February 05, 2019

New study shows positive results of the Safe Delivery App in DR Congo

A recent pilot study on the use of the Safe Delivery App in remote health facilities in DR Congo shows a significant increase in healthcare workers’ knowledge and confidence when managing childbirth emergencies after using the App.

The Democratic Republic of Congo is one of the most dangerous places in the world to be pregnant and give birth. Poor infrastructure, insufficient training of health workers and a weak healthcare system make the quality of maternal and newborn care one of the lowest on the African continent. A recently published study examines the positive effects eLearning tools, specifically the Safe Delivery App, can have on quality of care for women and their newborns in DR Congo.

In collaboration with IMA World Health, Doctor Nancy Bolan has tested the Safe Delivery App in DR Congo through the pilot study, mLearning in the DRC: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App. The study sets out to show how the Safe Delivery App can help improve quality of care for women and their newborns in some of the most under-resourced and remote regions of DR Congo by using smartphones for continued professional development of frontline healthcare workers.

The study showed a significant increase in the healthcare workers’ knowledge and confidence when handling basic childbirth emergencies after using the Safe Delivery App for three months.

The Safe Delivery App is a smartphone application developed by Maternity Foundation in partnership with Universities of Copenhagen and Southern Denmark. It uses simple, intuitive animated instructions to guide health workers in basic emergency obstetric and newborn care (BEmONC). It includes quizzes, descriptions of practical procedures, and drug lists that midwives and healthcare workers can always refer to – either on the job, in their spare time or as part of their training.

Safer childbirths in DR Congo
With 846 maternal deaths per 100,000 live births, DR Congo has one of the highest maternal mortality ratios worldwide. Especially in remote areas, healthcare workers have limited competencies and next to no chance of continued on-the-job training.

“The problems of maternal health in Congo are so big, the health system is so broken. I wanted to propose and test a well-developed, concrete solution to the problem of poor obstetrical and newborn care management. The App fits in to all these criteria. It is based on recent state of the art clinical information. It’s up-to-date and evidence-based, it’s downloadable, and it’s available in many different languages including French, which is what health workers in DR Congo speak”, Dr. Bolan explains.

During three months in 2017, the Safe Delivery App was tested in two health zones in the province of Maniema, an under-resourced area in central DR Congo with weak infrastructure and some of the poorest maternal and newborn health outcomes in the country.

62 health workers across 8 health facilities participated in the study; 32 in intervention and 30 in control groups. The health workers in the intervention group were given smartphones and solar chargers and were trained in using the Safe Delivery App. After three months of using the App, health workers in the intervention group had significantly increased their knowledge and confidence levels when managing key areas of childbirth emergencies compared to the control group.

A mix of medical doctors, nurses and midwives took part in the study, and the positive results appeared across education level, job function and previous exposure to smartphones.

“One of the great things we discovered was that all health professionals, whether medical doctors, nurses or midwives were able to equally well understand and benefit from the content. There was also no difference in knowledge gained between people who had and hadn’t used smartphones before. This shows us that technology is not a barrier – using the App didn’t pose a challenge for people that hadn’t used a smartphone before”, Nancy Bolan explains.

Learning as a team
The healthcare workers in the study highlighted the interactive elements in the App as a useful and engaging way of learning.

“They told us that the effect of hearing and seeing things with their own eyes was more helpful than the training they had received in the past. The videos made the learning more interesting and made them want to watch the modules over and over”, Doctor Bolan explains, and elaborates:

“They would sometimes watch the videos alone but also often together, using the App as a team training tool. If they had an emergency case, which they weren’t sure how to manage, they’d use the App actively in emergency management. They would do it as a team – they would open the App together and follow the instructions in their work.”

The study from DR Congo supplements findings from Maternity Foundation’s own Randomized Controlled Trial among healthcare workers in Ethiopia in 2014. In the Ethiopia trial, healthcare workers in the intervention group significantly improved their knowledge and confidence and more than doubled their practical skills level when handling basic childbirth emergencies after 12 months of using the Safe Delivery App.

Scaling Up
After a successful pilot study, Nancy Bolan and IMA World Health are preparing to further roll out the Safe Delivery App in 250 health facilities throughout DR Congo in very under-served areas.

While the study shows great potential for eLearning tools such as the Safe Delivery App to improve quality of maternal and newborn care in under-served areas, Nancy Bolan underscores that the App should always be implemented in line with national strategies for maternal health.

“When implementing tools like the Safe Delivery App in the longer run, it is important to work with Ministries of Health to make it fit nicely within their program of continuing education. Ultimately, countries need a strategy for mLearning – that’s what will make it possible to take a project from pilot stage to a wider implementation.”

For more information of the Safe Delivery App in DR Congo, you can read Doctor Nancy Bolan’s full study here.