In sub-Saharan Africa, inadequate numbers of doctors and the relative lack of conventional health care have meant that the continent has maintained extremely high maternal and child mortality rates. Such a persistent and important problem naturally draws the attention of developers and entrepreneurs – people who want to bring new ways of reaching pregnant women in Africa to market and provide them with the information and access required to have a healthy pregnancy and birth process.
This burgeoning class of developers includes people like Usman Abiola, a user experience designer at African fintech powerhouse Flutterwave Inc. He says that he and others like him are attracted to the health space as it allows them to use their skills to improve people’s quality of life. Since they live in communities affected by poor maternal health, African developers know how important it is for the user to quickly access information and emergency care.
Health tech is mostly about solving problems for undeserved communities
– Usman Abiola
On the back of this kind of enthusiasm, multiple tech solutions targeted at tackling Africa’s maternal and child mortality problems have emerged in recent years, each aiming to help as many women and children as possible. In Ghana, Mobile Midwife, Obaatan Pa, and several others have launched. In Nigeria, the Babymigo app, artificial intelligence-based Ubenwa and a plethora of other apps and web services are helping guide women through pregnancy, delivery, and post-childbirth.
Lack of cut-through
Each African country has its particular apps or services, but they have all suffered similar setbacks. In the main, they haven’t been able to attract the user numbers that would allow them to make a significant impact on health and – crucially – make money at the same time.
In 2015 for instance, there were over 34 million births in Nigeria but none of the apps targeted at women, maternity or childcare has more than 100,000 active users. Most health start-ups in Africa cite attracting sufficient users as their biggest challenge.
Start-ups have two main approaches to this – either they work on directly engaging pregnant women or they attempt to get in touch with doctors, who will go on to recommend their apps or services. Both approaches, however, have their challenges since many patients will prefer to take advice from their doctors instead of an app, while the doctors themselves often don’t believe in products developed by “techies” who haven’t practiced medicine themselves. Doctors can also be reluctant to deviate from their long-trusted standard operating procedures.
The South African example
On 3 May 2011, then-US Secretary of State Hillary Clinton launched Mobile Alliance for Maternal Action (MAMA), a three-year public-private partnership to deliver health information to new and expectant mothers via their mobile phones. Two years later, it launched in South Africa as MAMA SA with several local partners. These included the 25 million subscriber-strong mobile network Vodacom, which offered free access to MAMA SA website, and South Africa’s most popular TV soap opera Generations. But in spite of all this, it could only cumulatively reach about 350,000 users.
In 2014, when MAMA was shut down, the South African Department of Health (DOH) integrated MAMA SA and turned it into its own mHealth initiative. The program was rebranded as MomConnect, a huge turning point for the implementation of tech in maternal health in South Africa.
MAMA SA’s Country Program Manager and Head of Business Development for Praekelt.org (previously known as Praekelt Foundation) Marcha Bekker says the involvement of the DOH made it possible to quickly achieve the set goals for the mHealth initiative. By mid-January 2018, the service had registered more than 1.72 million pregnant women, which is about 63% of the potential target audience and means that 100% coverage is a realistic goal. It is also available in about 96% of clinics in South Africa.
“MomConnect is now available in over 4,000 public health facilities, whereas for MAMA we couldn’t offer the service on a national scale due to funding constrictions and a lack of buy-in from the DOH,” Bekker says.
What the MAMA-MomConnect experience reveals is that government is the missing link for any innovation aiming at improving maternal and child health in Africa.
Government involvement is critical
– Marcha Bekker
This lesson appears to already be sinking in for several other African countries. In Kenya for instance, the African Population and Health Research Center (APHRC) has piloted a similar public-private initiative, which was also able to include clinicians and volunteers.
Exporting the model
Riding on the coattails of South Africa’s success with MomConnect, replica programs are already underway using different brand names and localized content in Nigeria and Uganda. Each one, though, has its own peculiar problems such as choosing the right local partner, data hosting, content localization, understanding the best approach to reach pregnant women and dealing with political issues.
Branded as HelloMama in Nigeria, the product has only registered about 25,000 users in two Nigerian districts even as plans are underway to add two additional districts.
“We are yet to have direct relationship with the current Nigerian government and we discovered that due to the literacy level of many of the users, the voice-based service could be our major approach in this country,” Bekker says.
As African maternal and child health innovators develop their solutions and set out their rollout plans, they are coming to terms with the fact that they need to obtain the support and assistance of government.
What needs to happen next is for digital health developers to not just focus on the central federal government, but also approach states, local governments and district leaders that often have independent healthcare systems to integrate innovative solutions into their maternal care processes.
Since most causes of maternal and child deaths are preventable, lowering the mortality rates in sub-Saharan Africa is strongly dependent on how pregnant women and mothers can be informed and empowered on prevention measures and connecting them to emergency care. With digital health tech quickly filling this gap, there is a real sense across the continent that things will improve if the government and the private sector can find more ways to work together and create lasting change.