Have you ever forgotten about a doctor appointment? Or put off scheduling an appointment because you didn’t have the time? With all the schedules and activities we juggle today, missing or forgetting to schedule appointments is common. Often, we put off making an appointment until we feel sick or are in pain. Waiting to go to the doctor until something urgent happens becomes particularly dangerous for pregnant women when routine antenatal care (ANC) is critical for both the health of the baby and the mother. In Malawi, where maternal and child mortality rates are some of the highest in the world, increasing ANC can be integral to improving maternal, infant, and child health, yet routine ANC is not a common practice. Increasing knowledge and awareness about the importance of ANC is a key component to improving maternal and child outcomes.
Through this pilot project, we are learning about some of the challenges and limitations mHealth projects face at the last-mile.
VillageReach, in partnership with the Clinton Health Access Initiative (CHAI) is currently piloting a new mHealth project aimed at increasing ANC participation among mothers in Malawi. The project, called ANC Connect, an extension of Chipatala Cha pa foni (CCPF), or health center by phone, links pregnant women with health surveillance assistants, or HSAs (community health workers). The HSAs play a central role in the project – they register women for ANC Connect through SMS and regularly visit the women throughout their pregnancy to encourage them to continue attending ANC and discuss where they will deliver.
HSA registering a pregnant mother for ANC Connect.
By talking to clients about delivery locations, the hope is that women will learn about the benefits of delivering in facilities and be more inclined to deliver in a health center. HSAs receive reminders via mobile phones and two-way SMS messages each week to indicate which clients are due for ANC or delivery and report back on their progress. Through ANC Connect, VillageReach and CHAI will learn if an HSA focused SMS reminder system is a feasible and functional option to increase ANC participation and health facility deliveries.
Women with regular access to cellphones also receive a SMS reminder the week they are scheduled to attend ANC.
Through this pilot project, we are learning about some of the challenges and limitations mHealth projects face at the last-mile. Communication with text messages can be particularly sensitive to keystroke errors or misspellings. We have found that when HSAs text in village names or expected delivery dates, errors are common. When texting a friend or family member, these type of errors are not critical. However, in this case, the SMS system is coded to recognize exact responses and deviation from the expected is categorized as an invalid response. This has led to various technical hiccups and can create a domino effect leading to a client or HSA being unable to successfully interact with the technology. A future implementation should include the functionality to recognize deviations from the expected response and appropriately categorize the message. In the absence of this functionality in this pilot, the Malawi staff has done a great job training HSAs in the SMS technology and responding to errors as they come up.
VillageReach staff train HSAs on ANC Connect
Despite these unanticipated issues, initial data suggest a strong interest and participation in ANC Connect by both HSAs and pregnant women. The full impact of the pilot will not be known until after all the data is gathered and analyzed. The ANC Connect pilot runs through the end of February and data analysis is expected to be completed by late March.