presenter: chris smith, motif lead investigator, msic

Promising Innovations to Improve PAFP Women Deliver 2013

MOTIF: MObile Technology for Improved Family PlanningMobile phone-based support for PAFP

in Cambodia

Presenter: Chris Smith, MOTIF Lead Investigator, MSIC

Contributors: Thoai Ngo, Judy Gold, Uk Vanak, Ly Sokhey, Caroline Free


Challenge: low uptake of PAFP and repeat abortionAbortion44 million/year, 50% unsafe, 47K maternal deaths (Sedgh 2011)

Low uptake of PAFPNo method 32%, condom 24%, pill 20%, injectable 11%, IUD 5%, implant 5% (MSIC data 2011)

Repeat abortion25% repeat abortion within 5 years (CDHS 2010)

4% return to the same MSIC clinic within 1 year (MSIC data 2012)

Repeat abortion negative health outcomes (Curtis 2010)

PAFP interventions are important to reduce repeat abortion


What are the opportunities for mHealth?

Of the world’s estimated 7 billion, 6 billion have access to mobile phones

In CambodiaMobile Phone access:

->80% of MSIC clients provided a mobile number

-As over 50% of clients (many from rural areas) don’t return to the clinic post-abortion, opportunity to maintain contact


Hypothesis: adding mobile support to the continuum of PA care can increase PAFP

OpportunitiesoInformationoRemindersoSupport (e.g. SE’s)

OpportunitiesoBuild on success in PAFP counselingoWide range of methods available

Beyond the FacilityAt the Facility Level


MOTIF programme intervention

MSI Innovation Fund

•October 2012 – December 2013

•Develop, implement and evaluate a mobile phone-based intervention to support PAFP in Cambodia

•Piloted in 4 MSIC clinics


Formative research to understand the local context

Interviews/focus groups:

Difficult to make PAFP choices at the time of abortion

Concerns about side-effects, want to complete abortion first, need to discuss with husband

Limited literacy, simple phones, prefer to talk

Women prefer voice message to SMS


Overview of intervention developed

Provider Client

Service provided for 3 months after which client continue to receive standard care

VM every 2 weeks

Pill/appointmentreminders

Client can call in

+/- follow up phone call

MOTIF: Mobile Technology for Improved Family Planning


Voice message as conduit for additional support

“Hello, this is a voice message from a Marie Stopes counsellor. I hope you are doing fine. Contraceptive methods are an effective and safe way to prevent unplanned pregnancy. I am waiting to provide free and confidential contraceptive support to you”.

Press 1 if you would like me to call you back to discuss contraception.

Press 2 if you are comfortable with using contraception and you do not need me to call you back this time.

Press 3 if you would prefer not to receive any messages again”


Mixing medical services with technology

http://instedd.org/blog/marie-stopes-verboice-will-mobile-phones-improve-contraceptive-use-in-cambodia/


Randomised controlled trial overview


Preliminary Results (using intervention data) PAFP (pill, injection,

IUD, implant) increase from 33-56%

Uptake new methods, support SE’s for existing users (continuation and safe method switching)

Post-abortion support (medical/emotional)

12% cancel 4% cannot contact


Next steps• Optimise registration process

− Client sign up• Increase automation

− Automatically schedule VMs and redial

• Improve content & delivery− Add SMS option / APP?− Adjust number of VMs

• Offer service in different settings− Private clinics/MOH

• Financial sustainability− Fee for service?− Revenue sharing/sponsorship− eVouchers


Thank you!

If you are interested to learn more about this project, or in funding thenext phase, please get in touch: [email protected]

Contributors:

•Thoai Ngo, Judy Gold, Uk Vannak, Ly Sokhey, Caroline Free

•MSI Cambodia, Innovation and Best Practice & Research Monitoring and Evaluation team MSI


SIM card switching

Phone sharing

Competition with commercial spam

Timing of VMs

Clients busy

Reaching out to youth/students/EWs

Challenges


Response to VM: first 100 clients


Appendix: Conceptual framework


Different categories of clients?

Urban youth, literate,

confidentiality important?

Urban youth, literate,

confidentiality important?

Rural, limited literacy, married,

disclosed to others re

abortion?

Rural, limited literacy, married,

disclosed to others re

abortion?

VoiceVoiceSMS / App?SMS / App?

presenter: chris smith, motif lead investigator, msic

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