For two years, an ambitious initiative in sub-Saharan Africa has showcased the transformative power of pocket-sized ultrasound technology in improving maternal care access. The deployment of point-of-care ultrasound (POCUS) across hundreds of healthcare facilities illustrates how innovative technology, paired with thorough training, can significantly improve maternal health outcomes in areas with limited resources.
This project has yielded impressive results, including training over 1,000 healthcare workers and conducting over one million pregnancy scans. The World Health Organization (WHO) recommends ultrasound scans before 24 weeks of gestation for all pregnancies. However, the reality of access to high-quality maternal healthcare globally presents a substantial challenge. Nearly 95% of maternal deaths occur in low and lower-middle-income countries (LMICs). In resource-scarce settings, the high cost of equipment and the need for trained sonographers limit ultrasound access for many women. UNICEF’s 2021 report and the WHO’s 2024 report both highlight that, in sub-Saharan Africa alone, roughly 202,000 mothers and 27 out of every 1,000 infants die annually due to childbirth complications. While multiple factors contribute to these statistics, limited access to antenatal diagnostic imaging is a significant barrier—a critical tool for identifying life-threatening pregnancy complications.
Many regions, especially LMICs, face diagnostic deserts. The lack of equitable and accessible primary healthcare for women, coupled with higher disease burdens, creates a perfect storm of risk, necessitating innovative solutions. This initiative offers a promising approach.
Impact in Kenya
The program began in Kenya in late 2022, distributing 500 single-probe, whole-body portable ultrasound devices across 224 healthcare facilities. This was coupled with ultrasound training provided by the Global Ultrasound Institute (GUSI) to over 500 frontline healthcare workers. The training focused on counties in Kenya with disproportionately high rates of maternal and neonatal mortality and morbidity. Kenyatta University oversaw participant recruitment and evaluation.
Initial results from Kenyatta University’s evaluation showed that 90% of healthcare workers could identify high-risk conditions, such as placenta previa or multiple gestations, using their devices within one month of training.
These research findings represent the most impactful study on point-of-care ultrasound in Africa to date, demonstrating significant results:
- 95% of participating providers now utilize POCUS to detect high-risk conditions and inform treatment decisions.
- 80% of participating providers have trained at least two other providers at their hospital to promote wider use.
In a survey of over 2,000 healthcare users or pregnant women, 48-55% reported receiving a POCUS scan during their visit—more than double the rate in their prior pregnancies.
The training program, developed with GUSI, employs a comprehensive approach. It begins by building local expertise, training over 50 Kenyan clinicians and sonographers in International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)-standard techniques, who then become trainers. The curriculum covers operation, image acquisition, and medical decision-making, with a special emphasis on identifying high-risk pregnancy conditions.
Phase Two of the Kenya program, developed by GUSI, included pre-tests and required participants to log at least 20 of five different scan types over the week. A post-test and a final Objective Structured Clinical Examination (OSCE) were administered on the final day. Those who passed all training and tests received a certificate at a closing ceremony.
As of December 2024, research outcomes from Phase Two were substantial. Over a 24-month period, Kenyan clinicians performed over 496,000 scans, with over 95% of the equipment continuing to function as a vital part of the care workflow for midwives at these facilities. The data underscores the sustainability of POCUS when easy-to-use equipment is combined with focused training for midwives.
Expansion to South Africa
Building on Kenya’s success, the program has expanded to South Africa, where maternal mortality and stillbirth remain disproportionately high, particularly in rural areas. The initiative launched across multiple provinces, starting in the Eastern Cape province in April 2024. During this training phase, learners received additional instruction in fetal biometry—an ultrasound test providing detailed information on fetal health and growth, including gestational age and estimated due date.
Implementation and evaluation of this phase was led by the Clinton Health Access Initiative and the University of Pretoria. While formal evaluation results are pending, preliminary findings are extremely promising. South African learners have conducted more than 573,000 scans and completed over 41,000 instances of fetal biometry.
These scans represent thousands of opportunities for mothers to learn about their pregnancies, and for providers to make informed decisions about additional testing or referrals if complications are suspected. Healthcare users require easier access to antenatal imaging, and clinicians need better capabilities to screen for high-risk conditions that lead to poor pregnancy outcomes, especially in rural areas. Increased ultrasound access can facilitate earlier identification of high-risk conditions, leading to improved outcomes.
The Technology and Training Equation
This initiative’s strength lies in its comprehensive approach to implementation. It provides valuable insights into scaling medical technology deployment in resource-limited settings. The program emphasizes sustainable integration within existing healthcare systems, which includes:
- Intensive training programs for healthcare workers
- Ongoing remote quality-assurance review and mentoring
- Partnership with local academic institutions for research and evaluation
- Integration with existing maternal health protocols
- Collaboration with local distribution and support networks
- Collaboration with local government for supportive health policy development
Future Implications for Global Health
The collaboration among stakeholders, including the Clinton Health Access Initiative, GUSI, Kenyatta University, and local healthcare institutions, provides a model for future health technology implementation. It showcases how public-private partnerships can address complex healthcare challenges while ensuring sustainability and local ownership.
Ongoing research (Kenyatta University’s College of Nursing in Kenya, CHAI, and the University of Pretoria in South Africa) is evaluating the impact of POCUS on broader health system metrics, including referral patterns and population-level maternal health outcomes. This data will inform the most effective deployment of POCUS to improve maternal health in similar settings around the world.
This initiative transcends technology, representing a comprehensive approach to addressing maternal health disparities through innovation, education, and systematic support. We must advocate for better and earlier maternal and primary care for all, especially in resource-limited settings. Addressing racial and socioeconomic disparities in healthcare access and improving healthcare quality across the continuum is also essential, and ultrasound plays a crucial role.
Providing affordable point-of-care diagnostic tools is vital for quickly assessing the well-being of all people, especially pregnant women. This can empower healthcare providers to be better diagnosticians and increase overall patient care, especially for those at risk. As global health leaders seek solutions for reducing maternal mortality, this program offers crucial lessons on effectively bridging the healthcare access gap in resource-limited settings.
This initiative described above was supported by a $5 million grant to Butterfly Network.
