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The Safe Delivery App

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Empowering skilled birth attendants to provide a safer birth for mothers and newborns everywhere.

Background

According to the September 2016 Lancet Maternal Health Series, it is estimated that globally three-quarters of women now deliver with assistance from a skilled birth attendant. However, it is not enough to just encourage women to give birth in health facilities, as quality of care remains a pressing issue— many facilities continue to lack emergency obstetric care (as well as even the most basic capability to manage uncomplicated deliveries) and fail to provide respectful, evidence-based routine care.

This is a direct result of the fact that many skilled birth attendants do not have the skills and knowledge needed to prevent the leading causes of maternal and neonatal death. In addition many skilled birth attendants have little in the way of up-to-date, guideline-adherent, easy to understand, practical job aids to help them deal with obstetric and newborn emergencies. And for skilled birth attendants in low delivery volume facilities, emergencies do not occur sufficiently often for them to become experienced in complication management.

At the same time, a growing number of skilled birth attendants in LMICs have regular access to smartphones – either personal devices or those supplied by the health system.

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The Safe Delivery App is a smartphone application that provides skilled birth attendants with direct and instant access to evidence-based and up-to-date clinical guidelines on Basic Emergency Obstetric and Neonatal Care. The App leverages the growing ubiquity of mobile phones to provide life-saving information and guidance through easy-to-understand animated instruction videos, action cards and drug lists. It can serve as a training tool both in pre- and in-service training, and equips birth attendants even in the most remote areas with a powerful on-the-job reference tool. The App was created in 2012 with support from MSD for Mothers, and in collaboration with the University of Copenhagen and the University of Southern Denmark. The App is also currently supported by the Bill & Melinda Gates Foundation. The content of the app is based on global clinical guidelines and has been validated with an international group of global health experts.

It contains four basic features: animated instruction videos, action cards, drug list and practical procedure instructions. All features and functions are designed for low-literacy, low-income settings and work completely offline once downloaded.  The 10 instruction films include the seven signal functions of BEmONC and an additional three essential procedures on infection prevention, newborn management and active third stage of labor. The videos are between 5 – 7 minutes and can be watched in sections.

VideosWhen the health workers handle emergency obstetric and neonatal situations, there may not be time to watch the full videos so the App contains action cards with clear, essential recommendations and direct instructions. The App also contains a detailed drug list of all drugs necessary for performing BEmONC, and a procedure function with written instruction on eight key procedures such as mixing alcohol-based hand rub.

Finally, to assess the health workers’ progress, the app contains two testing modules. One tests the health workers’ confidence level before using the app and after 3 months, and another tests the health worker’s level of knowledge. Furthermore the use of the app and its different functions are tracked and combined with GPS coordinates so it is possible to track the use of the app wherever in the world it is located.

The Safe Delivery App as a tool to improve skills, knowledge and practice can be used in a variety of ways determined by the need of existing health systems, programs, facilities and individual skilled birth attendants. Examples include that it can be used continuously for learning in users’ own time, in the face of emergent need, or for refresher training.

Proof of Concept

With the support of MSD for Mothers, the first four films of the app (Active management of third stage labor, Post-partum hemorrhage, Manual removal of retained placenta, and Neonatal resuscitation) were tested in a one-year randomized controlled trial in 78 facilities in Ethiopia in 2014 to assess the impact on health workers life-saving skills and knowledge. Key results revealed a significant increase in the skills and knowledge level of the health workers using app, e.g.: at 12 months health workers ability to handle post-partum hemorrhage (PPH) and to resuscitate a newborn (NR) more than doubled. These results were published in 2016 in JAMA Pediatrics which can be viewed here.

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Implementation

We believe that the Safe Delivery App will reach its full potential not as an isolated tool, but as an integrated part of health system strengthening efforts. Maternity Foundation’s Competency Center, based in Copenhagen, will support partners at national and programmatic levels to efficiently implement the App at scale, achieve impact and secure sustainability at different engagement levels. The Competency Center is comprised of staff, systems, and tools that capture, distill, apply and disseminate information, knowledge and emerging results to support implementing partners to enhance the impact and scale of the Safe Delivery App and to build the case for how to scale an mHealth solution.

How to download

The app can be pre-installed on phones and it is therefore not a requirement to have network connection or Internet access to view the videos and the other features of the app, once it has been downloaded.

The app is free for download and can be found at Google Play and at App Store.

Download on the App Store google-play-badge

Films about The Safe Delivery App

Apple’s video “Everyone can code”:

https://www.apple.com/education/everyone-can-code/

Short demonstration film:

Testimonials from Ethiopia:

“Scaling Innovations” event at Women Deliver conference:

Contact Us

For more information please contact our mHealth Competency Center: Tara Morazzini Talvacchia at tara@maternity.dk or Ida Marie Boas at ida@maternity.dk

For press related questions, please contact Head of Communications, Lise Knudsen, at lknu@maternity.dk