The problem we set out to solve
Sub-Saharan Africa accounts for roughly two-thirds of global maternal deaths — not primarily because of untreatable conditions, but because of delays. Three specific, addressable delays that sit between a complication and the care that could resolve it.
The Three Delays Model, first described in 1994 by Thaddeus and Maine, identifies exactly where the system breaks down: the decision to seek care, getting to adequate care, and receiving care once there. MamaReady is built to compress each of these delays.
"Most maternal health apps assume a well-connected user in a high-resource setting. We started from the opposite assumption: no reliable internet, no hospital directory, no guarantee that the phone will have signal."
The three delays — and how MamaReady addresses each
Delay 1: Deciding to seek care
Many complications go unrecognised or are misattributed. MamaReady includes an offline warning signs module that teaches families to identify danger signs during pregnancy and labour — in plain language, available in English, Pidgin, and Hausa. The content is pre-loaded and works with no internet connection.
Delay 2: Reaching care
Transport is the most operationally complex delay. MamaReady lets families pre-register local drivers, tricycle operators, and community vehicles during pregnancy — before an emergency. When a crisis begins, a single tap dispatches a location-stamped alert to all saved contacts simultaneously, via push notification with SMS fallback if data isn't available.
Delay 3: Receiving care at the facility
Facility unreadiness — no blood, wrong staff on duty, missing equipment — kills women who made it to the clinic. MamaReady sends a structured pre-arrival notification to the destination facility containing the patient's name, estimated arrival time, known complications, and blood type. The facility has time to prepare before the patient arrives.
Architecture decisions
Every architectural decision in MamaReady was made with a single constraint in mind: what happens when the network fails?
- Offline-first with WatermelonDB: All critical data — birth plan, alert drafts, contact list, warning signs content — lives in local SQLite via WatermelonDB. The app syncs when connectivity is available, but never requires it for core functionality.
- SMS as a first-class fallback: Push notifications are attempted first. When they fail, the app falls back to SMS via an SMPP gateway. If SMS also fails, the app surfaces a scripted voice call guide.
- Phone-number identity: Account creation friction kills adoption in this context. MamaReady uses phone number + PIN only — no email, no password reset flow, no third-party auth dependency.
- Reactive queries: WatermelonDB's observable query model means the UI automatically re-renders when data changes from a background sync — no manual cache invalidation.
The birth preparedness plan
The feature that drives adoption before an emergency: a structured birth preparedness plan created during pregnancy. It captures the chosen facility, transport option, saved funds, blood donor contacts, and designated support persons. Stored locally, accessible offline, and shared with the full care network. The plan is the anchor that makes the rest of the app worth keeping on the phone.
Technical stack
React Native with Expo for cross-platform reach targeting Android first (the dominant platform in the target demographic). WatermelonDB for offline-first sync. NestJS API on the backend for sync, notifications, and facility pre-arrival alerts. The sync layer uses a custom conflict resolution matrix — last-write-wins for most data, but assessment records are always append-only to prevent overwriting in-progress patient records.
Status
MamaReady is in active development, with a pilot planned across three primary health centres in the FCT. The emergency alert and birth plan modules are feature-complete. The facility pre-arrival notification system is in final testing.