mHealth and Neonatal Resuscitation: A Review of Interventions, Approaches and Application

"[T]he UNCoLSC’s Neonatal Resuscitation Technical Working Group (TWG) was formed to systematically identify best practices for scaling up interventions, identifying barriers in current implementation and gaps in knowledge, and addressing other issues related to reducing neonatal mortality through the development of technical standards."

As part of the Every Woman, Every Child effort, the United Nations (UN) Commission on Life-saving Commodities (UNCoLSC) identified 13 essential commodities which can save women and children. The list includes neonatal resuscitation equipment and devices. In support of the TWG's interest in how mHealth might support neonatal resuscitation, this paper describes existing mHealth approaches and tools: to track the availability and maintenance of resuscitation equipment; to increase health worker training and the appropriate utilisation of the resuscitation equipment; and to monitor and evaluate facility-level data.

This "landscape scan of mHealth" involved reviewing electronically available literature and reviewing mHealth case studies, programme descriptions, and other documents, then placing them into three categories of "possible and promising interventions":

1. "Supply and maintenance of newborn resuscitation commodities
2. Training of skilled birth attendants, including nurses and midwives trained on neonatal resuscitation
3. Monitoring and evaluation of neonatal resuscitation programs".

Examples include:

• Client education and behaviour change and communication - for example, Wired Mothers in Zanzibar and the Mobile Alliance for Maternal Action (MAMA) programme use SMS text messaging. "Messages, in particular, around the value and use of resuscitation equipment could be included in messaging packages similar to those developed in the Wired Mothers and MAMA programs."
• The United Nations Children's Fund (UNICEF) has been supporting the use of RapidSMS, a mobile phone application, to register births, issue birth certificates, and maintain a database of new births. This system, among others, could track and register deaths and their causes during the neonatal period to help focus needs for equipment and training for resuscitation.
• Further data collection, for example, the Helping Babies Breathe (HBB) programme monitoring and evaluation programme in Kenya, can yield information on training (initial and refresher), learner-centred evaluations, implementation evaluations, and quality improvement debriefs.
• MCHIP (Maternal and Child Health Integrated Program) developed a toolkit of "Maternal and Newborn Quality of Care" surveys with various assessment capabilities including questions on resuscitation procedures.
• Though mobile-focused decision support tools at point of care "are not an ideal option in improving neonatal resuscitation services" due to the 60-second timeframe for resuscitation, the devices facilitate communication among healthworkers on transfers of patients, training and supervision, and post-procedure follow-up. They may also be used in scheduling and provider training and education, for example, eMOCHA and eHealth Villages tools.
• Human resources management of locations of trained providers and supply chain management are additional uses. Because devices are re-used, the supply chain management differs from medicines supply management. For example, through its "Health Tech workplan, PATH plans to conduct a durability and cleaning assessment of neonatal resuscitation equipment in the field."
• Mobile cash and transfer systems can facilitate incentivising use of neonatal resuscitation-equipped facilities.

Barriers and knowledge gaps include the lack of coordination of systems tool development, organisation on collection and use of evaluation data, policy barriers on country-level mHealth provision and usage, and equipment availability. Recommendations for the role of mHealth include planning and advocacy for its potential use in:

• Client awareness and education
• Birth Registration and Data collection
• Provider training
• Supply Management