Grant Update: mWomen & mHealth – A Match Made in Nigeria

By Priya Bhandari

With most of the verticals in Mobile for Development at the GSMA, their names are fairly self -explanatory. mAgri? Catalyses mobile services that improve the productivity and incomes of smallholder farmers. Mobile Money for the Unbanked? Accelerates the availability of affordable financial services that provide safety, security and convenience to the unbanked. mWomen? Not so obvious. Our objective is to increase women’s access to and use of mobile and life-enhancing mobile services in developing markets. That broad objective can be achieved in many ways, often cutting across the other verticals and this is reflected in the diversity found in our portfolio of grants which span mobile financial services, education and skills training, sub-brands for the women’s segment and mHealth.

Given the informative reports recently released by both GSMA mHealth and GSMA Intelligence on the Nigerian market, we thought it was a good time to update you on the progress made by our grantee Grameen Foundation in developing an mHealth service in Nigeria. This service is a great example of an intersection between mHealth and mWomen as it will provide medically-proven, practical and relevant health information to pregnant women and nursing mothers.

What is Grameen Foundation doing?

The GSMA mWomen programme awarded Grameen Foundation a grant to bring its innovative “Mobile Midwife” service to Nigeria. This service was launched in Ghana in 2010, as part of the MOTECH initiative. It enables women and their families to receive SMS or voice messages that provide targeted, time-specific information about their pregnancy each week in their own language. Topics covered include hygiene, nutrition, immunisation, malaria, warning signs, and some messages address the husbands specifically. By using IVR to deliver the information, women with low literacy levels can also be reached.

The grant has enabled the high quality content used in Ghana to be customised and adapted to the Nigerian context. This was done by conducting in-depth research into the behaviours, attitudes and cultural myths surrounding pregnancy, delivery and nursing in Nigeria. Focus group discussions and in-depth interviews were carried out with pregnant women, new mothers, community leaders, family members and traditional birth attendants. Grameen Foundation then localised the content to address the specific myths being perpetuated and to ensure that the advice was applicable to women in Nigeria. For example, one of the messages for pregnant women challenges the commonly-held belief in Nigeria that eating certain foods can be harmful to one’s baby: “The early part of your pregnancy is very important as your baby’s body parts are forming. Eating well ensures that your baby develops properly and that you stay strong for delivery. There is no medical proof that eating certain foods like snail, banana or pineapple, directly affect your baby’s skin, head or make them drip saliva. Be sure to eat a lot of greens and vegetables such as spinach, garden eggs, okra, and tomatoes. You need foods which build your body and help your baby too, like groundnut, beans, eggs, beef, fish, soya or chicken. Eating plenty of fresh fruits like oranges, bananas, pineapples, helps your body make good use of the iron you are taking.”

Grameen then worked with local professionals to record the content in Nigerian languages, ensuring that Hausa – the language spoken in the northern region – was one of the first to be ready. Grameen is working with VAS2Nets, who will host the service, and local operators to launch the service in the coming months. In order to ensure the long-term sustainability of the service, end users will be charged a small fee for accessing the content. Users will be segmented by offering a Basic and Premium service, where the Premium service offers the additional ability to speak to a doctor on demand and join mobile chat rooms to discuss maternal healthcare topics.

The reports from our colleagues in GSMA mHealth and GSMA Intelligence help to answer key questions around the Mobile Midwife service in Nigeria:

What’s the size of the market? Why use IVR?

There is an addressable market of up to 4.4 million pregnant women and new mothers for text-based mHealth services. This number can increase to 18.8 million if IVR technologies and phone sharing are taken into account.

Source: GSMA mHealth

Will people pay for the content?

High out-of-pocket spend on healthcare in Nigeria indicates potential for commercial sustainability. Despite having the lowest income, the poorest segment has the least access to public healthcare funding and hence rely heavily on the private sector.

Source: GSMA mHealth (NDHS 2008)

Why focus on the northern regions?

The north bears the greatest burden of maternal and child morbidity and mortality in Nigeria. In fact, significant disparities exist between northern Nigeria and the rest of the country, as shown in the example below. This extends to literacy, where the rate is 30% amongst women in the north, compared to 78% amongst their southern counterparts.

Source: GSMA mHealth, FMOH statistics, 2010

Does the target population have access to mobile?

Nigeria’s population is split roughly 50:50 between urban and rural areas, with mobile penetration much lower outside of cities. More striking still is the north-south divide within the country, with southern regions well ahead of northern counterparts in access within a household to mobile phones. Please note that access is defined as ownership or access to a mobile without ownership, such as sharing between family members. The widespread incidence of phone sharing means that access to mobile is still high enough to allow the service to reach scale amongst those who need it the most.

Source: GSMA Intelligence, Nigeria Bureau of Statistics

And finally, why women?

Traditionally, the primary decision makers in the household for matters related to health, childcare and food are women. Women in Nigeria are in dire need of evidence-based health information for themselves and their families and with mobile being the predominant technology, it is the ideal medium for delivery of this information. We believe that the launch of life-enhancing services such as Mobile Midwife will help to achieve:

• Social impact, by improving maternal and child health behaviours, and
• Commercial impact, by providing mobile operators with access to a relatively untapped segment through a revenue-generating VAS

Photo by Roel Burgler, courtesy of IICD (iicd.org)