MobileActive.org

This paper examines the current use of ICTs to advance family planning, reproductive health, and other health programs, and identifies the enabling conditions for further scale-up. The examples of ICTs at work are structured around specific elements of success that were captured in the 2008 USAID-funded report, Elements of Success in Family Planning Programming: (1) building a high-performing, welltrained staff; (2) providing strong leadership; (3) communicating effectively; (4) basing decisions on evidence; and (5) assuring contraceptive security with a strong logistics system.

Examples of ICT are being applied to support or advance family planning and reproductive health programs in many African countries. Examples from Ethiopia, Kenya, Rwanda, Senegal, Tanzania, Malawi and Uganda are examined here, complemented by a review of efforts in Bangladesh and India as well as several virtual global programs. The paper also takes a look at how digital platforms and mobile technology are being integrated into the overall health systems strengthening approach. The collective review of these programs illustrates the myriad ways in which technology is adapted to respond to local needs as well as to support national health programs and global health initiatives.

USAID‘s Strengthening Health Outcomes through the Private Sector (SHOPS) project seeks to increase the role of the private sector in the sustainable provision and use of quality family planning/reproductive health and other health products and services. One of the areas of technical focus of the SHOPS project is to identify, deploy, and scale up promising uses of mobile technologies to improve health outcomes. Many developing countries have a severe shortage of health providers, and many of the providers who are working have only limited access to up-to-date clinical protocols, or face-to-face trainings. Mobile phones offer an innovative channel through which to provide cost-effective approaches for clinical training and support for improving quality of care.

SHOPS‘ partners Abt Associates, Jhpiego, and Marie Stopes International (MSI), collaborated in a mobile learning and performance support pilot called Mobiles for Quality Improvement (m4QI) conducted in Uganda during the period September 2010–August 2011. The goal of m4QI was to demonstrate the potential for positive behavioral change in service delivery by reinforcing face-to-face induction training lessons provided to Marie Stopes staff. Research supports the theory that spaced reinforcement of training combined with testing can significantly improve long-term knowledge retention and facilitate behavioral change.

The objectives of m4QI were to develop and test a technology-supported approach to performance improvement including processes for identifying performance gaps in adherence to clinical protocols, a platform to manage and automate the delivery and receipt of text message reminders and quizzes to address the gaps, and production of actionable data to improve effectiveness of supportive supervision and follow-up. To support scalability and replicability, the pilot platform was designed for users of low-end phones, and those without Internet access.

Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.

Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.

Results of proof-of-concept testing for an mHealth solution for reproductive health in Uttar Pradesh, India. The text messaging tool based on FrontlineSMS, is a family planning service that relies on the Standard Day Method system of birth control. This method of birth control depends on the woman's fertility cycles to avoid pregnancy. Women can text the date of their menses and user receives their fertility status. Additionally, women can receive information about other family planning options, and support. Presented are observations on the appropriatenss of the technology from focus group discussions. The authors share the input given by target users in the product and service design. Women tested the solution to give insight on feasibility and design.