The COVID-19 pandemic has caused substantial shifts in how maternity care is being delivered. As the virus began to spread, health systems across the world were forced into emergency mode, focusing on administering urgent care and reducing infection rate. The resulting staffing shortages and necessary restrictions put immense pressure on the maintenance of vital day-to-day health services, including those affecting expectant and new mothers.
COVID-19 has also been associated with a higher risk of maternal and newborn complications. While universally problematic, pregnancy outcomes are most severe in under-resourced areas, where misinformation has been rife, leaving many uncertain about COVID-19 symptoms, how it spreads, and how best to protect themselves.
At the Johnson & Johnson Center for Health Worker Innovation, we have been working with our partners to prioritize safe, accessible and equitable maternity care within the strategic response to the COVID-19 pandemic—and to safeguard these services against future health crises.
Technology has played a vital role as our partners have pivoted to meet the needs of pregnant women and new mothers during the pandemic; both using existing technology in innovative ways, as well as introducing new platforms to sustain and extend their maternal health services.
ARMMAN: Using mobile technology to close the information gap
Since 2013 the Johnson & Johnson Foundation has partnered with ARMMAN on mMitra, a voice call service designed to fill the information gap for expectant mothers in under-resourced urban and rural communities in India. The service sends pre-recorded voice messages to pregnant women and new mothers in their local languages, with vital healthcare information tailored to each stage of her pregnancy and her child’s infancy. A call center with trained counselors also offers additional support free of charge. As the pandemic spread across India, ARMMAN was able to leverage its extensive mobile technology platform and expertise to support people across the country, including migrant workers and health workers.
In addition to the existing mMitra platform, which helped hundreds of thousands of vulnerable pregnant women access vital information and avoid overcrowded health centers during the pandemic, ARMMAN used mobile technology to share the latest updates and advice regarding COVID-19, including washing protocol, mask wearing, lockdown rules and how to get vaccinated. Another vital pandemic initiative was launching a free virtual outpatient department with the help of volunteer doctors that provides free consultations for pregnant women and children (both obstetrics and pediatrics) and linkages to healthcare services and facilities.
ARMMAN also reached more than 800,000 health workers with critical new developments, best practices and myth-busting facts to break down stigma. They continued to run the Mobile Academy, a training course for ASHAs—Ministry of Health designated community health workers—to refresh their knowledge of life-saving preventative health behaviors, and improve the quality of their engagement with new and expecting mothers and their families. The program uses audio-based technology that can be accessed via a simple voice call, and is one of the largest programs of its kind.
“Because our partnerships and core infrastructure were already in place, and we had the technology and know-how, we were able to design and launch our response to the pandemic within a week,” says Swati Saxena, ARMMAN’s Director of Resource Mobilization, Communication & New Initiatives. “COVID-19 proved that tech-enabled interventions can play a huge role in addressing gaps in the current system.”
mothers2mothers: Supporting women to overcome barriers to medical care
Even before the COVID-19 pandemic, Africa’s health systems were already under strain with a shortage of 4.2M health workers and many women and families struggling to access vital, lifesaving medical care. One of the Center’s long-standing partners, mothers2mothers (m2m), centers its work around 'Mentor Mothers’—women living with HIV who are employed as community health workers to educate and support women and their families to overcome barriers to medical care, ensure pregnant women living with HIV receive the medication and health services they need to stay in treatment, and help HIV-negative people stay negative. From an initial focus of preventing mother-to-child transmission of HIV, today Mentor Mothers provide family-centered support from pregnancy and childhood to adolescence.
In the wake of COVID-19, m2m dramatically adapted their services with two overarching goals: to continue to meet the health needs of the communities they serve and protect their frontline staff from the virus. In most countries this looked like a hybrid between modified in-person services (in-person services supported by structured phone calls) and the new, Virtual Mentor Mother Platform (VMMP).
Developed with support from the Johnson & Johnson Foundation in a matter of weeks after the start of the pandemic, the VMMP is an interactive, on-demand service (or chatbot) delivered via WhatsApp. It was designed to ensure that m2m clients maintained contact and received vital health information for themselves and their families throughout the pandemic. Available across nine countries and in almost 30 languages, the VMMP, covers areas like HIV/AIDS, maternal health, child health and chronic disease management in addition to COVID-19.
“For many years we have been working to improve our service delivery underpinned by technology, and so when COVID hit, we were in a good position to respond,” says Dr Betty Mirembe, Country Director of mothers2mothers in Uganda. “Most of our frontline team already had smartphones or other appropriate devices, and were comfortable working with technology. eServices are now being implemented in 94% of health centers and communities we serve, and 100% of our clients who have phones in those locations are using at least one of the services.”
While the VMMP has played a vital role in allowing m2m continue operating during the pandemic, they are aware that technology alone isn’t enough. “Personal services need to work hand-in-hand with technology, and be closely integrated to meet the needs of our clients and our frontline team,” adds Mirembe. This combined approach is clearly working; 85% of m2m clients living with HIV picked up their antiretroviral therapy during COVID-19 with an adherence rate of 97%—higher than the pre-pandemic rate of 83%. Similarly, 65% of their clients living with HIV had a viral load test during COVID-19, higher than the 60% that did pre-pandemic.
Digital health is a key lever for progress towards all three of the Center’s goals—to reduce the health worker gap, improve quality of care, and strengthen primary and community health systems. Both ARMMAN and the team at m2m hope the pandemic has drawn attention to the potential of digital technology to deliver and receive health services; as well as the critical importance of solving basic infrastructure issues, such as the lack of connectivity and power supply they face in many rural areas in which they work, to achieve shared goals such as Universal Health Coverage.