This document summarizes the first year results of monitoring and evaluation of MomConnect, a South African mHealth program that aims to improve maternal and child health outcomes. Key results include: - Over 50,000 pregnant women registered for the program, though registration rates varied significantly between provinces. - Under 10% of subscribers to the program's text messages converted to registered users. - Most registrations (over 75%) occurred before or at 20 weeks of gestation. - Client satisfaction with health services was high, though only a small percentage provided ratings.

1. Addressing maternal & child health
using mHealth: First year of
MomConnect monitoring &
evaluation
P Delobelle, T Esterhuizen, L Dudley, A Parsons
A Fernandes, Y Pillay, P Barron

2. Table of Contents
 Rationale
 Aims & objectives
 Overview & set-up
 Logical framework
 Study design
 Output indicators
 First year results
 Discussion
 Conclusion

3. MomConnect : Rationale
 High rate of avoidable maternal mortality (140 /
100,000 live births) associated with late uptake of
antenatal care
 Barriers include lack of privacy and confidentiality
related to HIV/AIDS counselling and testing, lack of
knowledge and information about SRH and rights
and problems related to the availability and cost of
transport
 NDoH strongly committed to achieving MDG 4-5
targets related to decreasing maternal and child
mortality
 Mobile phone penetration in South Africa stands at
115%
 Benefits of text messaging include its low cost and

4. Aim : To contribute to decreased maternal and child
mortality in line with MDG 4-5 by using cell phone based
SMS technology
Objectives :
 To register all pregnant women in the public health sector
in South Africa on a national database;
 To send stage-based health messages to their mobile
phones during pregnancy, childbirth and up to the first
year of age;
 To provide a platform for feedback and strengthen the
demand and accountability of MCH services to improve
the access, coverage and quality of care
 To improve competency of nurses and midwives
delivering MCH services (end of 2015)
MomConnect: Aim & Objectives

5. MomConnect : Overview and Set-up

6.  Logical framework based
on a Theory of Change
approach with specific
indicators for each
component of the
framework including input,
process, output and
outcome indicators with
respective sources of
verification and underlying
assumptions
MomConnect M&E : Logical Framework

7. MomConnect M&E : Research Method
 Longitudinal time-series analysis of key indicators
(MNCH dashboard / MomConnect indicators)
 Nationally representative survey (incl. client
exit interviews, focus group discussions, in-
depth interviews)

8. Indicator Data Source
a % client registrations / (target) ANC 1st visits
(previous fin. year)
MomConnect /DHIS 2
database
b % client opt-outs from MomConnect and
reasons for opting-out
MomConnect /DHIS 2
database
c % client service ratings (response rate) MomConnect /DHIS 2
database
d % client ratings of privacy, staff attitudes,
cleanliness and waiting times
MomConnect /DHIS 2
database
e % clients using the help-desk and categories
of messages sent
MomConnect /DHIS 2
database (if available)
f % clients logging complaints / compliments MomConnect /DHIS 2
database (if available)
MomConnect M&E: Output Indicators

9. 0
10000
20000
30000
40000
50000
60000
Number
Registrations
Subscriptions
Conversions
MomConnect: Subscriptions & Registrations

10. 0%
50%
100%
150%
200%
250%
Kwazulu-Natal
Gauteng
Western Cape
Free State
Northern Cape
Limpopo
Mpumalanga
Eastern Cape
North West
Target Registration Achievement by Province
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%

11. MomConnect Registrations by Gestational Age
0
10
20
30
40
50
60
70
80
90
100
Percentage
Reg < 20 weeks Reg 20 - 34 weeks
Reg ≥ 35 weeks Reg / ANC 1st visits (prev fyear)
ANC 1st visit < 20wks rate

12. MomConnect Registrations by Age Group
0%
5%
10%
15%
20%
25%
30%
35%
40%
< 20 years 20y - 24y 25y - 29y ≥ 30 years
0%
5%
10%
15%
20%
25%
30%
35%
40%

13. MomConnect: Opt-outs by Reg Category
0
2
4
6
8
10
12
14
Percentage
Registration CHW subscription Public subscription

14. MomConnect: Opt-out Rates by Reason
0
10
20
30
40
50
60
70
80
90
100
Percentage
Baby loss
Miscarriage
Not useful
Other
Stillborn
Unkown

15. MomConnect: Opt-out rates by Province
0
2
4
6
8
10
12
14
16
18
20
Percentage
Kwazulu-Natal
Gauteng
Western Cape
Free State
Northern Cape
Limpopo
Mpumalanga
Eastern Cape
North West

16. MomConnect: Satisfaction with Services
0
10
20
30
40
50
60
70
80
90
100
Percentage
Cleanliness
Friendliness
Privacy
Waiting times (felt)
Waiting times
(length)
Regs submit
service ratings

17. MomConnect M&E: Discussion
Data quality issues
 Data script errors / missing values (e.g. divergence
between early booking and registration rates)
 Data processing issues and time lag between integration
and reporting
Issues to be explored
 Significant variation in target registration achievement
between Provinces and (sub)-Districts
 Reasons for low conversion rate (<10%) among
subscriptions
 Opt-out among registered clients for unknown / other
reasons
 Relatively low service ratings coverage

18.  Uptake of MomConnect as measured by target
registration achievement varies widely between
Provinces and Districts
 Conversion rates of MomConnect subscriptions remain
low
 Registrations before 20 weeks of gestation approximate
the rate of first ANC visits
 Registrations among women younger than 20 years
increased slightly overall and was higher in rural districts
in EC / KZN
 Opt-out among registered clients showed variation over
time albeit at a low rate
 Service ratings are highest for satisfaction with
MomConnect M&E: Conclusion