This is a guest blog by Dr. Peter Benjamin, Director of the mHealth Expert Learning Program (mHELP). This is part 2 of a 2-part blog. Part 1 was posted on Thursday 26/8/14..
The 21st of August was a big day for mHealth in South Africa!
The first national public mHealth service has been launched by the Department of Health, by the Minister of Health Dr Aaron Motsoaledi at KT Motubatse Clinic in Shoshaguve, Tshwane.
MomConnect is important as the first large-scale mHealth implementation run by the Department of Health (DOH) in the country. There are many maternal mHealth services in SA (a survey by the GSMA last year identified over 40), most are small pilots, though there are some significant services (MXit’s BabyInfo with over 800,000 subscribers, MAMA with over 300,000 subscribers, Hi4Life and Every1Mobile). MomConnect is the first national service owned by the DOH and promoted through nationwide clinics.
Another interesting feature is that MomConnect is much more than sending messages. While the main features that women subscribers will see are the SMSs they receive, appropriate to the stage of pregnancy or their baby’s age, there are other significant features of MomConnect. There are other ‘health system’ components that aren’t part of the other maternal mHealth systems mentioned in the previous paragraph. Firstly, this is a ‘point of care’ system, meaning that during the interaction between the woman and the health worker at the clinic a mobile phone is used to register the pregnancy (which subscribes the women to the messaging). This use of mHealth during the patient encounter has the potential for great improvements (e.g. improving the quality of healthcare through decision support; or linking to a patient record system so the health worker has easy access to the woman’s medical record, lab results and other information, improving the continuity of care to the patient; or training updates for the health staff). (For info on mHealth improving the quality of healthcare see www.cosolutions-and-impact/connectivity-for-good/mobile-for-development/mobile-money/certification/arehq.org/home and www.d-tree.org)
Secondly, the registration and subscription of MomConnect directly feeds into a national database. For the first time, South Africa will have a coherent National Pregnancy Register (NPR). Chris Seebregts and his team at Jembi, with Matthew Chetty and others at the CSIR, have done a huge amount of work in the past year to build this complex system. This NPR will greatly improve the information around maternal and child health in South Africa.
Thirdly, MomConnect will allow the women subscribers to get information on frequently asked questions and to give feedback on the quality of health services they received. These comments, complaints and compliments system will for the first time allow users of the health system around the country to report on the service they receive (though an impressive SMS feedback system has been working in the Western Cape for over a year). The Minister is very passionate about this. On the MomConnect roadshow that has gone to all 9 provinces over the past month, he has highlighted that this will mean that staff in the clinics will have to show more respect to their patients. He tells stories of pregnant women being neglected, with differentiated treatment for women who have connections to politicians and high ranking officials. To quote the Minister, “The women now have more power.” Addressing the assembled provincial health staff he said, “The cell phone in the hand of the pregnant women is like a bazooka – she can shoot you”. This feedback system is much more than a nice-to-have after thought: MomConnect was to be launched in April, but the Minister said we could not launch until this feedback system was working.
There are dozens of maternal mHealth messaging systems around the world (Text4Baby was the first one in the USA, and MAMA is doing stunning work in many countries including South Africa www.mobilemamaalliance.org). However I only know of two other maternal mHealth systems globally that have a similar scale and scope to MomConnect. They are Motech in Ghana (funded by the Grameen Foundation www.grameenfoundation.org/what-we-do/health/maternal-and-infant-health) and Mobile Khunji in Bihar, India (with BBC and the BM Gates Foundation www.bbc.co.uk/mediaaction/where_we_work/asia/india/india_sdp_empowering_chw_ma_mk.html)
It will be interesting to see how MomConnect develops – the positive benefit it will have, the inevitable teething problems there will be, and any unintended negative consequences that emerge. It is good that a great deal of care has gone into monitoring and evaluation: the GSMA, through UK aid from the Department for International Development (DFID) managed through Mott MacDonald, got Johns Hopkins University (the US university that is leading mHealth research globally) and the WHO to design an M&E framework, and this is being implemented by teams at the University of the Western Cape and the University of Stellenbosch.
The MomConnect launch is a huge step forward for mHealth in South Africa, and around the world (last week I happened to be in Washington DC, and I spoke to over 20 people in many meetings who are really interested in MomConnect as a global first). All those involved can feel proud. However, it is not a question whether such a big ambitious ground-breaking health initiative will have difficulties, complaints and setbacks – of course it will. The issue is whether we can be open about them and learn together so that we use technical tools to better the care women receive, and empower women to improve their health and the health of their babies, while demanding good quality health services.