Safemama Digital Health Solution

We are addressing the problem of high rate of preventable maternal mortality and morbidity due to poor access to healthcare services in rural Uganda. The healthcare system in rural Uganda is considered fragile due to a variety of challenges that make it difficult for people in these areas to access essential healthcare services. These include limited access to healthcare facilities by many rural dwellers who live far away from health facilities, making it difficult to access medical care when they need it, especially those living in remote areas, where infrastructure is poor and transportation is limited. Furthermore, severe shortage of healthcare workers, particularly doctors, nurses and midwives made it impossible to provide required manpower for essential medical services to those who need them. 

Every day in Uganda about 12 women die from preventable causes related to pregnancy and childbirth, according to an analysis of data from the Uganda Demographic and Health Survey by the Uganda Bureau of Statistics. Underlying the direct causes of maternal deaths are the three levels of delays namely; delay in decision making to seek medical care, delay in transport to healthcare provider and delay in disease management at the point of care service. 
Thus, we focus on the challenge of high maternal and child death and disabilities associated with high blood pressure in pregnancy also referred to as Pre-eclampsia. This is a disorder of pregnancy characterized by high blood pressure and associated organ system damage, typically occurring after the 20th week of pregnancy, which, if not diagnosed early, usually results in a pre-mature delivery and high mortality risk for both mother and child. The secondary outcomes are usually miscarriage, gestational hypertension, significant proteinuria, serious maternal and perinatal morbidities, Caesarean delivery or perinatal death. Preeclampsia is the most common known cause of premature birth and is responsible for half a million (500,000) neonatal deaths every year worldwide. Scanty statistics showed that 1,400 women die each day – and more than 500,000 each year – from pregnancy related causes. If undetected, preeclampsia can lead to eclampsia which is one of the top five causes of maternal and infant illness and death, causing an estimated 13% of all maternal deaths worldwide or literally a maternal death every 12 minutes. Approximately 5 to 8 percent of pregnancies are affected by preeclampsia.
Pre-eclampsia is responsible for 10% – 40 % of maternal deaths in Africa and the causes of pre-eclampsia remain unclear and so difficult to prevent.  So far, its definitive cure is delivery of the placenta/fetus. 
In Uganda, high blood pressure (pre-eclampsia) is the 2nd leading cause of maternal mortality with 15% next to bleeding that cause 42% of maternal death (MPDSR Report 2020/2021).
 Pre-eclampsia causes a lot of death and disability in newborn, stillbirths, preterm birth, early neonatal death etc. Many survivors end up with long-term complication example cardiovascular diseases, chronic kidney disease amongst others, pre-eclampsia has no cure expect for delivery of baby. Hence, early diagnosis and appropriate intervention mitigate complication and improve outcome.

SafeMama Digital Solution is a community level intervention for pre-eclampsia aimed at transforming healthcare through self-care, in resource limited settings using mobile application, open-source DHIS2 software interface and network of community based healthcare support groups called Village Health Teams (VHTs) and Community Health Workers (CHEWs).

The rationale of the SafeMama Digital Solution is based on the fact that early diagnosis of pre-eclampsia and appropriate intervention mitigate complication and improve outcome. Many survivors end up with long term complication like hypertension and kidney diseases. Thus, the solution addresses the key maternal health challenges faced by women and adolescent girls such as (a)Poor socio-economic status limiting access to quality healthcare (b) Geographical remoteness with hard to reach access for healthcare delivery (c) harmful cultural norms and values affecting the health seeking behavior (d) the 3 levels of delays; (i) delay in decision to seek medical care, (ii) delay in reaching care due to poor road network and (iii) delay in management at the health facility. Pre-eclampsia has no cure except for delivery of baby.

We leverage on the existing infrastructure of the Village Heath Team (VHTs) who are community volunteers trained to provide basic healthcare services and health education to their communities. They work closely with formal health services and are supervised by local health authorities. We trained and selected some the VHTs to monitor enrolled pregnant mothers weekly at home in between their regular monthly Antenatal Care (ANC) visits at the health facility. On every visit, the VHT goes with his/her ‘Safemama Kit’ to measure and record the Blood Pressure (BP) and Pulse Rate (PR) of the pregnant woman using semi-automated BP measuring machine. The measured values of BP and PR are then entered into DHIS2 tracker App using a smart phone. Suspected cases of high BP are referred to the healthcare providers for confirmation and early intervention. The ‘Safemama Kit’ comprises of a special field bag, BP machine, Smart phone, portable power bank, monitoring register and other field accessories like referral forms.

Our adopted technology is the District Health Information System (DHIS2) which is one of the leading global goods software system currently use by more than 75 countries globally. Our solution digitalizes maternal health records using DHIS2 tracker and mobile applications for disaggregating patients’ data using secure, easy to use and interoperable system. Thus, democratizing healthcare services through community based disease detection and timely referral system, provision of affordable, accessible and user-friendly healthcare solutions closer to the communities.

Our target population is the rural pregnant women with highest unmet needs for pregnancy monitoring and access to healthcare services. This segment caters for over 75% of total pregnant women in the country. In Uganda, rural pregnant women face numerous challenges in accessing pregnancy monitoring and healthcare services. This has resulted in high maternal mortality rates and high rates of maternal and neonatal morbidity. The Safemama Digital Solution offers a potential solution to addressing these challenges and improving pregnancy monitoring and access to healthcare services for rural pregnant women in Uganda. This provides critical role in increasing access to healthcare services for the underserved populations, including rural pregnant women, through the regular Blood Pressure monitoring of pregnant women in their communities. They are also educated on the importance of antenatal care visits and help them schedule appointments with formal healthcare providers.

The solution further strengthen the referral system to formal healthcare services when necessary, including antenatal care clinics, delivery services, and emergency obstetric care. It also provide cheap and accessible transportation services through strategic partnerships with actors of the transport sector. Another benefit to the enrolled mothers include postnatal care monitoring of their Blood Pressure for 6 months after delivery.

This in turn enable early detection of high Blood Pressure, timely referral and effective management of pregnant women who developed pre-eclampsia, thereby mitigating severe complications of organ damage or death due to delayed intervention.

Global Pre-eclampsia Initiative is a non-profit organization addressing the challenge of high maternal and child death and disabilities associated with high blood pressure in pregnancy also referred to as Pre-eclampsia. We are based in Sheema District Local Government of rural Uganda, currently working in 162 villages, 324 Village Health Teams (VHTs) and 418 pregnant women engaged. Our team has a combined experience of over 85 years in the field of critical care medicine, community development, research and innovation, access and impact, health informatics and human development. We employ the principle of user-centered design and strategic partnership to develop our ‘Safemama Kit’ and our interventional approach to community based healthcare solutions. Our team lead invented the Pre-Eclampsia Toxaemia GRAPH called PETOGRAPH tool for the management of Pre-eclampsia in Resource Limited Settings. Our previous achievement for winning The Joint Innovations Challenge 2022 further indicated the strength of our team and viability of our solution in combating maternal mortality and morbidity due to pre-eclampsia in low resource settings.

We signed Memorandum of Understanding with the Sheema District Local Government to pilot the SafeMama Digital Solution in its 4 Health Facilities and the 324 catchment villages. And having positive discussions with Uganda Industrial Research Institute (UIRI) for further development and manufacturing of the 'Safemama Kit' as we position to scale.

We are currently serving 418 women, 324 Village Health Team members  from 162 villages (2 VHTs per Village)

We are applying to Solve inorder to establish network of social impact investors who could partner with us in our Social Enterprise, so that more VHTs and Pregnant women could be reached. This could help reduce maternal mortality and morbility in Uganda and other developing nations.

Our innovation uses community based approach to managing pre-eclampsia rather than the conventional hospital-based approach.

1. To enhance early detection: Early detection of pre-eclampsia is essential to prevent serious complications. However, this is challenging in low-resource settings due to limited access to antenatal care, inadequate screening tools, and a lack of trained healthcare workers who can recognize the signs and symptoms of the condition.
2. To facilitate timely referral: Once pre-eclampsia is identified, timely referral to a higher level of care is critical to prevent severe complications. However, referral systems in low-resource settings are often inadequate, with limited transport and communication infrastructure, and a shortage of healthcare providers who can provide specialized care.
3. To support effective management: Management of pre-eclampsia involves the use of medications to control blood pressure and prevent seizures, and in severe cases, delivery of the baby. However, the availability and affordability of these medications can be limited in low-resource settings. Additionally, there may be cultural and social barriers to accepting medical interventions, such as cesarean section.
4. To provide effective follow-up: Women who have had pre-eclampsia are at increased risk of developing hypertension and other cardiovascular diseases later in life, and their babies may also be at increased risk of long-term health problems. However, follow-up care for these women and their babies is often inadequate in low-resource settings, with limited access to postnatal care, monitoring, and education.

(1) The number of pre-eclampsia cases detected from the community

(2) Total number of Lives saved through early detection and timely referrals of women who developed Pre-eclampsia.

(3) Number of VHTs trained on Blood Pressure Monitoring

The core technology is the District Health Information System (DHIS2)- an open source software.

Our organization is all inclusive.