FamPlan: mHealth Family Planning in Malawi

Ashby, R., Chung, Y., Day, A., & Zuzek, A.
Technology Solutions for  
Development & Social Change:  
Columbia University  
School of International and Public Affairs
Fall 2015
mHealth
Family
Planning
in Malawi

Problem 1
Hypothesis 2
Solution 2
Product 3
Customer Stories 7
Product Wireframe 8
Pilot & Customer Acquisition 9
Budget & Milestones 10
Competitive Landscape 11
Insights 12
Business Model 13
Team 14
Social Impact 15
Appendix 16
Endnotes 17

Problem
Women and girls in Malawi do not have sufficient knowledge of, or access to, various methods
for family planning. This is leading to unplanned pregnancies, and late detection is preventing
women from seeking early antenatal care.

Malawi currently has the second highest rate of
population growth in the world at 3.32%.1
Furthermore, according to Malawi’s 2010
Demographic and Health Survey (DHS), only 55%
of births in the 5 years preceding the assessment
were planned and wanted at the time that they
occurred (26% were unwanted and 19% were
wanted at a later time). This amounts to2
approximately 336,000 unplanned and/or unwanted
births per year. In fact, Malawian women at all3
income levels are having more children than they
want, but particularly if they are poor (see figure 1).

The 2010 DHS also reveals important information
about the state of family planning. On average, only
66% of the demand for family planning in Malawi is
met, and unmet need is slightly higher for unmarried
women as compared to married women.
4

However, DHS data does not necessarily capture the extent of the
need, as it does not account for changes in fertility preferences
over time. Fertility preferences can be tied to many factors,
including age, education, employment, health, pregnancy,
relationship status, partner’s preferences, and socioeconomic
position. As these factors change, fertility preferences may5
fluctuate, changing the demand for family planning services.
According to the DHS, 27% of married Malawian women reported
unmet need by point-in-time measures; however, in an analysis of
the five-year DHS calendar data, the Population Reference
Bureau found that 51% of this group experienced unmet need
over the period of the study. Given that the need is lower for6
married women, this indicates that at least 1.9 million Malawian
women have experienced an unmet need for family planning.
7

Finally, as almost half of all pregnancies are
unplanned, Malawian women are late in
detecting their pregnancies and are
therefore not seeking early antenatal care.
Receiving antenatal care in the first trimester
is critical in supporting an infant’s growth. In
Malawi, only 12% of pregnant women
receive their first antenatal check within this
first trimester, and the median time of
pregnancy for first antenatal visit is 5.6
months (see figure 2). Many studies in sub-8
Saharan Africa show that women miss their
first trimester antenatal care because of late-
stage detection, , , and missing antenatal9 10 11
1
"At least 1.9
million Malawian
women have
experienced an
unmet need for
family planning."
Figure 1: Fertility levels in Malawi.
Figure 2: Percent of women receiving antenatal care within the
first four months of pregnancy (by country).

care in the first trimester is suggested as a primary cause of malnutrition and stunting.12
Equipped with better knowledge and access to family planning, women will be more able to
plan and detect their pregnancies and seek critical care.

Hypothesis
If we decrease the unmet need for family planning tools, then women will have greater control
over planning their families. This will lead to a decrease in unplanned pregnancies and an
increase in women who access early antenatal care. 
 
The Malawian Ministry of Health (MoH) provides women with contraceptive information and
tools in district hospitals and health clinics throughout the country. Furthermore, the MoH has
deployed a team of Health Surveillance Assistants (HSAs) to reach remote villages with these
same services. Many NGOs supplement these efforts, such as Save the Children, Jhpiego, and
Banja la Mtsogolo (BLM) - the Malawian branch of Marie Stopes International. BLM in
particular has taken the lead in providing sexual and reproductive health services, and in
additional to their 31 centers, BLM conducts mobile family planning clinics in 460 hard-to-
reach communities every month, across 27 of Malawi’s 28 national districts.  13
 
Despite this breadth of service providers, only 46.2% of women are currently practicing family
planning. Many factors are contributing to this low rate of contraceptive prevalence, including14
frequent stockouts at clinics, infrequent access to HSAs, and inadequate information about the
range of methods available. FamPlan believes that by addressing and decreasing these
barriers, we will be able to link women to the family planning methods they need.

Solution
FamPlan is a mobile service that provides rural Malawian women with education about, and
access to, family planning services. FamPlan serves as a personal family planning advisor to
each user, and allows each woman to choose the information and tools that she needs. The
service will be available to aid our users 24 hours a day, 7 days a week.

FamPlan provides a range of family planning services, described in detail below. As we aim to
serve rural Malawian women, our mobile solution will be built for feature phones, and will allow
women to request and receive information via SMS. Furthermore, as an estimated 58.6% of
Malawi’s female population is illiterate, we will also make our services available via interactive
voice response (IVR), nearly doubling our customer base and our impact. During the pilot15
phase, all functionality will be manual, and SMS messages and voice calls will be answered by
a team of trained call center operators.

Also during the pilot phase, FamPlan will only be available to women who own or have
consistent access to (through a spouse or family member) a mobile phone. We believe that
consistent messaging and the ability to send push notifications is key to maintaining
engagement with the service. Furthermore, as we aim to empower women with the information
they need when they need it, regular cell phone access will be necessary to ensure timely
communication and action. While mobile penetration in Malawi is rather low at 30%, growth in
this area has been rapid, and a decade ago the penetration rate was only 5%. We believe16
2
Mission: FamPlan is a nonprofit organization that provides personalized
family planning to women in rural Malawi through mobile technologies.
][

that the market will continue to move in this direction, and more women will soon gain access
to cellular services.

In the meantime, post pilot we hope to develop a secondary system for users without personal
phones. These customers will be assigned a unique user ID upon registration, and this ID will
allow them to query the database for their personal information from any cellular phone. While
this model will require more proactivity, VillageReach’s “Chipatala Pa Cha Foni” - a Malawian
mHealth operation which focuses on maternal and child health - has seen success with this
model. According to their data, about 50% of users are in this no-phone category, and 30-40%
of them call in regularly to receive personalized messaging.
17
Product
Recognizing that women in Malawi will have different preferences about family planning
methods - and different levels of knowledge as to what is available - FamPlan provides a range
of services in order to accommodate each individual woman. Based on her needs, a woman
will be able to create a package of services for herself drawing from four features, with a fifth
feature supporting our back-end operations (see figure 3). We will design and develop these
features to fit the cultural context of Malawi through consultations with the Ministry of Health
and existing expert organizations, such as Banja la Mtsogolo. All services will be available in
both English and the national language of Chichewa.

Feature 1: Fertility Tracking & Traditional Birth Control
When Malawian women were asked about menstruation, only 15.9% answered correctly about
the timeframe of the fertile window. In addition, the 2010 DHS showed that only 53.4% of all18
female respondents knew about the rhythm method as a birth control technique, whereas
95.3% of respondents knew about injections. FamPlan believes that knowledge about one’s19
own menstrual cycle is the most fundamental concept for any woman interested in
understanding fertility. As such, we will make tracking services available to any woman who is
interested, and encourage clinic staff and HSAs to explain the basics so that new users can
seek further information.

3
Figure 3: Overview of FamPlan services.

However, while we plan to make fertility tracking available to all users, women must meet
certain criteria in order to enroll in the rhythm method through out traditional birth control
service. New users who register for tracking services will begin to report to FamPlan about the
start and finish dates of their cycles. Using this data, FamPlan will be able to determine if a
woman is on a regular cycle - the first criteria for successful use of the rhythm method.
Irregularity is generally not a cause for concern, as many factors can affect a woman’s cycle,
including age, stress, weight loss, illness, and malnutrition. Nevertheless, irregularity will likely
render the rhythm method ineffective, and so women who do not experience regular cycles will
not be able to access this method via our service. For women who are regular, however, and
able to track their fertility pattern, the American Pregnancy Association reports that the rhythm
method is up to 90% effective if women practice abstinence or use a barrier form of birth
control during the fertile window. As such, we believe that the rhythm method will provide a20
strong solution for a subset of our users. Studies show that many women try modern
contraception, but refuse to continue due to heavy bleeding and discomfort. We believe that21
the rhythm method may assist these women in family planning.

The second criteria for using the rhythm method, which will require user acknowledgement
before enrollment, is having the support of their partners. The success of the rhythm method
relies not only on tracking, but on practicing abstinence or utilizing condoms during certain
timeframes. Thus, having a partner who will agree to this system is critical. Furthermore, as
many cellphones are shared within families, having a supportive partner - who will tolerate and
communicate consistent FamPlan alerts - will be equally as important.

Women who choose to utilize the rhythm method will receive alerts from FamPlan regarding
critical times in their cycles, most importantly when they are in their fertile windows and most
likely to become pregnant. We will alert women before they enter this window, as well as once
they have moved out of it. During this time, we will also send reminders to practice abstinence
or use a barrier method of birth control if they wish to avoid pregnancy.

Feature 2: Contraception Access & Alerts
As previously mentioned, only 46.2% of Malawian women are currently practicing family
planning. There are many reasons this rate is so low, and many of them have to do with22
limited access. Rural villages in Malawi are extremely dispersed, requiring women to walk long
distances to reach hospitals and local clinics. When asked about their main barriers to
accessing healthcare, 56% of women of reproductive age cited distance to a health facility.23
Furthermore, even when women are willing and able to walk the distances required, they often
find that the clinics are out of stock when they arrive, and 61% of women cited this concern as
a primary barrier to access. This discourages women from coming back, and leads them to24
give up on obtaining and using modern contraceptives.

FamPlan will decrease barriers of access by providing information to women about when and
where family planning is available. By registering their locations and contraceptive preferences,
FamPlan will be able to alert women when their chosen methods are available in nearby clinics,
saving them the time of unnecessary visits. FamPlan will also alert women about when and
where mobile clinics are offering family planning services in their area. Finally, if women keep
FamPlan up-to-date with their dosage schedules, we will send alerts that remind them when it
is time to receive their next doses. Paired with the information about how to access these
contraceptives, women will be able to adhere to regular systems of family planning. This
feature will rely on integration with cStock, a stock tracking app, described in Feature 5.

While we plan to send push notifications out to users with this critical information, FamPlan
customers can also query the service to find out if methods are available, and where. This will
4

be particularly important in the post-pilot phase, when we plan to build out the service and
offer these features to users without personal cell phones.

Feature 3: Education & Trivia
A lack of education about family planning is another critical barrier to access. The FamPlan
education service will provide women with vital information about family planning, including
modern and traditional birth control methods as well as fertility. Users will receive SMS push
notifications with family planning information twice per week. This feature will cater to women
with different levels of knowledge, and will reinforce the information provided to the community
by HSAs and Banja la Mtsogolo. It will help women make more informed decisions about
which methods to use, and raise their awareness about family planning and fertility.

Our education database will be developed in partnership with the Ministry of Health and Banja
la Mtsologo, in order to ensure accuracy and consistency in our messaging. The notifications
will deliver basic information, but also serve to debunk common myths. For example, some
women choose not to receive injectables because of a misconception that they will cause
permanent infertility. By providing accurate information, FamPlan will demystify family planning,
and mitigate the intimidation that women face when considering different methods.

In order to incentivize engagement with our service and promote ongoing learning, users will
also be offered weekly trivia questions to test their knowledge. Every correct answer will be
awarded with a point, and every 10 points will earn the user an award of free airtime. Correct
answers will also earn simple messages of positive reinforcement, and users can attain
different levels of achievement, such as a "Gold Star in Family Planning." Trivia questions will
be based off of FamPlan's education notifications, and will incentivize knowledge retention. In
addition to the fundamental demand for family planning that draws users to our service, we
believe this component will keep users engaged with FamPlan so that we can continue to aid
them in their family planning needs (see figure 4).

Feature 4: Family Planning Q&A
FamPlan's Q&A feature complements our other services by allowing women to call in or send
SMS queries and receive an immediate reply from one of our call center operators. This
interactive feature will allow users to receive timely answers as questions arise, and further
assist in correcting misconceptions. As with our education component, FamPlan will partner
with the Ministry of Health and Banja la Mtsogolo to develop a database of accurate and easily
accessible information for our call center operators. During the pilot, all answers will be
5
Figure 4: FamPlan trivia will reinforce family planning education.

delivered manually by these technicians; however, as we build out our final product, we plan to
code common questions and answers for automatic reply via SMS and IVR.

FamPlan's Q&A service will cover a wide range of topics, including the usage, effectiveness,
and side effects of various family planning methods; fertility and menstrual tracking; and many
other topics related to sexual and reproductive health. For topics that fall outside of our scope,
we also plan to integrate our service with Chipatala Cha Pa Foni, and connect users who have
questions regarding maternal and child health to this mobile hotline. For other general health-
related questions, we will direct users to their local clinics and HSAs.

FamPlan is committed to delivering accurate information to users, while ensuring that each
answer adequately addresses the question that is asked. As such, all answers will be delivered
with the follow-up query, "Did this answer your question?" If the answer is "no," call center
operators will contact users to assist them further. This will be the case both during the pilot,
when technicians are engaged with customers already, but also in the final product. If our users
receive an SMS or IVR message that does not satisfy their need, an operator will contact them
for further assistance.

Feature 5: Stock Maintenance
In order to make much of our work to improve access possible, we will partner with the
Ministry of Health and integrate our services into their efforts to improve the health system
value chain and minimize stockouts.

Recognizing that frequent stockouts
pose a serious barrier to Malawians
who are seeking medical services, the
Ministry of Health partnered with John
Snow, Inc. (JSI) and the Bill and
Melinda Gates Foundation on a
project known as "Improving Supply
Chains for Community Case
Management of Pneumonia and Other
Common Diseases of Childhood
(SC4CCM)." The project developed a25
technological solution called cStock,
which allows HSAs to submit stock
reports on essential medications and
commodities via SMS. This data is
transmitted to health centers, who can
then pre-pack supplies and alert HSAs
when they are ready, but is also
available to higher-level health
systems staff in case clinics need
replenishing (see figure 5). According
to the 2013 midline evaluation of
cStock, the system more than doubled product availability at the community level within its first
18 months of operations.
26
Further bolstering these efforts, USAID partnered with the Ministry of Health in offering
technical assistance on supply chain management. This project built upon the work of cStock
by not only managing inventory, but also the transport of these materials. Between 2013 and
2014, this work reduced clinic stockout rates from 88% to 24%.
27
6
Figure 5: cStock data and product flow throughout the health system.

FamPlan will capitalize on this critical work in order to take this data and information one step
further: to the end user. As cStock is an open-source system, FamPlan will integrate our
service with the data available through cStock in order to track product availability and alert our
customers. We also plan to work with the Ministry of Health in order to build upon the list of
commodities they are currently tracking (injectables and condoms are current cStock products,
but birth control pills, emergency contraceptives, and other family planning tools are not).28
Additionally, FamPlan will share data on (anonymized) requests for contraception from our
users with the cStock system, by adding this demand data to the supply data we believe we
augment the cStock system to be more robust and predictive. By tracking a more complete
package of family planning methods, FamPlan and the Ministry of Health will provide women
with options to suit their preferences, thereby reducing their barriers to access. This will
support Malawi's commitment, as part of the Family Planning 2020 (FP2020) global
partnership, to increase family planning information, access, and supplies.
29
Customer Stories
Charity is a married mother of seven children, and she recently learned
about FamPlan from her HSA. Charity is concerned about the size of
her family, and is interested in preventing additional pregnancies. She
has tried both pills and injectables as forms of contraception, but as
she does not like the side effects of either, she has discontinued use of
both. Charity’s husband, Peter, supports her decision to limit further
growth of their family, and so at times, he uses condoms. However,
Peter says that he hates the way they feel, and so he will not use them
all the time. Charity and Peter have also run into stockout issues at
their local clinic, further preventing consistent use.

Charity learns about FamPlan from her HSA and decides to enroll, and
although she is hesitant to try modern contraceptive methods again, she signs up for fertility
tracking. She begins tracking her cycle, and in the meantime, she signs up to receive
notifications when condoms are available in her area. After a couple of months, Charity learns
that she is regular, and is a candidate for the rhythm method. She confirms with FamPlan that
she would like to use this method, and that her partner supports this choice. Charity receives
detailed information about how to track, and the importance of proper use of this method in
order for it to be effective. She begins to receive alerts about times in her cycle when she is at
greatest risk to become pregnant, and Peter agrees to use condoms during these windows.
Charity is now able to access family planning without using the products that made her feel ill,
and Peter must only use condoms around the time when Charity is in her fertile window.

* * *

Madalitso, or "Mada," is a 16-year-old girl living in the Mchinji
district of Malawi. She and her boyfriend, Alex, are sexually
active, and so Mada wants to protect herself from early
pregnancy by using a method of family planning. She received
an injectable at her local health clinic three months ago, but
although she has returned twice to receive a new dose, both
times she has found the clinic out of stock. She was told the
injectable would only protect her for eight weeks, so as of now
she is unprotected. Mada has also heard about the mobile clinics
put on by Banja la Mtsogolo, but she lives in a very remote
village and never knows when they will be visiting her area. She
has given up on searching for contraception.

7

A few weeks later, Mada visits her health clinic again to receive treatment for Malaria. During
her intake, the nurse asks her if she is sexually active and if she is using contraception, and
Mada explains her situation. The nurse then tells her about FamPlan. Mada enrolls in the
service, and signs up to receive notiﬁcations when products become available in her area. She
is not interested in tracking her menstrual cycles, but through the bi-weekly educational
messages and weekly trivia, she begins to learn more family planning and reproductive health.
A week later, Mada receives an alert that Banja la Mtsogolo will be setting up a clinic in her
closest trading center. Mada travels to the mobile clinic, and is able to receive another
injectable. She reports this to FamPlan, so that FamPlan can keep track of when Mada will
need a new dose and alert her to the need and nearby availability of products. With FamPlan’s
reminders about when she needs contraception, and information about when and where it is
available to her, Mada adopts a regular system of family planning.

Product Wireframe
Figure 6 illustrates Mada's journey and interaction with FamPlan, from her visit to the clinic, to
enrolling in the service, and ﬁnally to gaining access to her chosen contraception. As a
FamPlan customer, Mada will continue to receive alerts, such as those in line 3, so that she can
consistently maintain her method of family planning.

8
Figure 6: Product mockup illustrating user's interaction with FamPlan.

Pilot & Customer Acquisition
Our pilot will be based in the Traditional Authority (TA) Chitukula Area (see figure 7). Chitukula is
located about 30 minutes away from Malawi's capital city of Lilongwe, and has a population of
approximately 28,500 people. Within the five Group Villages under TA Chitukula, there are 25030
villages and around 8,000 women of reproductive age.
31
The TA Chitukula area is rural, but due to its
proximity to Lilongwe City Center, it has
also been an accessible area for prior family
planning interventions. In particular, Banja la
Mtsologo is active in this area, and Save the
Children has done extensive work on family
planning education and sensitization,
especially for men. We believe this is an
ideal environment for the introduction of
FamPlan, as this work has helped to
destigmatize family planning for potential
users and their families. We believe our
service will be able to capitalize on this
work by providing further opportunity for
questions, discussion, and service access.

During our pilot phase, we will target one hundred women of reproductive age served by one
clinic, the Daeyang Health Center. In total, 34 HSAs serve the Chitukula area, but we will train
and work with only those affiliated with Daeyang (approximately 15 HSAs). In partnership with
the Ministry of Health, FamPlan will be integrated into the package of services offered by these
HSAs, and we will train HSAs and Daeyang clinic staff on FamPlan's use and features.

In order to acquire our first 100 users, we will work with these HSAs and clinic staff, who will
introduce, promote and explain FamPlan to women interested in family planning. To provide
any public health service in Malawi, an organization must first receive approval from the
Ministry of Health. The MoH expects all organizations to work cooperatively with local health
clinics and HSAs, especially when interventions are public-facing. As HSAs and other medical
staff are paid employees of the Ministry of Health, our partnership will the MoH will help ensure
that FamPlan services are marketed and used. Furthermore, we believe that FamPlan will ease
the work of these service providers by supplementing community education and easing access
issues, further incentivizing them to promote the product. HSAs and clinic staff will also be the
primary registration points for users beyond the pilot phase.

While our final product will utilize automated SMS and IVR functionality, during the pilot, call
center operators will conduct our operations through manual messages and voice calls. We will
establish a strong partnership with Banja la Mtsogolo, and leverage its family planning
expertise in developing a database of information that will equip our call center staff. AS BLM
currently has no technological operations, FamPlan will serve as a their mobile branch,
promoting their messaging and directing people to their clinics. By building our services in
coordination with BLM, we will be able to more easily integrate into the ecosystem of trust that
this organization has built as the largest provider of family planning services in Malawi.  
In total, our pilot phase will span 16 months from setup to assessment (see figure 8). Before
launching our minimum viable product, we will collect baseline data on family planning
knowledge and needs, and develop indicators to measure FamPlan's impact. In the short-term,
we will look at users' engagement with FamPlan, but also assess effectiveness beyond simple
9
Figure 7: Map of Malawi and TA Chitukula, FamPlan's pilot area.

customer retention. Our short-term indicators will include more meaningful measures, such as
the percentage change in women who report having consistent access to family planning, as
well as the change in family planning knowledge and overall use. Post-pilot surveys - as well as
data on trivia responses and reported contraception use - will allow us to assess progress on
these indicators. In the long term, we will be able to develop more robust and meaningful
indicators, such as the change in unplanned pregnancies and early antenatal care.

Budget & Milestones
We estimate FamPlan's pilot will cost a total of 250,000 USD (see table 1). This will include
moderate salaries for our four pilot staff (Director, Technology Architect, Data Analyst, and
Partnership Liaison), as well as their travel and relocation to Malawi. It will also include salaries
for twenty call center operators at $200-$250 per month, in line with the Ministry of Health's
grade schedule. These operators will work in rotating shifts, with 8-10 in the office at a time, so
that the FamPlan line is consistently staffed. Maintenance, rent and technical equipment costs
are also incorporated, as well as costs associated with training HSAs and clinic staff. During
our pilot, we want to make all FamPlan services free to our users. As such, we will work with
Malawi's two mobile providers - Airtel and TNM - to purchase all airtime associated with
FamPlan's service. Post pilot, we hope to develop a mutually beneficial partnership with these
telecom companies, with some services provided free of cost (or funded by FamPlan/MoH/
donors), and others earning profits for the service providers (see Business Model).

 
10
ITEM AMOUNT
Executive Director $30,000
Tech Developer $30,000
Data Analyst / M&E $30,000
PR/Liaison $30,000
SMS/Voice Tech Staff $80,000
Rent, Maintenance, Airtime & Equipment $40,000
Travel $8,000
Trainings $2,000
TOTAL $250,000
Table 1: Budget for FamPlan's 16-month pilot.
Figure 8: FamPlan's 16-month pilot timeline.

During the pilot phase, we estimate that user services will average $156 per woman per month
(see table 2). This estimate incorporates all start-up costs associated with our services. Major
milestones during our 16-month pilot will include establishing partnerships, training staff and
HSAs, registering users, and integrating our services into the mHealth landscape. Figure 9
details these key milestones along our 16 month timeline and beyond.

Competitive Landscape
In Malawi, the Ministry of Health is the largest provider of health care services, accounting for
60% of health facilities in country. Malawi’s current health system is a three-tiered structure,32
where a patient first visits a primary level community clinic (first tier) and moves up to higher
facilities as needed. In addition to these government clinics, the MoH works with several
development partners including multilateral, bilateral and nongovernmental organizations, as
well as private for-profit companies, to offer additional clinics and services. As described
above, most health services are carried out through HSAs and local clinics. Therefore, most
NGOs who work in health and family planning work with HSAs and local clinics to promote and
provide intervention programs. As mentioned above, Malawi has shown a strong commitment
11
Table 2: FamPlan Pilot Unit Economics
Service Features 100 Women Per Woman
x 16 Months
Per Woman/Month
Fertility Tracking & Traditional Birth Control $62,500 $625 $39
Contraception Access & Alerts $37,500 $375 $23
Education & Trivia $37,500 $375 $23
Family Planning Q&A $75,000 $750 $47
Stock Maintenance $37,500 $375 $23
TOTAL $250,000 $2,500 $156
1 - 3 Months 4 - 6 Months 7 - 12 Months 13 - 16 MONTHS
FamPlan and cStock Integration
100 Women Registered With FamPlan
10 Call Center Staff Trained
10 HSAs Trained
MoH 
Partnership
Established
Figure 9: Milestones for FamPlan pilot phase.

to increasing family planning as a part of FP2020, and the Ministry of Health is eager to work
with partners in order to increase access and services.

Banja la Mtsogolo - the Malawian branch of Marie Stopes - is the largest non-profit provider of
sexual and reproductive healthcare services to the women of Malawi. Operational since 1987,
they provide family planning, HIV testing and counseling, and essential health services in rural
areas where resources, capacity, and access to health facilities are limited. They work in 28 of
Malawi's 29 districts, through 31 centers and mobile clinics reaching 460 remote areas. BLM
has no technological reach, but is interested in developing this service through partnerships.

In addition to the MoH and BLM, many other NGOs are also active in this space. The Family
Planning Association of Malawi (FPAM) offers sexual and reproductive health services that are
similar to those of BLM but on a much smaller scale, and particularly targeting youth aged
10-24. Jhipego, a nonprofit health organization affiliated with The Johns Hopkins University,
also works through clinics and hospitals to improve education and service delivery in the areas
of family planning and reproductive health. Finally, Save the Children and many of the large
NGOs that are active in Malawi provide family planning education and sensitization as part of
their overall operations in the country.

Currently there are 45 mHealth solutions in Malawi, but only one - VillageReach's maternal and
child health app, "Chipatala Cha Pa Foni" - reaches community members as end users. In33
many areas of Malawi, HSAs and clinic staff are proficient in the use of mHealth applications,
as the target users of solutions for supply chain management, patient follow-up, health and
nutrition, and more. As described above, there are many actors involved in providing family
planning services in Malawi; however, there is currently no technological solution to address
this need. FamPlan will fill this critical gap.

Insights
FamPlan is not the first mHealth operation, and while it will be the first family planning app in
Malawi, it is also not the first mobile technology dedicated to this issue. As such, FamPlan has
taken numerous insights from other endeavors and incorporated these learnings into our
model. By conducting this market analysis, we believe we will be able to build a stronger, more
engaging, and more sustainable product.

In 2008, Grameen Foundation’s AppLab piloted 6001, an SMS‐based Sexual and Reproductive
Health application in Uganda. While overall use was high, the database was incorrectly coded34
and missing information. This led to failed queries, and users reported receiving information
that did not match the questions they asked. Frustrated users lost trust in the system, and35
thus stopped using the service. We will address this by partnering with Banja la Mtsogolo to
establish a comprehensive database of questions and answers on family planning.
Furthermore, we will ensure that users receive accurate information by seeking feedback on
each and every SMS/IVR request as to whether or not the question was answered sufficiently.
If the user feels that the reply was inaccurate or insufficient, our call center operators will follow
up with the user to provide further information. We will continue to analyze failed queries, and
update the database to improve our service. For queries beyond FamPlan's scope, we will
integrate our service with Chipatala Cha Pa Foni, and direct maternal and child health issues to
their hotline. For other health questions, we will direct users to their clinics and HSAs.

Another big learning from AppLab's venture was the need to engage users in order to promote
retention and sustained use. Users are often excited to try a new service or mobile application.
However, with a service that is primarily based on pull information, users soon forget to use the
app. When asked, users of 6001 said that they would use the application if they were reminded
12

of it. While initial marketing will encourage people to try FamPlan, we want our users to stay36
engaged long after our initial contact. Therefore, FamPlan will maintain consistent
communication with users through alerts (fertility notifications and due dates for contraceptive
doses), as well as bi-weekly educational push notifications with facts on family planning and
reproductive health. We will also engage users through weekly trivia challenges, and reward
them for knowledge gains. By sending consistent reminders about our services, women will be
more likely to show sustained use of FamPlan.

The 6001 service also illustrated that knowledge does not equal access, and being better
informed does not lead directly to behavior change. FamPlan is committed to increasing
access to family planning methods. We believe that education on family planning and
reproductive health is an important part of this mission, but we recognize that information
about family planning is not enough for women to access and utilize these tools. This is why
we will go further, by monitoring stock information, alerting users to availability, and linking
them to our service partners (Banja la Mtsogolo mobile clinics and local health clinics) where
they can get contraceptives for free or at highly subsidized prices. In this way, we hope to
empower women to turn knowledge into action.

 
FamPlan is also mindful of the fact that service integration will be key to uptake and consistent
use. mHealth is now a burgeoning industry, with well over 1,000 services available globally.37
Different applications have different technical standards and clinical protocols, leading to
interoperability issues and market fragmentation. As mentioned above, there are currently 4538
health applications in Malawi, though only one reaches community members. As we build and
launch our service, we will be mindful to do it in such a way as to complement pre-existing
solutions and encourage future integration by developing our application using open standards
and by open sourcing our code. By integrating and open sourcing our operations, we will ease
scaling and encourage wider adoption.

Finally, while we believe FamPlan's services will be able to increase family planning knowledge
and access for thousands of Malawian women, we recognize that our product does not
address all barriers - perhaps most significantly, gender disparities and power dynamics. Lack
of family planning knowledge - particularly among men - is thought to be a primary barrier in
women's access to these tools. As FamPlan continues to grow, we will work with NGOs like39
Save the Children in providing community sensitization to bolster our education service.
Changing social dynamics may be slow, but we believe FamPlan is a key part of the solution.

Business Model
As a nonprofit organization (NGO), we plan to cover early operational costs through donor
funding, and we will seek out grants from donors committed to improving maternal and child
health outcomes as well as menstrual hygiene. Such agencies include the Bill and Melinda
Gates Foundation, MacArthur Foundation, Clinton Foundation, World Bank, USAID and DFID.

As Millennium Development Goals (MDGs) 4 and 5 focused on reducing child and infant
mortality and improving maternal health, many such agencies are already quite active in
donating funds to develop solutions to address these issues. In fact, many of these40
organizations are long-time supporters of our implementation partner, Marie Stopes (BLM).

As FamPlan is primarily a product for social good, donor funding will likely be a necessary
component of ongoing operations, as well. However, in the long term we envision a partnership
between the telecommunication companies and the Ministry of Health as a cornerstone of
project support. Since our solution necessitates the use of airtime, FamPlan can increase the
consumer base for telecommunication companies. As the MoH has shown great commitment
to increasing access to family planning, we believe they will support the project through41
13

airtime subsidies, allowing Malawian women to access information at low or no cost. FamPlan
would like to make as many services free as possible. However, adopting a similar model to
that of Chipatala Cha Pa Foni, Q&A access may be charged after a given point (with CCPF,
each user receives 10 free calls to the hotline before he or she is charged for airtime).42
Eventually, this service model will start to generate revenues for the telecom companies, and a
percentage of this will feed back into FamPlan project support.

FamPlan will integrate with the current family planning landscape through key partnerships with
the MoH, BLM, and others in health provision. HSAs and clinic staff will be our primary points
for registration, and we will build our customer base through them. HSAs and nurses have built
trusting relationships with the communities they serve, and by building our service through
them, we will be able to more easily access this trust ecosystem. BLM has been providing
sexual and reproductive health services in Malawi for nearly 30 years, and by launching
FamPlan as the mobile arm of their operations, we will access their expertise and bring
legitimacy to our operations. Finally, as described above, we plan to integrate our product with
Chipatala Cha Pa Foni and other mhealth services to create a more seamless user experience.

Team
The FamPlan team is passionate about family planning, community health, women's
empowerment, and building technological solutions to aid in development. We bring a
combination of expertise in these areas that will allow us to launch this product swiftly and
successfully. Furthermore, our team has vast experience in Malawi, and our solution is
grounded in a solid understanding of the landscape and context.

Yaera spent three years in Malawi, as a Program Manager for a maternal and child intervention
at Daeyang Luke Hospital and a Research Manager in Gumulira Millennium Village. As Program
Manager, she built a strategic partnership with the Ministry of Health and managed daily
operations of the project, overseeing 3,000 pregnant women and infants with 54 HSAs and 30
staff. In Gumulira MVP, she worked on various research projects on public health, education,
and inclusive growth. She also has experience writing successful grant applications. Combined
with previous experience in public health and management, she is well-equipped to lead
FamPlan, a solution she believes will empower women with better access to family planning.

 
Ashley started her development career as a Peace Corps Volunteer in Malawi, where her work
centered on education, tech literacy, and girls' empowerment. Frustrated by the abundance of
well-intentioned but poorly executed work in Malawi, she returned to Columbia's School of
International and Public Affairs (SIPA), where she has focused on program design, monitoring
and evaluation, and technological solutions for change. Most recently, Ashley worked on a
14
Yaera Chung,  
Executive Director
Ashley Day,  
Data Analyst
Anna Zuzek,
Partnership Liaison &
Public Relations
Roger Ashby,  
Technology Architect

community feedback project in post-earthquake Nepal, where she designed and implemented
a survey using mobile data collection to analyze citizens' opinions and needs. Ashley is thrilled
to be applying her expertise in data-driven solutions to FamPlan in a country she feels is home.
 
Anna has over six years of experience in managing public relations and outreach in the public
and nonprofit sectors. During her time with Hold the Child (South Sudan), Anna cultivated
partnerships and built new ones with local and international organizations and stakeholders
that enhanced the sustainability of the organization’s projects. Anna worked as a focal point for
coordination of a joint UN program, where she successfully maintained relationships between
the government, UN implementing agencies, NGOs and civil society groups. Her experience in
managing relations with different stakeholders and developing communications materials for a
range of audiences will help FamPlan cultivate strong partnerships in Malawi.

Roger has over sixteen years of experience in Information Technology working in academia,
state and local government, nonprofits and private companies. Areas of expertise include
solutions development and engineering, cloud computing solutions, managed application and
hosting services, project and program management, operations management, and strategic
partner management. Roger's technical subject matter expertise includes storage architecture
development, database administration and systems architecture development, and Open
Source Software (OSS) systems and applications. Additionally, Roger is a social entrepreneur
who has committed to using his management experience and technical expertise to help
ensure that every person realizes their potential to live happy, healthy and fruitful lives. He
holds a degree in computer science, and a degree in business from Johns Hopkins Carey
Business School, and is completing an MPA in Development Practice at Columbia SIPA.  
Social Impact
FamPlan will feed into Malawi’s Family Planning 2020 (FP2020) strategy by supporting the
sexual and reproductive rights of women, while also saving the government money. This dual43
benefit will spur further support from the Malawian Government. According to the Bill and
Melinda Gates Foundation, every dollar spent on family planning saves the government up to
six dollars. In fact, it is estimated that fulfilling the unmet need for family planning in Malawi44
would result in a net annual savings of $11 million USD (4.1 billion Malawian kwacha).
45
Increasing access to family planning services has numerous benefits for women, their families,
and society at large. Women who are empowered to make choices about childbearing are
more likely to take advantage of economic opportunities and invest in their children’s
education. Furthermore, by decreasing unintended pregnancies and slowing population
growth, FamPlan services will have a positive impact on the environment. Malawi has one of
the highest maternal mortality rates in the world at one in 36 women, but women who plan46
their families prevent up to one in three maternal deaths, as well as two million deaths of
infants and children. FamPlan empowers women to make these important choices.
47
As described above, in the pilot phase we will look for short-term wins to assess impact, such
as user engagement, as well as increases in knowledge, contraceptive use (behavior change),
and consistent access. In the long term, we believe these gains will translate into profound
change for Malawi in the areas of sexual, reproductive, and maternal and child health. FamPlan
will allow women to access family planning, empowering them to plan their families with
intention. This will lead to fewer unwanted pregnancies, an increase in early antenatal care,
better maternal and child health outcomes, and even stronger economic standing.

The positive social benefit of increasing access to family planning is inestimable. This impact
starts with FamPlan. 
15

Appendix
16
Appendix A: FamPlan Business Model Canvas detailing the structure of our long-term business plan.

Endnotes
“Malawi.” The World Factbook. Central Intelligence Agency, n.d. Web. Dec. 2015.1
Demographic and Household Survey 2010, Ministry of Health, Malawi, September 20112
“Malawi.” The World Factbook. Central Intelligence Agency, n.d. Web. Dec. 2015.3
Sennott, C., & Yeatman, S. (2012). Stability and Change in Fertility Preferences Among Young Women5
in Malawi. International Perspectives on Sexual and Reproductive Health, 38(1), 34–42. http://doi.org/
10.1363/3803412
Kaneda, T., et al. (2014). Unmet Need for Family Planning: What Can We Learn from the DHS Five Year6
Contraceptive Calendar Data. Population Reference Bureau. http://www.prb.org/pdf14/unmet-need-
research-dhs.pdf
Population Reference Bureau. (2015). Data Finder. http://www.prb.org/DataFinder/Topic/7
Rankings.aspx?ind=18
Demographic and Household Survey 2010, Ministry of Health, Malawi, September 2011.8
Gross, K., Alba, S., Glass, T. R., Schellenberg, J. A., & Obrist, B. (2012). Timing of antenatal care for9
adolescent and adult pregnant women in south-eastern Tanzania. BMC pregnancy and childbirth, 12(1),
16.
Launiala, A., & Honkasalo, M. L. (2007). Ethnographic study of factors inﬂuencing compliance to10
intermittent preventive treatment of malaria during pregnancy among Yao women in rural Malawi.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 101(10), 980-989.
Mathole, T., Lindmark, G., Majoko, F., & Ahlberg, B. M. (2004). A qualitative study of women's11
perspectives of antenatal care in a rural area of Zimbabwe. Midwifery, 20(2), 122-132.
Bhutta, Z. A., Das, J. K., Rizvi, A., Gaﬀey, et al. (2013). Evidence-based interventions for improvement12
of maternal and child nutrition: What can be done and at what cost? The Lancet, 382(9890), 452-77.
doi:http://dx.doi.org.ezproxy.cul.columbia.edu/10.1016/S0140-6736(13)60996-4
Banja la Mtsogolo. (2015). Services. http://www.banja.org.mw/services13
“Literacy.” The World Factbook. Central Intelligence Agency, n.d. Web. Nov. 2015.15
“Mobile cellular subscriptions (per 100 people).” World Bank, n.d. Web. Nov. 2015.16
Jessica, VillageReach, personal communication, December 2015.17
Grant, M. J., Lloyd, C. B., & Mensch, B. S. (2013). Menstruation and school absenteeism: Evidence18
from rural Malawi. Comparative education review, 57(2), 260.
Demographic and Household Survey 2010, Ministry of Health, Malawi, September 2011.19
17

American Pregnancy Association. (2004). Fertility Awareness: Natural Family Planning (NFP). American20
Pregnancy Association.
Kibira, S. P., Muhumuza, C., Bukenya, J. N., & Atuyambe, L. M. (2015). “I Spent a Full Month Bleeding,21
I Thought I Was Going to Die…” A Qualitative Study of Experiences of Women Using Modern
Contraception in Wakiso District, Uganda. PloS one, 10(11), e0141998.
ibid.23
ibid.24
n.d. (2015). Cstock:Supply Chains for Community Case Management. CommCare Supply. http://25
www.dimagi.com/wp-content/uploads/2015/01/CommCare-Supply-cStock-case-study.pdf
Community Health Supply Chain Midline Evaluation Report. (2013). http://sc4ccm.jsi.com/files/26
2013/11/Malawi-Midline-Report_FINAL.pdf
USAID Malawi Family Planning and Reproductive Health Fact Sheet. (2015). https://www.usaid.gov/27
malawi/fact-sheets/usaid-malawi-family-planning-fact-sheet-2012-13
Community Health Supply Chain Midline Evaluation Report. (2013). http://sc4ccm.jsi.com/files/28
2013/11/Malawi-Midline-Report_FINAL.pdf
Family Planning 2020. (2015). Countries. http://www.familyplanning2020.org/entities29
Malawi Census Survey. (2008). http://www.nsomalawi.mw/2008-population-and-housing-census/30
107-2008-population-and-housing-census-results.html
Malawi Census Survey. (2008). http://www.nsomalawi.mw/2008-population-and-housing-census/31
107-2008-population-and-housing-census-results.html
WHO. (2009). Country Cooperation Strategy: Malawi. http://www.who.int/countryfocus/32
cooperation_strategy/ccs_mwi_en.pdf?ua=1
Friderichs, C., Foh, K., Gathinji, C. (2014). MHealth Country Feasibility report. GSMA.33
Grameen Technology Center. (2009). Health Application Pilot Final Report. https://34
courseworks.columbia.edu/access/content/attachment/INAFU6211_001_2015_3/Syllabus/e4ded161-
dde2-47c0-a230-1a3cda980889/AppLab-Health-Pilot-Report.pdf
Jamison, J. C., Karlan, D., & Raffler, P. (2013). Mixed method evaluation of a passive mHealth sexual35
information texting service in Uganda (No. w19107). National Bureau of Economic Research.
ibid.36
Ohuruogu, V., Fernan, P., Foh, K. (2015). Mobile for Development
37
Catalysing mHealth Services for Scale and Sustainability in Nigeria. http://www.gsma.com/
mobilefordevelopment/wp-content/uploads/2015/05/GSMA-Nigeria-Business-Framework-web.pdf
ibid.38
18

Nkawihe,M. (2014). Men Shun Family Planning as Malawi Adds 400,000 people annually. http://39
www.nyasatimes.com/2014/03/04/men-shun-family-planning-as-malawi-adds-400000-people-annually/
USAID. (2014). Family Planning Partnerships. https://www.usaid.gov/what-we-do/global-health/family-40
planning/partnerships
Family Planning 2020. (2015) Malawi. http://www.familyplanning2020.org/entities/6941
Jessica, VillageReach, personal communication, December 2015.42
Family Planning 2020. (2015) Malawi. http://www.familyplanning2020.org/entities/6943
Gates Foundation. (2015). Family Planning: Strategy Overview. http://www.gatesfoundation.org/What-44
We-Do/Global-Development/Family-Planning
Beneﬁts of Meeting the Contraceptive Needs of Malawian Women. (2014). Guttmacher Institute.45
https://www.guttmacher.org/pubs/IB-Malawi.html
UNICEF. (2010). Statistics. http://www.unicef.org/infobycountry/malawi_statistics.html46
Smith, R., Ashford, L., Gribble, J., & Clifton, D. (2009). Family planning saves lives.http://www.prb.org/47
pdf09/familyplanningsaveslives.pdf
19
Figures, Images & Tables References
Figure 1: Guttmacher Institute. (2014). Beneﬁts of Meeting the Contraceptive Needs of Malawian
Women. In Brief, 2014(2). doi:http://www.guttmacher.org/pubs/IB-Malawi.html

Figure 2: Demographic and Household Survey 2010, Ministry of Health, Malawi, September 2011

Figure 3: Created by FamPlan.


Figure 5: Created by FamPlan (using Google Maps).


Figure 7: Supply Chains for Community Case Management. (2013). cStock Data and Product Flow.
doi:http://sc4ccm.jsi.com/emerging-lessons/cstock/



Table 1: Created by FamPlan.

Table 2: Created by FamPlan.

Cover Image: Danish Institute for Parties and Democracy. (2015). http://dipd.dk/partnerships/ghana/
danish-social-democrats-and-ghanas-national-democratic-congress/centre-for-multiparty-democracy-
malawi/

Page 7 (Charity): Dsenyo. (2014). http://www.dsenyo.com/blogs/dsenyo/tagged/social-
entrepreneurship#

Page 7 (Mada): Chung, Yaera. (2014).

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