Improving Access to Maternal and Newborn Health Services While Strengthening Health Systems: Why mHealth Should be Part of the Solution

Session: Access to Maternal Newborn Care: Improving Quality, Improving Outcomes

Presenter: Jean Christophe Fotso, Concern Worldwide
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Background: The potential of the rapidly expanding field of mobile health (mHealth) has not yet been fully harnessed in support of efforts to improve maternal and newborn health (MNH). An mHealth project named CCPF was launched in rural Malawi in 2011, consisting of a toll-free case management hotline and an automated and personalized mobile messaging service for pregnant women and caretakers of children under five. This paper aims to assess CCPF impact on the demand for home-based and facility-based MNH care, and discuss opportunities for scaling up and integration into the wider health systems strengthening.

Methods: The quantitative data was collected using a quasi-experimental design, including a sample of 2,840 women at baseline (in 2011) and 3,853 at endline (in 2013). We assess the impact of the intervention using the treatment on the treated (TOT) estimates. We also use qualitative evaluation data and desk review on the current mHealth landscape.   Results: CCPF had significant impact on bed net use, breastfeeding within one hour, ANC initiation, and institutional delivery. The negative effect facility-based treatment of fever suggests that CCPF helped women avoid unnecessary trips to the health facility for care that could be provided at home. The interpretation was corroborated in the qualitative data, with one respondent asserting: “We first talk to CCPF worker before we decide to go to the health center”.

Conclusion: Most mHealth interventions support vertical programs and are rarely designed with a roadmap to guide integration into broader health systems. CCPF was designed in close collaboration with the Ministry of Health (MOH) who has since endorsed the project and is encouraging its national scaling up. Discussions are underway with Malawi’s largest telecom provider to incorporate CCPF into the national MOH plans, and ultimately increase demand for, and delivery of MNCH and sexual and reproductive health care.