Mobile Based Design for Strengthening Traditional Birth Attendant Health Care Systems in Low Resource Settings: The Case of Migori County, Kenya

Abstract

Mobile health applications are established tools for healthcare management, patient education, and capacity building of healthcare providers. However, their use for strengthening Traditional Birth Attendant (TBA) health care systems is surprisingly limited in low resource settings where geographic, social, or economic barriers render the World Health Organization (WHO) policy of facility births untenable. The work presents a blueprint for implementing a mobile-health intervention for strengthening TBA health care systems in low resource settings. The objectives were to establish existing TBA structures, their challenges, TBA user requirements, and to develop and test a prototypical implementation. A mixed methods study facilitated the collection of quantitative and qualitative data from a population of pregnant mothers seeking care within public hospitals in Migori County, TBA & skilled birth attendants (SBAs). A survey instrument administered to 20 patients, 20 skilled birth attendants, and 20 traditional birth attendants was used in establishing challenges of existing structures, eliciting user requirements, and for the design and testing of the prototype mobile based design. Snowballing sampling enabled the researchers reach patients and TBAs who had visited the four public facilities in Rongo Sub County in the second quarter of the year. The focus group discussions method led to refined user requirements, while review of documents on maternal and newborn care protocols enabled the research to determine desired system functionalities for the new roles envisaged by the World Health Organization (WHO) for TBAsin low resource settings. Findings showed that TBA health Care systems were manual with weak links to the formal health care system. Users required a system that could support secure collaboration between TBAs and SBAs, address the problem of scarce SBAs and facilities, improve the convenience, cost and quality of care suitable for their social economic status. Figma was used as a user interface design tool to rapidly prototype the design. The prototypical design was implemented in MySQL and Java. The resulting mobile based design provided users with functionality to register and log into the system, capture, and avail patient data, access global maternal and child health protocols and offer telemedicine sessions between patients, TBA and SBAs. The prototypical TBA app was tested during a focus group session for performance, usability, and utility. The TBA app offers a convenient, cost effective and quality system while addressing the key challenges of manual TBA health care systems in low-income settings. Findings offer valuable design insights for implementing a mobile based initiative to address the challenge of reducing maternal mortality in low resource settings in Kenya and beyond.