Mobile phones and mobile money to expand access to emergency obstetric care

1. Fuel For Life
A Model to Increase Access to Timely Emergency
Obstetric Care in Uganda

2. The Problem
Every day, 800 women die from
preventable pregnancy complications

3. Why are Mothers Dying?
Three Critical Delays lead to 75% of
Deaths from preventable complications
 Delay in seeking care
 Delay in transportation – reaching
an adequate health facility
 Delay in receiving appropriate care

4. A Daily Occurrence
Imagine you’re a midwife caring for pregnant
women in labor in rural Uganda. One day, a woman
comes to your clinic in labor. You identify a problem
but it takes over 20 hours to coordinate reaching the
hospital. By the time she arrives, the baby she
carried for 9 months is dead.
Each day, nearly 20 mothers in Uganda die, 41
babies dies within 1 minute of delivery, and
countless stillbirths occur in similar circumstances…
What can we do?

5. Why are Mothers Dying?
Three Critical Delays lead to 75% of
Deaths… preventable deaths
1. Delay in seeking care
2. Delay in transportation – reaching
an adequate health facility
3. Delay in receiving appropriate care

6. Barriers to Care
1st Delay
•Perceived value
2nd Delay
•Communication
•Cost
3rd Delay
•Supplies, Staffing, & Training
•Advanced Notification
WHO: Reducing
Maternal Deaths, 2001

7. Paper Transport Vouchers Increased
Skilled Attended Deliveries
Ekirapa-Kiracho et al. BMC Intl Health Human Rights 2011

8. Referrals Vouchers
Implementation
of SMGL voucher
program
Saving Mothers Giving Life, unpublished data

9. Paper Vouchers are Unsustainable
• Inefficient
• Cumbersome overhead
• Subject to Fraud & Abuse
THEREFORE NOT SCALABLE

10. Paper Vouchers are Inefficient
• Vouchers are submitted monthly to
a log maintained by program staff
• Each month claims are verified
• Voucher officers visit all health centers and
hospitals
• Summarize data
• submits funding request to finance office
• Reimbursement made (7 weeks later)

11. Mobile Network e-Fuel Vouchers
Faster, Efficient & Scalable

12. Fuel For Life
• Free Dispatch and Reimbursement
platform
• Designed, Programmed, and
Developed in Uganda, by Ugandans
• Strengthens and Supports Existing
infrastructure
– Existing Drivers and Cars
– Extensive Mobile Network

13. Grass Roots Emergency Maternal Response
1a
1
Hospital Ambulance
Community Drivers
Dispatch
1b
1. Midwife activates
emergency alert
2
2. Driver selected; Midwife
notified; clinical
information captured &
transmitted to Hospital
3. Patient promptly
transported to hospital
4. Hospital Referral
confirmed, Driver
compensated
4
3
Picks up Patient

14. Not Only Emergencies
• Community Vouchers Can Increase
Demand
• Antenatal Care
• Skilled Attended Deliveries

15. Facilitating Community to Hospital
Dispatch
Patient is
registered at
Antenatal Care

16. Facilitating Community to Hospital
4.
Dispatch
6.
5.
2.
3.
1.
1. Laboring patient
contacts local Boda
driver
2. Boda driver confirms
maternal voucher
3. Patient transported
to health center
4. Health Center
Midwife validates
Boda voucher
5. Driver receives
voucher for 1.5L fuel
6. Voucher redeemed

17. Rapid, Efficient Transport
Delay #1
•Emergency Transport Incentivizes Delivery at
Health Centers
•Bodas assist with community transport
Delay #2
•Decreased Referral Time & Cost
Delay #3
• Rapidly Communicates Clinical Info from
Midwife to Hospital

18. Mobile Maternal Health Log
• Facilitate M&E of Utilization and
Outcome reporting
Paper  Electronic data base
• Facilitates Real Time Reporting
• Expedited Measurement/Evaluation
• Optimized Resource Management

19. Future Integration:
Partograph
• Charts progress in labor
• Records fetal and maternal
condition during labor
• Detects abnormal events and
patterns

20. Partograph
Prompts Providers to
Record & Respond to
Critical Intrapartum
Events
•Tracks changes in Fetal Heart Rate
and Contractions
•Tracks cervical dilation or progress
in labor
•Records maternal vital signs (Pulse,
Blood pressure, Temperature) to
improve diagnosis of problems
•Records changes in amniotic fluid or
maternal urine

21. mParto
Winner of the 2012
Microsoft Imagine Cup
• A digitized/mobile Partograph
• Centralized Patient Management
• Notifications and Reminders
prompt Provider
• Can identify problems early and
recommend evidence based
responses
• Tracks multiple patients at the
same time
• Works on Feature phones,
Android and Windows Phone

22. FUEL For LIFE
A Community Led, Emergency
Obstetric Referral System

23. Join Us Today
Contact: Peter Klatsky M.D., M.P.H.
Department of Obstetrics & Gynecology
Albert Einstein College of Medicine,
Montefiore Medical Center
Email: pklatsky@montefiore.org