with a normal delivery starting at 16,000 Kenyan shillings (£120). The company has developed digital tools to provide nurses with mentorship, feedback and training after each delivery, automated the hospital’s administrative systems so it can cope with rising demand, and invested in mobile technology to provide continuity of care from pregnancy and beyond.
Jacaranda, a member of UNDP’s Business Call to Action (BCtA), is one of a growing number of companies investing in improving the maternal health of low-income mothers through technology. In a country where mobile penetration is around 87%, Jacaranda uses tools such as SMS messages to remind mothers to attend their antenatal appointments (the World Health Organization recommends eight during pregnancy), watch out for danger signs such as headaches, swollen hands, or bleeding, and to vaccinate their children once they’re born. There are also WhatsApp support groups for mothers who can’t attend in person. The company has since worked in partnership with 25 public hospitals across three counties to reach more mothers. Rajasekharan estimates the text messages now reach 2,000 women a day.
“The results are pretty amazing,” he says. “Mums, as soon as they recognise a danger sign will go to a facility, they have better knowledge of two or more danger signs and they’re also taking up family planning postpartum.”
Working with a broader group has also provided valuable feedback and inspiration for Jacaranda’s next development. “While we were pretty explicit we didn’t want to answer clinical questions [through WhatsApp, text and on Facebook], because we couldn’t moderate effectively, they kept coming up. That’s what we’re working on now – providing a chat service, so women can ask [a nurse] questions … and we can escalate emergencies.”
It’s an innovative approach to a challenge that Kenya has struggled to overcome. The country fell short of its millennium development goal target to cut its maternal mortality rate by three-quarters by 2015. That year there were 510 deaths per 100,000 live births nationally, and in one rural county, 10 women died every day due to birth-related complications. But the Kenyan government has committed to reaching the sustainable development goals by 2030, one of which aims to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births, and to end preventable deaths of newborns and children under five.
Pauline Irungu, a senior policy and advocacy officer from the non-profit Path, says she has seen growing interest in improving maternal, newborn and child health in Kenya in recent years. In 2013, the government introduced free primary healthcare for children and free maternity care to encourage mothers to give birth in health facilities, rather than at home. By 2014, 61% of live births (pdf) were delivered in a health facility, compared with 43% in 2008/9.
Path itself has been involved in introducing a number of innovative healthcare solutions to public hospitals, including a simple device that stops postpartum haemorrhage, and chlorhexidine (often used in mouthwash) for cleaning babies’ umbilical cords and preventing infection. “If anyone’s going to innovate [in this area], it’s got to be frugal innovation,” Irungu adds. “A lot of people are living on the lower economic bracket. Your tech must match what Africa needs, wants and can buy.”
For Felix Kimaru, the inspiration for setting up mobile-health provider Totohealth in 2013 came after his aunt died giving birth. Because she hadn’t seen a healthcare professional during her pregnancy, she hadn’t known she was expecting twins and hadn’t gone to a hospital to deliver. Kimaru, a computer science graduate, wondered if he could build something to remind mothers to attend checkups. Totohealth now reaches 39,000 subscribers via its SMS and pre-recorded voice messages (key for reaching those with literacy issues), and has attracted more than 6m Kenyan shillings (£45,000) investment to develop the product.
The service now covers advice in early pregnancy, through to the child’s fifth birthday. The team has added new languages (there are 68 in Kenya) and context for different regions or cultures (such as not recommending fish for women living in the landlocked north). Kimaru works with five counties, with another two in the pipeline, but would like to see more government support for innovation at an earlier stage: “We’re not good as a country at trying things out. It needs to be proved and proved for the government to take up [these ideas],” he says.
Rajasekharan agrees that government support will be key to improving maternal healthcare in the long term, particularly as the majority of women (pdf) in Kenya give birth in public facilities. But Irungu is heartened by the tech sector’s input, which continues to improve the situation through innovators such as Jacaranda Health and GiftedMom, another BCtA member soon launching in Kenya. “As Africans, we’re increasingly becoming aware of the need for us to step up and address our own challenges. For me, there’s really hope that maternal, newborn and child health is a space where partnerships between government, private sector businesses, NGOs and civil society can [work] … It’s one of the areas where people are starting to see value in working together.”
Photography: Roopa Gogineni/Panos for the Guardian
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