As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
The information below appeared in the original case study.
The Global K4Health project led by Johns Hopkins University Center for Communication Programs (JHU-CCP)
Management Sciences for Health (MSH)
Madeleine Short Fabic
K4Health Malawi Manager
Health Care Provider
Services and Applications
This case study was originally published in the mHealth Compendium Volume 1, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study appear in the final section of this case study.
Providing health workers with access to current health information can help to improve the quality of health services. However, health managers and providers working at all levels to provide HIV and family planning services frequently lack up-to-date and relevant information. Existing information is often scattered, too technical, and difficult to access. Health workers tend to rely on outdated information, even when new guidelines or protocols have been introduced at higher levels of the health system.
The Knowledge for Health (K4Health) Malawi Pilot Project was funded by USAID and implemented by Management Sciences for Health (MSH) as part of the Global K4Health project led by Johns Hopkins University Center for Communication Programs in partnership with MSH and FHI 360.
The K4Health Malawi Pilot Project was designed in 2009 as a small Mobile Learning project, designed to improve access to and use of information by health care providers at the district all level of the health system in Malawi. The project aimed to show that providing health workers with access to current, relevant family planning, reproductive health, and HIV/AIDS information improves the quality of health services. The project worked with health managers and service providers at the national, district and community levels and ended in December 2011.
In order to provide up-to-date information in a more efficient manner, a system was developed at the district level to provide information to community-based health workers.
This distance learning program included four key components.
In collaboration with Frontline SMS, an SMS-based mobile telephone network was established that allows community health workers to send text messages between cell phones and other devices. Through the mobile network, the program alerts these health workers to new resources, training opportunities, changes in protocols, and other relevant knowledge exchange and public health activities in their district.
Since the launch of the project in May 2010, K4Health project has achieved the following:
Most importantly, a final project evaluation found that the pilot project demonstrated immediate benefits to front line health workers in the areas of increased knowledge, greater self-confidence, cost and time savings, and widened service coverage.
In the context of sustainability, strengthening the Malawian health system at district level is an important investment of resources to provide timely and informed services to clients. The K4Health project provides a good platform for data collection and information dissemination via text messages in low income countries.
In addition to the Lot Quality Assurance Sampling (LQAS) surveys with community health workers (CHW), the project also engaged in a Net-Map evaluation activity. Net-Map is a process adapted from social-network analysis to understand how individuals’ actions, and the impact of those actions, are determined by the social-network structure in which they are embedded. The Net-Map process demonstrated the effects of the mobile phone intervention, revealing that knowledge exchange was extremely hierarchical; high-level actors had high influence and information flowed from the top to the bottom. The Net-Map workshops and focus group discussions revealed the direct effect of the mobile phone intervention on health services, including CHWs’ ability to get timely assistance for clients and a reduction in stock shortages as a result of timely reporting. In addition, CHWs reported increased self-confidence and increased trust with their communities.
Original Case Study
K4Health Malawi Project Overview; http://www.k4health.org/malawi#toolkit
mHealth in Malawi: Improving Access to Family Planning and Reproductive Health Information – Thozani Bema K4Health Network Coordinator K4Health Malawi Project Overview; http://www.k4health.org/sites/default/files/Malawi%20Fact%20Sheet_1-pager.pdf
Nancy Vollmer Lemay, Tara Sullivan, Brian Jumbe & Cary Peabody Perry (2012): Reaching Remote Health Workers in Malawi: Baseline Assessment of a Pilot mHealth Intervention, Journal of Health Communication: International Perspectives, 17:sup1, 105-117. Available at http://dx.doi.org/10.1080/10810730.2011.649106
Campbell, N., et al., Taking Knowledge for Health the Extra Mile: Participatory Evaluation of a Mobile Phone Intervention for Community Health Workers in Malawi. Global Health: Science and Practice 2, no 1 (2014): pp.23-34.
Note: this project update was produced by PRB based on the reference listed above.