Introduction
While Tanzania has made progress on many fronts in healthcare, maternal and neonatal deaths are still a major concern. According to the 2022 Tanzania Demographic and Health Survey, six percent of female deaths in the seven years preceding the survey were attributed to maternal causes, while neonatal mortality was recorded at 24 deaths per 1,000 live births (Ministry of Health et al, 20221).
To address these challenges, the country has prioritised increasing the number of pregnant women receiving antenatal care. Among other measures, the government encourages women to make their first antenatal care visit before 12 weeks of pregnancy, and to make at least eight visits throughout the pregnancy (Ministry of Health, 20212). The government is also promoting delivery under the care of a skilled health worker, and higher quality postpartum and neonatal care.
Application of Blockchain Technology to Improve MNCH in Tanzania
In 2018, Tanzania started a pilot project to support maternal and neonatal health services by leveraging blockchain technology. PharmAccess in collaboration with the Ministry of Health and AID:Tech, a technology company, started a pilot project, Chain of Trust (CoT) initiative, to test the use of blockchain technology in public antenatal care services. AID:Tech provides digital payment solutions by merging client digital identity with payment data.
In the pilot project, each pregnant woman was given a digital identity that tracked their progress in the care chain via data added to the blockchain. The ID was bundled into a mobile wallet/app that could run on a very basic phone. AID:Tech also digitised a care package comprising of folic acid, iron tablets and a care bundle that pregnant women receive in Tanzania and directly linked it to the individual pregnant women’s digital identity.
Through this system, pregnant women received automated reminders before their next ANC appointments, ensuring they did not miss any check-ups. Care providers could also track the individual women on the platform, and the full records of their care throughout the pregnancy and postpartum. The digitisation eliminated manual record-keeping at the clinics, added security, transparency and confidentiality to the client data and records of care. It also provided the care providers at a glance all the vital information needed for every pregnant woman enrolled on the programme.
Policy and Regulatory Framework
Current and past policies highlight the Tanzania government’s commitment to integrating emerging technologies to improve health outcomes. As early as 2017, the government set up a Health Technology Assessment Committee, to review emerging technologies and advise the Ministry of Health on those that can be adopted into health service. The 2019-2024 Digital Health Strategy emphasises the use of digital solutions in health care to enhance access to high-quality health services (Ministry of Health, 20193). Specifically, the strategy prioritises digitalisation and improving health worker competency and use of technology to provide specialised care. In 2022, the government launched the Policy Framework for Artificial Intelligence in Tanzania Health Sector, to guide adoption of AI in the health sector, in line with the country's health goals. The current Health Sector Strategic Plan (2021 – 2026) also prioritises the use of new technology, ICT and artificial intelligence to increase access to quality diagnostic services. The 2023 ICT policy provides the framework for regulation in the application of technology in service, which can cover technologies in health.
Impact
Using the blockchain-based innovation, CoT made it possible for the pregnant mothers to receive prompt and appropriate care throughout the pregnancy and in the postnatal period. While no results are directly available to show its impact, similar technology-based projects have showed positive outcomes. For instance, a digital-based MNCH project in Kenya and Tanzania enhanced access to health services, optimised ANC use, and ensured respectful care, while reducing financial constraints that impede care-seeking (Izudi et al, 20234). Women enrolled in the programme reported that the services were good, and many recommended the facilities to other mothers because of the good quality care, friendly health workers during labour and delivery, easy access to health services, and affordable care.
Lessons Learnt
Blockchain technology ensures data integrity, privacy, and interoperability in managing medical records and supports information exchanges. With greater investments, countries in Africa can reap the benefits of blockchain technology in their healthcare services. The pilot project in Tanzania highlighted the following lessons for African countries to fully exploit emerging health technologies in improving maternal and neonatal health outcomes.
- Embrace private-public partnerships to fund and implement innovations. In Tanzania, the partnership between PharmAccess and AID:Tech brought in the technology, while the Ministry of Health availed its facilities for the pilot project.
- Pilot test, to learn before full scale up. Running a pilot project offers important lessons that can be applied for successful scaling u.
- Infrastructure: Limited infrastructure, such as poor internet connectivity and mobile phone penetration, can delay or undermine the rollout of health technologies such as blockchain. While Tanzania has very high mobile phone penetration, with nearly all the population connected to a mobile network, only about a third (32%) have access to a smart phone. For the successful scale up of such innovations as the CoT, more women need to have access to a smart phone.
Conclusion
Emerging technologies hold tremendous potential to transform maternal and neonatal health in Africa. Innovations such as blockchain can revolutionise healthcare delivery and health outcomes, and the challenges that hinder their uptake should be addressed. African countries should develop comprehensive e-health strategies that prioritise the integration of emerging technologies into maternal and neonatal health programmes and the regulations and guidelines needed to guide their deployment. These countries should also address the resource constraints that limit adoption of health innovations