The power of health in every mama’s hand: using mobile technology to educate and empower low-income mothers and families

MAMA is a public-private partnership between USAID, Johnson & Johnson, United Nations Foundation, mHealth Alliance and BabyCenter that supports programs to deliver vital health information through mobile phones to mothers and families in low-resource settings.

MAMA messages currently reach over one million users.

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The Mobile Alliance for Maternal Action (MAMA)

1) Research on behavior change theory

• BJ Fogg and Prochaska

2) Topic maps and message creation

• Identifying topics, health interventions, barriers & motivators

• Timing by age and stage

• Alignment with WHO & UNICEF guidelines

3) Review by experts

• Health Content Advisory Council

4) Developing specific message sets

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Message development

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Evidence-based messages inform and educate

Bangladesh

• Aponjon was launched in December 2012 by social enterprise Dnet and the MoHFW of Bangladesh

• Currently reaching over 400,000 subscribers

• Partnerships with 6 MNOs, 3 corporate partners and the government

• Delivered twice weekly: SMS or a 60-second “mini-skit” voice message

• Revenue via user fees, ads, corporate partnerships and a ‘Sponsor-a-Ma’ campaign

• Aponjon is free to the poorest 20% of subscribers

South Africa

• Launched in May 2013 • Currently reaching almost 200,000 • 4 different channels • Free SMS though six inner-city clinics in Hillbrow, Johannesburg. Women

can opt in for additional information specifically designed for HIV-positive mothers

• A dynamic community portal: askmama.mobi, free of charge to all

Vodacom subscribers in SA • USSD-based interactive quiz service • Portal on MXit - a popular mobile social network

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MAMA Reaches Vulnerable Mothers

Enrollment data from MAMA Bangladesh: • 45% of subscribers had received

a primary school education or less

• 26% of subscribers had a

combined monthly household income of $51 USD

In South Africa, recent poll results on the askmama.mobi site:

• 77% of users are unemployed

• 52% receive a government assistance grant

• 47% live in a household with a combined monthly income of $180 USD or less

• 44% live in a village or rural area

MAMA Subscribers Trust and Value the Service

A 2012 MAMA Bangladesh phone survey revealed:

88% of respondents rated the service Excellent to Very Good Over 90% of the respondents felt the messages were meeting their needs for information during and after pregnancy. 95% said they will recommend MAMA/Aponjon to others. High levels of trust in the messages (on a Likert scale of 1 to 5, with 5 being the highest level of trust): 28% indicated a 5 and 63% indicated a 4

Improved Knowledge, Attitudes and Behaviors: Bangladesh Substantially higher percentages of MAMA subscribers in Bangladesh reported adopting recommended behaviors in a 2012 Phone Survey versus national averages in the 2011 Bangladesh Demographic and Health Survey.

Aponjon Subscriber

National Average BDHS 2011

Attended 4 ANC visits

63% 32%

Had a facility-based birth

45% 29%

Exclusively breastfed

83% 64%

Improved Knowledge, Attitudes and Behaviors: Bangladesh The 2012 Phone Survey also revealed that nearly three-quarters of both women (72%) and gatekeeper (73%) respondents reported that they had the ability to take action to improve the health of the mother or baby as a result of the MAMA messages.

Improved Knowledge, Attitudes and Behaviors: South Africa

Qualitative feedback during MAMA South Africa’s user-testing revealed that most users felt the service gave them new knowledge on how to care for their child, specifically mentioned were when to introduce solid foods, how to monitor developmental milestones, never to leave the child unattended on a bed or couch, and when to vaccinate.

Current Research

The International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) is currently conducting a mixed methods outcome evaluation of MAMA Bangladesh to examine the effects of Aponjon on outcome-level indicators (knowledge, attitude, behavior, service uptake).

Current Research

MAMA South Africa team, is about to commence a scientific randomized-controlled study to examine effects of MAMA South Africa’s SMS service on women living with HIV, particularly around prevention of mother-to-child transmission of HIV.

Each country program has shared goals and similar challenges, but unique solutions

The MAMA Community

MAMA Country programs generate lessons and practical experience that inform the design of tools and resources to help other organizations accelerate the launch of their own systems – creating a multiplier effect. These like-minded organizations, which make up the MAMA Community, now number close to 300, and span almost 70 countries. Tool and resources include:

• Free, adaptable mobile messages • Online learning sessions • Interactive forums • Spotlights

MAMA Community Member: Chipatala Cha Pa Foni External evaluation of Chipatala Cha Pa Foni in Malawi with a sample of 6,479 found increased uptake of these practices among the intervention group:

• Increase in use of a bed-net during pregnancy and for children (25 percentage points higher than control group)

• Attending four ANC visits, and starting ANC during the first trimester • Giving birth in a facility • Receiving a postnatal check-up within two days of birth • Breastfeeding within one hour of birth, and exclusive breast-feeding

through six months of age • Use of oral rehydration salts (ORS) to treat diarrhea

Best practices

Case studies of programs using the MAMA messages illustrate emerging best practices.

• Cross-sectoral partnership • Close government engagement • Community engagement • Highly localized content • Driving demand for life-saving commodities

Emerging best practices:

Cross-sectoral partnership & government engagement Wazazi Nipendeni, Tanzania

• “Each partner is valuable with its unique skills and resources to

develop, operate, promote and maintain the service”

• The Ministry of Health and Social Welfare (MoHSW) Reproductive Child Health Services (RCHS)

Community Engagement

Wazazi Nipendeni, Tanzania • Collaboration with community health workers and local civil

service organizations

Liga Inan, Timor Leste • Socialization activities

Highly localized content

Liga Inan, Timor Leste • Sitting fire Wazazi Nipendeni, Tanzania • Lost in translation: English to Swahili • Comparing fetus to fruit MAMI Colombia • Catholic, conservative society

Driving demand for services

Chipatala Cha Pa Foni, Malawi • Launch of pneumococcal vaccine Living Goods, Uganda • Example text: “Dizziness, headaches, tiredness are all symptoms of low iron. Take a daily iron supplement. Need iron? Call Living Goods (Nakamya Rebecca 0774862596).”

Hierarchy of Needs

Tier 3: Supporting Elements Best Practices

M&E

Tier 2: Important Elements Landscape Assessment

Content Localization Effective local distribution/customer recruitment

Clear operational model Long term financial plan

Tier 1: Critical Elements: Content

Technology platform Telecom carrier agreement

Government Approval Funding

Where MAMA is headed

5 million by the end of 2015

India and Nigeria

• India and Nigeria alone account for 33% of maternal deaths and 37% of under 5 deaths globally.

• In India, for every 100 people only 35 have access to a toilet or latrine, but 69 have a mobile subscriptions.

• For every 100 people in Nigeria, only 50 access to have electricity, just 30 have access to a toilet or latrine, but 68 have mobile subscriptions

INQUIRIES: info@mobilemamaalliance.org