Nigeria has one of the highest rates of maternal mortality in the world. Official maternity services can be only part of the solution to this problem because, outside the largest cities, most women in Nigeria do not have access to them. This project is testing a health information system that links skilled obstetric services directly to households by electronically-monitored health worker visits to pregnant women and their husbands where they live. It is being conducted in one subcivision of Bauchi State (called a Local Government Authority or LGA) in the north of the country where only 15% of deliveries are attended by skilled health personnel.

A series of questions identifies the risk profile of each pregnant woman, including such factors as: divorced or widowed, domestic violence, hard work in pregnancy, knowledge of danger signs, lack of support networks and lack of access to facilities or supportive attitudes regarding safe birth. Cellphone handsets collect and relay the information to a data base in the headquarters of the LGA. If needed, these home visits facilitate the referral of high risk cases before there is a life threatening crisis. Within seconds of completion of the interview, high risk cases show up on a central processor in the LGA data base, usually while a health worker is still in contact with the woman in question. If the cellular system is non-functional at the time of conclusion, the information and location of the high risk woman is available the following day.

A small team at the district centre has been trained to process the data, key off relevant clinical action and consolidate information for policy purposes. Geo-indexing of all households helps to maintain quality control and allows for case-specific followup. Visits after delivery also increase the likelihood of appropriate postnatal care.

For more information about the health information and monitoring system of which this is a part click here.