Case Study
Butterfly Deploys 1,000 POCUS Probes to Practitioners Across Kenya and South Africa To Help Improve Maternal and Fetal Outcomes.
Overview
Of all instances of maternal and neonatal mortality rates, 94% occur in settings with limited access to healthcare1. In sub-Saharan Africa, as many as 200,000 mothers and 28 of every 1,000 infants die in childbirth every year2,3.
During pregnancy and delivery, ultrasound is a critical tool for early detection of life-threatening complications. However, access to affordable ultrasound technology has been extremely limited in these areas.
In 2022, Butterfly Network received a $5.8 million grant from the Gates Foundation to deploy 1,000 Butterfly iQ+ probes and train more than 1,000 healthcare workers across Kenya and South Africa in obstetric point-of-care ultrasound (POCUS).
To date, this initiative has facilitated ten week-long trainings for 514 healthcare workers and the deployment of 500 iQ+ devices to health centers in Kenya. The second phase of deployment culminated in December 2024 with the deployment of 500 devices in South Africa and the training of 483 healthcare workers.
Impact evaluation is ongoing, but early results indicate high adoption rates, sustainability of the technology and improved maternal and neonatal health outcomes through early detection of high-risk conditions.
Impact in Kenya and South Africa
total scans
average monthly scans in Kenya
lifetime minutes of scanning and an average scan time of 1.91 minutes, which is steadily decreasing
passing rate on obstetric POCUS exam after week-long trainings, including didactic lectures and hands-on experience
POCUS adoption rate by participant providers
of respondents self-reported having identified a high-risk condition using the Butterfly iQ+
In Kenya alone, the implementation has resulted in over 500,000 Butterfly scans carried out by 514 distinct users across 224 public facilities, predominantly in rural settings. This widespread adoption has lead to over 927,000 lifetime minutes of scanning. Scans last an average of 1.85 minutes, but that number has been steadily decreasing. Scan times averaged over two minutes in 2023, but practitioners achieved an average scan time of under two minutes in 2024.
Advanced probe utilization data reveals more than 49,000 instances of fetal biometry in both Kenyan and South African cohorts as of early 2025. According to the interim qualitative data analysis conducted about 6 months post-training, more than 90% of respondents said they had self-reported a high-risk condition using Butterfly iQ+*.
The deployment of point-of-care ultrasound has allowed healthcare workers in Kenya to identify and take action on high-risk conditions including multiple gestation, breech presentation, and placental abnormalities. Practitioners have also assessed fetal cardiac activity and amniotic fluid volume. Healthcare workers have indicated that POCUS gives them greater confidence in decision-making and patient management and improves collaboration and referrals. In some cases, POCUS replaces the physical examination or the use of the fetoscope.
Butterfly will release a full impact analysis in both Kenya and South Africa after further evaluation.
Deployment
The initiative began with site selection in summer 2022, followed by device deployment and training in Kenya between September and December 2022 and in South Africa from April 2024 to December 2024.
In Kenya, Butterfly Network partnered with Kenyatta University who both selected and recruited end users and health facilities, as well as leading the impact evaluation of POCUS on patient outcomes in this first of its kind large scale deployment. The university’s research and recruitment informed a phased deployment across health centers and implementation of 10 week-long training seminars including lectures and hands-on training experiences with live models. Butterfly partnered with PHSL for logistics and distribution of probes, the Global Ultrasound Institute (GUSI) for training and adoption, and Jamf for mobile device management software.
Bringing the diagnostic tool to the hands of the midwives that are actually taking care of patients in rural areas is what we specialize in. That way, the midwife can get rapid answers right away at the bedside. Care providers need easy tools like Butterfly at their fingertips to quickly triage their sickest patients, so everyone gets high quality care.
VP of Global Health, Butterfly Network
In South Africa, Butterfly partnered with Zebra Medical and CORE for local logistical support, GUSI for training, CHAI (Clinton Health Access Initiative) for implementation and recruitment, and University of Pretoria for an impact study.
Student knowledge and confidence were assessed by a pre-test and post-test, as well as Objective Structured Clinical Examination (OCSE) upon course completion. In Kenya and South Africa, 99% of clinicians passed the OCSE, and students showed marked improvement in post-training test scores compared to pre-test scores. Along with healthcare worker examination, impact was evaluated at the health system and patient level with improvements in Kenya, and the impact study in South Africa is commencing.
For me, there was this very critical moment when the first group of students actually held the probe and put the probe onto the skin for the first time and could suddenly make sense of what they were seeing. They went from feeling very overwhelmed to thinking, ‘Maybe I could do this.’
South African Family Physician and Instructor, Global Ultrasound Institute
POCUS Impact
In both countries, the initiative aimed to strengthen diagnostic imaging to achieve improvements in maternal and neonatal health outcomes. These facilities, which are located in predominantly rural settings without access to broadband, are safety nets for hundreds of thousands of patients in the community. Most women in these communities had never before received ultrasound during their pregnancy.
POCUS via handheld ultrasound devices empowers midwives and other mid-level practitioners to unlock insights that support life-saving interventions for pregnant women. Through the initiative, practitioners in Kenya and South Africa now have instant access to these insights using Butterfly devices.
The dissemination of the POCUS devices with a short intensive obstetric POCUS training serves as an example of the feasibility of rapidly scaling ultrasound access and services to areas with limited healthcare resources. Because of the great need for accessible POCUS training programs in low- and middle-income countries (LMICs), the results of the initiative reveal significant potential future impacts on patient care.
The program has been a remarkable exhibition of the power ultrasound information offers when made portable, accessible, and usable through advanced technology and focused, hands-on training.
CEO, Global Ultrasound Institute (GUSI)
Conclusion
The benefits of POCUS in LMICs is clear4,5. Numerous studies have associated it with benefits such as improved access to ultrasonography services, timely diagnosis and referral of high-risk pregnancies, and improved maternal and neonatal outcomes6. In regions with limited healthcare infrastructure, affordable digital health tools and scalable in-person training for mid-level practitioners can empower better clinical decision-making to help save lives.
At Butterfly Network, we envision worldwide access to medical imaging that can meaningfully improve outcomes for pregnant women and their unborn infants. The widespread adoption and embrace of affordable point-of-care diagnostic tools through this initiative provide powerful evidence of the capacity for handheld ultrasound to transform care.
The Gates Foundation funded device rollout, implementation, and training program should serve as a model for further medical imaging advancement in remote settings. Instead of solely distributing services, the program collaborated with local support networks, integrated with existing maternal health protocols, and partnered with local institutions to evaluate impact. This is an effective framework to scale medical technology deployment in under-resourced settings.
One final outcome of the initiative is its potential to inspire both governmental health organizations, as well as nonprofits that seek scalable and sustainable technology, to improve global health.
Last week, I had a mother who came in with antepartum hemorrhaging (APH). I was called upon, did the ultrasound, and found out there was placental detachment. I made the decision to take the mother to theatre and managed to save the mother and the baby. As we are speaking, the mother and baby are doing good. I don’t take it for granted that I was among the people who went to train for POCUS because it’s helping the community down here where infrastructure is slightly poor. I hope it’s also the same with the other members who attended the training.
- www.unfpa.org
- data.unicef.org
- www.who.int
* conducted via internal survey. - Onsongo et al., 2024
- Wachira et al., 2023
- Hall et al., 2021; Kumar et al., 2023; Wanjiku et al., 2024
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