Addressing maternal & child health using mHealth: First year of MomConnect monitoring &

evaluation

P Delobelle, T Esterhuizen, L Dudley, A ParsonsA Fernandes, Y Pillay, P Barron

Table of Contents

Rationale Aims & objectives Overview & set-up Logical framework Study design Output indicators First year results Discussion Conclusion

MomConnect : Rationale High rate of avoidable maternal mortality (140 / 100,000

live births) associated with late uptake of antenatal care Barriers include lack of privacy and confidentiality

related to HIV/AIDS counselling and testing, lack of knowledge and information about SRH and rights and problems related to the availability and cost of transport

NDoH strongly committed to achieving MDG 4-5 targets related to decreasing maternal and child mortality

Mobile phone penetration in South Africa stands at 115% Benefits of text messaging include its low cost and

instant transmission

Aim : To contribute to decreased maternal and child mortality in line with MDG 4-5 by using cell phone based SMS technologyObjectives : To register all pregnant women in the public health sector

in South Africa on a national database; To send stage-based health messages to their mobile

phones during pregnancy, childbirth and up to the first year of age;

To provide a platform for feedback and strengthen the demand and accountability of MCH services to improve the access, coverage and quality of care

To improve competency of nurses and midwives delivering MCH services (end of 2015)

MomConnect: Aim & Objectives

MomConnect : Overview and Set-up

Logical framework based on a Theory of Change approach with specific indicators for each component of the framework including input, process, output and outcome indicators with respective sources of verification and underlying assumptions

MomConnect M&E : Logical Framework

MomConnect M&E : Research Method Longitudinal time-series analysis of key indicators

(MNCH dashboard / MomConnect indicators) Nationally representative survey (incl. client

exit interviews, focus group discussions, in-depth interviews)

  Indicator Data Sourcea % client registrations / (target) ANC 1st

visits (previous fin. year)MomConnect /DHIS 2 database

b % client opt-outs from MomConnect and reasons for opting-out

MomConnect /DHIS 2 database

c % client service ratings (response rate) MomConnect /DHIS 2 database

d % client ratings of privacy, staff attitudes, cleanliness and waiting times

MomConnect /DHIS 2 database

e % clients using the help-desk and categories of messages sent

MomConnect /DHIS 2 database (if available)

f % clients logging complaints / compliments

MomConnect /DHIS 2 database (if available)

MomConnect M&E: Output Indicators

Aug-14

Sep-1

4Oct-

14Nov

-14Dec-

14Jan

-15Fe

b-15Mar-

15Apr-

15

May-15

Jun-15

Jul-15

Aug-15

0

10000

20000

30000

40000

50000

60000

RegistrationsSubscriptionsConversionsNu

mbe

rMomConnect: Subscriptions & Registrations

0%

50%

100%

150%

200%

250%

Kwazulu-Na-talGautengWestern CapeFree StateNorthern CapeLimpopoMpumalangaEastern Cape

Target Registration Achievement by Province

Mpumala

nga

North W

est

Limpo

po

Kwazu

lu-Nata

l

Free S

tate

Gauten

g

Northe

rn Cap

e

Easte

rn Cap

e

Western

Cape

0%20%40%60%80%

100%

MomConnect Registrations by Gestational Age

Aug-14

Sep-1

4Oct-

14

Nov-14

Dec-14

Jan-15

Feb-1

5

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

0102030405060708090

100 Reg < 20 weeks Reg 20 - 34 weeksReg ≥ 35 weeks Reg / ANC 1st visits (prev fyear)ANC 1st visit < 20wks rate

Perc

enta

ge

MomConnect Registrations by Age Group

0%

5%

10%

15%

20%

25%

30%

35%

40% < 20 years 20y - 24y 25y - 29y ≥ 30 years

Mpumala

nga

Easte

rn Cap

e

KwaZ

ulu-Nata

l

Limpo

po

Northe

rn Cap

e

Free S

tate

North W

est

Western

Cape

Gauten

g

South

Africa

0%5%

10%15%20%25%30%35%40%

MomConnect: Opt-outs by Reg Category

Aug-14

Sep-1

4Oct-

14

Nov-14

Dec-14

Jan-15

Feb-1

5

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

0

2

4

6

8

10

12

14 Registration CHW subscription Public subscription

Perc

enta

ge

MomConnect: Opt-out Rates by Reason

Aug-14

Sep-1

4Oct-

14

Nov-14

Dec-14

Jan-15

Feb-1

5

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

0102030405060708090

100

Baby lossMiscarriageNot useful Other StillbornUnkown

Perc

enta

ge

MomConnect: Opt-out rates by Province

Aug-14

Sep-1

4Oct-

14

Nov-14

Dec-14

Jan-15

Feb-1

5

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

02468

101214161820

Kwazulu-NatalGautengWestern CapeFree StateNorthern CapeLimpopoMpumalangaEastern CapeNorth West

Perc

enta

ge

MomConnect: Satisfaction with Services

Aug-14

Sep-1

4Oct-

14

Nov-14

Dec-14

Jan-15

Feb-1

5

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

0102030405060708090

100

CleanlinessFriendlinessPrivacyWaiting times (felt)Waiting times (length) Regs submit service ratings

Perc

enta

ge

MomConnect M&E: DiscussionData quality issues Data script errors / missing values (e.g. divergence between

early booking and registration rates) Data processing issues and time lag between integration and

reportingIssues to be explored Significant variation in target registration achievement

between Provinces and (sub)-Districts Reasons for low conversion rate (<10%) among subscriptions Opt-out among registered clients for unknown / other reasons Relatively low service ratings coverage

Uptake of MomConnect as measured by target registration achievement varies widely between Provinces and Districts

Conversion rates of MomConnect subscriptions remain low Registrations before 20 weeks of gestation approximate the

rate of first ANC visits Registrations among women younger than 20 years

increased slightly overall and was higher in rural districts in EC / KZN

Opt-out among registered clients showed variation over time albeit at a low rate

Service ratings are highest for satisfaction with friendliness and privacy and lowest for satisfaction with waiting times overall

MomConnect M&E: Conclusion