You are about to visit a Philips global content page

You are about to visit the Philips USA website.

Knowledge Hub

Empowering midwives to deliver community-based ultrasound screening

Study to explore sustainable decentralization of obstetric ultrasound screening to primary healthcare facilities through an income-based model for midwives



    The World Health Organization (WHO) recommends one ultrasound scan before 24 gestation to help identify pregnancy outcome risks. However, diagnostic imaging is insufficiently available in rural and remote areas in low-resource settings. In several projects, Philips Foundation explores models to increase access by task sharing between locally operating midwives supported by sonographers at distance via telehealth.

    In this project with Amref International University we focused on testing the viability of a sustainable income model for a social franchise of midwives offering pregnancy screening in primary healthcare facilities.





    The main goals of the pilot was to analyse the mothers’ willingness to pay for an ultrasound, to examine the ability of midwives to become social entrepreneurs, and to test the viability of the proposed business case. To this end, the following intervention and activities were conducted:


    • The project was fully aligned with and endorsed by key stakeholders, including Society of Radiography in Kenya, Nursing Council of Kenya, Midwives Association of Kenya, and the County Governments.
    • 42 midwives were trained successfully on two standardised and blended learning modules. 10 sonographers were involved to conduct the training and subsequently support the midwives in conducting and interpreting the screenings. 950 pregnant women were screened at no charge during this training. To date, at total of 67 midwives have been trained. The performance of midwives to correctly conduct obstectric ultrasound screening was assessed and rated by radiologists.
    • 2-5 midwives were grouped into business units (BUs) to create functional teams in 10 health facilities in 2 counties in Kenya (Kadjiado and Kisii). Each business unit was mentored by a radiographer. Each business unit received a Philips Lumify point-of-care ultrasound device and a subscription to the Reacts platform that enabled remote collaboration with professional sonographers. County governments allowed the midwives to charge Ksh 500 per session. Midwives’ monthly incentive was performance based.
    • The study identified women’s motivations and barriers to take up routine ultrasound screening and the willingness to pay for it.

    Based on these findings, the study explored a potential income model for midwives.



    The training, implementation and study of the project were successfully completed. Over the project period, more than 1,200 paid ultrasound screenings were conducted. The study confirmed women’s willingness to pay for the service, hence confirming the principal foundation for an income-based scalable model. Whether the time to break even is sufficiently short to enable the midwife based ownership model will strongly depend on utilization flows. The project led to valuable new insights that were disseminated through several peer reviewed publications, conferences and online webcasts.

    Learnings and next steps


    1. Midwives are able to learn the essential skills for obstetric ultrasound screening as confirmed by both sonographers and self rating. The midwives’ competencies increase over time. Training, mentorship and coaching are critical drivers in decentralisation of ultrasound screening.
    2. Women are willing to pay for obstetric ultrasound screening. Women’s education level,pregnancy gestation and distance to the point of care were the most critical determinants of undertaking obstetric ultrasound screening service. Mothers paid for the service mostly to confirm the pregnancy gestation, fetal position and fetal sex.
    3. Over the project period, women’s uptake of the obstetric ultrasound services increased to 50% within the pilot sites from <10% at the baseline period. Community sensitisation (conducted by community health workers) is a critical driver of the uptake of obstetric ultrasound screening. The distance of accessing the essential service reduced to 3-5 km for 45% of the mothers in the pilot sites.
    4. Public owned business units (BUs) had higher flow of clients than privately owned BUs.
    5. The sustainability of the business model strongly depends on patient flow. In the current settings, the time to break even was relatively long, suggesting that different investment, ownership and incentivizing models might be more suitable. Uptake of the service by local governments and/or the National Hospital Insurance Fund (NHIF) of Kenya will increase sustainability.




    2019 - 2021


    Care to collaborate, or want to learn more about this project?  
    Do not hesitate to contact us.

    In line with Sustainable Development Goal 17 (partnerships for the goals), we believe we can make a real difference in providing access to quality healthcare if we work together.

    You are about to visit a Philips global content page

    You are about to visit the Philips USA website.

    Our site can best be viewed with the latest version of Microsoft Edge, Google Chrome or Firefox.