OVATE EVALUATE ALE UP IMPROVE ALTH RESEARCH ALUATE SCALE UP PROVE INNOVATE ALUATE SCALE UP PROVE HEALTH
SMS-based family planning in Kenya and Tanzania: FHI 360’s m4RH Sub-Saharan Africa has the highest unmet need for modern contraception: approximately 25% of married or in-union women who want to stop or delay pregnancy are not using any form of birth control. Currently only 23% of women in Tanzania and 28% of women in Kenya use modern contraception. Both women and men cite concerns about side-effects as one of the top reasons for their unwillingness to begin family planning – but misconceptions and misinformation abound (1,2). Exacerbating this unmet need is a severe shortage of trained health personnel: there are only 1.8 doctors for every 10 000 patients in Kenya and 0.1 doctor per 10 000 patients in Tanzania (3). With such shortages, the health sector is turning to alternative ways of providing the information that couples need – both about the benefits of contraception and about the management of side-effects. FHI 360 developed and piloted Mobile for Reproductive Health (m4RH) in Tanzania, Kenya and Rwanda, and is implementing the programme in collaboration with local partners in Tanzania and Kenya. The programme takes advantage of the increasing ubiquity of mobile phones to put contraceptive information directly into the hands of African women and men. Research has shown that m4RH can reach populations that are often underserved by reproductive health programmes, including those in rural areas, as well as men and youth. About half of m4RH users in Kenya and Tanzania are young people, with roughly equal numbers of women and men. In Tanzania, m4RH is accessed in 98% of all districts (4).
How m4RH works m4RH is an automated, interactive and on-demand text message (SMS) system that provides essential facts about contraception while addressing common misconceptions. It is simple to access: users text “m4RH” to a short-code telephone number to receive an SMS menu of various contraceptive methods, then select a number to learn more about each method. Users must opt in to use the system, and can access it as many times as they like. The system also allows users to locate nearby family planning clinics.
Supporting national public health programming m4RH was developed and deployed in close collaboration with the Ministries of Health (MOHs) of Kenya and Tanzania to support their family planning priorities and strategies. The SMS messages were developed using best practices for health communication programmes, global guidance from the World Health Organization (WHO), country-specific national family planning guidelines, and assistance from local agencies. Family planning technical committees sitting within the MOHs also reviewed the content. Additional messages have been added to reflect evolving government family planning priorities, such as ensuring correct use of fertility-awareness based methods and targeting content to young people. Governments in both countries have remained active in m4RH implementation. The Department of Reproductive Health in Kenya convened an m4RH task force during the pilot study, which has since merged with a broader one charged with developing the national approach to eHealth. In Tanzania, the MOH employs a point person for mHealth who is co-Secretary of a very active mHealth Community of Practice (CoP) that meets at least quarterly.
m4RH
? Users then select from a menu of contraceptive methods to learn more Concise messages describe the various contraceptive methods Users can also find their nearest family planning clinic through a searchable database
m4RH offers family planning information via SMS
Users opt in by texting “m4RH” to a short-code telephone number
Partnerships for support and sustainability FHI 360 is exploring three avenues that could contribute to the financial sustainability of m4RH in Kenya and Tanzania, thereby increasing the programme’s reach: (1) creating partnerships with private companies and organizations, (2) charging user fees and (3) marketing the service at different price levels. Mobile operators may be interested in public–private partnerships that align both corporate goals, such as advertising and brand loyalty, with publicservice goals related to improving public health. Private health organizations may be interested in supporting m4RH as a means of increasing traffic to their health-care facilities. Exploration of the user-fee model will involve conducting research with current and potential users in Kenya and Tanzania to assess their willingness to pay for the service under various conditions. The tiered model for sustainability involves working with FHI 360’s technology partner, Text to Change, to develop a pricing scale based on the level of technical support required, ranging from off-the-shelf to full-service.
Kenya 60 000 Tanzania 220 000 1 455 000 300 000
Kenya and Tanzania Number of unique users Number of “hits” or times the system has been accessed
IWG catalytic grant for mHealth programme scale-up FHI 360 was awarded a grant to scale up the m4RH programme in Kenya and Tanzania by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the United Nations Foundation. FHI 360 was successful in the grant competition because it employs an effective delivery strategy for an evidencebased reproductive 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 5.1 Through IWG, FHI 360 is receiving assistance
from WHO’s Department of Reproductive Health and Research to optimize scale-up of the m4RH programme while contributing to the mHealth evidence base and best practices on implementation and scale-up. Please visit http://www.who.int/reproductivehealth/ topics/mhealth/en/ or http://www.unfoundation.org/features/ mhealth/iwg.html for more information. Partners: Text to Change, Johns Hopkins Center for Communication Programs, Population Services International (PSI), Marie Stopes International, Family Health Options of Kenya, Pathfinder For more information please contact: Kelly L’Engle, Scientist, FHI 360 (KLEngle@fhi360.org)
References: 1. Kenya Demographic and Health Survey 2008–09. Nairobi: Kenya National Bureau of Statistics; 2010 (http://dhsprogram.com/pubs/pdf/FR229/FR229.pdf, accessed 21 August 2014). 2. Tanzania Demographic and Health Survey 2010. Dar es Salaam: National Bureau of Statistics Tanzania and ICF Macro; 2011 (http://dhsprogram.com/ pubs/pdf/FR243/FR243[24June2011].pdf, accessed 16 September 2014). 3. World health statistics 2013. Geneva: World Health Organization; 2013 (http://www.who.int/gho/publications/world_health_statistics/2013/en/, accessed 16 September 2014). 4. L’Engle K, Vahdat H, Ndakidemi E, Lasway C, Zan T. Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania. Contraception. 2013;87:251–6. doi:10.1016/j.contraception.2012.07.009. Credits: Icons from The Noun Project designed by: Luis Prado, Photo: © FHI 360 Editing, design and layout: Green Ink (www.greenink.co.uk) WHO/RHR/14.31
1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www.unmillenniumproject.org/goals/gti.htm)
Julien Miclo
© World Health Organization, 2014
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