Dili, Timor-Leste, April 22, 2016
In 2013 Health Alliance International (HAI), Catalpa International, and the Timor-Leste Ministry of Health launched the first ever mobile health, or mHealth program in Timor-Leste. Liga Inan (“connecting mothers”) is an innovative approach to linking pregnant women with health information and the midwives who serve them by means of mobile phones, both through text messaging and facilitated voice communication. The Liga Inan program was first implemented in Manufahi Municipality with funding by the United States Agency for International Development. Since 2014, the Australian Government has funded expansion of Liga Inan into three additional municipalities, with further expansion planned in 2016.
The Liga Inan program aims to improve women’s knowledge and practice of healthy behaviours before, during and after childbirth. Key behavioural outcomes are to increase the number of women who deliver with a skilled birth attendant and in a health facility, and to increase the number of women and newborns who are seen for a health check within two days following birth.
To evaluate the impact of the mHealth intervention, Liga Inan was implemented in Manufahi Municipality with neighboring Ainaro Municipality serving as a control site where Liga Inan was not implemented. A baseline and final knowledge, practice and coverage survey that compared pre- and post-intervention time periods in both intervention and control sites was carried out. A random selection of women who had given birth in the two years prior to each survey were asked questions regarding health care seeking behaviors throughout pregnancy, delivery and during the post-delivery period.
The 2012 baseline survey was conducted in both sites prior to launching the program; the final survey, also in both sites, was conducted in 2015 after Liga Inan had been operating in all areas of Manufahi for at least two years. The research aimed to determine whether women in the Liga Inan program municipality had significantly greater use of maternal health services compared to women in the control municipality of Ainaro while also taking into account differences between the municipalities before Liga Inan began.
The survey results showed very high rates of participation in the Liga Inan program: 70% of surveyed women pregnant during the time Liga Inan was operating in Manufahi participated in the program. Women in Manufahi during that time had nearly twice the odds of delivering with a skilled birth attendant – midwife, nurse or doctor — when compared with the two-year period before the program began and to the control site of Ainaro. While the percent of women delivering with a skilled attendant rose from 48% in 2012 to 62% in 2015 in Manufahi, there was no change in skilled attendant deliveries in Ainaro during this same period.
Women in Manufahi also had nearly twice the odds of delivering in a health facility when compared to the control site. The percent of women delivering in a health facility rose from 32% in 2012 to 49% in 2015 in Manufahi. There was no change in this rate in the control site of Ainaro during this same period.
Finally, women in Manufahi had seven times greater odds of receiving a postpartum check of their health, and over five times greater odds that their newborns would receive a health check within two days of birth than women not exposed to the program.
Promoting the use of skilled attendants and health facilities for maternal and newborn care is a major emphasis of efforts to reduce mortality among mothers and their infants worldwide. These results show not only a high rate of participation in the Liga Inan program among pregnant women in Manufahi Municipality, but also that women exposed to the Liga Inan mHealth program were much more likely to receive services from health staff at the most critical time for saving the lives of women and newborns: at birth and two days after childbirth.
Health Alliance International is a nongovernmental organization and a center in the University of Washington’s Department of Global Health based in Seattle, USA, that has been engaged in health efforts in Timor-Leste since early 1999.
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Health Alliance International