Making connections for better maternal health in Peru

January 29, 2018

eHealth initiatives increase women’s access to health information in Peru.

Photo: Pan American Health Organization

On January 16, 2017, Peru’s Minister of Health, Patricia J. Gargía Funegra, signed a ministerial order to implement an innovative eHealth system throughout the country.

Known as WawaRed, the system was piloted in 15 health centres in the district of Ventanilla to improve maternal and child health. With the signed ministerial order it will now reach 350 centres countrywide, including 20 in the humid lowlands where the Zika virus continues to spread.

Key to WawaRed’s success is the creation of an integrated data collection and analysis platform. Designed by researchers at Universidad Peruana Cayetano Heredia with IDRC support, it links the country’s fragmented healthcare system — from local health centres to the central Ministry of Health.

The eHealth promise

EHealth holds great promise in Peru, where more than 65% of the population owns a mobile phone. In 2010, the Universidad Peruana Cayetano Heredia in Lima launched the WawaRed project to support the government’s efforts to improve maternal health (wawa means baby in Quechua, red is network in Spanish).

Deep inequities underlie the country’s health system, but WawaRed could save the lives of Peruvian women — particularly the poor and Indigenous who suffer high rates of preventable death and illness.

Of the estimated 615,000 Peruvian women who become pregnant each year, 420 will not survive childbirth. Most of these women die from preventable causes that arise, in large part, because vital information is not available when and where it’s needed. Rural areas, which are generally poorer and have higher populations of indigenous Peruvians, are hardest hit.

Benefits at all levels of the health system

WawaRed tackled the poor availability and quality of health data by introducing an integrated electronic health record for mothers and children. Standardizing and sharing data through an electronic health record system ensures that the right information and advice can benefit the most vulnerable mothers and children.

For example, the system sends customized text messages to pregnant women based on their health profile and in their local language. These messages include appointment reminders, nutritional recommendations, and healthy living tips, as well as general information about pregnancy care. Women can also call in to obtain additional information about pregnancy, nutrition, and danger signs. Sending information to women wherever they are and in a language that is familiar to them can transform how they understand their pregnancy and the measures they take to stay healthy.

Equally important, WawaRed enables women to access their own health records and those of their family so they can better manage their health and well-being. Sharing and discussing this information with healthcare providers not only increases their interaction with the health system, it also improves the system’s accountability, ultimately boosting health outcomes.

WawaRed also provides the Ministry with accurate and timely data for planning and allocating health services. For example, it can track what supplies women need when they visit each health centre. This information ensures that medical and other supplies are available when they are needed.

Improving efficiency and accuracy

Time is of the essence when health providers interact with community members. Previously, midwives spent some 40 minutes to complete as many as 15 forms for each expectant mother, leaving very little time to interact with the patient. Data in those forms were redundant and, as most of it was not considered useful by the providers, little care was taken in recording it. This poor quality of information was then digitized five times: at the local health institution, the sub-health network, network, regional, and national levels.

As a one-way system, the consolidated information never made it back to local health planners or providers to help correct inefficiencies or deal with common problems faced by expectant and new mothers. It was also too narrowly focused on pregnancy and childbirth. However, the researchers found that women were much more concerned with broader aspects of their health and their children’s basic health.

From local to national

WawaRed enables all levels of the health system to communicate seamlessly and effectively by balancing technological solutions with the social processes of how information is collected and used.

Some 100 midwives were trained in data gathering and in creating and using eHealth records, and 28 ministry statisticians were trained in data analysis. Numerous tests on the viability of WawaRed to improve efficiency and protect patient confidentiality in two health centres showed that the system could be replicated and scaled up elsewhere.

In August 2016, WawaRed was extended throughout the district’s health network, benefiting some 18,372 women. As the researchers point out, the system also enhanced the status of midwives and promoted greater equity among workers in primary health centres since everyone can access the new e-records. Now that women can ask questions of their healthcare providers, there is a better understanding between them. Women can also share information about their pregnancy and health with spouses and family members to involve them in their care.

WawaRed is likely to expand to other areas of healthcare, including tuberculosis treatment and tracking HIV and other diseases. Already, the ministry has electronic health records for children under 5, which are linked to their mother’s pregnancy record. This helps parents and health workers track diseases and vaccinations over time. It can also improve responses to outbreaks wherever they occur.

Talks are now underway with Peru’s mobile telephone companies to fund the service on a national scale. Eventually, everyone in Peru could have a single eHealth record, leading to better health and healthcare and allowing the government to best use its healthcare resources.

graphic: 1,800 health workers entering data into the system
graphic: 50,000 women registered in the system
graphic: national scale up to all health centres in Peru

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