Connecting women and children to health care services
The first 1,000 days of life between a woman’s first day of pregnancy and her child’s second birthday offer a unique window of opportunity to build healthier generations and more prosperous societies.
However, in many countries, including Uganda, there are challenges to ensuring that this critical period lays a strong foundation for health and wealth. Child and maternal mortality rates remain high in Uganda – 90 under-five child deaths per 1,000 live births and 438 maternal deaths per 100,000 live births. Among children under 5, more than a third are stunted and under-nutrition contributes to four in 10 deaths.
These child deaths are caused by preventable diseases such as pneumonia, malaria and diarrhoea, which often manifest as a result of chronic and systemic problems in health service delivery and use.
A particular challenge in Uganda is inconsistent service coverage along the continuum of care, and low uptake of reproductive and child health services in public health facilities.
One key way to leapfrog these hurdles is through the use of digital technology. Basic mobile services and broadband access are rapidly increasing in Uganda. Sixty-five per cent of Ugandans own a mobile phone and network coverage is one of the best in Africa. Therefore, there is a unique opportunity to use digital technologies to improve health service delivery and ultimately save lives.
What is FamilyConnect?
FamilyConnect sends targeted life cycle-based messages via SMS to pregnant women, new mothers, heads of households, including male partners, and caregivers with information on what they can do to keep themselves and their babies in good health and stimulate optimal development during the critical first 1,000 days of life. The system also strengthens the referral chain by sending SMS follow-up reminders to community health workers, who are a community’s initial point of contact for health services. They record whether key interventions have taken place and identify which households need additional follow-up.
FamilyConnect was designed on the basis of the RMNCAH model of ‘three delays’, which recognizes the different barriers that care seekers – particularly pregnant mothers – face in receiving timely and effective health care. These are (1) the delay in the decision to seek health care, (2) the delay in reaching health care and (3) the delay in receiving adequate health care.
FamilyConnect is part of the Ministry of Health’s Community Health ‘Suite of Tools’ and was developed in collaboration with UNICEF to support the priorities of Uganda’s Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan.
- The FamilyConnect programme in Uganda is based on MomConnect, a South African government initiative. As a result of a learning exchange between the Ugandan Ministry of Health and the National Department of Health in South Africa in May 2015, the Ministry of Health formally requested UNICEF assistance to transfer and localize MomConnect to Uganda.
- FamilyConnect is currently being piloted in two districts in Uganda. During the first user experience testing in Kabale District in July 2016, more than 300 community health workers were registered and 70 pregnant mothers enrolled.
- The Ministry of Health established a community health steering committee to ensure government leadership and coordination of FamilyConnect and other related activities.
- Along with the Ministry of Health and UNICEF, a wide range of organizations have officially partnered to support this initiative, including the United Nations Population Fund, the United States Agency for International Development, Pathfinder, Johnson & Johnson, Pfizer, the Elma Foundation, the Praekelt Foundation, GSMA and Health Enabled.
- The national health workforce management information (iHRIS) digital registry is being expanded to include community health workers. Together with tracking uptake of key interventions at the household level, the expanded registry will facilitate planned performance-based financing schemes.
We have now gone past the time of questioning the value of mobile technology innovations and must ask ourselves how these systems can best be used to strengthen results for children, especially those who are hardest to reach.
By 2018, more than 150,000 pregnant women and heads of households in nine districts will be enrolled in FamilyConnect, with a strategy in place to reach national scale by 2020.
Connecting women and children to health care
Pregnancy registry: Pregnant women are registered in a national client registry and grouped by household. FamilyConnect leverages the national ID system to track individuals across multiple systems and points-of-care.
Life cycle-based messages: Based on the stage in a woman’s pregnancy, she and the head of household will receive targeted SMS messages, relevant to that stage of pregnancy, which will be available in at least six different local languages.
Service rating: To improve service provider accountability, mothers will rate the services they receive at their health centre and from their community health worker. These satisfaction ratings will be used to identify bottlenecks affecting the use of health care services.
Help desk: Mothers, heads of households and community health workers can reply to any of the messages they receive with questions, compliments or complaints. A central Ministry of Health helpdesk will then reply, using pre-written and approved responses. All compliments and complaints are then forwarded to district focal people who have two weeks to respond.
System-wide integration: FamilyConnect will be integrated with other Ministry of Health-approved tools and will feed into a reproductive, maternal, newborn, child and adolescent health (RMNCAH) scorecard (a decentralized monitoring system).