Feasibility of mhealth in improving uptake of antenatal and postnatal care services in peri-urban areas of Karachi : a qualitative exploratory study

From 1990 to 2013, there is an estimated 57% reduction in the incidence of maternal deaths in Pakistan. Despite this, Pakistan is considered amongst the countries having high MMR. The national MMR is 276 maternal deaths per 100,000 live births. In Pakistan, only 37% of pregnant women obtain the WHO recommended a minimum of four antenatal visits and 60% of women receive PNC within the first two days following delivery. The poor ANC and PNC attendance coverage, account for 70% of preventable maternal deaths in Pakistan. Many interventions have been operationalized to increase uptake of ANC and PNC services in Pakistan. However, systematic information on the effectiveness of these interventions remains scarce. While evidence on the use of mobile health interventions for uptake of ANC and PNC services have shown significant improvements in maternal health outcomes. Study Objective: The study aimed to investigate if mHealth technology is feasible in improving uptake of ANC and PNC services in peri-urban areas of Karachi. Methodology: The study employed an exploratory qualitative research design using focus group discussions and key informant interviews. FGDs were conducted with pregnant women, women in the postnatal period and LHWs, whereas key-informant interviews were conducted with MNCH and mHealth experts. By using purposive sampling technique, LHWs, pregnant women, and women in postnatal period were invited for FGDs from peri-urban areas of Karachi (Malir and Kharadar), whereas MNCH and mHealth experts at district and provincial level were interviewed from Karachi. The study was carried out over a period of three months. The study data were analyzed via NVivo version I I. Results: The major barriers reported for not receiving ANC and PNC services include negative advice from older females\u27 relative, lack of awareness, lack of time, lack of money and long distances to the healthcare centers. All the study respondents alike saw much potential in using mobile health to address barriers related to provision and utilization of ANC and PNC services. Health care workers and women reported their present use of mobile phone for providing and receiving ANC and PNC services and showed readiness to adopt mHealth in future. Women and healthcare providers saw mHealth as a solution for filling gaps in existing healthcare service delivery structure. Respondents identified a number of benefits of mobile phone use for ANC and PNC services including improving accessibility to healthcare providers, reducing consultation and transport cost, reducing wait times and in increasing service utilization, particularly in the postnatal period. However, the study also reported perceived challenges of mobile phone use including, illiteracy, technological incapability, lack of trust on technology and cultural restrictions for mobile phone use. To successfully deploy mHealth, the study suggested building a sustainable model of mHealth by involving government, local communities, telecommunication personnel, health care providers and ml lealth and MNCH experts. Conclusion: Study findings explicitly demonstrate the feasibility of using mobile phones to improve ANC and PNC services in ped-urban areas of Karachi. mHealth interventions are technologically appropriate and culturally acceptable for women living in peri-urban areas of Karachi. However, they lack skills to use advance functions of basic mobile phones and smart phones and have specific preferences in terms of time, language and mobile phone functions. Additionally, healthcare providers are technological ready for adopting ml lealth to improve uptake of ANC and PNC services. However, provider biasness and poor coordination between key stakeholders is associated with the limited use of mHealth technology indicating lack of awareness about the marvels of mHealth technology