About  

Anna Frellsen is the CEO of Maternity Foundation, a global not-for-profit organization aimed at building midwifery knowledge and skills among healthcare professionals in low-resource countries by providing innovative learning programs and life-saving and cost-effective digital health solutions, including the Safe Delivery App. During her leadership, Anna has led the scale-up of Maternity Foundation’s Safe Delivery App, which has reached more than 435,000 healthcare professionals in 70 countries. 

Tell us about why and how the Safe Delivery App was developed? 

After being founded in 2005, Maternity Foundation conducted trainings of midwives and other healthcare professionals in Western Ethiopia for several years, but a question recurred - how can we reach and support the professionals working alone and miles away from hospitals outside Western Ethiopia? How can we be more systematic and scalable in our approach?

The answer came with the mobile phone revolution in Africa, where we started to see more people having access to mobile phones than to basic sanitation. Together with Danish universities we developed and tested the Safe Delivery App (SDA).  

The idea of the Safe Delivery App was, and still is, to help healthcare professionals to handle life threating complications, and therefore we compressed the complicated global guidelines into simple, animated instructions and guidance. 

And then we did what a lot of people back then told us was impossible. We spent more than one year testing the app in healthcare facilities in a large randomized controlled trial. Healthcare professionals in half of the facilities were given the app while the other half continued business as usual. We followed the groups for one year. At the start only 20% of the healthcare professionals had the skills to, for example, handle a bleeding after birth, and in the control group it remained that low. But in the group of workers using the app, after one-year not only 20%, but 70% had the skills. This was quite incredible and marked the start of the Safe Delivery App´s journey towards scale. So, in 2015 we launched the SDA and started to figure out how to best reach as many as possible with the free tool and resources.  

What’s the research-proven impact you’re seeing in terms of improvement of the care experiences, and most importantly, health outcomes?  

Maternity Foundation continues to document the impact of our work.  We can see that after having monitored and evaluated projects in 16 different countries, the user of the Safe Delivery App has had an average improvement in knowledge of 24%, in confidence of 22% and in skills of 65%.  

The results also show that with the increase of knowledge and skills in managing birth complications in smaller healthcare centers, the number of referrals to other hospitals often decrease. Fewer referrals indicate that complications are being effectively managed on-site in the local healthcare centers, improving patient care, reducing unnecessary transfers, and in the end, improving patient experience and creating possibilities for mothers who may live in remote communities, for example.  

How can digital tools be used to enhance communication and teamwork? 

Today, digital tools are essential in enhancing communication and teamwork within maternal healthcare settings. Our digital tool, the Safe Delivery App is a central part of our Safe Delivery+ Program and used as a main component in the mentoring programs and trainings that we facilitate, providing a common platform for midwives and other healthcare professionals. Midwives and other healthcare professionals can then access the same up-to-date information and resources, creating a uniformity that ensures an alignment between team members in terms of access to the same information and resources, reducing the risk of miscommunication and errors. It is has also proven an effective way of availing updated guidelines and disseminate new evidence on an ongoing basis to our growing user base.  

Overall, by ensuring that all team members have access to the same information and tools, digital apps may enhance collaborative efforts, improve maternal care outcomes, and contribute to a more cohesive and efficient healthcare ecosystem. 

How do you leverage the power of partnership and collaboration to amplify the impact you hope to achieve? 

I believe that by aligning with like-minded partners, we create a unified force that can address the various challenges of maternal and newborn health from multiple angles. Our strategic selection of partnerships ensures that every project benefits from the combined strengths and resources of all involved, leading to more robust and scalable solutions to increase our impact.  

Maternity Foundation has a partner-driven implementation model, and we work closely with national governments, local and international associations, UN agencies and other international NGOs to ensure that our programs are rolled out to help strengthen existing health systems in resource-constrained settings around the world. These partners often have on-the-ground experience of the existing healthcare ecosystems, and in many ways our role is to support and complement them in any way we can. 

Collaborating with partners also allows for knowledge sharing between people with different expertise, ensuring the best and strongest outcome.  Laerdal Global Health has been one of our key global partners for the past many years. Since the first meeting we had many years back, it was clear that we have strong synergy and complementarity in our work and mission. It was also clear that we had a very likeminded approach and that we really liked each other :) 

What do you see as the most important elements of a good partnership?  

A good partnership is about strategic fit and good relationships. At the strategic level there needs to be a natural complementarity in the offering, and shared vision and goals. 

At the personal level, there needs to be good chemistry and trust. Good partnerships are in the end about relationships. Trust is not something that is just there; it something you need to build and invest in. Deeper relationships are often something that develop when you are tackling a challenging situation together as partners; that is when real trust in a relationship is built. 

Last but not least, a good partnership is of course about making impact. There is the African proverb saying, “if you want to go fast go alone, if you want to go far do it together” and that is so true.  

Can you share a personal story where you’ve seen the direct impact of the Safe Delivery App from the perspective of a healthcare provider? 

Earlier this year I visited Afar, Ethiopia, one of the regions affected by multiple crises, which can make giving birth dangerous. In the region, Maternity Foundation supports the Ministry of Health in rolling out a catchment-based mentorship program for midwives together with UNICEF and UNFPA, with the aim to increase the quality of care that they provide to mothers and their newborns in the health facilities.   

Here, I met Sofia, a midwife working at one of the remote health centers. She shared how she and her colleagues used the Safe Delivery App on the job, as a tool for continuous professional development, and as a part of the mentorship program. She explained how the Safe Delivery App had helped her with practicing various skills, how it provided clear guidance on a day-to-day basis and had helped her assess her learning gaps through gamified question and answers.  She shared that she now was able to treat many critical interventions; interventions that she had learned about in theory in school, but never had felt comfortable with doing in practice and therefore in the past had had to refer women to the nearby hospital rather than treating them herself.  She also explained that she now felt so much more confident and supported in her everyday working life.  One thing is to see the impact of our work in the data and in the reports, but meeting midwives like Sofia is a completely different thing and so much more motivating. 

How do you envision technology can be used to improve maternal care in the future? 

As technology is advancing, so is healthcare. Not only in terms of tools and equipment used in treatment, but also in ways of training healthcare personnel, such as midwives. With technology, even the most remote healthcare professionals can be reached. And it is known that within maternal health, most deaths happen in remote and low-resource areas with limited access to quality healthcare before, during and after childbirth.  

We strive to constantly invest resources and knowledge in developing our technology to address the gaps that exist within maternal and newborn care. At the same time, we are always designing with the most remote setting in mind. This is also why our offering works offline and on the simplest smart phones.  

However, as technology is progressing everywhere, we do see a huge potential in advancing our offering. One example of this is the opportunity of AI. Together with Neuvo Inc. and UNFPA, we have developed and evaluated a new AI-component that we are looking to insert into the Safe Delivery App to advance it further. The AI-component, a Smartbot, can give instant answers to pregnancy- and birth-related questions, with the hope to elevate the assistance provided to midwives and other healthcare professionals through the Safe Delivery App, to aid safer births.  

New technologies also allow for data collection, with permission of course, that can help developers of new technologies by demonstrating how the technology is being used by users. In our case, the data collection during the pilot testing has been crucial to see how the midwives and healthcare professionals used the tool to help us understand what the needs are, and what needs to be further developed.

We try to continue to listen, learn and adjust our approach to what works best for Sofia and the many other midwives working every day to ensure safer births in some of the most challenging settings in the world.   Because technology alone does not make a difference. Midwives do.