Applying mhealth to improve supportive supervision of a large scale maternal and newborn health program in Ethiopia

The Last Ten Kilometers (L10K) project strengthens the link between Ethiopia's health extension program (HEP) and households to improve community-based maternal and neonatal health (MNH) services in 115 districts covering about 14 million people in 3,000 kebeles/communities. The HEP services to a kebele are provided by two female health extension workers (HEWs). Seventy-two L10K field coordinators (FC) provide supportive supervision (SS) to the HEWs using a checklist. A limited number of checklist items were being analyzed, while programmatic feedback was often delayed. M-health was implemented to address the issue. This study assesses its adequacy in improving the quality and performance of the SS.

Using web based EpiSurveyor, the SS checklist was installed in smart phones given to the FCs. The smart phones allowed offline data collection during SS which were uploaded to the web whenever network was available; allowing program managers to access the data from anywhere to provide feedback.

The system improved the efficiency of the central, regional, district-level program managers to give feedback to the FCs by reducing the cycle from every three months to every month. Although the FCs usually visited the target number kebeles, there were kebeles that were not visited; while checklist items were often missed. Between April 2012 and January 2012 the SS coverage of kebeles increased from 30% to 70% while the missed items reduced from 25% to 5%. The m-health also provided information on the variation in maternal health care coverage according to the different in L10K strategy areas.