South Africa’s MomConnect’s expanding
Mothers and babies are long-standing health priorities for Africa. South Africa’s MomConnect’s been a source of support for many of its mothers and babies in an effort to reduce their mortality rates, which, up to 2014 and 2015, had been higher than Africa’s average.
- South Africa has significant avoidable maternal and child mortality
- It has not achieved its Millennium Development Goals (MDG) targets for Maternal Mortality Rates (MMR) and Under Five Mortality Rates (u5MR) and will need a big push to achieve its Sustainable Development Goal (SDG) targets
- Strong political leadership from the government and health minister has set in train several initiatives to improve progress towards MDGs and SDGs
- MomConnect’s one, aiming to strengthen health system in a number of ways
- MomConnect’s built on:
- Very strong political support and leadership of the National Department of Health (NDoH)
- mHealth programmes already in place in SA that harness support of a range of stakeholders including funders, technical experts, mobile network operators and training partners, so a true Public Private Partnership (PPP).
Four activities are:
- Strengthen information systems by registering electronically all pregnancies in the public health system as early as possible using unique ID number
- Strengthen the demand side of health system by sending targeted health promotion messages to these pregnant women to help them to improve their health and their infants’ health
- Provide pregnant women with an interactive mechanism to feedback on the service they’ve received
- Use NurseConnect to empower and support nurses with regular content, encourage study and peer support groups and provide feedback mechanism for nurses to make suggestions and improve their performance.
There are six steps in MomConnect. They’re:
- Nurses confirm pregnancies at clinics
- Nurses help expectant mothers to register on their mobiles using Unstructured Supplementary Service Data (USSD)
- Expectant mothers answer questions about their pregnancies
- MomConnect then registers them and links them to their clinic
- Their pregnancies are registered in the national database
- They receive weekly SMSs appropriate to the stages of their pregnancies about their health and their babies and infants health until their child’s one, and they can opt out at any time.
MomConnect’s voluntary. In its first two years, nearly 900,000 women registered on MomConnect. The MomConnect Helpdesk has received over 6,000 compliments and 1,000 complaints a ratio of 6:1 often seen as a health service benchmark. Complaints are fed back to relevant facility managers to ensure that problems are addressed. These are matched by answers to more than 200,000 routine questions that arrive at the Help Desk at a rate of about 1,000 a day.
A survey response of nearly 10,000, about 22%, in 2015 found that:
- Over 98% felt that MomConnect messages had helped them
- Over 80% shared SMSs with friends or partners, so extending MomConnect’s reach
- Over 75% said the SMSs helped them feel more prepared for childbirth and delivery
- Over 70% wanted more SMSs than the 100 plus messages they already receive during pregnancy and the first year of their child's life.
Alongside pregnant mothers, staff are positive about MomConnect. They think it’s a beneficial programme to mothers. Their views were reinforced in February 2016 when MomConnect was ranked as second prize in the African Association for Public Administration and Management Innovation Awards (AAPAM).
Many lessons have been learned since MomConnect started. They include:
- Ministerial and senior NDoH management vision and leadership
- Need for full time co-ordination
- Harness skills, resources and energy from numerous partners to achieve scale-up
- Manage many stakeholder agendas so everyone benefits
- Flexible funding for the start-up phase was critical
- Appropriate technical solution forms the basis but isn’t enough
- Links to the health system are critical
- Sharing data with the provincial and district staff important for their commitment.
Looking forward, MomConnect has several initiatives underway:
- An additional service for HIV positive pregnant women to ensure they have additional support, especially those who are at high risk
- An overall, formal, independent evaluation is due for completion by independent academic institutions, with results soon
- Network issues and time-outs are a barrier to MomConnect registrations, so need fixing
- Extending messaging to partners and children up to five years
- Other parties are interested in teenage pregnancy, early childhood development and adherence for TB and HIV
- Moving to data from SMS as smartphone coverage increases and testing Facebook Messenger and WhatsAPP for communications
- Improving the Help Desk to support women and enable the supply side to respond to complaints and address these
- Extend support and empowerment of nurses with a mobisite with materials and access to online support
- Ensuring sustainability by reducing operational costs of MNOs and setting a mainstream budget into routine NDoH financial management.
The future’s looking positive for MomConnect. It’s set to take its place with other initiatives as an integrated package to help to reduce maternal and child mortality.