Giving Women in India the Voice and Choice to Drive Maternal Healthcare Quality
By Priya Agrawal and Aparajita Gogoi
When women discover they are pregnant, they often turn to a small, trusted group of family members and friends with questions about the best places to get care. Mums, aunties, neighbors – everyone has an opinion. But what if instead of relying on just a handful of personal experiences, a woman could easily find quality care based on ratings from hundreds of pregnant women in her community? And what if, at the same time, she could become better educated about what services she’s entitled to so she’s more empowered to demand the care she deserves?
A new, free, phone-based service in India may be the answer.
Merck for Mothers—a 10-year, $500 million dollar initiative to reduce maternal mortality—collaborated with the White Ribbon Alliance for Safe Motherhood India (WRAI) and the social technology company Gram Vaani to develop the Mobile Monitor for Quality Maternal Care (MoM-QC). The prototype is a mobile phone line that uses interactive voice response (IVR) technology so even women with limited literacy are able to use it.
The idea is simple: women call a free number to connect to MoM-QC to learn about available health programs and services in their area and to be informed about the care they can expect at health facilities (e.g., service availability, timeliness, cleanliness, respectful care, etc.). But what’s particularly exciting is that this platform goes beyond just dispensing information; it also engages women in two-way communication. MoM-QC asks pregnant women for feedback on the quality of care they received, pools that information and makes provider ratings available.
Key decision-makers responsible for maternal health (e.g., health providers, hospital network managers and government officials) also have access to the ratings to help inform their quality improvement efforts and hold providers more accountable to the quality of care they provide.
This accountability component is critical because without knowing what to expect, women may be unable to express their dissatisfaction, hindering their ability to provide feedback that can lead to improved care. If patients do not have a way to voice their concerns and there are no ramifications if healthcare providers deliver poor care, there is little incentive to change practices.
Many community accountability models rely on time-intensive, grassroots efforts to gather evidence and facilitate face-to-face conversations among community members, healthcare providers and officials. While these efforts often reap rewards, what if mobile phones could help streamline the process while amplifying the impact?
To put this idea to the test, WRAI and Gram Vaani conducted a pilot of the technology in 20 villages in Jharkhand, India that reached nearly 10,500 callers without direct outreach. Lessons learned from the five-month pilot are encouraging:
- Women were eager to receive information on maternal health and quality of care
- Women liked sharing their feedback and experience
- Despite income, literacy and connectivity barriers, the interactive voice response platform was a useful way for women to engage with, learn from and provide feedback
- Users believe that providers’ quality ratings would influence where they seek care
- Health providers and government officials were open to receiving women’s feedback to improve care
We are optimistic about the pilot’s results and are continuing to refine and adapt MoM-QC for use with more women in India. As a next step, we will apply user-experience design techniques to broaden the platform’s appeal and uptake in both rural and urban settings—potentially expanding into web and app formats as well.
We believe an interactive model has the potential to empower women to speak out about the care they receive and—just as important—help ensure that their voices will be heard and acted upon. We hope that MoM-QC will be a valuable tool as the maternal health community strives to improve the quality of care all pregnant women receive and deserve.
Dr. Priya Agrawal is an ob/gyn and the Executive Director of Merck for Mothers, Merck’s 10-year, $500 million initiative to reducing maternal mortality. Dr. Aparajita Gogoi is the National Coordinator of White Ribbon Alliance India, which unites citizens to demand the right to a safe birth for all women.