OVATE EVALUATE ALE UP IMPROVE ALTH RESEARCH ALUATE SCALE UP PROVE INNOVATE ALUATE SCALE UP PROVE HEALTH
Facilitating MNCH care seeking among rural women in Malawi – Chipatala Cha Pa Foni services Malawi experiences high rates of maternal and child mortality; 675 maternal deaths per 100 000 live births and 112 deaths per 1000 underfive births (1). Underlying causes include the limited availability of timely and reliable health information for decision-making, as well as poor access to, and use of, health services. Pregnant women and caregivers of young children may delay seeking care or taking appropriate preventative or curative action (2), may not be able to access health facilities (3), or may use health facilities unnecessarily, in an already overburdened health system. Knowing where to go for care and when are key to reducing maternal and child mortality. As part of Concern Worldwide’s Innovations for Maternal, Newborn, and Child Health initiative, VillageReach, Concern Worldwide and the Malawi Ministry of Health (MoH) developed and piloted an innovative solution using mobile phones to improve case management of maternal, newborn and child health (MNCH) and to increase the uptake of home- and facility-based care practices. The innovation – known in the local language as Chipatala Cha Pa Foni (CCPF) or ‘health centre by phone’ – consists of a toll-free hotline offering health information, advice and referrals, as well as automated personalized tips and reminders (T&R) mobile messaging for pregnant women, guardians of young children and women of reproductive age. Since only about one third of the target population has access to a mobile phone in rural Malawi, community-identified village volunteers ensure those without phones can access these services. How Chipatala Cha Pa Foni works The hotline is staffed by individuals trained in MNCH and family planning using the MoH’s Health Surveillance Assistance curriculum. The staff are supervised by a nurse who can assist callers with particularly difficult cases. With technology developed by Baobab Health Trust, hotline staff are guided through point-of-care protocols on a touchscreen to provide health information, advice and referrals to callers. Hotline workers also offer clients the opportunity to enrol in the T&R service where they can access weekly voice or text messages. The touchscreen devices collect information on the call, providing a rich data set that can be used to monitor the intervention and inform the MoH about community health issues. Clients who enrol in the T&R service can sign up to receive recorded voice or text messages directly if they have personal phones, while others can use a community phone to access their message through an interactive voice response system. Messages are tailored to clients’ gestation periods or the child’s age to provide relevant and timely information. All services are free to callers.
Supporting national public health programming The MoH seeks to achieve health for all Malawians by delivering health services and health information to the general public (4). CCPF is designed to provide a range of quality health services
1 PER WEEK
1 YR Clients can opt out at any time, and are automatically opted out once the child turns 1 year old
Knowing where to go for care and when are key to reducing maternal and child mortality
Mother calls hotline service and is given health information and referrals
If the call is complex, a nurse supervisor can help
Mother and child’s health data are recorded
Mother opts to enrol in the Tips & Reminders notification system; receives weekly SMS/voice messages
for women and young children by extending the MoH’s ability to provide health information and advice to the hardest to reach populations. CCPF also generates demand for health services by encouraging early and regular antenatal and postnatal care, facility births, immunizations and early identification of danger signs. In Balaka District, CCPF is working with the district health management team to incorporate MoH staff as hotline workers for long-term sustainability of the intervention. CCPF also facilitates data sharing to collaborate on district-level goals for positive health outcomes. The MoH asked VillageReach to scale CCPF to other districts. Services are now available in four districts.
Health centre catchment areas Balaka District Chiyendausiku Year
Kalembo Year
1
Year
2
1
Year
2
538
301
1008 Mbera Year
910
Kwitanda Year
1
Year
2
1
Year
2
372 Phimbi Year
795
1457 Other
1140
1
Year
2
Year
1
Year
2
Partnerships for support and sustainability Local partnerships have been integral to the success of CCPF. The hotline software was created by local eHealth organization Boabab Health Trust and is designed to work with Malawi’s electronic medical records systems at District Hospitals. Airtel, the Malawi telecom company boasting the highest coverage in the country, provides discounts in telecom costs, hosts the CCPF server, and has committed to a greater discount and corporate sponsorship if the programme can be expanded. The MoH in Balaka has provided three nurse consultants who review randomly selected hotline call recordings on a weekly basis and provide real-time feedback. MoH staff help generate demand for CCPF in the community and participate in supervision of community volunteers. The MoH also provides the space for the hotline and pays the electricity and water bills for the hotline call centre.
Malawi Year
762 Year
504
1171
1287
1 (July 2011–June 2012)
Number of calls in Year 1
2 (July 2012–June 2013) June data not yet available
Number of calls in Year 2
health (mHealth), managed by the mHealth Alliance. VillageReach 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 5.1 Through IWG, VillageReach is receiving specialized assistance from WHO’s Department of Reproductive Health and Research to optimize the scale-up of CCPF while contributing to the mHealth evidence base and best practices on implementation and scale-up. Partners: Malawi Ministry of Health, Airtel, Baobab Health Trust, Concern Worldwide US, Concern Worldwide–Malawi, Support for Service Delivery and Integration/Save the Children For more information please contact: Jessica Crawford, Malawi Country Director (jessica.crawford@villagereach.org) or Zachariah Jezman, Project Manager (zachariah.jezman@villagereach.org) 1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www. unmillenniumproject.org/goals/gti.htm)
IWG catalytic grant for mHealth programme scale-up VillageReach was awarded a grant to scale up the use of CCPF in Malawi by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile
References: 1. Malawi National Statistical Office. Malawi Demographic & Health Survey, 2010. Government of Malawi, 2010 (http://www.measuredhs.com/ publications/publication-FR247-DHS-Final-Reports.cfm). 2. Thorsen V, Sundby J & Malata A. Piecing together the maternal death puzzle through narratives: the three delays model revisited. PLoS ONE, 2012, 7:12. 3. Malawi Ministry of Health. About Ministry of Health. Government of Malawi, no date (http://www.malawi.gov.mw/index.php?option=com_content&vie w=article&id=50&Itemid=22, accessed 13 September 2013). Credits: Icons from The Noun Project designed by: Matt Daigle, Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, Jamie Cowgill and Jim Bolek, Ben Rex Furneaux, Jens Tärning Photo: VillageReach Editing, design and layout: Green Ink (www.greenink.co.uk) WHO/RHR/13.25 © World Health Organization, 2014 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.