By Stefano Montanari
As she gets ready for her daily visits as a community health worker, Nomfusi Nquru makes sure that she has not forgotten her new tablet. A trained mentor mother with the Philani Maternal, Child Health and Nutrition Trust, Nquru is among the 12 workers who are testing tablets pre-loaded with educational videos provided by Stanford University to help expand access to health knowledge in the Khayelitsha Township, the poorest and fastest growing slum near Cape Town, South Africa, home to some 500,000 people.
“I am excited about using the tablet as it is something new and a chance to use technology that I do not get to use,” Nquru said in an interview. “Mothers react excitedly to the videos and seem to pay careful attention to what is being said. Hearing lessons in a different way is something that catches the mothers’ attention and afterwards they ask questions on how to feed their children well and look after themselves in their pregnancies.”
A single mother of two from Mount Fletcher in the Eastern Cape, Nquru moved to Cape Town in 2007 in search of a better life for her and her young children. She worked as a housekeeper in Cape Town for three years, until a friend told her about Philani. “My friend said that Philani is a place where you learn to help children. I am a single mother and I know how difficult it is to look after children alone. So I wanted to be part of the program to help other mothers in any way and make them not feel alone.”
Around 100 mentor mothers work at Philani today. In the past seven years, they have brought health care interventions into the homes of thousands of pregnant women and new mothers, teaching them how to rehabilitate underweight children, improve birth outcomes, obtain state allowances and assist in the prevention of mother-to-child HIV transmission. Their work has now caught the attention of a team of professors at Stanford University who started a pilot project in February to provide them with digital educational support through sturdy tablets.
“When we first introduced the teaching tablets, it was quite amazing to see how quickly these mothers picked up this technology,” said Dr. Maya Adam in a phone interview. Adam is a lecturer at the Stanford School of Medicine and initiator of the project. “In a way we are bypassing the blockage in access to education at least in the short term and providing these women with the opportunity to access knowledge using the technology we have today.”
Each tablet costs $170 U.S. dollars and uses only pictures so that the video can be dubbed in different languages.
Stanford University’s program is not the first case in which technology is used to sustain health progress. The Mobile Alliance for Maternal Action, for example, delivers vital health information to new and expectant mothers through their mobile phones in several developing countries, including South Africa where it is cooperating with the national Department of Health to reduce maternal and child mortality.
“Since MAMA launched in 2011, we have seen many changes in mobile technology and the field of information communication technology for development,” said Kirsten Gagnaire, Executive Director of MAMA in an email. “We are increasingly seeing people in developing countries make the leap from no internet access to internet access via mobile phones. This gives us a tremendous opportunity to reach more people with information that can truly transform their lives.”
Such initiatives hope to accelerate progress in improving maternal health, which remains slow according to the World Health Organization. In spite of considerable improvements as part of the global mobilization promoted by the Millennium Development Goals, 800 women still die every day from preventable causes related to pregnancy and childbirth. In addition, a recent report by Save the Children warns about the increasing health divide between wealthy and poor living in cities, highlighting that poor children in urban slums face a higher risk of death than better-off children.
In a country like South Africa, where 30 percent of pregnant women do not access prenatal care, more than 12 percent of the population live with HIV, and around 40% of maternal deaths are HIV/AIDS-related, mentor mothers have proved a remarkable remedy to reduce the incidence of diseases and malnutrition, especially in children. A recent study conducted by Philani together with the University of California, Los Angeles, and Stellenbosch University in South Africa found that repeated home visits by trained community health workers to neighborhood mothers led to significant health improvements both for mothers and children, including in the prevention of mother-to-child HIV transmission.
“Community health workers can help bridge the gap in the short term between what we need in health care providers and what we have,” said Adam, who has years of experience in developing digital educational content for the School of Medicine at Stanford. “If we wait for education in South Africa to catch up with the need for it in these under-resourced communities, we are going to wait for a long time. By using technology like the tablets, we can accelerate that process in communities otherwise cut from main infrastructures.”
The World Health Organization considers the use of digital technology as a tool to strengthen the quality and coverage of existing health interventions. “Digital technologies like those used in this project have proven valuable for both community members as well as the health workforce to gain access to quality information that can help make timely and well informed health decisions that can impact on the lives of mothers and their children,”said Dr Lale Say, coordinator of the adolescents and at-risk populations team at the Department of Reproductive Health and Research of the World Health Organization.
While a scientific evaluation of the project is expected to start next year, the 12 mentor mothers using the tablets have already provided very positive feedback, according to a questionnaire prepared by Stanford University, obtained by The Imprint. The Stanford University team is now raising funds for additional tablets and preparing translations into Spanish to extend this project into other countries. “We have the technology, we have the equipment. If we can get support, we can really put our heads down and start creating a comprehensive, multilingual, open access library to promote the health of mothers and children everywhere,” Adam said.
Stefano Montanari is a freelance journalist based in Europe.