Digital Decision Making Support for Midwives

Testing tools and prototypes in Trans Mara, Kenya
July 8, 2016

Project iDeliver is a programme designed to improve maternal healthcare in low resource settings. Project iDeliver will do this by creating tools to help support midwives with decision making, from the moment a pregnant woman arrives at the facility to give birth until the time she is discharged. The tools will enable pregnancy complications to be assessed and prioritised simply and for women to be tracked throughout their stay at the facility. The data gathered throughout the care journey will enable government policy makers and facilities to identify areas for improvement and have confidence in the quality of the midwifery care.

Project iDeliver started with a research phase to identify opportunities and develop an understanding of the users’ needs. Now we are developing prototypes for digital tools based on these research insights.

In June 2016 my colleague Raphael Mutiso and I travelled to Kenya to test our first tool prototypes. Although the tools we will develop will eventually be digital (e.g. an app, website etc) the prototypes we use at this stage are printed out on paper, enabling testers to reorder and change things easily.We spent over a week in Trans Mara area, where the Project iDeliver pilot will be implemented, conducting workshops, interviews and observations in three dispensary facilities (maternity wards in rural areas) and in Kilgoris District Hospital.

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We conducted a workshop with midwives, nurses, doctors and facility managers. The aim was to create detailed maps of their clinical workflows and the most common processes they use when admitting, discharging and referring a client. We also learned a lot from the interviews we conducted with users and from our observation sessions. The fact that there is only one midwife per shift makes it challenging to have an eye on everything. One of the features of the tool that we are developing which was most appreciated by users is the ‘facility overview’. It helps midwives to keep track of the women during their time at the facility and prioritise their care based on the level of urgency.

We are also trying to solve the problem of an overload of paperwork. The midwife spends almost half an hour per woman on reporting. Usually at the district hospital there are 10 women in labour, therefore a midwife will spend the majority of her shift doing paper work. We want to reduce the pain of paperwork not only by digitising the reporting system but also by identifying the best way of entering the right data at the right time.

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Collecting data also offers the opportunity to put it into use. The Project iDeliver tools will offer decision making support for identifying and managing the care of women. And we aim to reduce the chances of maternal and newborn death over the long term by early and constant collection of data so facilities can spot trends and patterns in healthcare outcomes and intervene promptly.

We are developing solutions to improve the referrals systems. One of the major challenges is that referral facilities might lack up-to-date information on available resources (such as blood stocks or whether a surgeon on duty), causing significant delays for approving the referral. We aim to solve this type of problem with an efficient inventory system and by streamlining the communication among different facilities.

Last but not least, we want to contribute to helping midwives in communicate health information to women. The education levels in rural Kenya are diverse and often women are not made fully aware of their condition or that of their babies. We are creating visual tools that can help communicate health information to women, for example why C-section is needed or why a referral is being made.

During this trip we gained a clear understanding on the user workflow which will allow us to develop the Project iDeliver tools further. Next step is the design of the user experience and user interface, we’re looking forward to working on it!

Follow the M4ID blog for updates on Project iDeliver and all our programmes.