Sustainable cross-cultural innovation leads to safer labour and delivery of newborns in India

The following blog post by Dimagi India Country Director Stella Luk and Field Manager Max Izenberg is about Dimagi’s work developing  mLabour, a mobile tool to be used by healthcare providers in resource-constrained settings to help monitor women’s labors. The original blog post was written for Grand Challenges, which is sponsoring the development of mLabour. 

When stepping into many tertiary healthcare facilities in India, the major challenge faced by nurses and midwives across the country seems to be consistent: lack of time. Often, when some women across rural and urban India finally access a facility to deliver a child, the clock may be running out for the woman’s labour, and the aids to assist delivery are limited or challenging. In 2010, 56,000 women in India died during or shortly after their pregnancies, accounting for 20% of maternal deaths globally (UNFPA). The WHO promotes universal usage of the partograph, a paper labour management tool that can halve prolonged labour and postpartum infection, and prevent obstructed labour. However, partograph usage and competency remain low among Indian healthcare providers.

Grand Challenges Canada has given Dimagi the opportunity to develop mLabour, a mobile tool to be used by healthcare providers in resource-constrained settings during the intrapartum period, which includes the development of a mobile partograph. mLabour, based on Dimagi’s cloud-hosted CommCare platform, will be used by healthcare providers to facilitate decision-support throughout the intrapartum period and will provide timely alerts for appropriate actions, to prevent the leading causes of maternal mortality in India. By developing a mobile partograph that addresses these challenges, Dimagi hopes to create a compelling tool to redu

ce obstructed labour, which causes 10% of maternal deaths in India and disables tens of thousands of women annually.

Despite the paper-based partograph’s immense value in reducing maternal mortality and morbidity, many healthcare providers find it complex and that it requires unreasonable amounts of training. Over the past few months, as part of Dimagi’s “design under the mango tree” philosophy, Dimagi Field Manager Maryam Khalid has been conducting formative research throughout India on partograph usage in a myriad of healthcare delivery settings. Maryam has been researching the difficulties of the paper-based partograph and its limitations in usage during labour, and has been working with healthcare providers to gain insight on strategies to optimize the value of the partograph on a mobile platform. By focusing on user-centric design, mLabour aims to address the challenges faced by healthcare providers learned from these formative experiences. To meet the specific needs of the healthcare providers Maryam has interacted with, mLabour will provide relevant and contextually appropriate real-time decision support on a tablet device, to improve these providers’ performance and to increase the uptake of the partograph. Based on Maryam’s findings, Dimagi has begun to build candidate designs and will test these out over the next couple of months.

Earlier this week, Dimagi’s Partnerships & Development Manager, Devika Sarin, attended an exciting roundtable with His Excellency the Right Honourable David Johnston, Governor General of Canada, the High Commissioner and some members of Parliament in New Delhi, organized by the Grand Challenges Canada team. The meeting allowed a few public health innovators like us to provide insight on the work we’ve been able to accomplish thus far through the Stars in Global Health grant, and to discuss how the collaboration has provided us the opportunity to move the partograph idea forward in a scalable and sustainable manner. It was a rewarding experience that provided a high-level perspective on the role of our project, and of course it was a pleasure to hear His Excellency’s engaging and thought-provoking stories on why innovation and cross-cultural projects are crucial to making sustainable impact.