1. Safer Deliveries: improving health in Zanzibar through integration of mobile health & mobile money

2. what D-tree does point of care decision support leverage technology to improve systems systems, not apps

3. 1 in 12 infants die 1 in 220 women die in childbirth Up to 98% of maternal deaths are preventable 50% of births at home maternal health in Zanzibar

4. constraints family permission birth plan savings transportation fear family permission birth plan savings transportation fear

5. all on one mobile device Register pregnant women and get permissions Agree on an birth plans based on established risk factors Counsel mothers and families on healthy behaviors Screen pregnant mothers to identify danger signs and refer as needed Coordinate transport and call facility staff Pay for transport to health facilities using mobile banking Monitor mother and baby up to 10 days after delivery

6. increased facility deliveries

7. results 75% facility delivery rate overall out of 14,000 deliveries 88% post-partum follow-up from baseline 10.9%

8. challenges Sustainability Managing 200+ mobile money accounts Non-integrated mobile app + mobile money Mobile money system reporting Limited software functionality

9. Safer Deliveries Phase III

10. EMERGENCY TRANSPORT BIRTH PLANNING & COUNSELING HIGH QUALITY FACILITY CARE SAVINGS & ROUTINE TRANSPORT

11. Birth Planning, Counseling

12. Obstetric history review, delivery facility planning

13. Birth planning: savings counseling

14. Counseling messages

15. SAVINGS & ROUTINE TRANSPORT

16. Estimate costs Transportation & facility expenses calculated by app Link with savings groups Pre-programmed in app Access to short term loans Pre-arrange drivers & prices Community drivers & prices pre- programmed in app

17. IMPROVED FACILITY CARE

18. performance based financing, DHIS-2

20. EMERGENCY TRANSPORT

21. challenges ambulances often unavailable for maternal & neonatal emergencies No fuel Driver not available Needs maintenance On another call No system to manage fleet, capture outcomes, monitor data

22. solution: innovative emergency referral system 24-hour toll free call center where dispatchers use a mobile application to: Triage calls from communities and health facilities to determine emergencies for women and babies Organize transport using the government ambulance system or community drivers Pay community drivers automatically using mobile money system Follow up with all emergencies to document outcome

23. learn from successful model from mainland Tanzania D-tree & partners currently operating emergency referral system in 2 districts in TZ (pop. ~1M) 1,200 emergencies transferred to-date 9 emergency referrals per day Estimated up to 3,000 deaths averted per year

24. how does it work? Triage emergency based on Ministry guidelines Determine where emergency should be transported

25. Organize transport government ambulance (preferred) Otherwise, community driver Automatic SMS sent to driver

26. Manage transport Confirm driver arrived Automatic payment via mobile money

27. follow up with facility 2-3 days later

28. SYSTEM MONITORING

32. monitor individual emergencies in real time

33. use data for decision-making

34. mobile money: before & after Phase II 225 mobile money accounts Manual payments to drivers by CHW Limited report capabilities Weak accountability structures Payments for all referrals (labor, danger sign, emergency) Not scalable Phase III 1 centralized mobile money account Automatic payments to drivers Comprehensive reporting capabilities Accountability mechanisms Payments for emergency referrals only Scalable

35. Keys to success Integration Mobile money Performance based financing HMIS Collaboration Ministry of Health District, community health teams CHWs Drivers Other initiatives Continuous learning Strong dashboards Evaluation Mid-course corrections

36. Thank you! Erica Layer Program Director elayer@d-tree.org +255 75 525 8988