Assessing the Impact of Mobile Phone Technology to Improve Health Nutrition and Population (HNP) Service Utilization in Rural Bangladesh Through Pilot Intervention

Introduction In Bangladesh, about 2 million new faces are added to the population annually with a growth rate of 1.4% . Last Health Population and Nutrition Sector Development Programme (HPNSDP) of the Ministry of Health and Family Welfare (MOHFW) had set a target of total fertility rate (TFR) of 2.0 and contraceptive prevalence rate (CPR) of 72 by 2016 which is currently 2.3 and 61.2 respectively. It is necessary to increase the age at first birth as data indicates almost half of women giving birth by age 18 and nearly 70% giving birth by age 20. It is indicated that only 26% women received four or more antenatal care (ANC) visits during their pregnancies, while 68% received at least one ANC during their pregnancies which are the great challenges for ensuring safe motherhood in the country. As a part of safe motherhood, it is estimated that only 29% deliveries are being conducted in health facilities in the country. In case of postnatal care (PNC), from 2008 to 2010, only 27 percent of women received PNC for their last birth from a medically-trained provider within two days of their delivery . Despite the tremendous success of EPI in Bangladesh, a substantial number of children are not fully vaccinated under EPI as data shows 82% were fully vaccinated by the age of 12 months. In case of diarrhoea among under 5 years of age, 25% received treatment from a health facility or healthcare providers. Thirty-five percent of the children under 5 years who had acute respiratory infection (ARI) received treatment from a health facility or healthcare providers. More than six of every ten children with fever sought treatment from the private medical sector. Although 90% of children are breastfeed until age 2, as recommended, but 36 percent of children less than age 6 months are out of exclusively breastfed. Though the health indictors in Bangladesh are improving, these rates are behind from the target.

In recent years, mobile phone use in healthcare (mHealth) has emerged to augmented of healthcare services where the population is underserved especially in rural areas . In a systematic review, Tamrat and colleagues (2011) highlighted the scope of mHealth along the stages of the 'continuum of care' for maternal, newborn and child healthcare [8]. mHealth programs are being used for pregnancy tracking, appointment reminders for antenatal care, and SMS-based health education during pregnancy. During the birth, mHealth can be used for point-of-care remote consultation, facilitate referral to health facility; facilitate access to health facility and to promote timely contact with community health workers. For postpartum and newborn care, mHealth can be used for maternal and infant growth monitoring, timely reminders for immunization .

In Bangladesh, mHealth and eHealth initiatives are being implemented by MOHFW and different organizations and donors are supporting to the initiatives. This initiative will complement with existing health systems and contribute to increase effectiveness of HPN services by using mobile phone based technologies.

The Government of Bangladesh has placed a high priority on eHealth, which is reflected in the ICT Policy 2009. The strategic areas/issues relevant to health in the ICT Policy 2009 include the following (Clauses 7.1-7.4 of ICT Policy): 'Improve healthcare delivery management through use of telemedicine and modern technology; create awareness at all levels, including hard-to-reach areas with particular importance in making maternal, child and reproductive care available; ensure quality of care and increase the capacity of health care delivery system'. But use of technology for covering all or major components of primary health care (PHC) is yet to be developed and tested in Bangladesh. Further, no such initiative has yet been taken focusing community clinic (CC) to ensure universal health coverage in Bangladesh.

At present, in Bangladesh, the CCs can cater the services on family planning (FP), maternal neonatal and child health (MNCH) and health education for the rural people by using eHealth strategy as the community health care provider (CHCP) and other staff of CCs are equipped with internet connected laptop service . One recent study findings show that 33% rural married women and 69% of their family members have mobile phones. Therefore, the MOHFW, icddr,b and Ethics Advance Technology Limited (EATL) have taken this initiative to utilize mobile phone technology to improve HPN service in rural areas of Bangladesh. This study will be implemented with the aim to develop and test a mechanism of mHealth strategies as well as assessing the impact in improving reproductive health and family planning, maternal neonatal and child health, integrated management of childhood illness, expanded programme on immunization, and other primary health care services in community level in rural areas of Bangladesh. This is an evidence based research for HPN services using mobile technology and proposed extension of the project and integrated with health system of the Government in Bangladesh.