Opportunities and challenges for the world's first national mobile health initiative

Today, to coincide with National Woman’s Month, the South African National Department of Health launch MomConnect - a bold initiative and one of the first national, at scale, mobile health (mHealth) initiatives in the world. 

MomConnect is part of a project that seeks to register all pregnant women in the country for an SMS service that will provide information and advice on pregnancy. It’ll also act as a channel to notify the government about poor service.
While the academic and policy community continues to grapple with the many challenges of implementing mHealth initiatives in low and middle income countries, South Africa has taken the plunge and we commend the National Department of Health on its vision and commitment to address maternal and child mortality.

Potential benefits of MomConnect

There are a number of fantastic reasons to be excited about MomConnect:
  •  It will help South Africa meet the Millennium Development Goals (MDGs) on maternal and child mortality. 
  • It offers a way of improving South Africa’s data systems by recording all pregnancies as early as possible.
  • It helps to promote healthy behavior, help mothers identify risk factors and improve mothers’ knowledge of, and uptake of, available health services.
  • It enables pregnant women and mothers to ask questions and seek clarity on maternal health issues. It offers the opportunity for women to  give feedback on the services that they have received from the clinics.  This addresses supply side challenges, particularly discrepancies in the kinds of services provided by health clinics. Health workers throughout the country have already received some training in relation to MomConnect and this feedback mechanism enhances the demand for and recognition of good performance.  SMS messaging will also be used to enrich health workers’ skills and augment their training.
  • Finally, all women can de-register at the time of their choosing. 

3 important areas that must not be neglected

The rollout of mHealth at national scale will be watched by South Africans and others around the world.  Can mHealth really be used to overcome health system challenges experienced in low and middle income countries?  Will the results from MomConnect finally provide evidence that mHealth initiatives can be successfully scaled up and can meet the health needs of poor and marginalised populations? 

But social science research calls attention to another dimension – how might MomConnect be experienced and used differently to policy makers’ expectations?  We predict three areas where MomConnect implementation may differ from the ideal and where early attention may ameliorate undesirable and unintended consequence: 

Unintended pregnancies
South Africa has a history of population control under the previous apartheid government.  Attempts to redress this have focused on women’s sexual and reproductive health rights and South Africa has very progressive policies on sexual and reproductive health.  Yet implementation is not always easy and this, coupled with strong cultural or religious commitments, may mean that MomConnect is seen as a means of committing women to motherhood.  How will adolescent girls with unintended pregnancies be treated in relation to their attendance at clinics and MomConnect?  Will they be informed of their right to access early safe abortion services and quality contraceptive options or will they be encouraged to register with MomConnect as pregnant women?  What incentives will encourage clinic and health workers to ensure that women receive information about safe abortion or other services appropriate to their needs rather than assuming motherhood is always desirable?

Negative feedback
Research in South Africa has frequently pointed to the structural problems associated with delivering health services to all South Africans, for example lack of infrastructure, equipment and drugs, poor staffing ratios, lack of alternative services etc.  This combined with the very personalized nature of the MomConnect service, may mean that pregnant women and mothers of young children do not use the feedback and complaint services for fear of retaliation or withdrawal of subsequent health services. What reassurance will they have that their complaints are anonymous?   Also, how will information be disaggregated to ensure that health workers who need better management and support are provided with this?

Privacy
There is massive, and well-placed, optimism about the use of mHealth to address health system challenges such as maternal and child mortality.  Nonetheless, feminist and political economy researchers remind us to pay attention to power differentials in access to, and control of, electronic networks.  Extensive debates about gender and ICT technology point to the ways in which technology facilitates surveillance, commercialisation and privatisation.  Private companies are invested in the ‘bottom of the pyramid’ and in accessing women through mobile phones.  The role of the private sector – in public private partnerships on health – requires more interrogation.  Who will have access to the data about which women are pregnant and how will this be used?  What mechanisms will ensure women’s privacy against commercial exploitation? 

South Africa, as a young democracy, has a legacy of pioneering health achievements aimed to redress the imbalances of the past and current challenges. We welcome this initiative and look forward to its success.  



Read more about our work on the Empowerment of Women and Girls in  in urban areas in low-income settings on our Interactions website

Find out more about our case study on the role of technology in sexual and reproductive health policy.