Leveraging digital solutions to improve the quality of maternal healthcare in low-resource settings

Maternal mortality remains a pressing global challenge, with one woman dying approximately every two minutes due to complications related to pregnancy and childbirth. The burden is particularly high in Sub‑Saharan Africa. Although the Maternal Mortality Ratio (MMR) has declined since 2000, progress slowed in the first eight years of the Sustainable Development Goals (SDG) era. Achieving the 2030 target of reducing MMR to 70 per 100,000 live births will require an annual reduction of 14.8% between 2024 and 2030—an ambitious goal that demands substantial effort. Failure to achieve this target could place the lives of about 700,000 women at risk.
This dissertation assessed maternal healthcare utilisation and examined adherence to maternal healthcare recommendations in Ethiopia. In addition, through research on the World Health Organization’s layer‑2 Standards‑based, Machine‑readable, Adaptive, Requirements‑based, and Testable (SMART) guidelines implementation, we documented processes and lessons learned, contributing to the development of a framework for the systematic implementation of clinical recommendations within digital systems.
Although more than three‑fourths of women initiate antenatal care, only about half reported receiving four recommended services, revealing gaps in adherence to clinical protocols and the quality of care delivered. Immediate postnatal care utilisation improved over time, yet coverage remains low. In the emerging regions of the country, fewer than 10% of women complete the full continuum of maternity care, with poorer and less educated women disproportionately underrepresented.
Based on the WHO SMART Guidelines–Digital Adaptation Kits (DAKs) implementation experience in five African countries (Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe), the dissertation offered processes and early insights into the opportunities and benefits of a structured approach to digitalizing primary healthcare services. Moreover, it introduced the concept of how digital health interventions can be mapped across the obstetric transition stages.