Marie Gorethe Nyirabambari is animatedly engaged with her mobile phone under a tree outside Karwasa Health Centre in Musanze District. She also sieves through a handful of documents on her lap.

Nyirabambariis a community health worker. Her task is to keep tabs on pregnant mothers from the time the pregnancy is announced until delivery.

She also follows up the life of a child after birth in the outskirts of Musanze city.

This, according to Nyirabambari, was difficult until she started using RapidSMS programme to convey all the messages related to the state of pregnant mothers to the concerned institutions, mainly those under the Ministry of Health.

The RapidSMS system was initiated in 2009 by the Ministry of Health in collaboration with the United Nations Children’s Fund (UNICEF).

It is run by the ministry, which hosts the server that receives all kind of information from across the country and sends the needed feedback to the sender.

RapidSMS is used to monitor the activity of community health workers (CHWs) whose job is to ensure their respective jurisdictions improve maternal, newborn and child survival.

Nyirabambari, who had been working as community health worker even before the system was initiated, says it has eased their work compared to the past when everything was virtually ‘manual’.

"RapidSMS has changed our way of communication and helped us speed up communication while following up with pregnant mothers,” Nyirabambari says.

"With RapidSMS, everything is easy, when we know a mother is pregnant, we immediately send the short message which is received by the ministry of health and we receive a feedback on how to proceed,” she added.

The feedback they receive is also sent to health centres where the community health workers are based.

The system is built as a circle and it never breaks until the mother and the baby are given necessary care.

‘Complicated pre-RapidSMS era’

Before the system was introduced, everything was complicated, we used to make hand written reports monthly on the progress of pregnancy, the feedback was delayed and it was even difficult to keep following on after delivery, Nyirabambari says.

As a community health worker, she says that they played a big role in saving lives of many before the RapidSMS was introduced but required a lot of effort and time.

"For instance, I don’t need to go every time. I have the whole programme with me and whenever time to visit a certain family comes, I receive an alert from health officials, this means that I am always on standby and can’t miss any day,” she says.  

RapidSMS is credited for reducing child and maternal mortality rates.

Before the RapidSMS was introduced, we recorded many deaths, most pregnant women were helped to deliver by traditional birth attendants who were unable to handle attendant infections or complications,” she adds.

Christine Uruvugundi, another community worker in Musanze, appreciates the role of the mobile technology in saving lives.

"RapidSMS has saved many lives we would have lost. Previously, community health workers found it hard to help pregnant women as the process was too long but currently things are done in a few seconds,” says Uruvugundi.

Jeaninne Uwimanimpaye, a mother of four from Cyuve Sector, Musanze District, commends CHWs for helping her in various ways when she was pregnant until delivery.

They have also worked closely with her to raise her babies through counselling.

"Community health workers have helped me since I conceived my second born. One of them visited me so often and whatever we talked was sent via SMS, she could also tell me what to do next and in some cases accompany me for consultations,” says Uwimanimpaye.

RapidSMS is managed by more than 45,000 CHWs operating in 15,000 villages across the country and has saved lives of thousands of new expectant mothers and their new born babies, according to Dr Emmanuel Manzi, a UNICEF health specialist.

Infant mortality drops

The programme started in 2009 and, ever since, has seen some improvement of its versions and services from supporting pregnant mothers until birth up to 1,000 days of the babies and their hygiene and sanitation, he said.

Angelique Nyirafaranga, CHW’s supervisor at Ruhengeri Hospital in Musanze, says they have been mandated by the Ministry of Health to monitor the outcomes of care in Musanze District.

This is done through quality improvement committees with the most prevalent diagnoses and the outcomes of the most common operations in order to improve them over time.

One of the mandates is to improve neonatal and child survival at the health centre and community levels. 

In Musanze District, infant mortality decreased from 130 in 2012 to 81 in 2013; then to 66 in 2014. Last year, the mortality rate stood at 50, according to Nyirafaranga.

The number of home deliveries also decreased from 296 mothers in 2012 to 223 in 2013 and to 189 and 152 in 2014 and 2015, respectively, she added.

The last findings from Rwanda Demographic and Health Survey 2014-2015 shows  that infant mortality has fallen from 50/1000 births in 2010 to 35/1000 births in 2014-2015.

Under- five mortality rate have fallen From 76/1000 births in 2010 to 50/1000 births in 2014-2015.