Check2Gether improves antenatal care in Indonesia

The maternal and neonatal mortality rate in West-Timor was 127/100.000 in 2015, making it one of the highest in the world. The quality of antenatal care is low due to lack of equipment and qualified staff. Furthermore, pregnant women commonly fail to follow-up referrals for testing due to remote and hard-to-reach health facilities, costs related to travel and income loss and lack of awareness. This results in undiagnosed life-threatening complications.

Innovative portable kit for antenatal care

Check2Gether is an innovation which aims to provide women in rural remote areas access to quality antenatal care services. Check2Gether consists of a mobile non-invasive testing kit that incorporates blood pressure measurements, non-invasive HB and urine tests for protein and glucose. Furthermore it includes a smartphone application implementing a medical decision support. This ensures informed diagnostics based on anamnesis and diagnostic data allowing midwives to immediately interpret the result and identify women at risk of (pre-) eclampsia, gestational diabetes and anemia. The statistic outcome will result in an online dashboard to monitor impact for all stakeholders such as health directors, decision makers and funders. The portable kit enables antenatal care services in low-resource areas. Using accurate measurements in combination with the medical decision support, empowers the midwife and stimulates local entrepreneurship.

Application in Ghana and Indonesia

TNO is responsible for designing and implementing the application and medical decision support tool (MDS). In cooperation with Simavi and Relitech, medical knowledge has been put in the MDS. Check2Gether has been piloted successfully in Ghana in 2017. In the meantime the lessons learned have been implemented and the kit has been improved both in quality and cost effectiveness. Results and analysis of the pilot in Ghana can be found in the PhD thesis of I.O.Abejirinde.

With funding from Grand Challenges Canada and in collaboration with the local partner IHAP, Simavi and TNO are able to pilot the improved version of the kit in West-Timor. Early November 2018 Simavi and TNO visited Kupang for the kick-off of the pilot study to demonstrate the efficacy and to develop a sustainable business case. This pilot aims at testing the Check2Gether concept by monitoring a total of 2000 pregnant women in 5 different puskesmas (clinics) in the vicinity of Kupang.

25 midwives will reach 2000 pregnant women

The three-day kick-off started with a presentation to representatives of the antenatal care clinics and the local government. The kick-off included a two-day training in which 25 midwives were trained in using the app and their medical knowledge was refreshed. The kit was received with great enthusiasm, also because the kit contains new medical equipment which is very welcome in the clinics. The kit brings standardization during the check-ups. The system is a great support making the midwives feel more certain during their work. The enthusiasm of the coordinators and midwives even resulted in new ideas from their side such as integrating Check2Gether with the registration system of the clinics. Currently, the kits are being used in the clinics and soon the first database synchronization is planned. Together with Pluut, TNO will develop and launch the online dashboard where the geographical usage of the kit can be monitored. This is essential to demonstrate the impact to funders and health directors and to scale-up this sustainable concept.

Experiences of the TNO engineer

Because the application will be used internationally, the programming itself is not the greatest challenge. The challenge is to consider cultural differences and local (medical) standards such that the kit is accepted by the communities. For example, the kit will be used by people who are not skilled in using tablets or who have never seen a tablet before which requires the app to be robust and the interface to be obvious. Being an engineer, these aspects were new to me and challenged me throughout the project. Giving the training in Indonesia forced me to be dynamic and to make ad-hoc decisions. The experience was intense but as it being the highlight of the project, it has been rewarding. It is great to see how the product is used and how my work can support local communities. What impressed me most has been the eagerness and willingness of the Indonesian people involved in the project to make this into a success.