Text4Life design and operation

Rationale

Across sub-Saharan Africa, maternal and child health initiatives are embracing the use of electronic or mobile technology to improve access to and utilization of skilled obstetric care, especially among marginalized and vulnerable populations. These initiatives have been shown to be successful in increasing the use of health facilities by pregnant women, improving two-way communication between healthcare workers and pregnant women, and increasing women’s self-efficacy through the dissemination of pertinent health information.

The research team at the Women’s Health and Action Research Centre (WHARC) in Nigeria, led by Professor Friday Okonofua in collaboration with national and international partners and with funding from the International Development Research Centre (IDRC) and the West African Health Organization, began formative, intervention, and implementation research in 2017 to identify innovations and evidence for improving women’s access to skilled pregnancy care in rural Primary Health Centers (PHCs). During the formative study, we identified transportation as a significant barrier for pregnant women to access existing PHCs.

对女性，男性和社区领袖的多次定性研究表明，由于缺乏交通运输无法到达医疗机构，尤其是在晚上开始劳动或并发症时，妇女诉诸传统的怀孕方法。这是孕妇更喜欢使用离他们最近的非熟练传统亲生服务员（TBA）的最重要原因之一。

The Text4Life intervention was carried out for nearly 24 months, yielding impressive results with no documented maternal deaths.

为了应对这一挑战，该团队使用基于社区的参与性研究技术设计了一系列干预措施，以与妇女，社区领袖和政策制定者合作解决这一障碍。text4life是一种急流系统，是为了应对妇女在妊娠并发症时达到PHC所面临的困难。

How it works

Text4Life旨在实现女性，PHC提供者和运输所有者之间的双向交流。当孕妇经历出并发症，例如出血，正常或异常的劳动，严重的腹部疼痛等，并且她没有运输方式，她通过向链接的中央服务器发短信给中央服务器来激活警报系统。到所有尼日利亚电信网络。她自己发起警报，或者她得到了其他人的协助。

当激活警报时，已建立了病房发展委员会主席（WDC），该委员会在该妇女所居住的社区中注册孕妇会收到警报并确定她的位置。WDC是尼日利亚联邦卫生部的倡议，旨在加强社区关系和合作伙伴关系，以实施PHC的管理。同时，最接近PHC的提供商还收到了警报，并开始准备接收该妇女。然后，WDC主席将联系社区中的一位授权和预注册的运输商（出租车所有者），后者将前往该妇女的家，并将她送往健康中心。Text4Life包括一种反向计费技术，该技术发送免费警报消息。

Text4Life在连续的电源上运行，其中中央服务器连接到Internet和网站。该系统包括一个用于注册新怀孕的平台，以及在整个产前，出生和产后阶段监测怀孕的帮助。

在项目地点组织了许多能力建设研讨会，以供WDC，PHC提供者，孕妇（及其配偶或护理人员），以及女性志愿者在社区利益相关者之间发展能力来管理该系统。培训包括对妇女需要紧急转移的潜在怀孕并发症的解释。还向他们展示了如何传输消息并解释中央服务器的响应。

这对即兴表演干预持有强烈的承诺ving access to skilled pregnancy care, reducing delays due to lack of transportation, and decreasing the rate of maternal mortality.

Health providers were instructed on ways to prepare to receive women as well as the specific actions to take in response to emergencies, such as primary treatment, triaging, and referrals to secondary care hospitals should the need arise. Following the completion of the training, mobile phones were given to PHC healthcare providers and the WDC chairmen. During antenatal care visits, the PHC providers also showed the women how to use the Text4Life app.

text4life的结果和其他应用

As reported in our新文章，Text4Life干预进行了近24个月，在农村社区没有记录的孕产妇死亡的情况下取得了令人印象深刻的结果。联合国人口活动基金会（联合国人口基金）尼日利亚办公室目前正在利用Text4Life方法对九个尼日利亚州和联邦首都地区的320个社区进行干预，以报告妇女的妇女报告基于性别的暴力案件（GBV），Covid-19，计划生育需求和不必要的怀孕。

Women experiencing GBV and other complications can text a code to a central server via their mobile phones. The messages are then relayed to trained nearby health providers and civic society officials, who are expected to provide health care and social management to the distressed callers. The findings show that over a 22-month period, the server received a total of 3,200 reports, with the data currently being analyzed to determine the outcomes of management.

Conclusion

The development of the Text4Life app shows the potential of a quick short message sent from a mobile phone to a central server and linked to community managers, transport providers, and health providers to increase pregnant women’s access to skilled emergency obstetric services in rural Nigeria. The findings suggest that the intervention is feasible and sustainable, particularly when implemented with the active involvement and ownership by community members. We believe that this intervention holds a strong promise for improving access to skilled pregnancy care, reducing delays due to lack of transportation, and decreasing the rate of maternal mortality in rural Nigeria and other sub-Saharan African countries.