OVATE EVALUATE ALE UP IMPROVE ALTH RESEARCH ALUATE SCALE UP PROVE INNOVATE ALUATE SCALE UP PROVE HEALTH
MAMA South Africa: Putting the power of health in every mama’s hand South Africa has seen a dramatic increase in maternal deaths since 1990, with the maternal mortality ratio peaking at 625 deaths per 100 000 live births in 2007 (1). Latest figures available for 2010 show that the country is losing 300 mothers per 100 000 live births (2). At this rate, it seems very unlikely that South Africa will reach Millennium Development Goal 51 by 2015. The influx of deaths is attributed to HIV/AIDS, with some reports linking 40% of maternal deaths to the virus (3). Underfive mortality rates have increased as well, from 59 deaths per 1000 live births in 1998 to as high as 75 deaths per 1000 live births in 2007 (4). The South African government provides free life-long Highly Active Antiretroviral Therapy (HAART) to all pregnant HIV-positive women from their first antenatal visit (5). However, pregnant women tend to initiate antenatal health care late into their pregnancy (6). In addition, loss-to-follow-up of the mother-baby pair remains an important cause of ongoing infant infection. Mothers need direct information in order to adopt healthy behaviours at home and to strengthen their awareness of clinic-based services. The MAMA mobile suite empowers women by delivering timely, personalized information that will affect health-seeking behaviours. How MAMA South Africa works The MAMA suite comprises an interactive, mobile-based community portal, twice-weekly SMS (text) messaging services, a series of weekly interactive quizzes delivered via USSD, and a messaging stream on MXit (an African mobile social network). ‘MAMA on Mobi’ features an interactive social network where mothers can read articles and have a conversation with their peers on ‘feature phones’ (mobile phones with web access which represent 60% of cell phones in South Africa). ‘MAMA on SMS’ is a set of free, twice-weekly text messages tailored to the mothers’ gestational stage and/or the age of her baby, to be offered in six South African languages through enrolment at selected health facilities. ‘MAMA on USSD’ offers twice-weekly interactive quizzes tailored to mothers’ gestational stage or the age of their baby. ‘MAMA on MXit’ will launch in December 2013 and will offer the MAMA content to MXit’s 6 million strong user base in South Africa.
Supporting national public health programming In its effort to achieve Millennium Development Goals 4 and 5, the South African Department of Health has pledged to support major supply-side initiatives to strengthen and improve the quality of maternal and child health services, such as the Campaign on Accelerated Reduction of Maternal Mortality in Africa and the Re-engineering of Primary Health Care. MAMA is a complementary effort designed to create demand for these services, capitalizing on the ubiquitous nature of mobile phones. MAMA forms part of a consortium of over 20 organizations working in the field of ’mHealth for MNCH‘ (mobile health for maternal, newborn and child health).
Partnerships for support and sustainability A variety of public and private sector partners collaboratively support the MAMA suite to promote the long-term sustainability of the innovation. The Wits Reproductive Health & HIV Institute provides 1
MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www.unmillenniumproject.org/goals/gti.htm)
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Mothers need direct information in order to adopt healthy behaviour at home. The MAMA South Africa mobile suite includes:
MAMA on Mobi, an interactive mobilebased social network
MAMA on SMS, twice-weekly text messages tailored to mothers’ gestational age or their baby’s age
MAMA on USSD, weekly interactive health Q&As tailored to mothers’ gestational age or their baby’s age
MAMA on MXit, healthrelated content transmitted through the MXIt mobile social network
critical support for the monitoring and evaluation of the MAMA programme through their trained fieldworkers. Johnson & Johnson and the United States Agency for International Development (USAID) provide financial and technical support as the founding partners of MAMA globally. BabyCenter contributes their bestof-breed maternal health content, and mothers2mothers and the Perinatal Education Trust have contributed to developing and reviewing content for the programme. South African operators Vodacom and MTN are offering the MAMA SMS and Mobi content as a value-added service to their customers. The leading South African soap opera ‘Generations’ wrote MAMA-related content into its storyline, thereby reaching 10 million viewers. Lastly Johnson’s Baby and The Baby Expo promote MAMA at road shows and expos in communities across South Africa.
South Africa Currently: 96 000 By 2015: 500 000
South Africa Number of women registered for MAMA SMS, USSD and Mobi MAMA MXit not yet live
IWG catalytic grant for mHealth programme scale-up In late 2012, the United Nations Innovation Working Group’s (IWG’s) catalytic grant mechanism for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance, awarded a scale-up grant to MAMA South Africa. MAMA South Africa was successful in the grant competition because it employs an effective delivery strategy for an evidence-based maternal and child health intervention, combined with creative financing strategies to promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5. Through IWG, MAMA South Africa is receiving specialized assistance from WHO’s
Total number of women reached
Department of Reproductive Health and Research to optimize the scale-up of its suite while contributing to the mHealth evidence base and best practices on implementation and scale-up. Partners: USAID and Johnson & Johnson (MAMA founders), BabyCenter, UN Foundation, Praekelt Foundation, Cell-life, Wits Reproductive Health & HIV Institute, Vodacom and MTN For more information please contact: Marcha Bekker, Head of Business Development, Praekelt Foundation (marcha@praekeltfoundation.org)
References: 1. Millennium Development Goals: Goal 5 – Improve maternal health. South Africa, Government of the Republic of South Africa, National Statistic System, 2010. http://www.statssa.gov.za/nss/Goal_Reports/GOAL%205-IMPROVE%20MATERNAL%20HEALTH.pdf 2. Maternal mortality ratio in South Africa. Trading Economics (http://www.tradingeconomics.com/south-africa/maternal-mortality-ratio-modeledestimate-per-100-000-live-births-wb-data.html, Accessed 13 September 2013). 3. Millennium Development Goals: Goal 5 – Improve maternal health. Op cit. 4. Nannan N et al. Under-5 mortality statistics in South Africa: shedding some light on the trend and causes 1997–2007. Cape Town, South African Medical Research Council, 2012 (http://www.mrc.ac.za/bod/MortalityStatisticsSA.pdf) 5. The South African Antiretroviral Treatment Guidelines. South Africa, Government of South Africa, Department of Health, 2013 (http://www.sahivsoc. org/practise-guidelines/national-dept-of-health-guidelines). 6. Sellers P. Midwifery: a text book and reference book for midwives in South Africa. Volume 1 and 2. Claremont, South Africa, Juta, 1993 Credits: Icons from The Noun Project designed by: Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, Jamie Cowgill and Jim Bolek, Matt Daigle, Yorlmar Campos, Alec Dhuse Photo: Praekelt Foundation Editing, design and layout: Green Ink Ltd. (www.greenink.co.uk) WHO/RHR/13. 26 © World Health Organization, 2013 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.