Bornfyne: prenatal management system in Cameroon

Maternal health remains a public health emergency in Cameroon, with a relatively high maternal mortality ratio (MMR) of 596 deaths/100,000 live births. Gender inequalities and the proportion of qualified midwives are key social determinants that explain variations in maternal mortality in sub-Saharan Africa. Women living in rural areas and poor women are respectively 30% and 50% more likely to die in childbirth than urban women and wealthy women. Women from poor and rural populations are less exposed and less informed about family planning education due to poor access to healthcare services. In addition, most women tend to be made aware of family planning during antenatal or postnatal consultations, to which part of the population does not have adequate access, partly because of the high costs involved.

The main challenges facing the healthcare system in Cameroon, highlighted by the Ministry of Public Health in its Digital Health 2020 framework, are geographical inaccessibility, low demand for services, delays in care delivery, low adherence to clinical protocols, high out-of-pocket expenses, which can be mitigated by the contribution of digital health interventions. Paper service records prevent the rapid implementation of care standards, and the systems in place to assess the consistency of health protocols are insufficient. In addition, the current DHIS2 system creates aggregated data based on incomplete, poorly documented registers, errors and data errors (BMC Health Service Research) that cannot support clinical decision making to improve maternal health practice

In partnership with the Denis and Lenora Foretia Foundation, Cires is implementing the Bornfyne project: prenatal management system in the health districts of Akonolinga and Ayos in the Centre Cameroon region. The aim is to improve the access and use of maternal health services, and to strengthen the capacity of district health services and health facilities to provide innovative, evidence-based, accountable, quality maternal, newborn and child reproductive health (MNCH) services for women and the most vulnerable population in Cameroon.

More specifically, the project aims to explore and report on strategies for implementing and integrating the World Health Organization (WHO) Digital Adaptation Kit (DAK), examine its impact on the quality and coordination of care and the use of data, and assess the interoperability of BornFyne-PNMS and DHIS2 implemented in an integrated manner to minimise vertical investment.

The BornFyne user interface offers six PNMS-related functionalities, both online and offline.

1. The offline functionalities are family planning (messages are downloaded in different regional languages according to the needs of each community) and medical advice (designed to disseminate risk or public health messages, as for Covid-19). The ongoing education platform and the knowledge specific to households and women encourage involvement in the community.
2. The interactive online elements, which include antenatal care (A.N.C.), pain management, emergencies and postnatal care – are linked to the PNMS, a health facility, via the ‘user’ interface.

The WHO digital adaptation kit for antenatal care was used to develop the antenatal care and emergency functions. Basic data elements are described in detail, coded according to I.C.D. and other terminology standards to ensure consistency of data representation, and workflows are distilled to improve coordination of care between actors. It also includes descriptions of decision-support logic, algorithms and indicator calculations for integration into digital systems. The “emergency” functionality uses geolocation data to geo-navigate and geo-locate anxious patients in an emergency, establishing a real-time digital connection between the pregnant woman and the doctor/healthcare facility. Unfortunately, there is currently no system in place to help pregnant women in the event of an emergency in Cameroon.

For women who cannot read or write, BornFyne’s user interface is designed to use pictures as an alternative form of communication linked to PNMS. It uses reminders and signals through the user interface and web interface to encourage behaviour change.

The PNMS uses a decision tree system that facilitates referrals, automatically flags high-risk pregnancies, enables early diagnosis of these pregnancies and alerts the district to potential clusters of health problems. This procedure enables health professionals to act quickly. The project is currently being rolled out in nine health facilities, with 27 healthcare providers and 20 community health workers.

The BornFyne-PNMS addresses this problem by focusing on maternal and child health, as it generates highly disaggregated data designed using the WHO recommended guidelines for the Antenatal Care Digital Adaptation Kit. BornFyne-PNMS data will be pushed to DHIS2 to strengthen the health management information system using FHIR HL7 interoperability layers, adding value to the health management information system and minimising parallel structures.

BornFyne-PNMS is the only digital platform that has been introduced to support two-way interactive care between the pregnant woman and the health facility and health providers and integrated into the district health delivery system in Cameroon.

In addition, we are working in partnership with the Department of Public Health to ensure that the variables and data generated align with national indicators and support ongoing efforts to develop an interoperability layer between systems.

At the end of the grant, we will develop a knowledge translation plan with our stakeholders to support the digital ecosystem for antenatal care DAK implementation to support healthcare staff and countries committed to using the antenatal care DAK tool to improve practice and policy in the era of digital transformation.