ICT4Health 2015 -Peter delobelle
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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
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Table of Contents
Rationale Aims & objectives Overview & set-up Logical framework Study design Output indicators First year results Discussion Conclusion
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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
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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
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MomConnect : Overview and Set-up
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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
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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)
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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
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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
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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%
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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
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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%
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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
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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
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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
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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
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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
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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