By James Rwema;
I am pretty sure we could have lost this baby, if this community health worker hadn’t shown up,” Verene Mukamusoni, a 28 years-old young mother from Karama a remote rural village in Nyagatare, a district from Eastern Rwanda says, a smile sweeping her face.
Mukamusoni was in her routine farming activities when she noticed a bloody mucus discharge and water breaking before notifying a nearby health care provider using an established SMS system.
Just after receiving the SMS, the medical staff at neighboring Ngarama hospital (East) started to trace the pregnant mother to her home. By the time the ambulance returned to the hospital, the operation room was ready for her and she was taken into maternity immediately. Few minutes later, her 4 kg baby boy was born.
According to the latest figures from the Demographic and Health Survey (DHS) conducted by the Government and partners, out of every 100,000 live births 203 women in Rwanda die. Official figures also state that the infant mortality rate for Rwanda in 2020 was 26.536 deaths per 1000 live births, a 4.75% decline from 2019.
The adoption of the SMS technology kicked off a few years back with the sensitisation of local community health workers, hospital staff and the general public.
The programme has purposes of tracking all pregnant women, hence, reach every pregnancy, promote and monitor antenatal care through CHWs, increase communication between CHWs and health centres, identify and refer to women at risk and prompt death audit.
Before the advent of this solution a decade ago, the system was initially used to fight stunting and malnutrition among children in their first 1,000 days before it was fully expanded since last year in monitoring maternal, newborn and child health through two years of age.
Since then Geraldine Uwamurera, a Community Health Worker (CHW) from Nyaruguru in Southern Rwanda used SMS only to reach family and friends, but little did she know that the same texting application would save lives of many mothers.
45,000 Community Health Workers across Rwanda are contributing toward reducing maternal and child mortality rates with Rapid SMS
Uwamurera is part of the 45,000 CHWs across Rwanda who are operating at the village level to provide the first line of health service delivery where their role has greatly contributed toward tracking maternal and under five children health to prevent unnecessary deaths.
The Rwanda CHW Program was established in 1995, aiming at increasing uptake of essential maternal and child clinical services through education of pregnant women, promotion of healthy behaviors, and follow-up and linkages to health services.
There are currently about 45,000 CHWs operating at the village level provide the first line of health service delivery, according to official estimates.
Interactive real time communication
The mobile phone (mHealth) monitoring system is one of the innovations that is currently boosting smart health in Rwanda where Community Health Workers like Uwamurera are relying on to report on antenatal care visits, pregnant women with risks, report death of a child or a mother, and a simple text will avail an ambulance even in the remotest parts of Rwanda.
CHWs work in tandem with over 500 health centers in hard-to-reach communities across Rwanda. The health centers provide a range of services as CHWs, as well as consultation with nurses, hospitalization, pharmacy services, evacuation, and arrangements of hospital visits, deliveries and caesarean sections.
CHWs who follow up pairs of mother-infant in their villages, are trained and equipped with mobile phones to allow interactive real time two-way communication with the health ambulance system.
Using mobile phones provided as part of the RapidSMS program, CHWs record new pregnancies including mother/infant identification and the first day of the last menstrual period into the RapidSMS system.
“We also record danger signs and symptoms suggestive of potential life-threatening event that warrant urgent attention,” Uwamurera said in an interview.
According to Dr Ndayishimiye, the application is a free and open source platform for mobile system built in Python and Django, where it was customized to track key maternal, newborn and child health indicators across all villages in Rwanda.
Whereas the platform’s main solution aims to facilitate communication between CHWs and the ambulance system, health facilities staff, and the central government, some experts in public health sectors note that yet the system contributed in increasing the number of women who are delivering at a healthcare facility, there are still some problems that are not addressed by the RapidSMS.
According to Ruto Hinda, one of the senior researchers at the e-Health program at the School of public Health of the University of Rwanda, lack of trainings, lack of motivation fee among CHWs, remoteness and network coverage by the smart phones used in visiting pregnant women remains one of the biggest challenges with Rapid SMS reporting on child and maternal health in Rwanda.
Dealing with cases of diseases
Despite these limitations, however, Rwandan health officials are convinced that the adoption of the technology is significantly contributing to identify and refer to women at risk in remote rural zones and prompt death audit.
In addition health officials said that the new system helps in decreasing transit time from arrival to hospital to entering theatres, thus, it reduces the rate of maternal deaths and other unexpected deaths caused by avoidable conditions.
Thanks to the achievements made through this innovation, the Rwanda Biomedical Center (RBC) is currently exploring the use of the same solutions in dealing with various cases such as malaria, diarrhea and pneumonia as another section of diseases that are slowly rising drastically in the country.