Project Update: BRAC’s Manoshi Project

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By: Emily Puckart, Program Associate, MHTF

BRAC’s Manoshi project works to establish a community-based health program in urban slum areas of Bangladesh in order to reduce maternal and child mortality. In May 2010, BRAC instituted a mHealth project in order to redesign the Manoshi Project’s health delivery system. By incorporating mHealth technology into the Manoshi project, BRAC staff hoped that pregnant women facing health emergencies would become easier to reach virtually which in turn would improve their chance for emergency management of their health problem, their chance for quick referral to a health center of clinic if needed, and ultimately improve their chance for survival. Two goals of BRAC’s mHealth project were to “streamline emergency management and increase accountability through hotline” and “develop efficient and effective protocols for providing automated response to patients, and hence increase scalability of the model in places where no doctors are available.”

The emergency support system included the establishment of an emergency hotline, the integration of medical records, and software for emergency services in order to connect emergency calls to ambulance and hospital system which would encourage fast referrals to ambulances and health clinics. This emergency management system with the establishment of an emergency hotline should decrease maternal, neonatal and child morbidity and mortality in the urban slums of Bangladesh by allowing community health workers to quickly respond to maternal health emergencies. The hotline agent could also arrange for transport, and notify the closest hospital or clinic that an emergency case would be incoming, giving the health facility time to prepare. By creating a centrally driven hotline, it is also easier to track the processes around management of women’s health emergencies as well as identify “holes” in the system that could contribute to maternal morbidity and mortality.

During the phase of this project funded by the MHTF, BRAC staff sought to establish patient response protocols, ensure preparation of emergency resources (hotline agent, community health workers, health facilities etc.), mobilize community support, ensure patient acceptance and trust in BRAC’s emergency service, and develop evidence-based plans for an effective emergency management system for maternal and child health.

As BRAC staff began to wrap up this phase of the project they conducted an evaluation on the status and use of the hotline system in order to assess the status quality of the system, the quality of services provides, and the opinion of hotline system users. They collected data between December 7 -21, 2011, and focused on the urban slums of Dhaka city (population of 223,487 people) that are now under the emergency management system. Some interesting information came out of their survey, including:

  • During the survey period a total of 86 emergency calls were placed, 1/3 of all calls were made by beneficiaries about 65% of whom were in their antenatal period of pregnancy
  • Most patients (83%) were able to get the hotline during their first attempt
  • Based on interviews of 30 callers of the hotline – 57% of callers (or the husband of the caller) owned the mobile phone, followed by ownership by neighbors and relatives
  • 94% of calls required referrals to health centers

BRAC also spoke to patients and managers regarding the hotline. One patient noted that it was a relief to always have someone attending to the hotline in case the local health workers were on vacation. Another patient urged BRAC to staff the hotline with female doctors since female patients can be uncomfortable discussing pregnancy related issues with male doctors, especially considering they do not even discuss these issues with their husbands. As the establishment of the hotline was a new event, BRAC has continued conducting meetings and outreach with stakeholders at the community level in order to encourage usage of the hotline when emergencies arise in the future.

Although this study was conducted in a small area with a small sample size it provides a valuable insight into the importance of establishing emergency management systems as well as the challenges that these types of systems may face.