How we used communication technologies in Burkina Faso
Keeping maternal and newborn health high on the agenda during COVID-19
De Clara Mayer
As the pandemic restricted access to maternal and neonatal health (MNH) care in Burkina Faso, Enfants du Monde (EdM) chose to use information and communication technologies to continue its activities while expanding its outreach. We managed to enable women, and communities to access reliable information, encourage them to continue seeking MNH care during COVID-19 and keep themselves and their babies safe. Moreover, we informed health care providers on how to protect themselves, pregnant women and their babies from COVID-19, creating a safe place for women to receive the necessary MNH care.
Burkina Faso suffers from a weak health system [1], and was poorly prepared for a pandemic. Already before the COVID-19, long distances/travel time to the nearest health facility, the need for husband’s permission to attend a health centre, the lack of qualified healthcare workers and lack of medicines/medical equipment, and insecurity were some of the significant barriers to healthcare access (iMMAP, 2021). In Burkina Faso, about 320 women per 100,000 live births die each year as a result of pregnancy or delivery complications (WHO, 2017).
As a result of the pandemic and control efforts, the provision and utilisation of maternal, newborn care were affected. Women avoided seeking care during pregnancy, for birth and for postnatal check-ups by fear of contracting the disease at health facilities. As reported by iMMAP in December 2021, the COVID-19 pandemic strongly impacted the utilisation of MNH care in Burkina Faso: a significant reduction in skilled delivery assistance and of institutional deliveries has been reported (12 % decrease compare to 2018) with inadequate monitoring of pregnancies at the community level (iMMAP, 2021).
Enfants du Monde (EdM) has been supporting the Ministry of Health (MoH) of Burkina Faso on Health promotion in the field of maternal and newborn health (HP/MNH) since 2006. While access to MNH care has proven to be even more difficult than usual during the pandemic, EdM chooses to use information and communication technologies (ICT)[2] to continue its activities during the COVID-19 pandemic to:
enable women and communities to access reliable information on the perinatal period and the effects of COVID-19 on their health and encourage them to continue seeking MNH care during the pandemic;
inform health care providers on how to protect themselves, pregnant women and their babies from COVID-19, creating safer places for women to receive the necessary MNH care.
"Mon bébé et moi”: a free mobile application for pregnant women and new mothers
Promoting health literacy The COVID-19 pandemic had a negative impact on the rights of women to access information, in a moment where it was difficult to provide information particularly on the impact of COVID-19 on MNH that represented a key blind spot (in the response to COVID-19, there was little information available on the impact of COVID and MNH). In 2020, as part of the response to the COVID-19 pandemic, Enfants du Monde (EdM) supported the Incub@UO (a digital start up incubator within the University Joseph Ki-Zerbo of Burkina Faso), the Ministry of Health of Burkina Faso (MoH), and Initiative Privée et Communautaire pour la santé et la riposte au VIH/Sida au Burkina Faso (IPC/BF), to develop the mobile application (app) “Mon bébé et moi”.
Developed in collaboration with the Obstetric Department of the Geneva University Hospital and Terre Innovative Healthcare, the app provides direct and reliable information on pregnancy, birth, postnatal period. This innovative app empowers them to make appropriate decisions regarding their health and the health of their baby, especially in times of COVID-19, when health education sessions or visits by community health workers are proven to be difficult.
“Mon Bébé et moi” dedicated a special focus on the effect of COVID-19 on MNH, giving information to women on the impact of COVID-19 on MNH, recommending appropriate behaviours for pregnant/mothers in COVID-19 situations and encouraging women to continue to seek MNH care during the pandemic.
The app was specifically developed for women, accessible to all including the members of their family, and is available in French with audio in 4 local languages (mooré, djoula, fulfuldé et bissa). The audio of the app have been extracted and can be listening by women that don’t have a smartphone on phones, computer, and radio. Based on culturally appropriate illustrations and simple explanations, the app can be downloaded free of charge from Google Play Store, via USB and Bluetooth, and work offline, it does not collect personal data.
The app was specifically developed for women, accessible to all including the members of their family, and is available in French with audio in 4 local languages (mooré, djoula, fulfuldé et bissa). The audio of the app have been extracted and can be listening by women that don’t have a smartphone on phones, computer, and radio.
Developing and implementing the app The app was developed by a group of students from the University of Ouagadougou. 43 women in the Tenkodogo district tested and made recommendations to make “Mon bébé et moi” easy to use, adapted to the Burkinabe context and the rural environment. The illustrations were reviewed by the women to make sure they were understandable and adequate. Through a validation workshop, the MoH pre-validated the content of the app. The MoH commented and validated the final product during a final validation workshop. Following the official launch, the app was disseminated among 383 health care providers in the nine implementation districts: Mangodara, Barsalogho, Tenkodogo, Zabré, Koupéla, Boulmiougou, Bogodogo, Nongremassom and Sighnonhin. In total, at the end of 2021, the app benefited 18,000 pregnant and breastfeeding women.
Results and way forward A survey conducted by our local partner in 5 districts of intervention out of 9 showed that challenges remain to disseminate the app to a significant proportion of women. So far, the app is known by 24% of the women. On the other hand, the application is known by 88% of health workers, and 68% of them reported having disseminated the app. Difficulties in disseminating the application to women stem mainly from the fact that lots of women don't have suitable phones.
The survey also shows that both women (87%) and healthcare providers (97%) considered the application useful, easy to use and containing understandable illustrations. During the pandemic, “Mon bébé et moi” appeared particularly relevant to provide direct and reliable information to pregnant women and new mothers. A key result is that the application contributed to improving the knowledge of all the women surveyed who listened to it and/or viewed it, mainly with regard to the behaviours to adopt in order to remain healthy during pregnancy and after childbirth, in times of COVID-19.
Following the above, the challenge for next year is to improve the communication about and dissemination of the application. In addition, EdM and its partners are considering adding additional relevant components to the app, such as family planning, early childhood care, sexual and reproductive health, and nutrition.
A key result is that the application contributed to improving the knowledge of all the women surveyed who listened to it and/or viewed it, mainly with regard to the behaviours to adopt in order to remain healthy during pregnancy and after childbirth, in times of COVID-19.
Distance-learning training for Health care providers
Improving the capacities of health care providers on health promotion in the field of MNH
Since 2019, the MoH, the African Institute of Public Health (IASP), IPC/BF, the University of Geneva (TECFA), and EdM provide a distance learning training on Health Promotion in the field of MNH to respond to MoH’s need to strengthen the skills of health care providers in health promotion. The training aims at strengthening the knowledge and capacities of health providers on quality of care and community participation to care, enabling participants to mobilise their new skills in their daily practice. The training includes both online classes and days in presence. The training is downloadable on smartphones, tablets, and computers for offline use.
Providing information on COVID-19 to health care providers During a conceptualization phase, the e-learning modules were developed with Storyline 360, and uploaded on a Moodle platform. During the COVID-19 outbreak, a pilot session was ongoing in the Health District of Zabré. Despite the pandemic, the pilot successfully took place, to support MoH in its effort to diffuse information on COVID to health providers, an e-learning module on COVID-19 was added to the platform.
The training was also used to disseminate a video on COVID-19 and its effect on MNH, developed by the HUG, Terre Innovative Healthcare, the University of Geneva, IASP and EdM. The IASP brought key information for the health care providers to understand the COVID-19 pandemic while the Obstetric Department of HUG gave recommendations on the protective measures and on the health management during MNH consultations in time of COVID pandemic. In addition, the video was disseminated through Whatsapp and Facebook in Burkina Faso.
Result and way forward Stakeholders show strong interest in this mixed-mode training. According to the participants, the themes were considered very relevant, this education will strengthen their skills in MNH, the learning method was considered very interesting and formative. Despite the COVID situation, the 30 participants could terminate the training, and this tool has proven to be particularly useful in times of COVID-19 to provide information to health care providers.
Following an evaluation and reorganisation of the training, a new cohort will be held in the Health District of Zabré enabling 30 health care providers to be trained on Health promotion in the field of maternal and newborn health and COVID-19.
Conclusion
Health systems were heavily disrupted by the COVID-19 pandemic. The use of ICT enabled Enfants du Monde to continue its activities and increase accessibility to information on COVID/MNH among pregnant women, their family and health care providers. The use of ICT gathered many actors both in Burkina Faso and in Switzerland, enabling them to deliver a cross-sectoral response for the promotion of health in the field of MNH. The ICT implemented went through a successful pilot phase, and discussions are currently ongoing to launch a scaling up phase. With regards to the impact of COVID-19 on MNH care, ICT enabled EdM to keep MNH high in the agenda while very limited information was available on the effect of COVID-19 on pregnancy, childbirth and the post-natal period.
Participating Organisations / Institutions
African Institute of Public Health (IASP) is a non-profit organization that conducts research on the major population health issues and trains academics and health care providers capable of providing relevant analysis and research capacity on health systems in health care networks.https://iasp-bf.org/index.php
Direction de la Santé de la Famille of the Ministry of Health of Burkina Faso is the referee and respondent of EdM for the coordination of projects of Health promotion in the field of maternal and newborn health.https://www.sante.gov.bf/detail?tx_news_pi1%5Bacti...
Enfants du Monde is a Swiss Non-Governmental Organisation that provides quality education and access to health services for children and mothers in the poorest countries of the world for more than 50 years.https://www.edm.ch/en/
Incub@uo is a digital incubator housed within the University Joseph Ki-Zerbo of Burkina Faso initiated by the computer science department, the incubator targets all the university's fields of study for any project related to ICTs.https://incubuo.tech/
Initiative Privée et Communautaire pour la Santé et la Riposte au VIH/SIDA au Burkina Faso (IPC/BF) is an Non-Governmental Organisations (NGO) that works in the field of health, HIV response, gender promotion and human rights since 1994. www.ipcbf.org
Obstetric Department of the University Hospital of Geneva has been involved in development aid and international cooperation for more than 40 years with projects focusing on training, capacity building of partner institutions and research.https://www.hug.ch/engagement-humanitaire
Terre Innovative HealthCare is a cutting edge start-up that provides practical, context-specific solutions to underserved populations through the conception, development and implementation of telemedicine systems, specialising in icon-based mobile health applications.. https://www.terreinnovative.com/
TEFCA, University of Geneva, is an academic unit specialized in the field of educational technologies since 1989, which conduct researches on a broad field of studies, such as cognitive, social and affective implications of information and communication technologies. http://tecfa.unige.ch/en/
Annotations
[1] According to the Global Health Security Index, the health care system of
Burkina Faso was ranked 145th of 195 countries in the 2019.
Clara Mayer has a double Master's degree in International and European Human Rights Law. Following her contribution to the 2nd World Forum for Climate Justice, she participated in the implementation of a project on the prevention of malnutrition in Madagascar and joined Enfants du Monde as Health Assistant. Email
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