Even though the structure of healthcare system is well organized and distributed throughout Thailand, the system still does not function efficiently in many areas, especially in rural and remote communities. The difficulties in those under-served areas include not only the poverty of the communities but also the limited availability and access to healthcare services within the communities; both inhibit the treatment-seeking behaviors of the villagers. The project Application of Smart Phone in "Better Border Healthcare Program" was thus proposed and it was awarded by the Microsoft Research in early 2008. The main objective of this 2-year project was to develop technology-based healthcare solutions that will increase the accessibility and affordability of healthcare services.
The public health services proposed in the better border healthcare project were corresponding to the goals, in part, of the United Nations - Millennium Development Goals as well as to the public health key indicators of Thailand Ministry of Public Health. Three major goals of the Millennium Development Goals targeting at healthcare services include: (1) improve maternal health, (2) reduce child mortality, and (3) combat HIV/AIDS, malaria and other disease. In contrast to metropolitan areas and large cities/towns, the access to care in the rural areas remains a problem due to the limited health resources, lack of health concerns, and poor education. Surprisingly, the use of communication technology, i.e., cellular phone, is becoming popular outreaching even to those living in the remote areas. Thus, application of such technology might be a proven solution to alter treatment seeking behavior and create opportunities for better healthcare access.
The specific objective of the better border health project was therefore to develop models for utilizing smart cell phone as health communication tool: (1) to improve maternal health focusing on antenatal care (ANC), (2) to reduce child mortality focusing on the Expanded Programme on Immunization (EPI), and (3) to prevent/monitor disease incidence and to ensure treatment outcomes focusing on malaria due to malaria endemic in the border areas. The project consisted of 2 models: (1) Mother and Child Care Module (MCCM) and (2) Disease and Treatment Monitoring Module. This study focused on the results of MCCM implementation in the study area; the second module was described elsewhere.
The optimal number of ANC visits as well as the activities at the ANC visits have been discussed in literature [1
]. The World Health Organization (WHO) recommends a typical ANC program for the minimum of four ANC visits for low risk pregnancies and prescribes certain activities at each visit [1
]. Clinical activities usually include, for example, blood pressure measurement, urine testing for bacteriuria and proteinuria, blood testing to detect syphilis and severe anemia, and weight/height measurement (optional). Thailand Ministry of Public Health has recommended that the first antenatal consultation should be performed at the gestation age of approximately 6-8 weeks [5
]. The practices in Thailand at all healthcare levels also follow ANC standard such that the healthcare provider would set extra appointments for re-examinations if any abnormality is found [6
The EPI is a program launched in 1974 by the WHO in attempt to vaccinate and protect as many individuals as possible from preventable diseases including mainly six common diseases: polio, diphtheria, tuberculosis, pertussis, measles and tetanus [8
]. Thailand had set its goal within the Universal Child Immunization Programme to fully immunize at least 80 percent of children under one year of age with one dose of Bacillus Calmette Guerin (BCG), three doses of Diphtheria, Pertussis and Tetanus (DTP), three doses of Oral Polio Vaccine (OPV) and one dose of Measles containing vaccine (MCV); all of these routine EPI vaccines are supported by the government [10
The MCCM was developed under software development life cycle approach to cover the ANC/EPI activities mentioned above. The module has been integrating into the existing open-source Health Care Information System (HCIS) which is used by health centers across country. The main objective of this study was thus to assess the module effectiveness in improving antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area.