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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! 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: 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 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.



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Photo of Anne-Laure Fayard

Thanks Maurizio for this rich and thought provoking inspiration, which highlights key issues to keep in mind as we think of developing ideas in the next phase of this challenge.

You noted a key structural challenge - lack of resources at the health facilities, or no health facility at all - but in fact I can see several others to which one should add the sociocultural challenges.

Other structural challenges: access to phone, batteries, for your SMS program but also corner store or TV (as suggested in another post). By the way I like the pack of chips idea and it reminded me Meena's edible branding post:

I think the sociocultural challenges are as important, maybe more important as they might be harder to address: fear of going to the facilities because of husband and family pressure, traditions of being at home to give birth, not saying that you are pregnant as long as you can, etc.

These issues reminded me several points made by a friend I interviewed in another challenge on the importance to understand the local context of the community and to engage them in the process:

Really useful insights to keep in mind as we get into the ideation phase! Thanks!

Photo of Maurizio Bricola

Dear Anne-Laure, thank you for pointing me to the edible branding article and to your insightful interview with Tanya!
She has indeed a very strong point about motivation, even if it looks like more about extrinsic motivation, in certain context it is a matter of survival not fulfilment (unfortunately enough).
On the structural limitation of SMS based solutions I have posted several comments around (like this one: ) and a very brief summary in my fist post about Baby Blossom, you can see it here:

I like the bottle of soda and bag of chips idea too, we might come out with a fair trade snack box that could be produced by the same low-income communities.
It might even contain a board or card game... may be I need to wait before thinking about solutions ;). Cheers

Photo of Anne-Laure Fayard


glad you found the references useful.

I remember your comment on Toto and I'll check Baby Blossom.

Loving the seedlings of ideas... Looking forward to see them grow as the challenge continues. :-)

Photo of Anne-Laure Fayard

Maurizio, check out this post:
when I read it, it reminded us our conversation on possible ways to communicate ideas.

Photo of Maurizio Bricola

Hi Anne-Laure, thanks a lot for sharing this, and indeed yes that is the idea I wanted to pitch next week... I have a general version of it.. should I shoot a post already? or shall I wait? Cheers

Photo of Anne-Laure Fayard

Hi Maurizio, I don't think you can post until ideation starts but this is soon. make sure to build on this inspiration and also ping me as I'd love to see what you could up with! :-)

Photo of Meena Kadri

A good idea if you've got an idea brewing, is to add Research posts which feed that idea. This way, you can get discussions going which might help evolve your idea which you can post when we open the Ideas phase next week (and continue to evolve it there) And here's some early tips on prototyping idea so you can get planning!

Photo of Maurizio Bricola

Hi Anne-Laure I will surely let you know, since it would be great to collaborate with you. @Meena thanks for the tip, will have a look. Cheers

Photo of Maurizio Bricola

Hi Anne I just posted 2 ideas:

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