Objective

To improve the utilization of quality maternal and newborn care (MNC) services in Bangladesh.

Background

USAID’s MaMoni Maternal and Newborn Care Strengthening Project (MNCSP) has been implementing the objective of increasing the equitable utilization of quality maternal and newborn care related services at the public healthcare facilities. Dnet, as the technological partner of MNCSP, aimed to design prospective technology-based healthcare models to eradicate the delays causing maternal and neonatal deaths by disseminating MNC care-related information to the pregnant and neonatal mothers, providing an effective referral transport system to lower the travel time from home to facility, developing an effective registration, queue management and reporting system to lower the waiting and reporting time as well as the crowd at different service points of a facility, and lastly, designing and implementing an effective client feedback mechanism focusing on MNC related services using KIOSK to improve the quality of care at the public health care facilities.

Approach

Dnet has been implementing MNC pilot models in different districts of Bangladesh to attain its objective via 4 technological components: mHealth, a facilitated referral transport model, an OpenMRS+ based queue management and reporting system, and a KIOSK-based client feedback mechanism.

mHealth based SMS and OBD reminder service

Dnet has implemented mHealth based SMS and OBD reminder system initially in Madhabpur upazila of Habiganj district, and later on, scaled up the operation in 32 districts. Dnet has been sending service reminder SMS to the beneficiaries. As of now, Dnet has sent more than 60,000 SMS reminders to more than 20,000 beneficiaries in 32 districts. Dnet launched OBD based content service in Habiganj and Brahmanbaria districts. Since the initiation of this service, Dnet has provided more than 6,000 OBD content to more than 3,000 beneficiaries.

It was found that 81% of the beneficiaries think that the SMS reminder reminded them about the antenatal and postnatal checkup effectively through a survey conducted by Dnet research team.

Facilitated Referral Transport Model (FRTM)

Dnet has designed and developed a transport referral model similar to the Air Traffic Control (ATC) model to provide an emergency transportation system to take expecting mothers and delivery patients from home to the nearest facility, provided that the facility has the required service for the patients, for maternal checkup and emergencies.

In this system, patients call an emergency CRM number to request an emergency transportation, where a mediator receives and processes the request using a GIS based dashboard to fetch and connect the nearest available driver with the patient or their family members. Mediators use the system to contact the nearest public health facilities which have the required service sought by the patient. Since the initiation, Dnet’s facilitated referral transport model handled more than 500 transportation requests from 4 unions of Daulatpur upazila of Manikganj district. Dnet and MNCSP plan to expand the operation to other upazilas of Manikganj district after the completion of the pilot run in Daulatpur upazila.

OpenMRS+ based registration, queue and reporting management system

Dnet’s OpenMRS+ based service has been implemented at Manikganj District Hospital and Daulatpur Upazila Health Complex. Using this system, public healthcare facilities can provide registration tickets to the clients at a faster speed which saves up to 51 minutes at Manikganj District Hospital. OpenMRS+ based system also has provision of documenting patient history of the MNH, IMCI, ITD, laboratory, emergency and pharmacy corners of the facilities. This way, service providers can prepare the monthly and yearly reporting to incorporate with the DHIS2 system within a day compared to the 6-7 days of manual system. This registration and patient history data can be accumulated with the government's SHR system to develop health data of the population of the farthest corners of the country. Through the queue management system, patients can understand the approximate waiting time for the physicians’ consultation at the waiting areas. This way, crowds can be managed in an easier manner.

KIOSK based client feedback mechanism

Dnet’s program & technology team has designed & developed a KIOSK based feedback management system to capture the feedback of the clients served at the MNCH corners of public health care facilities. Using the feedback of the clients, public healthcare facilities can identify the areas where improvement is needed so that they can increase the Quality of Care (QoC). Dnet’s system has received more than 700 feedback at the MNCH corner through the KIOSK installed at Manikganj District Hospital. A dashboard has also been prepared to acknowledge the authority of the facility on the condition of the service and improvement areas.