1. HL7 MHWG LMIC Use Case Using Mobile Devices to Reduce Childhood Mortality Rate in Sub- Saharan Africa and Southern Asia

2. World Health Organization(WHO) Facts Source: Report by PMNCH, WHO and Aga Khan University 12 December 2011 358,000 women die during childbirth annually Annually, 7.6 million children die under the age of five – Majority of deaths occur immediately or after childbirth Common causes: – Bleeding – High blood pressure – Prolonged or obstructed labour – Infections 40% of under five deaths occurs during the first 28 days of life ~ 3 million deaths 75% of all newborn deaths occur during the first week of life – Main cause of neonatal deaths: pre-term birth; severe infections and asphyxia Lots of knowledge and information available on the subject. Main issue: Lack of consensus in how to move forward in a coordinated manner to be most impactful

3. Use of Mobile Devices to reduce childhood mortality rates via continuum of care Scenario: Coordinate care between clinic midwife, mobile midwife, and Community Health Worker (CHW). CHW identifies and registers pregnancies in the community. Standard care plan consists of iron tablets during entire pregnancy (dispensed by midwife or CHW) and 4 antenatal visits by a midwife. (Births attended by skilled personnel reduces perinatal, neonatal, and maternal deaths) Recommended delivery location is at a clinic with a midwife, although mobile midwives or trained birth attendants (TBAs) may also assist a birth in the community. CHW will visit mother 4+ times during pregnancy to provide counseling and to assist mother in maintaining her care plan. The CHW may also record pregnancy history and identify potential risk factors. Urgent risk factors (esp. in the 3 rd trimester) may be cause for urgent referral, in which case the CHW may help arrange transportation through an ambulance or local car owners. Prior consent for emergency transport from families can be recorded on phones to expedite the transition of care. Midwives will follow up during antenatal visits on risk factors identified by the CHW (or by a mobile midwife, if additional examination facilities are required). CHWs may also be prompted to follow up on potential issues identified by a midwife. CHWs play an important role in educating mothers on care options, birth preparedness, and family planning counseling. These services may be facilitated by job aids, which can be embedded on a mobile device.

4. Potential Solutions Leverage the wide availability of sub-$100 tablets (Limit access to non-health IT access) Leverage regular feature phones to send messages and communicate with pregnant women and new mothers – Load with applications for tracking pregnant women; – Leverage local storage on device to store data; upload when connection is available; at least once weekly – Develop simply applications to register pregnant women Use Text messages to educate women about proper prenatal care Application to track CHW visits to each patient; alert and schedule next visit Track blood pressure measurement (simple attachment to smartphone); set threshold for concern Use text messaging to send simple reminders to pregnant women; Track locations of women near delivery dates to ensure midwife availability for delivery or visit shortly after delivery CDC program deployed in 50 US states Text4baby is a free service that provides pregnant women and new moms with free text messages each week on pregnancy and baby care.

5. Trial Define proposed solution Select one of two test markets to trial proposed solution over a year to assess impact (Is this too short ) Define current conditions Define success Implement Document impact Amend solution based on lessons learned Secure funding for a larger trial Standardize based on what works