Although considerable progress has been made in reducing maternal mortality in Senegal over the past 25 years, the national maternal mortality ratio (MMR) sits at 315 deaths per 100,000 live births – still unacceptably high. Reaching women in rural and remote areas is a tremendous challenge and a major source of this problem.
Maggie MacDonald, Associate Professor of Anthropology at York University recently published a study exploring the potential of mobile health interventions to improve maternity care in remote, rural, and underserved communities in Senegal. The study was co-authored with Gorgui Diallo, Country Director of Africare Senegal, and is available in BMC Reproductive Health. The project was funded by Grand Challenges Canada in their Saving Lives at Birth stream.
The study used ethnographic research methods to look closely at a customized CommCare mHealth app (developed in collaboration with Africare) to help community health workers known as matrones deliver care in their communities and liaise with the formal health care system. The goal of the study was to identify locally specific social and cultural factors that contribute to the uptake and functioning of this mHealth intervention in Senegal.
Using the CommCare app, matrones enroll pregnant women in their communities and track them throughout pregnancy, birth, and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers. The research findings reveal five socio-cultural factors that contribute to the successful deployment and usage of the app:
- First, the matrone is a member of a community health intervention called the Care Group, which convenes women on a weekly basis to talk about shared health concerns.
- Second, the privacy of the Care Group enables women to disclose their pregnancies early on, get enrolled discretely on the system and begin antenatal care.
- Third, the study found that CommCare within the Care Group intervention is promoting a degree of collective authority for women in their communities that helps them take more control of their health.
- Fourth, CommCare harnesses the roles of older women — who hold more social power than young women — as advocates of the intervention rather than trying to side-step them.
- And finally, CommCare adds value to community health worker roles.
The paper elaborates on these factors, but across them all, the research shows the importance of including qualitative research in finding cross-disciplinary solutions to complex health issues.
“It’s somewhat rare for the work of an anthropologist using ethnographic methods to appear in a scientific journal,” said professor MacDonald. “As we argue in the paper, it is vitally important for health experts to talk across disciplinary boundaries if interventions to address the problem of maternal mortality in low resource settings are to work.”
MacDonald and Diallo are hoping that such qualitative research will be embraced by the scientific community.
The paper also makes the point that new mobile health technologies alone cannot reduce maternal mortality rates, but rather it is the technology in its social context that matters. In the case of CommCare, the technology creates social connections between matrones and the women they care for, and importantly, fosters mutual respect between matrones and skilled providers, thereby optimizing the function and effectiveness of the application.
“Successful mHealth interventions do not work as ‘magic bullets’ but are part of ‘assemblages’ – people and things that are brought together to accomplish particular goals,” Professor MacDonald explains in the paper. “While CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care.”
The study is available for free in its entirety at BMC Reproductive Health.
For more information on how to successfully implement a mobile data collection solution for anything from maternal mortality rates to crop yields, read out Guide to Mobile Data Collection.
