Skip to main content
Top
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana

Authors: Pedro Pagalday-Olivares, Bengt Arne Sjöqvist, Jessy Adjordor-van de Beek, Samuel Abudey, Ants R. Silberberg, Ruben Buendia

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

Login to get access

Abstract

Background

Despite the introduction of the Millennium Development Goal to reduce maternal deaths from 400 to 100 per 100,000 live births, the proportion of maternal deaths is still much higher in most developing countries like Ghana. Various interventions have been implemented in Ghana that focus on increasing skilled maternal care. These are especially needed in rural areas. EHealth has the potential to contribute to reducing the challenges in maternal healthcare (MHC) that poor areas suffer. This paper analyzes the potential of eHealth solutions to improve maternal health in rural Ghana as well as the challenges to their implementation. The work was carried out in cooperation with the local health directorate of Kpando Municipality, one of the administrative areas in the Volta Region.

Methods

The study is focused on remote peninsulas and islands in Kpando Municipality. Data was gathered through triangulated research methods. Maternal health challenges were identified using the Three Delays Model for MHC. The three delays are delay in seeking care, delay accessing health facilities, and delay receiving adequate care. Challenges to the implementation of eHealth solutions in remote communities were analyzed using the Drury’s 5C eHealth model for developing countries. The 5Cs correspond to context, community, capacity, connectivity, and content.

Results

The results show that financial dependence of women, a decision-making process based on previous experiences and traditional beliefs, competitiveness between facilities, organizational loopholes, lack of equipment, and geographical situations directly influence MHC outcomes. EHealth solutions, thanks to the high number of health workers with basic IT skills, have high potential to reduce MHC delays. However, poverty, cultural beliefs, organizational issues, connectivity, and lack of human resources were identified as main challenges to the implementation of eHealth solutions.

Conclusion

In Ghana’s rural areas the three delays proposed in the model affect the outcomes of MHC. These delays are influenced by socio-economic status, access to facilities, and quality of care. EHealth solutions show great potential to reduce the delays. Based on the 5C model, a mHealth solution aiming to improve guidance during pregnancy was outlined.
Literature
1.
go back to reference ICD-10. International statistical classification of diseases and related health problems: 10th revision. Geneva: World Health Organization (WHO); 1992. ICD-10. International statistical classification of diseases and related health problems: 10th revision. Geneva: World Health Organization (WHO); 1992.
3.
go back to reference UNGAOR, United Nations Millenium Declaration, in 55TH Sess, UN Doc A/RES/55/2,2000. UNGAOR, United Nations Millenium Declaration, in 55TH Sess, UN Doc A/RES/55/2,2000.
4.
go back to reference United Nations. The Millennium Development Goals Report. New York: UN; 2015. United Nations. The Millennium Development Goals Report. New York: UN; 2015.
5.
go back to reference General Assembly resolution 70/1, “Transforming our world: the 2030 Agenda for Sustainable Development” , A/RES/70/1 ( 25 September 2015), available from undocs.org/A/RES/70/1. General Assembly resolution 70/1, “Transforming our world: the 2030 Agenda for Sustainable Development” , A/RES/70/1 ( 25 September 2015), available from undocs.​org/​A/​RES/​70/​1.
7.
go back to reference Kpando Health Directorate, “Kpando Municipality – Health Sector (2014)”, (2014). Kpando Health Directorate, “Kpando Municipality – Health Sector (2014)”, (2014).
8.
go back to reference de Groot M. A qualitative health research about the challenges during pregnancy, delivery and after delivery on the islands in Kpando Municipality, Ghana. Kpando, Ghana: UNiTED; 2015. de Groot M. A qualitative health research about the challenges during pregnancy, delivery and after delivery on the islands in Kpando Municipality, Ghana. Kpando, Ghana: UNiTED; 2015.
10.
go back to reference Adema C. Decision making processes during antenatal period and the influence of the traditional birth attendant. Amsterdam: VU University Amsterdam & United projects; 2015. Adema C. Decision making processes during antenatal period and the influence of the traditional birth attendant. Amsterdam: VU University Amsterdam & United projects; 2015.
11.
go back to reference Der EM, Moyer C, Gyasi RK, Akosa AB, Tettey Y, Akakpo PK, Blankson A, Anim JT. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Medical Journal. 2013;47(4):158–63.PubMedPubMedCentral Der EM, Moyer C, Gyasi RK, Akosa AB, Tettey Y, Akakpo PK, Blankson A, Anim JT. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Medical Journal. 2013;47(4):158–63.PubMedPubMedCentral
12.
go back to reference Aoyama K, Suzuki Y, Sato T, Yamamoto T, Kojima K, Usami T, Ohte N, Suzumori K. Cardiac failure caused by severe pre-eclampsia with placental abruption, and its treatment with anti-hypertensive drugs. J Obstet Gynecol Res. 2003;29(5):339–42.CrossRef Aoyama K, Suzuki Y, Sato T, Yamamoto T, Kojima K, Usami T, Ohte N, Suzumori K. Cardiac failure caused by severe pre-eclampsia with placental abruption, and its treatment with anti-hypertensive drugs. J Obstet Gynecol Res. 2003;29(5):339–42.CrossRef
13.
go back to reference Montufar-Rueda C, Rodriguez L, Jarquin JD, Barboza A, Bustillo MC, Marin F, Ortiz G, Estrada F. Severe postpartum hemorrhage from uterine Atony: a multicentric study. J Pregnancy. 2013;2013, 525914 Montufar-Rueda C, Rodriguez L, Jarquin JD, Barboza A, Bustillo MC, Marin F, Ortiz G, Estrada F. Severe postpartum hemorrhage from uterine Atony: a multicentric study. J Pregnancy. 2013;2013, 525914
14.
go back to reference Ghana Health Service. Reproductive and Child Health Annual Report 2013. Accra: Ghana Health Service ICT Department; 2013. Ghana Health Service. Reproductive and Child Health Annual Report 2013. Accra: Ghana Health Service ICT Department; 2013.
15.
go back to reference Dislane FW, Akpalu A, Wegdam HHJ. The medical system in Ghana. The Yale Journal of Biology and Medicine. 2014;87(3):321–6. Dislane FW, Akpalu A, Wegdam HHJ. The medical system in Ghana. The Yale Journal of Biology and Medicine. 2014;87(3):321–6.
19.
go back to reference Internation Telecommunication Union. Implementing e-Health in Developing Countries - Guidance and Principles. Geneva: ICT Applications and Cybersecurity Division - Policies and Strategies Department; 2008. Internation Telecommunication Union. Implementing e-Health in Developing Countries - Guidance and Principles. Geneva: ICT Applications and Cybersecurity Division - Policies and Strategies Department; 2008.
20.
go back to reference Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Aff. 2010;29(2):244–51.CrossRef Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Aff. 2010;29(2):244–51.CrossRef
21.
go back to reference Akter S, Ray P. mHealth - an Ultimate Platform to Serve the Unserved. Yearb Med Inform. 2010;10:94–100. Akter S, Ray P. mHealth - an Ultimate Platform to Serve the Unserved. Yearb Med Inform. 2010;10:94–100.
22.
go back to reference mHealth Alliance. Leveraging Mobile technologies to provide maternal & newborn health. Oakland: The Center for Innovation & Technology in Public Health; 2012. mHealth Alliance. Leveraging Mobile technologies to provide maternal & newborn health. Oakland: The Center for Innovation & Technology in Public Health; 2012.
23.
go back to reference M. o. H. Dr. Benjamin Kunbuor, "Ghana e-Health Strategy". Accra: Ghana Ministry of Health; 2010. M. o. H. Dr. Benjamin Kunbuor, "Ghana e-Health Strategy". Accra: Ghana Ministry of Health; 2010.
26.
go back to reference American Telemedicine Association. Telehealth for High-risk Pregnancy: State Medicaid Best Practice; 2014. American Telemedicine Association. Telehealth for High-risk Pregnancy: State Medicaid Best Practice; 2014.
27.
go back to reference Fraser H, Biondich P, Moodley D, Choi S, Mamlin E, Szolovits P. Implementing electronic medical record systems in developing countries. Journal of Innovation in Health Informatics. 2005;13(2):83–95. Fraser H, Biondich P, Moodley D, Choi S, Mamlin E, Szolovits P. Implementing electronic medical record systems in developing countries. Journal of Innovation in Health Informatics. 2005;13(2):83–95.
28.
go back to reference Ivatury G, Moore J, Bloch A. A doctor in your pocket: health hotlines in developing countries. Innovations: Technology, Governance, Globalization. 2009;4(1):119–153. Ivatury G, Moore J, Bloch A. A doctor in your pocket: health hotlines in developing countries. Innovations: Technology, Governance, Globalization. 2009;4(1):119–153.
29.
go back to reference Krasovec K. Auxiliary technologies related to transport and communication for obstetric emergencies. Int J Gynecol Obstet. 2004;85(Suppl. 1):S14–23.CrossRef Krasovec K. Auxiliary technologies related to transport and communication for obstetric emergencies. Int J Gynecol Obstet. 2004;85(Suppl. 1):S14–23.CrossRef
30.
go back to reference Kallander K, Akpogheneta DJ, Asbroek AHA, Kirkwood BR. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review. J Med Internet Res. 2013;15:1.CrossRef Kallander K, Akpogheneta DJ, Asbroek AHA, Kirkwood BR. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review. J Med Internet Res. 2013;15:1.CrossRef
31.
go back to reference Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA. 2007;298(16):1900–10.CrossRefPubMed Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA. 2007;298(16):1900–10.CrossRefPubMed
32.
go back to reference Lund S, Rasch V, Hemed M, Boas IM, Azzah S, Khadija S, Makundu MH, Nielsen BB. Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary outcomes of a Cluster Randomized Controlled Trial. JMIR mHealth and uHealth. 2014;2:1.CrossRef Lund S, Rasch V, Hemed M, Boas IM, Azzah S, Khadija S, Makundu MH, Nielsen BB. Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary outcomes of a Cluster Randomized Controlled Trial. JMIR mHealth and uHealth. 2014;2:1.CrossRef
33.
go back to reference Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, Kaltschmidt J, Haefeli WE, Blank A. Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania. Global Health Action. 2015;8:25756.CrossRef Mensah N, Sukums F, Awine T, Meid A, Williams J, Akweongo P, Kaltschmidt J, Haefeli WE, Blank A. Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania. Global Health Action. 2015;8:25756.CrossRef
34.
go back to reference Ngabo F, Nguimfack J, Nwaigwe F, Mugeni C, Muhoza D, Wilson DR, Kalack J, Gakuba R, Karema C, Binagwaho A. Designing and Implementing and Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda. PanAfrican Medical Journal. 2012;13:31. Ngabo F, Nguimfack J, Nwaigwe F, Mugeni C, Muhoza D, Wilson DR, Kalack J, Gakuba R, Karema C, Binagwaho A. Designing and Implementing and Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda. PanAfrican Medical Journal. 2012;13:31.
35.
go back to reference Dimmick SL, Burgiss SG, Robbins S, Black D, Jarnagin B, Anders M. Outcomes of an integrated Telehealth network demonstration project. Telemed J E Health. 2004;9(1):13–23.CrossRef Dimmick SL, Burgiss SG, Robbins S, Black D, Jarnagin B, Anders M. Outcomes of an integrated Telehealth network demonstration project. Telemed J E Health. 2004;9(1):13–23.CrossRef
36.
go back to reference Finkelstein SM, Speedie SM, Potthoff S. Home Telehealth improves clinical outcomes at lower cost for home healthcare. Telemed J E Health. 2006;12(2):128–36.CrossRefPubMed Finkelstein SM, Speedie SM, Potthoff S. Home Telehealth improves clinical outcomes at lower cost for home healthcare. Telemed J E Health. 2006;12(2):128–36.CrossRefPubMed
37.
go back to reference Garg AX, Adhikari KJ, McDonald H, Rosas-Arellano P, Devereaux PJ, Beyene J, Sam J, Hayne B. Effects of computerized clinical decision support systems on Practicioner performance and patient outcomes. JAMA. 2055;293(10):1223–38.CrossRef Garg AX, Adhikari KJ, McDonald H, Rosas-Arellano P, Devereaux PJ, Beyene J, Sam J, Hayne B. Effects of computerized clinical decision support systems on Practicioner performance and patient outcomes. JAMA. 2055;293(10):1223–38.CrossRef
38.
go back to reference Piette JD, Lun K, Moura LA, Fraser HS, Mechael PN, Powell J, Khoja SR. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? Bull World Health Organ. 2012;90(5):321–400.CrossRef Piette JD, Lun K, Moura LA, Fraser HS, Mechael PN, Powell J, Khoja SR. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here? Bull World Health Organ. 2012;90(5):321–400.CrossRef
39.
go back to reference Williams F, Boren S. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care. 2008;16(2):139–45.PubMed Williams F, Boren S. The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform Prim Care. 2008;16(2):139–45.PubMed
41.
go back to reference Steen M. Data collection and management. In: Key Concepts in Nursing and Healthcare Research: SAGE; 1988. p. 211–7. Steen M. Data collection and management. In: Key Concepts in Nursing and Healthcare Research: SAGE; 1988. p. 211–7.
42.
go back to reference Flynn S. Observational research. In: Key Concepts in Nursing and Healthcare Research: SAGE; 1988. p. 111–6. Flynn S. Observational research. In: Key Concepts in Nursing and Healthcare Research: SAGE; 1988. p. 111–6.
43.
go back to reference Thaddeus S, Maine D. Too Far to Walk, Maternal Mortality in Context. Soc Sci Med. 1994;38:1091-1110. Thaddeus S, Maine D. Too Far to Walk, Maternal Mortality in Context. Soc Sci Med. 1994;38:1091-1110.
44.
go back to reference Drury P. EHealth: a model of developing countries. eHealth Int. 2005;2(2). Drury P. EHealth: a model of developing countries. eHealth Int. 2005;2(2).
45.
go back to reference Vink S. Stimulating SMC attendance in Kpando, GHana: Qualitative research into stakeholder influence. Kpando, Ghana: UNiTED; 2015. Vink S. Stimulating SMC attendance in Kpando, GHana: Qualitative research into stakeholder influence. Kpando, Ghana: UNiTED; 2015.
46.
go back to reference Borckink S. Influence of HIV testing on ANC attendance. Amsterdam: Athena Institue, VU University Amsterdam & United projects; 2015. Borckink S. Influence of HIV testing on ANC attendance. Amsterdam: Athena Institue, VU University Amsterdam & United projects; 2015.
47.
go back to reference Heinen M. Health care before, after and during birth in Kpando, Ghana. A community based assessment on maternal mortality. Kpando: UNiTED; 2013. Heinen M. Health care before, after and during birth in Kpando, Ghana. A community based assessment on maternal mortality. Kpando: UNiTED; 2013.
48.
go back to reference Oehler D, UNiTED and African Woman Alliance. A qualitative research on antenatal care utilization in Kpando Municipality, Ghana. Kpando: UNiTED; 2014. Oehler D, UNiTED and African Woman Alliance. A qualitative research on antenatal care utilization in Kpando Municipality, Ghana. Kpando: UNiTED; 2014.
49.
go back to reference Jongma S. "When Time Matters" A qualitative Health Researh on Delay in Emergency Obstetric Health Care in Kpando Municipality, Ghana. Kpando, Ghana ; Amsterdam, The Netherlands: UNiTED; 2014. Jongma S. "When Time Matters" A qualitative Health Researh on Delay in Emergency Obstetric Health Care in Kpando Municipality, Ghana. Kpando, Ghana ; Amsterdam, The Netherlands: UNiTED; 2014.
50.
go back to reference Tamrat T, Kachnowski S. Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Maternal Child Health Journal. 2011;16(5):1092–101.CrossRef Tamrat T, Kachnowski S. Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Maternal Child Health Journal. 2011;16(5):1092–101.CrossRef
51.
go back to reference Noordam C, Kuepper BM, Stekelenburg J, Milen A. Improvement of maternal health services through the use of mobile phones. Tropical Med Int Health. 2011;16(5):622–6.CrossRef Noordam C, Kuepper BM, Stekelenburg J, Milen A. Improvement of maternal health services through the use of mobile phones. Tropical Med Int Health. 2011;16(5):622–6.CrossRef
52.
go back to reference Heinzelmann PJ, Williams CM, Lugn NE, Kvedar JC. Clinical outcomes associated with telemedicine/Telehealth. Telemedicine and e-Health. 2005;11(3):329–47.CrossRefPubMed Heinzelmann PJ, Williams CM, Lugn NE, Kvedar JC. Clinical outcomes associated with telemedicine/Telehealth. Telemedicine and e-Health. 2005;11(3):329–47.CrossRefPubMed
53.
go back to reference Ngafeeson M. Healthcare Information Systems: Opportunities and challenges 2014, p. Paper 14. Ngafeeson M. Healthcare Information Systems: Opportunities and challenges 2014, p. Paper 14.
Metadata
Title
Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana
Authors
Pedro Pagalday-Olivares
Bengt Arne Sjöqvist
Jessy Adjordor-van de Beek
Samuel Abudey
Ants R. Silberberg
Ruben Buendia
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0552-z

Other articles of this Issue 1/2017

BMC Medical Informatics and Decision Making 1/2017 Go to the issue