Improving maternal and perinatal care for ethnic minorities in Thai Nguyen, Vietnam through an integrated eHealth and user-provider interaction model

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Duration: 2013 – 2016

This project examines a cost-effective solution to a problem of longstanding concern in Vietnam: how to improve the maternal and child health (MCH) of ethnic minority (EM) people living in mountainous and difficult-to-reach areas of Vietnam. All available evidence shows that EM women (EMW) have high fertility and disproportionately high infant and maternal mortality rates. This is likely due to poverty, remoteness from poor quality health centres, unattended delivery at home and minimal perinatal care. Moreover, as a result of language barriers, low education and limited accessibility to information, EMW typically have limited knowledge on reproductive health (RH), pregnancy and natal care. Given this context and the expansion of low-cost mobile phone service in Vietnam, mHealth holds great potential to mitigate these barriers by applying technology in improving RH service delivery and building demand for quality natal care. Capitalizing on these benefits, the current project will determine whether integrated use of a newly available Health Management Information System (HMIS), low-cost mobile technology, and a user-provider interaction model can lower infant mortality and improve health among EMW and their newborns.

The project includes a pilot intervention and a feasibility cum impact study. The intervention will develop a smart RH Information Center (RHIC) aiming to provide timely RH information-education-communication (IEC) and reminding messages to EMW via either short message service (SMS) or a phone call. Input data to the RHIC will come from a newly available computerized HMIS in Thai Nguyen. The RHIC will notify EMW of appropriate actions to be taken, aiming to encourage their use of RH services, increase their awareness of potential risk factors, or to seek emergency care if necessary. Simultaneously, CHC staff will be reminded by SMS to communicate with EMW and to take action if responses from EMW are delayed, point to possible problems or to warn about high-risk cases. These messages and reminders, as well as the strengthened interactions between EMW and CHC staff, will help to build demand for safe, quality natal care, while increasing the active participation of EMW in seeking RH care at the CHC. The study will explore effective ways to implement the intervention, evaluate project impacts, document implementation and lessons learned, and assess potential for scale up if the project is feasible and effective. Lastly, the project will do policy advocacy and training for the mHealth application.

The broad objective of this project is to determine whether the implementation of an integrated mHealth intervention will improve access to maternal and child health services for ethnic minority women (EMW) living in mountainous and difficult-to-reach areas of Vietnam. The specific objectives of the project include:

1) To determine the social, cultural and geographic conditions that contribute to poor maternal and child health and limited utilization of health services among the EMW and their children in the Thai Nguyen region;

2) To develop and pilot the use of mHealth as an integrated part of the HMIS integrated eHealth and user-provider interaction model with EMW for RH behavior change communication (BCC) in Thai Nguyen province of Vietnam;

3) To determine the social, cultural and technical barriers and facilitators that impact the implementation of this pilot intervention and the further scaling up this pilot intervention to other regions in Vietnam and other similar resource poor health system settings;

4) To determine the positive and negative impacts of this pilot intervention on the awareness and use of maternal and perinatal health services and on issues of equity, governance and the enhanced integration of health systems;

5) To improve capacity of health managers, health workers, and researchers in managing, implementing and researching mHealth projects for better health system outcomes.

The project builds on the current successful collaborative work on HMIS between the Institute of Population, Health and Development, the Population Council, and Thai Nguyen Health Department (TNHD); and engages mHealth and research expertise from the Global Health Program at Simon Fraser University and the Centre for Addiction and Mental Health. The project will also build capacity through international research collaborations and will provide opportunities for MPH graduate student training from both the Hanoi School of Public Health and Simon Fraser University (SFU).

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