A woman looking at the display showing an ultrasound scan of her baby at a health center in Homosha, Ethiopia. Photo by: UNICEF Ethiopia / CC BY-NC-ND

Every day, more than 800 women around the world die from preventable causes related to childbirth and pregnancy. COVID-19 has exacerbated many of the challenges faced in delivering maternal and child health care, yet it has also triggered a digital shift that brings huge opportunity.

Disruptions to maternal health services, as a result of the pandemic, have highlighted the fragility within health systems. One particular area thrusted into the spotlight was the lack of digital infrastructure and capabilities as well as how digital technology offers to support resilience in the health system and improve quality of care.

This was the subject of a virtual roundtable hosted by Devex, MSD for Mothers, and the Bay Area Global Health Alliance, on March 3, which explored the current barriers to accelerating the implementation of digital innovations for maternal health in low- and middle-income countries, as well as potential solutions for better efficiency in collaboration around digital solutions.

Speakers included Bernardo Mariano Jr., chief information officer and director of digital health and innovation at the World Health Organization; Njide Ndili, Nigeria country director for PharmAccess Foundation and MomCare; Natasha Sunderji, global health lead at Accenture; Nosa Orobaton, senior adviser for health at the Bill & Melinda Gates Foundation’s Africa region office; and Dr. Mary-Ann Etiebet, lead at MSD for Mothers.

Here are four takeaways from the conversation:

1. COVID-19 has triggered a digital shift that could transform maternal health care and drive progress toward universal health coverage

Over the years, digital technology has become an essential part of many countries’ health systems. COVID-19 and the subsequent strains on health systems have only further highlighted the need for, and progress in, the development of digital health solutions, noted Mariano.

For example, MomCare — developed by PharmAccess Foundation with support from MSD for Mothers — is a digital platform that helps women across sub-Saharan Africa track their maternal health journey to help ensure quality of service and provide data for building resilient quality focused health systems. At a time when in-person health care visits have been limited, such an intervention has been key in plugging the maternal health care gap.

“We need to engage with governments to advance an enabling environment and policies that incentivize health application innovation and investment in order to achieve global health goals.”

—  Dr. Mary-Ann Etiebet, lead, MSD for Mothers

Such innovations should be tapped into to continue driving progress in maternal health beyond the pandemic and accelerate progress toward UHC, all panelists agreed. “We’re not going to get to our goals of ending preventable maternal mortality without UHC and without leveraging the power of digital technology,” Etiebet said.

Some organizations have already taken steps to do so.

For example, during the past year, WHO has, for the first time, engaged extensively with technology companies to design, implement, and scale up digital solutions to support countries with their pandemic responses and other needs, Mariano said. This work has included accelerating the digitization of its antenatal care guidelines, which have now been released in SMART — standards-based, machine-readable, adaptive, requirements-based, and testable — form.

Orobaton warned that for all to benefit from such solutions, the digital divide must still be tackled.

A virtual roundtable held at Prescription for Progress 2021, identifying the current barriers to accelerating the implementation of digital innovations for maternal health in LMICs. Via YouTube.

2. Human-centered design is key to advancing quality maternal care

The design of individual solutions for maternal health care and the digital architecture behind them must be guided by the needs of women and children, argued Sunderji. “Digital health tools have the potential to give more power to the patient, and thus, give greater health equity,” she said.

A benefit of the move toward the digitization of health care is the opportunity to easily gather patient feedback and ensure that those served are at the center of the design and evolution of digital health solutions. This will lead to the advancements needed to achieve quality care and UHC.

Getting feedback from people receiving care is an important consideration for WHO when it considers partnerships with digital health initiatives, noted Mariano. “How can we ensure that we have a mechanism that allows us to listen to the person being treated?”

Countries must also invest in education and training for young people from diverse backgrounds, in both health care and digital skills, Sunderji added. This will ensure they have a workforce that not only has the right skills to develop digital health solutions, but that understands the health needs and challenges of a wider swath of society and can factor this into their design.

The combination of a talent acquisition strategy that attracts a diverse health workforce, educating young people, and gathering feedback via digital tools will support a human-centered design that leads to the strongest outcomes.

3. Governments must create the right environment for digital health care to thrive and incentivize private sector innovators and investors

Improving maternal health outcomes through digitization will only be achieved through collaboration with the private sector, Mariano said. “Governments must however take the lead in creating a supportive governance and regulatory environment that also takes into account the privacy and security of care receivers’ personal data,” he said.

“In countries where we want to scale, if the country does not own the strategy and process and governance of the data [coming from digital solutions], it’s a critical obstacle,” Orobaton agreed.

To achieve sustainable adoption of digital technology, “it’s important for the government to be in the lead with public-private partnerships to support for the end result they desire,” added Ndili.

This must include creating the right incentives for the private sector to develop and deploy health applications of current digital technologies and investments, Etiebet said. “We need to engage with governments to advance an enabling environment and policies that incentivize health application innovation and investment in order to achieve global health goals.”

4. Scale, sustainability, and accountability should be designed into digital health ecosystems from the outset

Breaking down silos between the various digital solutions and their operators, be it private or public providers, is also essential for ensuring ease of use for both health care providers and receivers, and for improving their scalability and sustainability within a UHC framework.

While front-end maternal health care solutions are important, it would be better to focus first on the back-end of digital health ecosystems, designing out fragmentation and designing in integration, argued Orobaton. Otherwise, “these types of pilot will not scale and not go anywhere.”

“We don’t think about scale and sustainability early enough,” agreed Sunderji. “Solutions that are appropriately designed with scale in mind will have the right elements to become the broader, more integrated digital health ecosystem that includes digital health records and beyond,” Sunderji added.

As governments, the private sector, and civil society work to close the maternal health gap, there also needs to be clarity around current and emerging challenges and constant dialogue on how to overcome them, with champions for the cause ensuring it remains high profile, concluded Etiebet.

Through its Maternity Matters series with Devex, for example, MSD for Mothers is working to “create visibility for this — for with visibility comes accountability,” she noted. To continue attracting not just financing but committed action to overcome obstacles, “we need to inventory those barriers, whether they’re policy barriers, process barriers, or people barriers.”

To find out more about how to implement innovative solutions for maternal health at scale, watch the full event.

The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.

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