I am the proud mother of an 18-month-old girl. Whilst this title comes with an incredible amount of joy, it also comes with a great amount of responsibility. Throughout my pregnancy, and even more so now as a parent, I wrestle with concerns over whether or not I am doing all the right things to ensure my little girl is getting everything she needs for her healthy development. Like most of the pregnant women and mothers in my community, I enjoy the luxury of my phone and the never-ending pool of resources it allows me to access from the comfort of my own home.
Having worked in the mHealth industry for several years now, I am well aware of the overwhelming amount of mothers around the world who simply do not have this luxury of information at their fingertips. I often think of all the women who have concerns about the health and wellbeing of their family, but have no way of getting information. It is the knowledge of this need that excites me to be working on products that are improving access to life-saving information and healthcare services for underserved communities – all through their mobile phones.
Healthy Pregnancy, Healthy Baby (HPHB) is one such service, delivering pregnancy and maternal and newborn child health content via SMS to families all across Tanzania. Thanks to the successful partnership with leading mobile operators (MNOs), it is freely available to all families across the country. As of November 2017, over 1.8 million service users have cumulatively received over 115 million messages through the service. That’s 1.8 million pregnant women and mothers who are able to make informed decisions and change their behaviours for the benefit of the health of their families.
Under the mNutrition Initiative, funded by UK aid (the UK Department for International Development, DFID), the GSMA has supported the HPHB service since 2014. With the help of our partners, we developed localised nutrition content and provided user experience and business intelligence consultancy to identify opportunities to enhance the HPHB service. In our recently published case study, we share the key underlying factors that have contributed to the success of the service and how it has improved nutrition behaviours amongst its users.
Achieving scale
Very few mHealth services have managed to achieve the scale and coverage that the HPHB service has. In our webinar we highlighted a few key factors that have contributed to the impressive reach of the HPHB service. The most notable of which is the diverse partnership network that HPHB service boasts – a mix of public and private sector stakeholders all coming together under a shared-value model to extend healthcare to underserved populations. We will discuss the contribution of three key partnerships to extending the HPHB service to the nation:
- Ministry of Health (MoH) – ownership of the service: MoH endorsement and branding gives the service validity and credibility. This promotes trust in the service amongst users and gives the service clout to engage new partners. Having MoH backing also gives the service access to leverage government clinics for service promotion activities.
- MNOs – zero-rating all SMS delivery costs: This in-kind contribution of mobile operators (zero-rating SMS delivery costs) reduces the overall service operating costs by roughly 63 per cent and enables the delivery of these messages at no cost to the end-user. Leveraging the MNO networks means that the service is made available to all users across all regions. Their support is pivotal to operating the service at its current scale.
- NGO partners – cross-promotion of the HPHB service: Historically, the HPHB service has been promoted through mass media campaigns. Although these campaigns have demonstrated impact in promoting the service amongst a large audience, they are prohibitively expensive and not sustainable without funding from donors. To overcome this, a growing network of NGO partners now promote the HPHB service through their existing services and workforce. These NGO partners cover the cost of training their staff to promote the service and in turn, they benefit from the value the service adds to their workforce and end-users.
Changing behaviours
What good is a service if it is reaching a large audience, but not having any impact on its users? As part of its support to the HPHB service, the GSMA also provided monitoring and evaluation (M&E) support to investigate how mobile is driving improved health outcomes amongst HPHB users. User feedback surveys revealed remarkably high levels of satisfaction amongst service users. Users rated different aspects of the content (clarity, actionability, relevance, usefulness) yielding an overall content rating of nine out of ten. As much as 73 per cent of HPHB users share the information they receive with their families and friends, and even write down messages to avoid losing the information.
“When I receive the messages I do not delete them immediately, I have a book which I use to note down the information. I delete them when my inbox is full” – Ashura, rural user
Services like HPHB add incredible value to their users. The majority of HPHB users (59 per cent) said this was the first time they were hearing about these nutrition practices and 22 per cent of users say that they have no other source of this nutrition information.
With newly acquired knowledge and clear guidelines on what they had to do to keep their families healthy, users were able to change their behaviours and were encouraged by the benefits of doing so.
One of the topics covered by the service is appropriate breastfeeding practices such as early initiation of breastfeeding (as soon as possible after birth) and exclusive breastfeeding (not giving children under the age of six months anything other than breastmilk). Although some messages on this topic contradict existing cultural practices (such as the belief that if a baby as young as one month old cries a lot you should give it cassava porridge to make it stop crying), these messages had significant impact on behaviours amongst end-users. Seventy-three per cent of HPHB users report to be implementing appropriate breastfeeding practices compared to only 64 per cent of non-users.
Mwanahamis, a mother of three in Dar es Salaam, subscribed to the HPHB service during her last pregnancy. She too received the messages educating her on the importance of exclusive breastfeeding for the first six months. After reading the HPHB messages, Mwanahamis was convinced that this practice was beneficial for her baby and so she changed her behaviours accordingly:
“Personally I used to feed porridge to all my children after one month, then immediately after forty days they start eating substitute food, but later when I conceived this last pregnancy I tried so much to follow the six months rule, I have done that and things went very okay and I have continued sharing the knowledge.” – Mwanahamis, urban user
Our Director General, Mats Granryd visited a health facility to meet some mothers who use the HPHB service – take a look at our video to understand his experience.
This project was funded with UK aid from the British people.