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What is this about? Information, resources, actions? Who? and where?

Is it about children? Is it about parents? Is it about the community? Is it about the village? Is it about the suburb? Where are we? in low income communities in Nairobi? or in low income communities in Loita Hills? That makes a big difference! When setting up several mobile health interventions in Malawi geared towards increasing the number of anti natal visits to improve maternal and infant health, we thought, easy, let's tap into mobile phones available in the community and send SMS reminders to pregnant women to motivate them to attend ANC visits. Sure.. we immediately have been confronted with a structural issue: lack of resources at the health facilities (or no health facilities at all.. nothing) in the rural areas.

Photo of Maurizio Bricola
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Easier thought than done!
..so well a part for having to reserve budget for improving the quality of the health facilities with some beds and basic mathernal health equipment (or built some little shelter for mobile ANCs) first we had to go and find these women and get their phones numbers (and No we did not want to run into the hassle of getting a short code, set up reverse billing with the 2 main telcos, print lots of posters, t-shirt and invest a lot of money in marketing a campaign with the hope our remote target group would have opted in sending JOIN to 55777 ;))
We decided to work with Community Health Workers, build their skills and enanche their capacity and work with the use of a mobile application. Hence we trained them in using a mobile application for registering and follow up on pregnant women and equipped them with phones and solar chargers.

You know what, the solar chargers, great idea.. sure till when you realize that to charge a phone in the middle of no nowhere with a solar charger you need to be stuck surveilling the device for at least 4 hours (maybe even under the sun...) otherwise it might get stolen. We got rid of the solar chargers and set up little charging station at the village Chief premises.

Since then we have been able to register about 3000 infants and about 1500 pregnancies spending a budget of about 250000 euro in 3 years of which a big chunck went in operational costs (salaries, fuel, investments, training). Still we face main challenges:
  • Generally women, due to community pressure (even if might be only a perception) won't tell they are pregnant before it is clearly visibile failing to attend the first of the 4 ANC visits in most of the cases, no matter if visited by a community health worker or reached by an SMS.
  • Community Health Workers are individuals, limited in space and time, even with the best intentions they are not able to cope with the necessary level of care and number of patients.
  • As previously mentioned, in the best case women start to attend ANC visits they might receive insufficient attention (a almost no time for counselling becouse of lack of time due to the high number of patients, see also: http://www.ajol.info/index.php/ajrh/article/view/7900/13887 page 4) at the health facilities, due to lack of nurses, midwifes and clinical officers.
  • Pregnant women do not decide alone. A part from the husband, their mothers, mothers in law and grandmothers have a huge influence in their decisions (see again http://www.ajol.info/index.php/ajrh/article/view/7900/13887 page 7 a and c), main fears for not going to the health facilities are: Father (or Family) won't recognize the baby, fear of cesarian due to misbiliefs, trusitng the love and care of grandma at home.
  • Lack of transportation and time costs. In fact we also had to had bicicle ambulances to our budget.
How might we empower women in low income rural areas to be able to actively take informed decision about their pregnancies and the care of their chldren in the first five years?

And pity enough no corner stores, at least not big enought to host any event and for sure without TV, may be a little radio that goes on batteries when there is money for buying them. Still indeed a nice idea! It might not be the corner shop, it might be the bottle of soda (or the bag of chips, or the piece of soap) telling a different short story every time which might prompt the needed actions for change.

Thanks!
 

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Photo of G. Quinque

Thank you, Maurizio. Your analysis is quite insightful and comprehensive. You're right that not only healthcare facilities, but also conceptual changes are needed in low-income communities. People there may refuse to talk about pregnancy publicly, or they may prefer taking care of infants in the traditional way in their culture. All of these perspectives are challenges when we try to encourage them to visit ANC.

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