D-tree's Safer Deliveries program empowers, informs and encourages women, with the support of their families, to deliver in health facilities.
It links pregnant women with community health workers (CHWs), community drivers, village savings groups and health facilities.
These connections are supported by the use of digital technology to facilitate better decision making and the co-ordination of resources and support.
DIGITAL ANTE-NATAL/POST-NATAL ASSISTANT
Our Community Health Workers are equipped with a dedicated app via which they register all pregnant women in their catchment areas. The app helps the health worker to schedule at least three visits to each client during pregnancy and three after delivery and helps systematise what happens during these visits.
With the support of this app, the CHW:
- Engages husbands and family members in the birth planning process
- Establishes, well in advance, family permissions for a facility delivery
- Screens for danger signs and makes appropriate referrals to the relevant health facility
- Counsels the woman and her family about healthy behaviors during pregnancy
- Supports the woman and her family to save enough money for transportation and other delivery-related expenses
- Maintains contact information for transport options and savings groups in the locality
COMMUNITY SAVINGS GROUPS
One key aspect of this program is community engagement and empowerment of women and their families to take responsibility for saving money in advance to pay for transport and other delivery-related expenses at the health facility.
To support this, the program works closely with already-existing community savings groups. Community savings groups have existed for decades throughout Zanzibar and much of the world.
Members meet on a weekly basis and contribute money to the group savings, which are then given out as loans to individual members and repaid over time. Community savings groups in Zanzibar also have a social fund which members also pay into on a weekly basis.
This money is used to help any member in the community in a time of need (for example, during a medical emergency, or to repair the village water pump). Money given out from the social fund is a gift which is not repaid by the recipient.
DANGER SIGNS SCREENING
At every visit, both ante-natal and post-natal, the CHW is prompted to check the client for important danger signs (and the baby too) and, if guided by the app, to refer her to a facility for medical attention.
The app auto-ensures a follow-up visit to the client at a set time after a referral has been made.
The app contains ministry guidance. Some of it is conveyed in the form of recorded dialogues, a medium with which people are familiar with via radio, and which is a popular and accepted medium for such messages on Zanzibar.
The CHW clicks a button to play a dialogue and discusses the contents of the dialogue with the client afterwards
Here are the main topics covered:
CITIZEN FEEDBACK AND PERFORMANCE-BASED FINANCING
Digital tools generate data, which yields potential for many new ways of working. One possibility which we have explored is using data generated by such a program in Performance-Based Financing schemes for facilities. To this end, we designed a "Citizen Feedback" questionnaire concerning client experiences when obtaining services from facilities. The content and structure of this questionnaire fits directly a current model of this kind of program. Aggregate data of this kind can be pulled from our system on a regular basis by a Performance-Based Financing system.