Class instructor and Student. Photo by Brian Donnelly
mHealth, or Mobile Health, can be defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, tablets, personal digital assistants (PDAs), and other wireless devices.
CHS and its affiliate University Research Co., LLC (URC) use mHealth to empower individuals, families, communities, and societies to increase control over and improve their health. We leverage mHealth to improve decision-making and performance by providers and clients and reach audiences previously hard to reach. Our overall goal with mHealth is to stimulate and sustain individual and social changes and contribute to better health outcomes.
Our approach recognizes that human behavior is complex and results from a combination of context-specific influences, including social norms, health policies, the quality of health services, and individual knowledge. Consequently, we apply a systematic, continuous process shaped by evidence and feedback to develop and monitor mHealth interventions.
Texting for Maternal Wellbeing in Benin
The USAID-supported Partnership for Community Management of Child Health (PRISE-C) project piloted an innovative mHealth application among community health workers (CHWs) and health center staff to improve contraceptive prevalence in Benin’s Toffo and Zè communes. The “Texting for Maternal Wellbeing” pilot equipped seven CHWs and two health center staff (a midwife and a nurse) with mobile phones with an application for data collection and case management.
After receiving family planning and mHealth training, the CHWs and health center staff used the application to register clients for family planning services, record each client’s chosen method, and monitor the method’s effects. The workers also used the application’s images and audio messages to counsel clients. The messages, adapted from the Ministry of Health’s family planning counseling tool kit, are in the local language.
During the four-month pilot (February–May 2013), 264 women/couples received family planning counseling. Of these, 225 had their family planning session with a CHW who referred them to a health center to receive a family planning method. Seventy-two of them (or 32% of the smaller number) went to the health center to meet with a health worker and 68 (or 30%) adopted a family planning method. These findings demonstrate the potential this type of mHealth approach has to significantly improve contraceptive prevalence in the country. The project will share the findings and lessons learned with the Ministry of Health, which will decide whether to expand the activity to other regions.
Sharing Safe Motherhood Messages in the Philippines
In the Philippines, USAID’s Health Promotion and Communication Project (HealthPRO), in collaboration with the Philippines Department of Health, used mobile technology to disseminate safe motherhood messages through the “Ask Ma’am Melba” interactive voice response (IVR) system pilot. The system enabled health system clients to get free, life-saving maternal health information in the form of pre-recorded voice prompts from “Ma’am Melba,” a virtual midwife. Users texted the keyword “Melba” on their mobile phones to pre-identified numbers, and the system automatically returned the call (at no cost).
During a two-week pilot, “Ask Ma’am Melba” provided just-in-time information to nearly 800 clients who used it to learn new information and act on it. One caller was nine months pregnant with her first child and experiencing headaches and dizziness. She texted Ma’am Melba for advice and received a call back advising her to “Go immediately to hospital.” She was soon diagnosed with pre-eclampsia, a medical condition that, if untreated, can lead to life-threatening seizures. She received treatment immediately and delivered a healthy baby boy.
Improving Health Care Quality in Guatemala
Through the USAID Health Care Improvement Project in Guatemala, health workers in clinics received text messages on their mobile phones to remind them of the principles of quality health care. In formative research, health workers said they would like to receive messages that 1) motivated them and promoted quality performance, 2) were sent no more than three times a week during lunch or before work, and 3) clearly identified the Ministry of Health (MOH) as the source. Mid-campaign assessments found that text messages helped create a sense of connection between public sector health workers and the MOH: Health workers 1) felt as though the MOH remembered them and 2) wanted to continue receiving messages regularly that included information on events, health, emergency alerts, and MOH norms. An end-of-campaign telephone survey found that 80% of health workers reacted positively to the messages; 82% found them helpful; and 39% shared them with co-workers.