mHealth and Leadership Skills Helping Midwives Improve Service Delivery for MNCH and HIV

Sarah McKee

Project Associate

This story orginially appeared on Management Sciences for Health's website.

Many discussions on incorporating technology in the health field revolve around flashy mHealth tools which improve overall health information systems. Yet smaller scale use of mobile technology can be just as effective in supporting health workers in developing countries to overcome day-to-day challenges and effectively deliver health services, especially in rural communities.

Mary Gonera is a midwife who led the Mucheke Community Health Center team to improve health services in Masvingo, Zimbabwe. (Photo: Amref Health Africa)

Mary Gonera is a midwife who led the Mucheke Community Health Center team to improve health services in Masvingo, Zimbabwe. (Photo: Amref Health Africa)

The challenges that these health workers, such as midwives, face while delivering services oftentimes are not clinical in nature: like long-wait times at health facilities that discourage male involvement in antenatal care, community distrust of health facilities or services leading to higher rates of unskilled birth attendance, or staffing shortages of midwives that hinder the number of skilled deliveries at district-level clinics.

A new leadership, management, and governance course for midwifery managers, developed by the US Agency for International Development (USAID)-funded, Management Sciences for Health (MSH)-led Leadership, Management, and Governance (LMG) Project, in close collaboration with Amref Health Africa, is an in-service training program designed to help midwives develop leadership, management, and other skills that contribute to an enabling environment for improved maternal, newborn, and child health (MNCH) service delivery.

By leveraging increased access to mobile phones and capitalizing on the growth of WhatsApp, a popular mobile instant messaging application, the LMG Project facilitates ongoing coaching and peer support among midwives who’ve taken the course by organizing WhatsApp group conversations. The WhatsApp groups eliminate the communication barriers posed by physical distance between the midwives, and allow midwives to maintain more reliable access to their peer support group instead of relying on inconsistent computer or Internet access.

The Course consists of a five-day workshop focusing on: teamwork and communication, advocacy, coaching and mentoring, data use for decision-making, change management, and strategic problem-solving. During the training, midwife participants identify a workplace challenge they wish to solve and develop a six-month action plan to implement at their facilities after the workshop. During implementation of their action plans, regular support, feedback, and coaching from facilitators and peers help hold the participants accountable.

Mary Gonera, one of the midwives trained in the LMG for Midwifery Managers Course, adopted a mobile-based intervention as part of her team’s action plan. Gonera is a midwife and mid-level manager at the Mucheke Community Health Center in Masvingo, Zimbabwe. At their facility, Gonera and her team saw a worrying reality: some HIV-positive postnatal mothers who had started antiretroviral treatments to eliminate mother-to-child transmission of HIV were discontinuing their treatment regimens.

Gonera and her team set a target of reducing the amount of mothers defaulting on their antiretroviral treatments to two percent of postnatal mothers by the end of their six-month action plan. Gonera planned a two-part community education initiative using both client group meetings in the health center and a community outreach program, which provided counseling for undisclosed HIV-positive couples. Through community education activities, Gonera and her team were able to educate more than 100 community members. After six months, no mothers in their clinic were defaulting on their antiretroviral treatment.

Throughout the process, the Mucheke Community Health Center team helped sustain these improvements by using mobile phones to conduct appointment follow up using text messages or calls.

Similarly, Gonera received consistent, reliable support from her peer network and coaching from her trainer through the WhatsApp group conversations. Through the use of mobile technology and the application of the leadership training Gonera received, her team was able to improve health service delivery and MNCH indicators in their community.

To date, 109 midwives across 10 Eastern and Southern African countries have completed the certificate course.