This is a guest blog by Jessica Crawford, Senior Manager and Group Lead, Health Systems at Village Reach. The views expressed do not necessarily reflect those of the GSMA. Photo credit – Paul Brown.
Mobile technology seems like a panacea to many global health practitioners. As phones become more affordable and cell towers appeared across low- and middle-income countries, rural communities are only a phone call away. Health hotlines, in particular, have great potential for increasing access to health information and advice. Yet, legal and regulatory environments coupled with (difficult) financial models challenge the potential scale and sustainability of these health hotlines in low resource environments. Moreover, a health hotline must be trusted and used in order to be an effective tool for improving health outcomes but often awareness of and ability to access the service can often be barriers for the very people we are trying to reach.
Chipatala Cha Pa Foni, (CCPF), or Health Center by Phone, a health hotline in Malawi, demonstrates that it is possible to not only overcome these barriers, but to build an impactful, cost-effective, and scalable solution. CCPF was originally designed and piloted in 2011 by VillageReach, the Malawi Ministry of Health, and Concern Worldwide through the Innovations in Maternal and Child Health initiative in one rural district of Malawi. CCPF was designed to increase access to timely and appropriate health information, advice and care. Where the distance and cost of reaching a health facility often prevents seeking care, and access to information is extremely limited, CCPF provides a critical, life-saving link to the health system. CCPF has two main components:
- A toll-free hotline connects callers directly with health workers at a call center who are specially trained to triage callers over the phone and answer questions on a wide range of health topics and to identify and refer callers displaying “danger signs” for further care at a health facility. Originally limited to reproductive, maternal and child health, CCPF has recently expanded to include nutrition and general health topics.
- A “tips and reminders” mobile messaging service provides regular text or voice messages on reproductive, maternal, and infant health topics. Messages are tailored to the client’s week of pregnancy or a child’s age.
Results from an independent evaluation of the pilot found that CCPF led to statistically significant improvements in maternal and child health indicators such as; increased use of antenatal care (ANC) within the first trimester, increased use of a bed net during pregnancy and for children under five, and early initiation of breastfeeding. Moreover, the evaluation found that CCPF encourages appropriate use of the health system with over 80% of calls to CCPF’s hotline resolved without a referral to a health facility. As a result, CCPF reduces undue burden on health facilities by helping callers address minor ailments at home or seek treatment from community health workers.
Since the time of the pilot, CCPF has scaled to eight districts in Malawi and is positioned to be transitioned to the Ministry of Health for management and support and scaled up nationally in 2017.
What has been the key to the success of CCPF? One word – partnerships!
Over the past five years, CCPF has been supported by an evolving range of partners and stakeholders from a number of sectors. Partnerships with NGOs has encouraged new content and expanded the hotline to new communities. Partnerships with the Private Sector allows CCPF to remain free to communities, leverage new marketing solutions, and bring in a wider pool of expertise. And most critically, partnership with the Government allows the hotline to continue its trajectory to reach every household in Malawi, and continue far beyond the capacity of the non-profit sector. In brief: partnerships have been and continue to be the determining factor in CCPF’s success.
Legal and regulatory environments
A direct partnership with the Ministry of Health provides a solid foundation for overcoming many of the legal and regulatory challenges health hotlines face. Many countries have prohibitions over-the-phone diagnosis, so it can be a fine line when providing health information and advice. Working through these regulations with the Ministry of Health and the professional associations in Malawi ensures that CCPF follows both the letter and spirit of the law – providing quality health services while not overstepping the boundaries of good practice. In our experience, providing health information, advice, and referrals to callers empowers them with information for making more appropriate health decisions on when and where to go for care. In a place like Malawi where delayed care seeking and an overburdened health system are real challenges, this can prove to be a tremendous benefit for the health system as well.
As CCPF was developing and being piloted, Airtel, Africa’s largest mobile carrier, was also building an mHealth program in Malawi called Dial-A-Doc where subscribers could call a shortcode and reach a physician. Given that some of the biggest cost drivers of CCPF in the pilot were telecommunications and outreach efforts often limiting factors in scaling and sustaining the hotline, VillageReach and Airtel worked together to merge CCPF and Dial-a-Doc into a single service. This partnership has been essential to both CCPF and Airtel for a number of reasons. Airtel now provides a zero-rating for the hotline, allowing CCPF to remain toll-free for communities and Airtel’s marketing strength has successfully promoted the service to people across Malawi.
CCPF relies on partnerships with local organizations who work at the community level, addressing many of the barriers end users face in accessing the service. Community mobilizers not only promote the service, but provide access to phones so users can call in to hear their tips and reminders messages. CCPF team members engage with health workers in rural health centers, building trust with both the health workers and patients. Patients can see the benefits of accessing CCPF, which is reinforced when they attend a health center. Finally, implementing partners such as Concern Worldwide Malawi, Baobab Health Trust, Project Concern International, GIZ, and CHAI have provided CCPF with content expertise and technical assistance throughout its history enabling the service to expand its relevance through additional health topics and ensure its ongoing quality so that the hotline provides timely and accurate information to Malawians.
The Ministry of Health, in particular the Department of Planning and Policy Development and the Reproductive Health Unit, have taken a great interest in CCPF and seeing it scale nationwide. VillageReach is currently working directly with the Ministry to build capacity and develop transition plans to ensure a successful national roll-out and move the ownership of this service to the Ministry. While seemingly a simple task, in order to be successful, VillageReach is assisting the MoH to spearhead a steering committee, develop of an MOU with various government offices including the MoH, Department of Finance and the Department of Justice, and incorporate the hotline into the Health Sector Strategic Plan. VillageReach has seconded staff to the MoH to facilitate this process. This will see CCPF become a national service, supported by a range of partners and coordinated by the government. Without a strong series of partners driving the project forward, Chipatala cha pa Foni would not be the success it is today. As more users begin accessing services, there will likely be other bumps in the road, but by maintaining a wide variety of able partners, there will be solutions and new approaches to call on.