Cellphone-based Community Health Information System Improves Maternal Health in Rwanda

Using RapidSMS, a community health worker requested an ambulance to transport Dorcelle to the Musanze Health Center, where she delivered a healthy baby. {Photo credit: Candide Tran Ngoc/MSH.}Photo credit: Candide Tran Ngoc/MSH.

In 2011, Drocelle gave birth to her fourth child, and, for the first time, delivered at a health center. Throughout her pregnancy, Drocelle had been monitored by a community health worker, Elizabeth, who regularly visited her at home and encouraged her to go to the Musanze Health Center for antenatal care. When Drocelle went into labor, she contacted Elizabeth, who sent a RapidSMS text message to the Musanze Health Center requesting an ambulance. Without the ambulance, it would have taken Drocelle three hours to walk to Musanze Health Center.

RapidSMS is a cellphone-based technology being used throughout Rwanda to improve community maternal and child health. This tool helps community health workers track women’s antenatal care visits, identify women at risk, refer women at risk to health facilities, and improve communication with health facilities in the event of an emergency. The system also requires community health workers to send simple text messages to the Ministry of Health reporting significant events during a woman’s pregnancy, delivery, and the first year after the infant’s birth. Once received by the central level, these messages are stored in a Web-enabled database and used to inform the Ministry’s strategic planning, technical supervision, monitoring and evaluation, and resource coordination.

Promoted and funded by UNICEF, RapidSMS was first pilot tested in Rwanda in Musanze District. After proving feasible, the Ministry of Health began a national roll-out of the system in June 2010. The USAID-funded Integrated Health Systems Strengthening Project (IHSSP), managed by Management Sciences for Health (MSH), helped the Ministry to develop a roll-out plan and budget, design a training curriculum, and train over 1,000 community health supervisors who, in turn, trained over 10,000 community health workers throughout Rwanda. IHSSP also procured and distributed cellphones to the 10,000 community health workers in 30 districts.

Before this system was in place, residents living in remote areas of Rwanda could not easily access health care facilities, as Drocelle did. Patients were often carried long distances to health facilities on stretchers and most pregnant women preferred to deliver at home or occasionally delivered on the way to the health center. Now health centers are aware of the number of pregnant women in their community, community health workers can easily communicate with health centers during emergencies, and patients urgently needing care can receive ambulance transportation to health facilities.

By May 2011, one year after initiating the RapidSMS system, prenatal care visits in Musanze District had increased by 25 percent, home deliveries had decreased by 54 percent, health facility deliveries had increased by 26 percent, and under-five mortality had decreased by 48 percent. 

Nationwide data are now being collected from the other 29 districts and will be used to inform future roll-out efforts in Rwanda and dissemination of these results to the global public health community.