HealthEnabled is part of the task team supporting the roll out of the National Department of Health’s MomConnect programme, a national government initiative seeking to register all pregnant women and provide them with stage-based messages about pregnancy, birth and care of an infant. The programme is available through all government clinics and aims to reach all of the approximately 1.2 million pregnant women in South Africa each year. Pregnant women are registered by health care workers on mobile phones (using USSD) and then receive SMS messages for the remainder of their pregnancy and for the first year of the child’s life. 

In the first year, MomConnect has registered over 500 000 women - that's over 1 registration every minute! Details of this amazing achievement are available in the HealthEnabled commissioned MomConnect case study.

HealthEnabled is leading the initiative to extend MomConnect to have a greater focus on Elimination of Mother to Child Transmission of HIV (EMTCT). Some aspects of this include further EMTCT specific messaging, extending the MomConnect registration to allow high risk mothers to be identified and followed up, and linking the MomConnect system to care.

Background

MomConnect is a National Department of Health initiative to provide information to pregnant women and new mothers and create greater accountability in the public health sector.

The initiative was launched in 2014 in the context of an ongoing maternal and child health crisis, where approximately 45/1000 children are dying before the age of 5 and 140/1000 women are dying during pregnancy and childbirth in SA. This is substantially higher than the Millennium Development Goal targets, and double the average for developing countries.

Although some of these deaths are still as a result of HIV and AIDS, the enormous ARV program in South Africa has started to turn the tide on child and maternal deaths. However, far too many children and women are still dying of preventable causes during pregnancy, childbirth and the first five years of life. Causes include hypertension and obstetric hemorrhage amongst women and diarrhea, measles and pneumonia amongst children. Many of these deaths could be prevented by improving maternal attendance at antenatal clinics, and sharing information about symptoms and treatment of diarrhea and other common ailments.

While maternal and child health in South Africa is in dire straits, almost all mothers in the country, including those in rural areas, have household access to a cellphone (even if they do not own their own). There is thus an enormous opportunity to reach pregnant women and new mothers with informative messages, and directions on attending antenatal clinics.

Following, the success of the MAMA initiative in Bangladesh and South Africa, the Department of Health initiated MomConnect. This massive initiative seeks to reach the million pregnant women in South Africa who use the public sector.

The Team

This initiative has included involvement from a wide-range of stakeholders including the National Department of Health, the 9 Provincial Departments of Health, the Praekelt Foundation WHRI, HISP SA, Cell-Life, UNICEF, VP systems, Jembi Health Systems, mHealth Alliance and HealthEnabled, UN Foundation, Baby Center, USAID and Johnson & Johnson.

Peter Benjamin from HealthEnabled is part of the MomConnect Task Team and has provided expert advice and support for the project.

The Initiative

MomConnect integrates the public health patient record systems and a messaging alert system and also incorporates a feedback component.

Registration: Whenever healthcare workers encounter a pregnant woman, they assist her to register on the system. The registration is done on a mobile phone through USSD and is free to the user. Registration captures the expected delivery date of the baby, as well as the mother’s details, health facility details and language preferences.

Messaging: Once registered, pregnant women receive regular stage-appropriate messages to support them through pregnancy, birth and the first year of their child’s life. Messages are received via SMS at no cost to the mother, in the language of her choice. Messages include informational messages that cover a diverse range of topics including pregnancy milestones, nutrition information, and HIV and PMTCT awareness. Clinical messages are also received that remind the mother when to attend antenatal check-ups, take her baby for immunizations etc. Finally, appointment reminders alert the mother to imminent or missed appointments.

Feedback: The compliments and complaints line allows citizens to contact the Department of Health regarding their treatment at public health facilities. The registration information for the pregnant woman links her feedback to the facility where she is receiving care, allowing the Department to link compliments and complaints back to specific facilities and staff.

The national roll-out of MomConnect officially launched on 21 August 2014. By the end of the first year of operation, the programme had reached over 500 000 women, over 33 000 nurses had been trained on how to use the system and more than 94% of public health facilities nationally were actively registering pregnant women.

Conclusion

One of very few mHealth projects to seek to reach over a million patients, MomConnect has the potential to have a massive impact. The enrolment of all pregnant women in the public health system in the MomConnect programme, has enormous potential to improve the health and wellbeing of mothers and their babies.