Toward a safer motherhood in Myanmar

Myanmar has some of the worst health indicators in South-East Asia. In Kayin State, the Maternal Mortality Ratio is 727 per 100 000, the Under Five Mortality is 138 per 1 000 and the Infant Mortality is 73 per 1 000 in Eastern Burma. There is an insufficient access to Reproductive Health services in addition to inadequate reproductive health awareness of the population. The number of skilled Reproductive health workers including Midwives is very low. The deliveries are rarely attended by MW. There is an urgent need to develop the skills of Reproductive health professionnals.

The project focuses on strenghtening the skills of midwives through continuous medical education, and creating a network with the auxilary midwives (AMW), based in the communities. The intervention aims to improve the quality of services reinforcing the competencies and capacities of midwives. It also stenghtens the AMW’s networks, through mentoring by competent midwives. The project is based on an innovative combination of two approaches. On one hand, standard Reproductive Health activities and trainings and on the other hand, a pilot m-health approach which enables to reinforce competencies all along the project. The standard approach which include internationally recognized and essential Reproductive Health services, will be leveraged by the introduction of mobile technologies to provide distance support to AMWs with a focus from the antenatal to the neonatal periods. The mobile phone based intervention will (i) reinforce routine patients management through the possibility for AMWs to access remote consultation, diagnosis and treatment support tools, and to consult with qualified and specialized midwices, (ii) support the provision of continuous training to AMWs through technology enabled multimedia content and (iii) enable timely dissemination of health information to the closest health centre and health authorities. The mobile application is composed of an algorithm based clinical decision support tool and an electronic patient registration form.

In order to compensate for the lack of midwives and to replace Traditional Birth Attendants (TBAs) whose practices were often dangerous for women, the government implemented the AMWs. The current approach enables the strenghtening of the quality of services to women and the recognition and inclusion of community health workers within the Myanmar system. Since the beginning of the project the level of knowledge and prepardness of AMWs at a community level has improved drastically, as they are benefiting from practical training sessions and supportive supervision in addition to the continuous technical support through the use of the mHealth application. The use of the application facilitates the communication between midwives and AMWs and contribute to build a strong bridge between the community and the health facilities. The use of electronic medical records allows midwives to have a better follow up of women in their catchment areas and to increase the quality of care.