This paper from Kenya illustrates how 'digital interventions communicated vital health information and promoted care-seeking behaviors during a pandemic, helping to maintain consistency in care and encourage progress toward lowering maternal and infant deaths in the region'.
CITATION: Maintaining Continuity of Care for Expectant Mothers in Kenya During the COVID-19 Pandemic: A Study of MomCare
Teresa De Sanctis, Mary-Ann Etiebet, Wendy Janssens, Mark H. van der Graaf, Colette van Montfort, Emma Waiyaiya and Nicole Spieker
Global Health: Science and Practice August 2022, 10(4):e2100665; https://doi.org/10.9745/GHSP-D-21-00665
The outbreak of coronavirus disease (COVID-19) challenged the care-seeking behavior of expectant mothers and their access to quality health care. MomCare, a digital care bundle that links mothers-to-be with care providers and payers, quickly adapted and provided a suite of support services throughout the pandemic.
Maintaining or improving care-seeking behaviors and quality of care for MomCare platform users shows how public health practitioners can promote interactive, patient-driven technology that can quickly link payments with patients and providers to support and empower mothers-to-be in times of crisis.
Program managers should consider implementing value-based health care frameworks, such as MomCare, to make care systems more outcome-driven and promote patients’ empowerment and transparency throughout the care pathway.
Policy makers should increasingly support the adoption of mobile platforms that can promote a user-centered approach, unlock rapid scale-up over a previously organized network, ensure accountability over the care pathway, and enable rapid adaptation to unexpected changes.
In Kenya, early coronavirus disease (COVID-19) modeling studies predicted that disruptions in antenatal care and hospital services could increase indirect maternal and neonatal deaths and stillbirths. As the Kenyan government enforced lockdowns and a curfew, many mothers-to-be were unable to safely reach hospital facilities, especially at night. Fear of contracting COVID-19, increasing costs of accessing care, stigma, and falling incomes forced many expectant mothers to give birth at home. MomCare, which primarily serves communities in remote areas and urban slums, links mothers-to-be with payers and health care providers, following a standardized pregnancy program based on World Health Organization guidelines at a predetermined cost and quality. Expectant mothers gain access to care through a mobile wallet on their feature phone (voice, text, and basic internet), and providers are paid after appropriate care is given. Within the first 3 weeks of the pandemic in Kenya, the following services were added to the MomCare bundle: emergency ambulance services during curfew hours, extended bed allowances to encourage early care, phone calls to check on mothers approaching their delivery dates and to promote the generation of a birth plan, SMS messages to inform mothers of open facilities and COVID-19 protocols, and training for clinic staff in managing COVID-19 patients and infection prevention. We compare data collected through the MomCare platform during the 6 months before the first confirmed COVID-19 case in Kenya (September 2019–February 2020) with data collected during the 6 months that followed. This study shows that care-seeking behaviors (enrollment, antenatal/postnatal care, skilled deliveries) increased for mothers-to-be enrolled in MomCare during the COVID-19 lockdowns, while quality of care and outcomes were maintained. Public health practitioners can promote interactive, patient-driven technology like MomCare to augment traditional responses, quickly linking payments with patients and providers in times of crisis.