Kunzang Choden, 30, from Samdingkha in Punakha, a mother of three, delivered her first and second child through normal labour and delivery. Therefore, she did not expect any complication with her third child. But on 9th November 2021, just three days before the due, her water broke. Kunzang and her husband immediately rushed to Punakha District Hospital where she was examined using iCTG, a mobile cardiotocography device for monitoring fetal heart rate and uterine contraction of pregnant women. 

"The doctor said my baby was in distress and there is no gynecologist at the Punakha hospital. I was referred to Wangdue Phodrang General Hospital so that I can receive care from a Gynecologist,” Kunzang said.

“I had to undergo C-section. I am very happy the complication was detected on time and I could receive timely care. My baby and I could have faced fatal consequences otherwise.”

Kunzang delivered her first and second child at the national referral hospital in Thimphu. “This time my husband and I decided not to go to Thimphu since we had to be with my aging parents.”

iCTG is a mobile innovative form of the conventional CTG based on Internet of Things (IoT) technology. The Ministry of Health in partnership with UNDP and JICA, and with fund support from the Government of Japan, launched the iCTG in 2021. And Punakha district hospital is among the 55 hospitals that were provided with iCTG devices to ensure continued maternal health care services during the COVID-19 pandemic. 

The hospital started using iCTG since January 2021. The Chief Nurse, Krishna Singh Monger said the device helped in minimizing pregnant women’s exposure to COVID-19. “Since it’s portable, we could conduct tests outside the Emergency Room.” 

In Thimphu, the technology was used in the ER set up outside the hospital, helping pregnant women reduce risks of exposure to COVID-19. Dr Sonam Gyamtsho, Head of the Department of Obstetrics and Gynecology at the National Referral Hospital said that with the use of iCTGs and its feature of online real time data review, providing of timely consultation and healthcare intervention has become much easier.

This technology is also helping the country address the shortage of gynecologists. With only 15 gynecologists for the whole of Bhutan, pregnant women particularly those in far flung remote places face hurdles in accessing quality gynecological and obstetrics services. In times of complications or emergencies, they are referred to bigger hospitals, which entails time and cost for families. Now with iCTG, these women can receive maternal health services at the hospitals in their villages and get advice from gynecologists remotely.

The technology has proved useful even in towns with bigger hospitals during the pandemic. In the Phuentsholing, for instance, where the COVID-19 lockdown remained in place for the longest time in 2021, the mobile device enabled the hospital in the town to provide continued and quality maternal and prenatal care during the lockdowns.

The introduction of iCTG has helped bolster the Ministry of Health’s efforts to scale up eHealth solutions in the face of growing uncertainty. According to the iCTG data usage, about 2500 women have availed the iCTG services which constitutes about 20% of the total pregnant women in the country. The technology will contribute towards the country’s goal to reduce neonatal mortality to 13.2 per 1000 live births and stillbirth to 12 per 1000 birth by 2023, and achieve the Sustainable Development Goal 3, Good Health and Wellbeing, target of reducing the global maternal mortality ration to less than 100,000 live births by 2030.