So what makes this program so successful? According to the service, the answer lies in the collaboration of a diverse group of partners. “Each partner takes responsibility for its part in the service implementation, ranging from technical assistance to media promotion and training activities in health facilities. It’s a resilient collaboration as we all share the common goal to improve maternal health and reduce infant mortality. Our partners benefit from this participation, as most use the service as a tool to strengthen their own specific safe motherhood activities,” explains Mr. Saulo Mutasingwa, U.S. Government Centers for Disease Control and Prevention (CDC) Foundation Project Manager for the mHealth Tanzania Public-Private Partnership program in Tanzania.
His organization manages the text messaging service in close collaboration with the Ministry of Health and Social Welfare (MoHSW). The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – through the CDC – funded the development of the service and continues to provide financial and technical support for its further development and operation.
The numbers on maternal and infant mortality in Tanzania have improved over the years; the maternal mortality rate has decreased 55% from 1990 – 2013 and the infant mortality rate has decreased 64% in the same period. However, they remain high. At least 21 women die while pregnant or during delivery and over 180 infants pass away, daily. Less than half the pregnant women (43%) in Tanzania attend at least four antenatal visits and if they do they come late in their pregnancy. Early promotion of healthy behaviors during pregnancy is key. The Healthy Pregnancy, Healthy Baby Text Messaging Service (HPHB) is a tool able to reach these women as well as their supporters at any time. Mobile phones provide such an opportunity. Recent studies show that at least 85% of the Tanzanians used a mobile phone within a 7 day span.
According to the company, the HPHB service is free to use for its steadily growing number of subscribers. Its aim is to reach out to no less than 1 million people by the end of 2016 seems within its reach, looking at the popularity of the service. Partnering for sustainability is a necessity. The program management and technical costs are donor funded. Until recently the donors also covered the majority of the text messaging costs. Airtel Tanzania was the first mobile network to ‘zero rate’ the service for text messages to and from Airtel subscribers on a provisional basis for two years. The program’s sustainability was further strengthened mid-2014 when Tigo, Zantel and the Vodacom Foundation implemented a ‘zero rating’ agreement for HPHB messages to and from their respective subscribers. Today all mobile networks support the continuation and expansion plans of the existing service. Some mobile operators intend to support the partnership’s safe motherhood goals further and are taking steps to create innovative supplementary HPHB services, expanding the breadth and reach of HPHB information in 2015.
The service also benefits greatly from a growing number of ‘on-the-ground’ partners. They provide important ‘in-kind’ support. These partners leverage their existing networks and training activities to orient health professionals and community health workers on the content of the healthy pregnancy and early childcare text messages such as midwife Getrude Justin Mushi. During this orientation, trainers show Gertrude and many other health workers how to help pregnant women register for the text messaging service during antenatal visits. Partners that make this facility-based registration possible are Elizabeth Glaser Pediatric AIDS Foundation, Afya Connect for Change, Aga Khan Health Services Tanzania (Joining Hands Initiative), Walter Reed Program–Tanzania Patherfinder/Vodafone Foundation and PharmAccess.
The oriented healthcare workers regard the service as a tool that helps them to proficiently educate women and provide better care. Midwife Gertrude states, “The informative text messages women and men receive make the life of a midwife a lot easier. You see, those women who receive [HPHB] messages early, come to us in time and are well-prepared. They come with this information and ask questions. These mothers also become cooperative and that is so very important for a successful delivery. I find that a lot of women need this kind of information. So, I promote this service to my clients. I think I can register at least 300 women in a year, and I will!”
Gertrude is one of the 1,300 healthcare workers actively registering women during antenatal visits. Others, who do the same, can be found in 35 different Tanzanian districts. Together they have already registered over 14,000 pregnant women. This number will grow as the number of participating healthcare workers continues to grow. Also more community healthcare workers (volunteers working in the villages) will join this effort as the HPHB on-the-ground partners collectively work with over 2,000 community healthcare workers across the country.
However, most of the registrants will continue to ‘self-register’ thanks to the highly effective nationwide Wazazi Nipendeni (Parents Love Me) campaign. Its nationwide multi-media products — such as television, radio and print materials — include the promotion of the free short-code 15001 and the registration keyword ‘mtoto‘ (‘baby‘). It instructs anyone, interested in healthy pregnancy and early childcare information to register and receive the information for free. Pregnant women, women with newborn babies, their supporters or just those seeking general information will then start to receive regular text messages, for free. The Wazazi Nipendeni multi-media campaign is implemented by partner Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. It is funded by PEPFAR and U.S. President’s Malaria Initiative through the U.S. Agency for International Development. This collaboration has proven to be critical in building awareness of the messaging service with registration rates reaching four times their average when there is a full media presence.
Lydia Mwakisambwe (age 35) is 16 weeks pregnant and she registered the moment she realized she was expecting. Lydia learned about the service while listening to a ‘Wazazi Nipendeni’ radio announcement. The pregnant housewife loves her weekly text messages with information on how to stay healthy. The service also reminds her when it is time to go to the clinic where she meets up with midwife Gertrude. Lydia believes that it is important for all pregnant women, mothers who have given birth and their supporters to know about the service. She agrees that the service is not just for first-time parents. Lydia herself has children ages three and six years-old, and she feels the text messages help her keep herself healthy and confident. “Last year I gave birth to a stillborn baby when I was 28 weeks pregnant,” she explains. “I lost a lot of blood during that delivery. I waited for the transfusion for almost 10 hours. I was in danger. Now I am so happy to see that there is a text message to tell your family to register at the blood bank and donate blood. I also learned about the right time to take medication against tapeworms and malaria, which is very good. I always plan to discuss this information with my healthcare worker when I go for a checkup. I like the text messages with good health information. I am learning things I did not know before.”
The mHealth Tanzania Public-Private Partnership, on behalf of the MoHSW and service stakeholders, will continue to connect as well as reach out to new partners in order to rollout the health facility registrations as well as sustain and expand the existing service.