Integrating mHealth solutions to improve quality of care for mothers and newborns in refugee settings: The case of Gambella
For women living in areas of conflict, pregnancy and childbirth are more dangerous than anywhere else. According to UNFPA, 60 percent of all maternal deaths take place in countries affected by humanitarian crisis or fragile conditions.

90% of these deaths can be prevented through access to quality maternal care and by the women giving birth with the help of a skilled birth attendant.


Since 2017, Maternity Foundation has worked with partners to increase and improve access to maternal and newborn care in refugee camps in Ethiopia’s western region of Gambella, which is the home to about 450,000 refugees from neighboring South Sudan. The approach focuses on training and capacity building of midwives and skilled birth attendants through the mHealth tool, The Safe Delivery App.

Managing emergency maternal complications and care for newborns is often a challenge for health facilities in humanitarian settings. Numerous reasons affect the quality of care provided, including poor compliance to evidence-based clinical interventions and practices; and poor documentation and use of information. The Safe Delivery App, Maternity Foundation's cornerstone mHealth innovation, bridges this gap by providing skilled birth attendants with direct and instant access to evidence-based clinical guidelines on Basic Emergency Obstetric and Neonatal Care (BEmONC). The Safe Delivery App provides life-saving information and guidance through easy-to-understand animated instruction videos, action cards and drug lists.

In Gambella, 57 midwives across six refugee camps have been trained through the Safe Delivery App since 2017. A multi-level qualitative analysis was conducted in the refugee camps in the Gambella region to explore how the Safe Delivery App and its integration into the training have enhanced the quality of care in the health facilities serving pregnant women in humanitarian settings. 

Eleven midwives, health facility heads, and stakeholders were interviewed to gain insights in the use of the Safe Delivery App and trainings. Stakeholders predominately discussed how it is contributing to capacity building and thus improving the quality of care. The findings also indicate that the midwives have experienced improvements in managing cases on site since having the Safe Delivery App “in their pocket” to guide them through procedures, refresh their knowledge, and learn about women-friendly care in vulnerable settings. 

This qualitative analysis shows how the BEmONC training coupled with the effectiveness and applicability of the Safe Delivery App has contributed to an improving in managing maternal complications in the refugee camps of Gambella.