“These text messages makes Tanzanian women come early for checkups and makes our work easier,” says midwife Getrude Justin Mushi. Getrude is one of the 1,500 Tanzanian health care workers who registers pregnant women and their supporters to the Healthy Pregnancy, Healthy Baby Text Messaging Service service. In November 2013, over 500,000 Tanzanian men and women will have registered and received more than 40 million maternal health messages on their phone for free.
During the Open Government Partnership Conference 2013 in London, President Kikwete presented the Health Pregnancy Health Baby (HPHB) service as an example of how the Ministry of Health and Social Welfare (MoHSW) in Tanzania communicates valuable information to its citizens. The service has also been recognized internationally as one of the 5 best 2014 mobile health programs worldwide by the 2014 GSMA Global Mobile Awards team.
The unique partnership construction of this program is what has led to the success of the HPHB service. “The service is truly an example of the coordinated implementation of expertise sharing and pooling of resources,” explains Janita Ferentinos, CDC Foundation Partnership Director for the mHealth Tanzania Public Private Partnership. The Partnership manages the text messaging service in close collaboration with the MoHSW. As an independent not-for-profit organization, the CDC Foundation assists the Partnership with attracting and maintaining partners to support the service. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the US Government Centers for Disease Control and Prevention (CDC), funded the development of the service and provides financial and technical support for its operations. Ferentinos highlights, “It is important to understand that the Ministry of Health and Social Welfare Reproductive Child Health Services section is the overall leader of the service. The service is effectively implemented and is continuously expanding its partnerships with on-the-ground communication with technical partners, as well as partnering mobile operators.”
Partnering for Sustainability
The HPHB Service is free to use for the almost 500,000 subscribers. However, the program management, aggregator, and operator messaging costs continue to be partly paid for by the CDC. 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. In 2014, Tigo and Zantel began zero rating the service, while Vodacom Foundation is now paying for Vodacom subscriber messages. All mobile networks are now supporting the expansion of the existing service and creating supplementary services for the future.
The service also benefits from in-kind support from a growing number of ‘on-the-ground’ partners who work at health facilities and community organizations. 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. They also show health workers how they can help pregnant women register for the services during ANC visits. Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Afya Connect for Change, and Aga Khan Health Services Tanzania – Joining Hands Initiative (funded by the Government of Canada- Department of Foreign Affairs, Trade and Development) are just some of the partners that make this facility based registration possible. Healthcare workers regard the service as a tool that helps them educate women and provide better care. Midwife Gertrude explains, “The text messages women and men receive makes the life of a midwife a lot easier. You see, those women who receive (HPHB) messages early, [are] well prepared and cooperative by the time they need to deliver. This cooperation between mother and nurse is so important for a successful delivery. I think I can register at least 300 women in a year and I will. I so like the service!”
Results and Appreciation
To date, 500,000 Tanzanian men and women have registered for the service. Over 1,300 health workers in 1,000 health facilities, who are working in 10 regions and 35 districts, are actively registering mothers and supporters during ANC visits. These efforts have resulted in the registration of over 14,000 pregnant women and supporters. The HPHB network of community partners collectively support more than 2,000 of the total estimated 7,000 facilities and they work with over 2,000 community healthcare workers across the country. Although health professionals and community health workers have become active advocates for registering for the service, the majority of the registrants continue to ‘self-register’ thanks to the active nation-wide Wazazi Nipendeni multi-media campaign that promotes the service.
Lydia Mwakisambwe, age 35, was 16 weeks pregnant when she registered for the service. Lydia learned about the service while listening to a Wazazi Nipendeni radio announcement, which is part of a national multi-media campaign implemented by Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. The campaign is funded by PEPFAR, through the United States Agency for International Development (USAID), and the U.S. President’s Malaria Initiative. This collaboration has proven to be critical in building awareness as registration rates have reached four times their average when there is a full media presence.
Lydia loves receiving her weekly messages with information on how to stay healthy. She agrees that it is important for all pregnant women, mothers, and their supporters to know about the service. Although Lydia already has two children, she feels the text messages will help her keep herself and her baby healthy. It is important for her to feel supported as she shares, “Last year I gave birth to a stillborn baby when I was 28 weeks pregnant. I lost a lot of blood during that delivery and stayed without blood for almost 10 hours. I was in danger. Now that I am receiving text messages every week with information I am learning things I did not know before. There is even a 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 was very good. I discuss these messages with my healthcare worker all the time.”