As patient groups go, pregnant women and new mothers are among the most motivated. They’re eager for information on how to care for themselves and their children, and quick to take action to ensure their children have the best start in life.
But in some low-income countries around the world, accessing high-quality health information at exactly the right time is not always easy. Recognizing the role a mobile phone could play in reaching expectant and new mothers, Johnson & Johnson made a commitment to Every Woman Every Child in 2010 to work with partners to reach women in six countries with evidence-based messages to motivate behavior change, and increase the likelihood that women would seek out antenatal health services.
Eight years after the initial Johnson & Johnson commitment, three of the six country programmes (Bangladesh, India, and South Africa) have reached more than a million mothers each.
How did this happen?
MomConnect, South Africa’s national mobile messaging service, is a useful case study. It has had a true commitment to universal coverage right from the start, and currently reaches over 60% of all eligible pregnant women in the country through over 95% of public clinics – the highest population coverage of any program of its kind in the world. The program is managed by the South African National Department of Health, with a diverse range of funding, technology, health and research organizations at the table.
To encourage uptake, BabyCenter collaborated with local partners to create messages that were carefully targeted to be relevant to the mother’s pregnancy stage or baby’s age. Messages were designed to have a warm, culturally-sensitive and relatable tone, and to provide parenting support and content to promote bonding, alongside more technical health promotion messages.
There have been several key elements to MomConnect that have made scale possible:
- It is accessible through all mobile phones. It uses the most simple USSD and SMS mobile technologies – despite their high costs at scale – to ensure that no mother is excluded because of the kind of phone she has. But as user habits have changed, MomConnect has also recently expanded to include WhatsApp as a richer and more affordable messaging platform.
- The messaging engages and empowers users, fostering a relationship of trust with the service and the health system. In a sample of 2000 women, 98% found the messages helpful, 77% felt better prepared for delivery, 81% shared their messages with family and friends, and 70% wanted more messages per week.
- It has had critical public-sector ownership. Private funders, with a larger appetite for risk, have contributed upfront investment and technical know-how to get MomConnect started, but only in the context of strong public leadership and an enabling policy environment.
- It can be adapted over time. The platform has been built with open architecture and open standards so that new features and functionality of increasing complexity can be added to engage new partners and users over time.
- It integrates supply and demand. The service doesn’t just push out messaging, but enables two-way interaction between the pregnant mother and the health system through phone-based surveys and a helpdesk. This enables real-time data collection on user knowledge, attitudes, practices, and experiences of service delivery to inform health care improvements.
With a technology platform now reaching over a million active users, MomConnect made it possible to bring direct messaging to mothers across the country with a flip of a switch during South Africa’s recent Listeriosis outbreak. MomConnect’s critical challenge remains long-term sustainability. Beyond maintaining its existing digital infrastructure, it needs to be agile to evolve in line with the technology landscape and the habits and needs of its users.
It will always need some degree of private funding for innovation, and it is critical that an ecosystem of funders and partners stay the course to collectively refine and augment this important public good for collective impact.