The journey begins: Real-time information for maternal health in Mauritania

In Mauritania, 13 women die each week at the time of pregnancy, childbirth or post-birth. Although the maternal mortality curve is beginning to move in the right direction, reproductive health indicators remain a concern. The maternal mortality rate is 582 deaths per 100,000 live births - one of the highest in the region. Those most at-risk are the poor, illiterate women from rural areas with low access to maternal health services, subject to socio-cultural prejudices, adolescents and youth.

We at the UN in Mauritania are committed to supporting the Mauritanian Government's efforts to drastically reduce maternal mortality. UN agencies (WHO, UNFPA, UNICEF) are supporting the Ministry of Health to better identify malfunctions in obstetric care and to improve the situation. They also support the ministry to supply health centers with life–saving products and medicines.

Faster information…could it save lives?

The Mauritanian government needs faster data to know why women are dying and to target resources to save lives.  They also want more up to date status on stocks of essential products and medicines in maternity hospitals, pediatric units and health center pharmacies to prevent stock outs and be able to respond quickly to breaks in critical supplies.

In thinking of new ways to solve this issue, we looked at one critical asset: an over 90 percent mobile phone penetration rate in Mauritania.  So we assumed that a real time monitoring system might be able to help.

For almost a year now, together with the Mauritanian Ministry of Health and Community Systems Foundation - CSF, we have been working to design a real time monitoring tool in three health centers in Nouakchott, which despite being the capital still constitutes 80 percent of the maternal deaths in Mauritania. We wanted healthcare providers to be able to report in real time (less than 24 hours) maternal deaths and drug inventory. We decided to use smart phones because they are less expensive than tablets and at least in Noakchott they are very common. We also couldn’t use basic phones because they couldn’t handle the volume of data we needed. Once data is recorded through a mobile survey using an open source tool, Ministry professionals can consult the information through key performance indicators on an inter-active dashboard.

So we tested it out. Nurses, midwives and doctors loved it. The app also attracted considerable interest among the other players in the health structures tested.

If you are considering a similar solution, let us save you a few steps!
Its great to see things coming together, but it has been a long and winding road. First, we built up the demand for real time data – which might be more than the system can respond to! Along the way, we had some seriously doubts in our ability to develop the envisaged system. To anyone thinking of moving in this direction   let us share some words of advice:

1. Narrow your data dreams. High expectations and a lot of data gaps meant that it was difficult to establish the scope of what data we really needed. We started too broad - ‘basic social services (health, education and protection of victims of violence)’ but this wide scope had led to practical implications, making the system too cumbersome and non-functional (too many issues covered and therefore too much data to be collected at high cost). Working across different sectoral experts and parts of the UN, we needed criteria to prioritize which data we really needed. We decided to consider a sector having an analysis of the situation with a clear identification of the bottlenecks and priority actions to be carried out, which could be monitored in real time. Back in the days of the Millennium Development Goals we had done a bottleneck analysis on how to accelerate progress in maternal health so this was a good factor in deciding in favor of a focus on this issue.


2. Health experts and data teams on board from the beginning. We started this  real time monitoring journey within the UN’s Program Management Group which is responsible for monitoring the results of the UN’s work in Mauritania. It brings together management across the UN and the monitoring and evaluation officers. We made progress, but really it was only when the health technicians were brought on board that the blockages could be lifted and we got real commitment and momentum to work together on this. Once we had the health people in the room, the added value of the real-time monitoring system was immediately clear. Those struggling to reduce maternal deaths saw it as an action-research tool that allows them to adjust their response strategies. So, if you plan to embark on a similar adventure, bring in the content experts from the start.


3. The mobilization of technical expertise: a challenge. Once the scope of the real time monitoring system was identified, the next challenge was to find a partner capable of supporting us in implementing it. After several unsuccessful attempts, we contacted CSF, based on the suggestion of our colleagues at UN DOCO, who already worked with the foundation in the framework of the UNDAF online monitoring tool. As CSF holds a long term agreement with UNFPA, we piggybacked on this and started our collaboration. After a first scoping mission in October 2016, CSF conducted a pre-piloting mission in Nouakchott this January to propose a mobile based solution to capture data at the health facility level.


4. Plan for the recurring costs of data collection. When we started, we looked at several options for data collection, based particularly on UNICEF’s experience with a real-time monitoring system. We looked at  one model that would have regional planning units and regional offices of the national statistical office collect the data and others that thought volunteers from the UN Volunteers Programme could do on-site collection of health data. All of these options had cost implications. Once we considered what would build on the work of the Ministry of Health, we realized that a smart phone would be best so that health personnel can directly record data as they are the ones closest to the job.


 

Within two or three months, we will expand the system to all health facilities in two regions of Mauritania and will provide real-time information on maternal deaths in these two areas and, ultimately, adequate response measures to prevent the occurrence of new deaths related to gaps in the health system.

Mauritania’s maternal health real time data journey continues…stay tuned for our next installment and do get in touch if you have questions or ideas.