For two years, an ambitious initiative in sub-Saharan Africa has demonstrated how pocket-sized ultrasound technology can help bridge the gap in maternal care access. The implementation of point-of-care ultrasound (POCUS) across hundreds of healthcare facilities offers new insights into how the innovative deployment of technology, combined with comprehensive training, can transform maternal health outcomes in resource-limited settings. This initiative has resulted in over 1,000 healthcare workers trained, and over one million pregnancy scans and counting.

The World Health Organization (WHO) recommends an ultrasound scan before 24 weeks gestation for all pregnancies, yet the stark reality of access to high-quality global maternal healthcare presents an immense challenge. Nearly 95% of maternal deaths occur in low and lower-middle-income countries (LMIC). And in low-resource settings like parts of sub-Saharan Africa and Asia, the high cost of equipment and the need for trained sonographers means that very few women have access to ultrasound. UNICEF’s 2021 report on child mortality trends and the WHO’s 2024 report on maternal mortality show that, in sub-Saharan Africa alone, approximately 202,000 mothers and 27 of every 1,000 infants die due to childbirth complications annually. While multiple factors contribute to these statistics, one significant barrier has been limited access to antenatal diagnostic imaging – a critical tool for identifying life-threatening complications during pregnancy. 

Many regions of the world, especially LMICs, are essentially diagnostic deserts. The lack of equitable, accessible primary healthcare for women, combined with higher disease burdens entering pregnancy, creates a perfect storm of risk factors that demands innovative solutions.

Breaking new ground in Kenya

The project began in Kenya in late 2022 and has resulted in deployment of 500 single-probe, whole-body portable ultrasound devices across 224 healthcare facilities in Kenya. This was combined with ultrasound training by Global Ultrasound Institute (GUSI) to over 500 frontline healthcare workers who provide care in counties in Kenya with disproportionately high rates of maternal and neonatal mortality and morbidity. Recruitment of the participants and evaluation of the implementation was conducted by Kenyatta University.

Initial results from the evaluation conducted by Kenyatta University suggests that 90% of healthcare workers reported identifying high-risk conditions such as placenta previa or multiple gestations using their devices within one month of training. 

The findings from the research represent the largest impact study in Africa on point-of-care ultrasound to date and show that:

• 95% of the participant providers are now using POCUS to detect high-risk conditions and inform treatment decisions
• 80% of the participant providers have trained at least two other providers at their hospital to drive further widescale 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 than in their prior pregnancies). 

The training program, developed in partnership with GUSI, takes a comprehensive approach. It begins with creating a foundation of local expertise by training over 50 Kenyan clinicians and sonographers in International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)-standard techniques, who become trainers. The curriculum covers operation, image acquisition and medical decision-making, with a specific focus on identifying high-risk conditions during pregnancy. 

Phase Two of the Kenya program included a curriculum from GUSI, which included pre-tests and required participants to log at least 20 of five different types of scans over the course of the week. On the final day of the program, a post-test and final Objective Structured Clinical Examination (OSCE) were administered. Participants who passed all training and tests were given a certificate at a closing ceremony. 

As of December 2024, research outcomes from Phase Two were significant. Over the 24-month period from the start of training, Kenyan clinicians have performed over 496,000 scans, with more than 95% of the equipment continuing to function as a vital part of the care workflow for midwives in these facilities. These data demonstrate the sustainability of POCUS when the approach pairs easy-to-use equipment with focused training for midwives.

Expanding impact: South Africa implementation 

Building on the success in Kenya, the program has expanded to South Africa, where maternal mortality rates and stillbirth rates remain disproportionately high, particularly in rural areas. The initiative rolled out across multiple provinces, starting in the Eastern Cape province in April 2024. In this phase of the training, learners received additional instruction in fetal biometry – an ultrasound test that provides rich detail on the health and growth of the fetus, in addition to confirming gestational age and an estimated due date for the pregnancy. Implementation and evaluation of this phase was led by the Clinton Health Access Initiative and University of Pretoria.

While formal evaluation results are forthcoming, preliminary results are extremely promising. South African learners have performed more than 573,000 scans and completed over 41,000 instances of fetal biometry. Taken together, these scans represent thousands of opportunities for mothers to be educated on the status of their pregnancies, as well as for providers to make informed decisions about additional testing or referral if complications were suspected. 

Healthcare users need easier access to antenatal imaging, and clinicians need better capabilities for screening high-risk conditions that lead to disproportionately worse pregnancy outcomes, particularly in rural areas. When ultrasound becomes more accessible, high-risk conditions may be identified earlier, leading to improved outcomes. 

The technology and training equation

What sets this initiative apart is its comprehensive approach to implementation. The program provides valuable insights into how to scale medical technology deployment in resource-limited settings effectively. But rather than simply distributing services, the program emphasizes sustainable integration into existing healthcare systems. This includes:

• Intensive training programs for healthcare workers
• Ongoing remote quality-assurance review and mentoring of the trained healthcare providers
• Partnership with local academic institutions for academic collaboration and impact evaluation
• Integration with existing maternal health protocols 
• Collaboration with local distribution and support networks
• Collaboration with local government for supportive health policy development 

Looking ahead: implications for global health 

The collaboration among multiple stakeholders — including the Clinton Health Access Initiative, GUSI, Kenyatta University and local healthcare institutions – offers a model for future health technology implementations. It demonstrates how public-private partnerships can work together to address complex healthcare challenges while ensuring sustainability and local ownership. 

As the program continues to expand, (Kenyatta University’s College of Nursing in Kenya, CHAI and University of Pretoria in South Africa) researchers are evaluating its impact on broader health system metrics, including referral patterns and population-level maternal health outcomes. This data will be necessary for understanding how POCUS technology can be most effectively deployed to improve maternal health outcomes in similar settings around the world. 

The initiative extends beyond technology. It represents a comprehensive approach to addressing maternal health disparities through innovation, education and systematic support. We must advocate for earlier, better maternal and primary care for all, especially for mothers who reside in resource-limited settings as they enter pregnancy. We also need to address racial and socioeconomic disparities in healthcare access and improve the quality of healthcare across the entire continuum — and ultrasound plays a role in that every step of the way. Providing affordable point-of-care diagnostic tools can be instrumental in quickly and efficiently assessing the well-being of all people, especially pregnant mothers. This can empower healthcare providers to be better diagnosticians and improve overall patient care, particularly for those at risk.

As global health leaders continue to seek solutions for reducing maternal mortality, this program offers valuable lessons on how to effectively bridge the healthcare access gap in resource-limited settings. 

The initiative described above was supported by a $5 million grant to Butterfly Network.

Photo: Ridofranz, Getty Images

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