RHEA Phase 1 Storyboard

Purpose This provides a high level overview of the solution, in a simple story format.

First Visit- Registration The pregnant woman will come to the health center for their first antenatal (pregnancy) visit. The Health Care Worker will go to the computer (running OpenMRS) and enter the woman's name and other identifying information to look them up. If they find them in the system, they will verify their information. If they are not found; the health care worker will register the woman in the system. This may include issuing a temporary ID if the woman does not have an NID.

First Visit- History The health care worker will enter the woman’s obstetrical history directly into the computer. This information is very similar to the current forms that are filled out by the health worker. By entering this information in the computer- they do NOT need to enter it into the register or the paper record. In addition to the history some tests and an examination is done, and these results/observations are also entered into the computer by the health worker. The woman is given the date for their follow up appointment. Based on the results of the tests- a referral may also be made to another area (such as PMTCT)

Routine Visits Based on a target of 4 health center visits per pregnancy, the woman returns at the scheduled time for these routine visits. At each visit the health care provider; Looks the woman’s record up on the computer (OpenMRS) to review the information, Records the tests and observations done at the visit, Determines if the woman will need to be referred for specialised care. There may be some alerts built in to the system that warn the health provider the woman may need to be referred

Between visits- in the community A community health worker is responsible for the pregnant women in their area. This responsibility includes checking on the woman between the 4 routine visits to the health center. If the CHW finds any issues, she will send an SMS (via RapidSMS). This may also trigger an alert and instructions (via SMS) advising the CHW on how best to advise the woman.

Needing Specialised Care The woman may develop a complication during pregnancy or delivery that requires specialised care. The health care worker will indicate the referral information on the computer as well as on paper (either hand written or printed). They will then send the woman to the specialised care (by ambulance if it is an emergency).

Providing Specialised Care When the woman arrives for referral, the health care worker (usually nurse or doctor) will be able to view her information by accessing the record through a web based application. They may also enter a very minimal amount of information about the care they provided (date, diagnosis, outcome) directly into the record. This information will be available to the health center as well when the patient returns to them for care.

Delivery and Birth When the woman is in labor, she is encouraged to go to the health center to deliver. When the woman arrives the health care worker will look her record up in the computer, review any relevant information (and print it if needed). After the woman delivers, a summary of the delivery will also be entered into the computer (this is similar to the information collected in the maternity register).

Registering the Baby After delivery, but before the new mother is sent home, the health care worker will enter the information about the baby. This will include creating a new record for the baby As part of this process, a printed birth registration form will be produced and given to the parents to be submitted (as the official birth registration)

After the pregnancy All of the women’s clinical information (specifically around her pregnancy) will remain in the shared health record. If she becomes pregnant again, her previous pregnancy history will be available to providers who have the authority to see clinical information.