program year 2 implementation plan - united states agency

Maternal and Child Survival Program

Nigeria

Hello Mama (MAMA Nigeria)

Program Year 2

Implementation Plan

October 2015 – September 2016

Submitted April 1, 2016 Revised and resubmitted May XX, 2016 to

United States Agency for International Development

Cooperative Agreement No. AID-OAA-A-14-00028

Submitted by: Jhpiego in collaboration with

John Snow, Inc. Save the Children ICF International

Results for Development Population Services International

PATH CORE Group

Institute of International Programs/Johns Hopkins University Broad Branch Associates

Communications Initiative Avenir Health

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TABLE OF CONTENTS

ACRONYMS AND ABBREVIATIONS .................................................................................................. 3

SUMMARY ....................................................................................................................................... 4

INTRODUCTION AND SITUATION .................................................................................................... 5

GOAL, OBJECTIVES, & EXPECTED RESULTS ..................................................................................... 7

RESULTS FRAMEWORK ................................................................................................................... 8

TECHNICAL APPROACH ................................................................................................................... 9

PY1 ACCOMPLISHMENTS .............................................................................................................. 13

PY2 Phase 1: Transition from Program Year 1 to Program Year 2 ................................................ 15

PY2 EXPECTED RESULTS AND ACTIVITIES...................................................................................... 17

MONITORING & EVALUATION ACTIVITIES .................................................................................... 25

MANAGEMENT PLAN .................................................................................................................... 26

SHORT TERM TECHNICAL ASSISTANCE ......................................................................................... 28

ANNEX 1. PROGRAM MONITORING AND PERFORMANCE PLAN INDICATOR MATRIX ................ 31

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ACRONYMS AND ABBREVIATIONS

ANC Antenatal care

FCT Federal Capital Territory

FMOH Federal Ministry of Health

ICT4D Information and Communication Technology for Development

ICT4SOML Information and Communication Technology for Saving One Million Lives in Nigeria

IVR Interactive Voice Response

J&J Johnson & Johnson

KPI Key Performance Indicator

LGA Local Government Area

M&E Monitoring and Evaluation

MAMA Mobile Alliance for Maternal Action

mHealth Mobile Health

MNCH Maternal, Newborn, and Child Health

MNH Maternal and Newborn Health

MNO Mobile Network Operator

PNC Postnatal Care

SC Steering Committee

SMS Short Message Service (Text messaging)

SURE-P Subsidy Re-Investment Programme

USSD Unstructured Supplementary Service Data

UX User Experience

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SUMMARY Country: Nigeria – Hello Mama

Field Representative(s): Professor Emmanuel Otolorin, Country Director, [email protected] (Project Director recruitment underway)

US-Based Contact Person(s): Koki Agarwal, Maternal and Child Survival Program Director, [email protected]; Laura Skolnik, Country Support Manager, [email protected]; Sarah Searle, Technical Officer II, [email protected]

Program Objectives: Objective 1: To establish an operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population Objective 2: To closely collaborate with demand-side MNCH implementers and health care providers to ensure integration with existing MNCH service delivery platforms Objective 3: To build upon and link Hello Mama data systems with existing electronic and paper-based data collection to improve health information systems

Budget Summary: A. Total FS Obligated through 10/30/2015 $1,250,000 B. PY01 FS Expenditures through 9/ 30/ 2015 (Accrual Basis) $ 904,914 C. FS Pipeline (estimated) as of 10/1/205 (A - B) $ 345,086 D. Additional FS pending obligation per FS Data Base (dated 9/21/2015) $1,250,000 E. Total FS Available and Pending for use in PY2 (C+D) $1,595,086 F. PY2 FS Budgeted with this Workplan $1,458,557 G. Difference (E - F) $ 136,529

MCSProgram Organizations: Jhpiego

Timeframe: Oct 2015- Sept 2018

In-Country Partners: Pathfinder International, Praekelt Foundation

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INTRODUCTION AND SITUATION The Maternal and Child Survival Program is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 24 priority countries with the ultimate goal of ending preventable child and maternal deaths (EPCMD) within a generation. MCSP engages governments, policymakers, private sector leaders, health care providers, civil society, faith-based organizations and communities in adopting and accelerating proven approaches to address the major causes of maternal, newborn and child mortality and improve the quality of health services from household to hospital. MCSP also tackles these issues through cross-cutting approaches that focus on health systems strengthening, household and community mobilization, equity, gender, eHealth, and others. MCSP carries forward the momentum and lessons learned from USAID’s Maternal and Child Health Integrated Program (MCHIP), which made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America and the Caribbean from 2008-2014. In the last two decades, Nigeria made significant progress towards achieving the Millennium Development Goals (MDG). However, maternal death-related statistics differ by source: the National Bureau of Statistics1 reported an estimated maternal mortality ratio of 243 per 100,000 live births in 2014, while the 2013 Nigeria Demographic and Health Surveys (NDHS)2 reported an increase of 576 deaths per 100,000 live births compared to the 545 deaths per 100,000 live births reported in 2008. The MDG target for this indicator was 275 deaths per 100,000 live births. In terms of child health, there seems to be agreement that MDG 4 (Child Mortality) targets were not met, though significant progress was made. With the advent of the Sustainable Development Goals (SGDs), introduced during the 2015 United Nations General Assembly, it is important for Nigeria to continue to collaborate with development partners to improve coverage and quality of high-impact maternal and newborn services proven to help achieve MDG and SDG targets, on both the supply side and the demand side. The Maternal and Child Survival Program (MCSP) is an important partner to the Nigeria government as it continues to strengthen life-saving services for pregnant women and newborns. The Mobile Alliance for Maternal Action (MAMA), as a global consortium with public-private funding, has delivered vital health information to pregnant women, new mothers and their families through their mobile phones with messages that are specifically designed for behavior change over the past five years. Through an “ages and stages” model, the messages correspond to what a woman is experiencing in her pregnancy or in her child’s development creating a trusting relationship between the end user and the MAMA service. With an intentional focus on countries where high maternal and newborn mortality rates intersect with an increasing proliferation of mobile phones, MAMA directly supported country programs in Bangladesh, India, and South Africa. In 2015, MAMA Nigeria was launched as a three-year program (October 2015-September 2018) branded in Program Year 1 (PY1) as Hello Mama. The Hello Mama project operates in Nigeria with the goal to improve the health outcomes for pregnant women, newborns, children and families in Nigeria through an age and stage-based mobile messaging that complements the efforts of frontline health workers. Hello Mama is locally led, planned for scale, and complements the national health care system by aligning with health priorities, policies, and systems.

1 National Bureau of Statistics: The Millennium Development Goals Performance Tracking Survey-2015 Report 2 National Population Commission (NPC) [Nigeria] and ICF International. 2014. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.

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In Program Year 1 (PY1), the seven core partners of Hello Mama were SURE-P, Pathfinder, Praekelt Foundation, Johnson & Johnson, United States Agency for International Development (USAID), MAMA Global, and the Federal Ministry of Health (FMOH). Please see below for further information on PY1 accomplishments. As of Program Year 2 (PY2), the MAMA Global secretariat, supported by USAID/Washington core funds (whose funds were administered through the United Nations Foundation) has been dissolved. While USAID funds for the Hello Mama project had previously passed through MCSP via consortium member ICF International to the United Nations Foundation, MCSP did not play an implementing role. In PY2, overall coordination of Hello Mama shifted to MCSP via implementing partner Jhpiego in-country, with Pathfinder and Praekelt Foundation remaining as sub-grantees, and Johnson & Johnson and USAID continuing as funding agencies. In November 2015 the Government of Nigeria called for the dissolution of SURE-P by November 31, 2015, therefore they are no longer an implementing partner for Hello Mama. The Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA) remains a key stakeholder and continues to be engaged as the project transitions into PY2. Hello Mama will draw upon key lessons learned and best practices from the other MAMA country programs. Included in this is MAMA’s unique ability to address the local context with solutions that fit both the need of the user and the resources available. MAMA has engaged BabyCenter to develop content that is highly localized, and will continue to refine the content for user acceptance through pre-testing before roll-out. Additionally, Hello Mama will leverage its extensive experience collecting and analyzing formative research and translating these findings into programmatic processes to tackle challenges related to various implementation activities. The core partners and stakeholders have agreed to their following responsibilities: MCSP: MCSP will in PY2 play a coordination role in leading Hello Mama across all states for implementation (to include Ebonyi, Kogi, Cross River, and any other state in which Hello Mama is rolled out) that includes hiring a Hello Mama Project Director and other support staff in-country. MCSP will also provide headquarters-level programmatic and technical support to Hello MAMA implementation. MCSP Nigeria also provides the platform for implementation of the pilot in Ebonyi state and later roll-out in Kogi state, where the MCSP Maternal and Newborn Health (MNH) project is currently being implemented. Pathfinder: In PY1 Pathfinder co-led with SURE-P the landscape assessment, community engagement, content technical review, and implementation. In PY2, they will serve as the key partner in content adaptation, translation, and pre-testing; monitoring, evaluation, and research; and provide the platform for implementation in Pathfinder-supported facilities in Cross River State. Praekelt Foundation: Having implemented a MAMA program at scale in South Africa, Praekelt Foundation is well positioned to provide insights from its experience as well as lead on technology design, development, and testing. Praekelt will lead specific activities related to the development of personas and user journeys, wireframes, prototyping, dashboards, and platforms for delivering mobile messages via IVR (voice) and SMS (text), training materials for health workers to register women, and marketing plan to raise awareness of the Hello Mama brand. In PY1, they supported the landscaping activities to inform the design of the project.

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GOAL, OBJECTIVES, & EXPECTED RESULTS GOAL To improve the health outcomes for pregnant women, newborns, children and families in Nigeria through an age and stage-based mobile messaging that complements the efforts of frontline health workers OBJECTIVES Objective 1: To establish an operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population Objective 2: To closely collaborate with demand-side MNCH implementers and health care providers to ensure integration with existing MNCH service delivery platforms Objective 3: To build upon and link Hello Mama data systems with existing electronic and paper-based data collection to improve health information systems EXPECTED RESULTS Objective 1, the functioning technology platform and its operationalization, is foundational for the Hello Mama project. Objectives 2 and 3 provide the enabling environment and support to promote sustainability, integration with the Nigerian health system, and synergies between existing MNCH programming in the focus areas. Please see Results Framework below.

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RESULTS FRAMEWORK

Expected Impact: Improved health outcomes and quality of life for pregnant women, newborns, children up to one year and their families in Nigeria through a scalable, locally led, and universally accessible demand generation service that complements the efforts

of frontline health workers

Objective 1: To establish an operational, scalable platform

that makes age- and stage-based mobile

messages/content available to the target population

Objective 2: To closely collaborate with demand-side MNCH implementers

and health care providers to ensure integration with existing MNCH service

delivery platforms

2.1 Train/orient health workers in Ebonyi and Cross River 2.2 Supportively supervise Hello Mama pilot sites 2.3 Monitor Hello Mama system data for targeted assistance to pilot sites

1.1 Develop/finalize content and pre-test content 1.2 Develop technology platform and deploy locally 1.3 Develop marketing and outreach materials 1.4 Launch pilot, monitor system, and review program learning to prepare for scale up

Intermediate Result 2: Improved knowledge, adoption of healthy

practices and demand for/use of quality maternal

health (antenatal, intrapartum and

postpartum) services


practices and demand for /use of quality newborn

health services

Objective 3: To build upon and link Hello Mama data

systems with existing electronic and paper-based data collection to improve

health information systems


practices and demand for/use of quality health

services for children up to the age of one

3.1 Finalize control interface/dashboard for Hello Mama platform 3.2 Analyze possible interoperation between Hello Mama platform and DHIS2

Intermediate Result 1: Operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population at adequate coverage

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TECHNICAL APPROACH Hello Mama will build on the groundwork from PY1 and continue to work to improve the health outcomes and quality of life for pregnant women, newborns, children up to one year and their families in Nigeria through a scalable, locally led, and universally accessible demand generation service supported by age and stage- based mobile messaging. Central to this approach in PY2 is the pilot roll-out of a robust system to support delivery of critical health information to mothers and other information “gatekeepers” at the right time and in the right format. Many of the simple health interventions that have been proven to reduce maternal and child deaths begin within the household. Birth spacing, attendance at antenatal appointments, exclusive breastfeeding, and cord care, all are behaviors that require the knowledge and willing participation of the mother, and other household and community decision-makers. Research shows that at the individual level, education is the most consistent and significant predictor of demand for maternal services.3 Mobile phone-based health messages can educate, offer support, dispel myths, highlight warning signs, and drive demand for local health services. Messages are targeted to a woman’s stage of pregnancy or the age of her child so that the information reflects exactly what she is experiencing at a particular time. With an estimated 110 million mobile subscribers, expected mobile penetration of 82% by 2015, and governmental investment in ICT for health, Nigeria has the potential to implement a MAMA program with scale, sustainability and impact. Real-world experience with mobile messaging for MNCH has shown to be acceptable to users, with promising suggestions of impact on knowledge and behaviors. Early evaluations of MAMA implementations in Bangladesh and Malawi show that baseline levels of key health seeking and home-based behaviors (such as four ANC visit attendance, exclusive breastfeeding, and use of bed nets to prevent malaria) changed significantly when compared to post-MAMA messaging. Key Stakeholders Multidisciplinary projects such as Hello Mama require close collaboration with a diverse group of stakeholders. Hello Mama works closely with and collaborates with key stakeholders in country: the Federal Ministry of Health, State Governments, Saving One Millions Lives, and ICT4SOML. Additionally, in order to leverage existing investment, prevent duplication, and create continuity between the project’s coordination by MAMA Global and coordination in-country by MCSP Nigeria, Hello Mama will continue to engage with many global organizations and non-governmental organizations involved in the MNCH digital health space: mPowering Frontline Health Workers, GSMA, HealthEnabled, the Global Digital Health Network (formerly the mHealth Working Group), Grameen Foundation, BBC Media Action, and many others. These partners have thus far been engaged via MAMA Global as potential collaborators on content and for the purposes of leveraging existing implementations for scale. Involvement of these stakeholders will be critical to the success of the MAMA program in Nigeria. Building and managing complex multi-sector partnerships was one of MAMA Global’s core strengths, and Hello Mama will work to ensure that these investments are not lost. These diverse engagements will also be key to full-scale implementation across three priority states: Ebonyi, Kogi, and Cross River.

3 Dalberg Nov. 2013 Analysis: Nigeria Demographic Health Survey, 2008; Babalola & Fatusi, Determinants of use of maternal health services in Nigeria – looking beyond individual and household factors, BMC Pregnancy and Childbirth, 2009.

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The nature of the overall MAMA model is such that considerable upfront investment is leveraged for longer term user acquisition, creation of a scalable platform, and diminishing program costs starting as early as year three. As such, PY1 focused on establishing the critical systems and processes necessary to support a scalable model. In PY1, Hello Mama developed a functioning management and operations structure, created a unique and scalable technical platform (Minimally Viable Product 1 (MVP1)), cultivated partnerships with key stakeholders, produced a set of carefully reviewed and vetted mobile messages targeted for the Nigerian context, completed a monitoring and evaluation plan, and shaped a local brand and logo. In PY2, the focus of Hello Mama will be pilot implementation in Ebonyi and Cross River states. These pilot implementation sites have changed since the pilot’s original conception, which included FCT as an area of focus. Since SURE-P, the main implementing partner in FCT, is no longer functional, the second pilot site has shifted to Cross River, where implementing partner Pathfinder already has a platform for implementation. Integration with existing MCSP programing in Ebonyi and Pathfinder programming in Cross River will be a priority ongoing through pilot roll-out, as the project seeks to create demand for quality services that are actually being provided. From a technology platform and communications perspective, activities in PY2 will include development of further enhanced iterations of the technical platform, execution of a proactive marketing and outreach plan, localization and translation of the mobile messages designed to change behaviors, including increasing use of services and development of a rigorous research agenda to start assessing impact. PY2 will also be a critical year for ongoing stakeholder engagement with public and private sectors, and laying the groundwork for sustainability. In PY3, MCSP expects that the Hello Mama service will be firmly in place and will be able to be rolled out at greater scale. With the program fully operational in the Ebonyi and Cross River, MCSP will be able to further refine the offering based on findings from pilot results and ongoing monitoring and evaluation. During PY3, MCSP will also expand beyond initial sites, into focus area Kogi and into other states. The goal for PY3 will be maintain the integrity and quality of the MAMA program while increasing the user base. Activities in PY3 will serve to advance ultimate objectives for national scale and sustainability. In PY3, MCSP will also begin activities aimed at evaluating Hello Mama’s effectiveness. Effectiveness of Hello Mama in achieving its objectives in increased knowledge and generation of demand for health services will be gauged by an evaluation, planned as part of a greater monitoring, evaluation, and research agenda for the entire project. Hello MAMA is currently engaged with HealthEnabled research experts to inform the design of the effectiveness evaluation. The refinement of this design and planning to begin a baseline (if feasible) in PY3 will be key activities in PY2. This program has been designed to be flexible and scalable enough that it can be delivered on a national level. SMS and voice capabilities are available on every mobile phone in the world, do not require access to data plans or Internet, and do not rely on integration into any non-standard systems (such as medical record systems), which means that there are very few barriers to scaling this project operationally. However, the one barrier that cannot be ignored is that of cost. As this system will be run with zero or minimal cost to the end user, the telecommunications costs associated with this project must be covered by donors/implementers of the project during the pilot, implementation, and scale up. In a country where there are 6 million live births per year, this means that

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scale up may incur considerable costs. The projected costs for the pilot phase (in PY2) appear as “inventory” in the Hello Mama budget. It is worth noting that frequently in digital health projects involving SMS and voice inventory, competitive pricing for SMS and voice can only be achieved by first demonstrating that the project will be providing a service of a particular volume to mobile network operators. Pilot phases with lower volumes of users may be expensive, but can lead to good data for advocacy with mobile network operators and in-country communications organizations for more competitive pricing. In PY2, Hello Mama is actively involved in exploring all options for reduced-price SMS and voice inventory in Nigeria, and is working with the USAID Nigeria mission to advocate with the Nigerian Communications Commission to secure a “short code”, or a short phone number that would allow us to have zero-rated (free of cost) SMS communications. In PY3, we expect to be able to show progress in these negotiations that will allow us to scale the project at a more competitive telecommunications price point. PY2 Pilot Site Selection and Projected Clients Reached Due to delays in pilot roll out, adjusted pilot implementation period, changes in pilot implementation focus areas, and high projected costs of telecommunications inventory during the pilot, planned pilot sites and projected numbers of clients reached by the Hello Mama service during the pilot phase (July 2016 – September 2016) have been adjusted. The tables below display suggested pilot sites (to be finalized after consultation with State governments) and relevant site characteristics for pilot site selection. The volume of ANC at these pilot sites will allow the program to reach an estimated 15,000-20,000 users during the pilot phase. Table 1. Suggested Ebonyi Pilot Sites and ANC volume Facility name Average Monthly ANC* 1 eb Amuzu HC 117 2 Federal Teaching Hospital 390 3 eb Effemgbabu HC 102 4 eb Ekoli HC 69 5 eb Ephuenyim HC 198 6 eb Ezzama HC 78 7 eb Ezzaofu HC 63 8 Holy Trinty Motherless And Maternity Home 74 9 Eb Iboko General Hospital 69 10 eb Ikenyi MDG HC 71 11 eb Iyioji HC 119 12 eb Izzi Unuhu HC 142 13 eb Matermisercordiae Hospital 435 14 eb Mile 4 Hospital 2125 15 Model HC 90 16 Nwezenyi HC 35 17 eb Nwofe HC 63 18 eb Odeligbo HC 254 19 eb Odomowo HC 154 20 eb Offiaoji HC 174 21 eb Okposi General Hospital 81 22 Onueke Gen Hospital 41 23 RIM Hospital (Ndegu Echara) 467 24 eb St Vincent Hospital (Ndubia) 485

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25 eb Sudan United Mission Clinic (IzzI) 486 26 eb Uburu Presbyterian Joint Hospital 74 27 eb Umuakuma Health Post 64 *Source: DHIS Table 2. Suggested Cross River Pilot Sites and ANC volume Facility name Average Monthly ANC* 1 GH Akamkpa 147 2 St Joseph Akpabuyo 22 3 PHC Ikot -Offiong Ambai 70 4 Cottage Hospital Akpet 44 5 Emmanuel Infirmary 121 6 Police Clinic 33 7 General Hospital Calabar 676 8 GH Ugep 166 9 PHC Ekori 50 10 CHC Okundi 54 11 Holy Family Hospital 286 12 CHC Ikom 150 13 Melrose Hospital 59 14 GH Sankwala 62 15 GH Obubra 69 16 Sacred Heart Hospital 248 17 PHC Obudu 53 18 GH Ogoja 250 19 Catholic Maternity Hospital Monaiya 72 20 Lutheran Hospital Yahe 103 *Source: DHIS

Client Acquisition Strategy During the pilot phase, clients will be approached at facilities by health workers (largely CHEWs, although cadre will depend on the facility) to enroll in the Hello Mama service. Health workers will be trained and equipped with job aids to assist them in enrolling the woman or family member in the service at his or her phone number of choice if they agree to participate. While eventually, the project anticipates the need to open up “public lines” for enrollment, where clients can use voice or SMS to enroll themselves, for the pilot, client acquisition will remain at the facility, where we can better control the roll out and iteratively respond to challenges as they arise in a more controlled environment. Collaboration with Other USAID-funded MNCH Projects As a demand generation project, Hello Mama must collaborate closely with projects working to improve the supply side of quality health services for pregnant women, infants, and children. Our pilot focus areas are Ebonyi and Cross River states, representing one state each from USAID-funded projects MCSP MNH and Saving Mothers, Giving Life (SMGL) (represented in the implementing consortium by Pathfinder). Hello Mama’s staff will be co-located with the MCSP MNH project (and, soon, with MCSP Child Health as they will be moving to be co-located in the Abuja office also).

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Hello Mama interacts informally with both MCSP MNH and SMGL frequently as implementing partners from both projects are part of the Hello Mama Pilot Implementation and Monitoring and Evaluation groups. Formally, Hello Mama plans to engage with MCSP MNH and SMGL by providing regular check-ins with leadership from those projects at MCSP/Jhpiego and Pathfinder. Additionally, Hello Mama is already collaborating with MCSP MNH and SMGL state staff to plan for and carry out content pre-testing and user acceptability testing through these existing platforms and relationships on the ground.

PY1 ACCOMPLISHMENTS Hello Mama activities during PY1 were critical to building the backbone for a mobile messaging program that is poised to scale over the next two years. During PY1, all of the critical foundational pieces were put in place, enabling the partner consortia to pilot in PY2. Activities this year focused on foundational aspects of the implementation including formative research, landscape assessment, content development, M&E structures, partnership building, operational protocols, communications strategies, and technical build. While many PY1 administrative and managerial activities required adjustment and refinement in Year 2 post-transition, the foundational aspects of formative research, landscape assessment, and content development remain relevant. Administration/Management: In PY1 MAMA Global established a framework for operations and management. A full time Program Manager was hired by Praekelt who spent 50% of their time supporting Praekelt and 50% supporting the coordination of the broad MAMA partnership in country, based in the SURE-P office in Abuja. Additionally, a Hello Mama Steering Committee was formed and was intended to provide decision-making, but it was not very functional.4 At the February 2016 partners meeting it was agreed that the Steering Committee would be dissolved and the management committee would serve as the main decision-making body. It was also agreed that MAMA would engage with the government through the Core Technical Committees at the national and state level. MAMA work in PY1 was managed through a series of Task Teams as well as an overarching Management Committee that met biweekly. The Task Teams pertained to Content, Research, Communications, and Technology and met on an as-needed basis. Additionally, MAMA Global conducted monthly conference calls with the funder representatives to ensure the program was meeting expectations. Additionally, key progress was made to engage key stakeholders essential to the long term sustainability of the Hello Mama program. Hello Mama presented their work, with a focus on the technical platform, to both NPHCDA and the Federal Ministry of Health. Research/M&E: In PY1, an overarching M&E framework was approved by the entire partner consortium. This M&E plan requires revisions in Year 2 as the program components and strategies take shape and as partners and pilot plans evolve. Those revisions are detailed in the M&E section of this document.

4 The Hello MAMA program was originally governed by a Steering Committee comprised of representatives from each of the partners: Gertrude Odezugo for USAID, Joanne Peter for Johnson & Johnson, Gustav Praekelt for Praekelt Foundation, Kirsten Gagnaire for MAMA Global, Adetokunbo Oshin for SURE P MCH, Farouk Jega for Pathfinder, and Mrs. Akinsanmi for FMOH (this is subject the change, pending her expected retirement). Since then, the steering committee has been dissolved and a Management Committee has been formed, per insights from USAID on the governance structure and in light of the transition of project coordination.

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In an effort to avoid developing a parallel or duplicate M&E system, and with an eye towards a scalable Hello Mama program in Nigeria, an indicator mapping exercise was completed in Year 1 to outline the range of systems currently in place. This exercise covered current data elements gathered and definitions applied in order to inform the Hello Mama M&E system, which will need to be inclusive of the range of electronic and paper-based systems currently in use. The indicator mapping exercise was a joint effort led by SURE-P with significant input from HealthEnabled, Praekelt, and MAMA Global. The mapping matrix allowed program planners, system engineers, and M&E leads to think through the nuances of data and sources for the planned indicators. Many improvements to the indicators were identified. It also facilitated a critique of the indicators identified for the dashboard and allowed for a phased dashboard development approach to be created. System engineers explained what is possible now versus what will require additional efforts and which team members are required in those efforts, and created functional requirements for the dashboard development. From a data perspective, the ultimate goal is to overlay clinical services data with the messaging system data within the dashboard, allowing program managers to observe trends or correlations in usage patterns at the facility level including women registered for messages and clinical services for each facility. We will then be able to track per facility if there are changes in uptake of services as more women are registered for the Hello Mama service in a given area. Completed PY1 activities related to formative and design research included: - Content Desk Review: This desk review of topics to be included in the messages, including any

government protocols and recommendations, was completed by BabyCenter with input from the Content Task Team. The topic map was reviewed by an extensive Expert Review Committee and served as the basis for the final pregnancy and baby messages.

- Pathways to Change Interview Games: Pathfinder completed two Pathways to Change Games in communities in Abuja. These interviews were conducted to better understand specific barriers and facilitators to behavior change. The interviews are used as a data collection tool to understand the target population’s perceptions of barriers to change and facilitators of change. The outcomes will help guide implementation strategies.

- Landscape Assessment Fieldwork: The landscape assessment fieldwork activities were conducted by Praekelt and Pathfinder to gather answers to key questions related to the content, technology and branding as well as barriers and facilitators to behavior change.

- Literature Review: This document explores the evidence base for mHealth interventions to drive demand for clinical MNCH services and links mHealth solutions to the barriers to such services in Nigeria. The range of underlying problems from the health system’s supply and demand-sides are presented while delving deeper into the causes of barriers to demand as well as the range of mHealth solutions used around the world to bolster demand for services. The review makes the case that a clear opportunity exists in Nigeria for leveraging the mobile technology infrastructure to drive demand for essential MNCH services through a MAMA messaging program there while juxtaposing that opportunity with the very real socio-cultural, infrastructural and security challenges that exist in Nigeria.

Content: The content creation process was completed and the partners have begun the translation and localization process. We successfully convened an extensive group of key subject area experts to review the content topic map and the resulting messages themselves. While recruiting for this group and confirming participation took longer than anticipated, our partners at BabyCenter were overwhelmed by the quality of feedback that was provided, indicating that it was the most thorough and useful of any MAMA country program to date. The messages, once completed, will undergo extensive testing, localization, translation, and recording processes.

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Technology: Minimally Viable Product (MVP 1 (voice technology)) is complete, and Minimally Viable Product 2 (MVP 2 (integration of text, USSD, and voice technology)) is being finalized. MVP1 acts as the backbone of the technology platform and was built with inputs from a systematic service design process that included all partners. The key objective during the development of MVP 1 was to make advances around the use of voice at scale through technical integration of voice lines with local providers, an area of functionality not previously part of Praekelt Foundation’s Vumi platform, upon which the Hello Mama platform is built. The project also sought to identify best practices around the use of text-to-speech systems versus audio recordings, and the target audience’s receptiveness to the use of these technologies when used to deliver stage based post and antenatal messaging. The core elements of MVP1 allow users to register via voice, receive stage-based messages via voice and make a state change via voice. At the end of Project Year 1, MVP1 was not yet end-user ready, but is ready for user acceptance testing amongst focus groups as well as the testing of content elements. Each building block went through various code reviews, quality assurance, and testing. The platform is now being deployed to production. SMS, USSD, and voice lines with various mobile aggregators are being tested in Nigeria to ensure a stable integration. Communications: Communications activities in Project Year 1 focused on two primary work streams; the local brand and identify assets, as well as the more external-facing communications strategy. The brand and assets have been finalized and are awaiting final approval. The Hello Mama brand went through a number of revisions, testing with focus groups, and internal vetting, in addition to the creation of a contextual logo and name. The identity and brand are ready for final approval. The external facing communications strategy still needs to be finalized, and determines key events, announcements, and media opportunities. It also includes the cultivation of user stories. Please see PY1 Activity Reports for further detail on the PY1 activities and their status at the conclusion of PY1. PY2 Phase 1: Transition from Program Year 1 to Program Year 2 Program Year 2 formally began on October 1, 2015. However, due to shifts in government partners and program administration and coordination, a transition period into planned Program Year 2 activities was required. To allow for activities to continue to be implemented by Pathfinder and Praekelt Foundation during this time, no-cost extensions were pursued under the previous project agreements to allow work to continue until December 31, 2015. At the same time, MCSP, USAID, Pathfinder, and Praekelt Foundation worked to perform due diligence to be able to transition the project over to coordination by Jhpiego under MCSP. The activities undertaken during this transition period (which, for convenience, we reference as “Phase 1” of PY2 in this workplan) are listed in a separate activity matrix below in order to clearly delineate the activities that occurred during this transition and during the period of no-cost extensions with Pathfinder and Praekelt separately from the PY2 activities starting in January.

ACTIVITY TASK USAID Funds (%)

J&J Funds (%)

RESPONSIBLE COMPLETION DATE

Transition of Sub-agreements until

No-Cost Extensions (NCE) sub-agreement between MCSP/ICF and

X MCSP/ICF and UNF

Sept 30, 2015

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Dec 31, 2015 United Nations Foundation (UNF) signed.

NCEs between UNF and Pathfinder and Praekelt signed.

UNF, Pathfinder, Praekelt

Sept 30, 2015 (Pathfinder); February 2015 (Praekelt)

Develop new sub-agreements under MCSP/Jhpiego

Approval for Jhpiego/MCSP to incur costs

X MCSP Dec 31, 2015

New sub-agreement: Jhpiego/MCSP & Pathfinder signed

X MCSP, Pathfinder Dec 31, 2015

New sub-agreement: Jhpiego/MCSP and Praekelt signed

X MCSP, Praekelt Ongoing from time of transition, approved by USAID March 22, 2016

Formal transition of MAMA Global functions

Transition MAMA Global functions to MCSP JHPIEGO/Nigeria

X MCSP Dec 31, 2015

Recruit local Nigeria staff for in-country MCSP program management and administration

X X MCSP Ongoing

All operating procedures are agreed upon by the partners and meetings are held as appropriate

Management Committee meets quarterly; guides coordination across partners

X X MCSP, All Partners

February 2016

Task teams revised/established for PY2: Coordination/Management Team; M&E Team; Pilot Implementation Team (Content, Technology, Pilot planning)

X X MCSP, All Partners

February 2016

Meetings for revised teams rescheduled and ongoing invitations sent to correct members of each team

X MCSP/Jhpiego February 2016

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PY2 EXPECTED RESULTS AND ACTIVITIES Objective 1: To establish an operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population The primary objective (Objective 1) of Hello Mama is to establish an operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population. Activities: 1.1 Content Development & Pre-Testing 1.2 Technology Platform Development & Deployment 1.3 Marketing & Outreach 1.4 Pilot Expected Results:

Content available to target population • 15,000-20,000 subscribers enrolled (cumulative) during pilot phase • Percent target population enrolled in services • Number of the targeted population reached with messages promoting obstetric care

Established platform functionality • MVPs 1 and 2 functional as defined per requirements document

Content Finalization and Localization • Content tested, adapted and integrated audio content for implementation in Ebonyi and Cross River • Content finalized, uploaded to platform, and scheduled based on developed stage-based calendar of messaging

ACTIVITY TASK USAID-funded

J&J-funded RESPONSIBLE EXPECTED COMPLETION Notes

Objective 1. To establish an operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population

1.1 Develop, finalize, and pre-test content

Pre-Testing Content

Finalize site selection criteria for pretesting; discuss with stakeholders; select pre-testing sites

X All Feb 15, 2016

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Finalize pretesting methodology X Pathfinder Feb 19, 2016

Finalize pregnancy (15) and baby messages (5) to be translated for pre-testing

X Pathfinder, Content Team Feb 19, 2016

Selection of vendors for recording voices/studios x Pathfinder Feb 28, 2016

Translation of sub-set of messages into Pidgin, Hausa, Igbo, Yoruba for pre-testing in Ebonyi and Cross River

X Pathfinder April 5, 2016

Record sub-set of audio messages selected messages for pre-testing in Ebonyi and Cross River

X Pathfinder April 5, 2016

Pre-test sub-set of messages in pretesting sites including health care workers (CHEWs/Nurses) and community

X Pathfinder April 10 – April 22, 2016

Analyze results of pretest and document X Pathfinder April 29, 2016

Share findings from the pre-testing with the partners X Pathfinder, Content

Team May 2, 2016

Share results of pre-testing with State stakeholders X Pathfinder,

MCSP/Jhpiego May 9, 2016

Make adaptations to the messages based on pre-test findings X Pathfinder May 9, 2016

Finalize Messages for Pilot

Translate all messages into Pidgin, Yoruba, Hausa and Igbo X Pathfinder May 15, 2016

Review by technical/medical experts X Pathfinder Third week of May, 2016

Record all messages into Pidgin, Yoruba, Hausa and Igbo X Pathfinder First week of June, 2016

1.2 Develop technology platform and deploy locally

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Develop Minimally Viable Product (MVP1) and Minimally Viable Product 2 (MVP2)

MVP 1: IVR/voice capability technical code reviews X X Praekelt February 1, 2016

MVP 2: USSD registration, dashboard/control interface development and optimization

X X Praekelt February 15, 2016

Changes/iterations to MVP 1 and 2 based on work planning meeting inputs

X Praekelt March 31, 2016

Internal testing, quality assurance processes for MVP1/MVP2 X Praekelt March 31, 2016

Release ready-to-user-test version for partners to view X X Praekelt May 15, 2016

Systems integration and local installation

Server allocation and deployment to production – Contract with hosting (MainOne)

X X Praekelt February 2016

Select/negotiate with aggregators X Praekelt February 2016

Lines/services set-up with aggregators X Praekelt February 2016

Contract/purchase order with aggregators signed X Praekelt March 2016

Develop estimates for Inventory Costs X X Praekelt Dec 31, 2015

Inventory Purchase

Request for Proposal released and advertised for aggregator partner X X Praekelt April 15, 2016

Selection of aggregator based on review of vendor proposals X X Praekelt May 2016

Integration with aggregator and purchase of inventory X X Praekelt June 2016

User Acceptability Planning

Update all user acceptability testing documentation and finalize X Praekelt March 15, 2016

Finalize site selection criteria for pretesting; discuss with X X Praekelt February 1, 2016 In conjunction with partners

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stakeholders; select pretesting sites

User Test Platform

Pre-test tech platform in selected pilot sites X X Praekelt April 15, 2016

Analyze findings from user acceptability testing X X Praekelt April 31, 2016

Share findings from the pre-testing with the partners X X Praekelt May 15, 2016

Share results of pre-test with States X X Praekelt May 15, 2016

Incorporate changes from pre-testing and updated technology platform ready for pilot

X X Praekelt May 31, 2016

Complete platform for launch

Final version of platform ready for pilot X X Praekelt July 1, 2016

1.3 Develop marketing and outreach materials

Brand development Final sign-off by management committee to approve corporate/brand identity

X Praekelt February 15, 2016

Develop Marketing Plan and Materials

Develop strategy/marketing plan to develop awareness about the Hello MAMA brand

X X Praekelt April 2016

Design media, materials needed to implement the marketing plan X X Praekelt April 2016

Production and procurement of marketing/promotional materials x Pathfinder May 15, 2016

Distribute materials and implement marketing plan X Pathfinder and

MCSP/Jhpiego May 31, 2016

Client acquisition planning

Finalize the registration process (e.g., CHEWs, self-registrations, Gate Keepers)

X X Praekelt April 2016

1.4 Launch pilot, monitor system, and review program learning to prepare for scale up

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Pilot launch Official start of pilot period X X All July 2016

Focus group discussions to assess tech platform and content

FGDs at facilities on technology X X Praekelt August 2016

FGDs at facilities on content X X Pathfinder August 2016

Pilot review

Aggregate, analyze, and convene to discuss lessons, data, and focus group results to inform further roll-out

X MCSP/Jhpiego September 2016

Develop criteria for opting registrants out

X All September 2016

Produce pilot report and disseminate to key stakeholders

X All September 2016

Objective 2: To closely collaborate with demand-side MNCH implementers and health care providers to ensure integration with existing MNCH service delivery platforms Hello Mama seeks to avoid a situation where demand for quality services is generated, only to have facilities be unprepared to receive a greater volume of clients or to enroll women in the Hello Mama service. Activities under Objective 2 aim to ensure that the continuum of care is upheld between supply- and demand-side interventions, and that Hello Mama activities are closely linked with MNCH service delivery platforms in focus states. Activities: 2.1 Training/Orientation of Health Workers 2.2 Supportively supervise Hello Mama pilot sites 2.3 Monitor of Hello Mama system data for targeted assistance to pilot sites Expected Results:

Training/orientation of health workers (HWs) • Health workers in pilot sites oriented to platform

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• Health workers in pilot sites actively enrolling clients into platform • Ease of registration/integration into workflow and usability qualitatively easy to use, as defined by survey of subset of HWs

Supportive supervision by USAID implementing partners • Hello Mama included in supportive supervision checklists for Pathfinder and MCSP/Jhpiego at pilot facilities • Supportive supervision visits to Hello Mama pilot sites carried out Monitoring of Hello Mama system data for targeted assistance to pilot sites • Hello Mama system dashboard monitored for rapid decision making • Service statistics made available to key stakeholders at the facility level



Objective 2. To closely collaborate with demand-side MNCH implementers and health care providers to ensure integration with existing MNCH service delivery platforms

2.1 Train/Orient Health Workers in Ebonyi and Cross River

Training of health workers for enrollment of clients into Hello Mama system

Develop orientation materials for health workers conducting registration

X X Praekelt May 2016

Training of trainers: Hello MAMA partners trained on the registration materials so they can train health workers in their respective areas


Partners train X health workers in Ebonyi X MCSP/Jhpiego June 2016

Partners train X health workers in Cross River X Pathfinder June 2016

2.2 Supportively supervise Hello Mama pilot sites

Hello Mama included in routine facility-based supportive supervision checklists

Hello Mama included in supportive supervision checklists for MCSP pilot sites in Ebonyi

X MCSP/Jhpiego June 31, 2016 These can be a supplement to existing supportive supervision checklists

Hello Mama included in supportive supervision checklists for Pathfinder pilot sites in Cross River

X Pathfinder June 31, 2016

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Supportive supervision visits carried out routinely

Supportive supervision carried out in MCSP pilot sites in Ebonyi X MCSP/Jhpiego July 1 – September 30, 2016

Supportive supervision carried out in Pathfinder pilot sites in Cross River

X Pathfinder July 1 – September 30, 2016

2.3 Monitor Hello Mama system data for targeted assistance to pilot sites

Weekly check-ins on Hello Mama dashboard to view enrollment at pilot sites

Check in on system data for Ebonyi sites X MCSP/Jhpiego July 1 – September 30, 2016

Check in on system data for Cross River sites X MCSP/Jhpiego July 1 – September 30, 2016

Weekly M&E team and pilot implementation team calls

Review system data and discuss action for any outliers or low service statistics

X X MCSP/Jhpiego, Praekelt, Pathfinder July 1 – September 30, 2016

Objective 3: To build upon and link Hello Mama data systems with existing electronic and paper-based data collection to improve health information systems Activities: 3.1 Finalize control interface/dashboard for Hello Mama platform 3.2 Analyze possible interoperation between Hello Mama platform and DHIS2 Expected Results: Control interface/dashboard operational and usable to collect system M&E data

• Requirements for dashboard aligned with project M&E plan • Data elements incorporated into dashboard for near real-time monitoring

Analysis of interoperation between DHIS2 and Hello Mama control interface complete

• Currently submitted DHIS2 forms reviewed and aligned with Hello Mama control interface if possible • Documented analysis of potential for interoperability with DHIS • If relevant, documented scope of work/requirements document for PY3 in order to complete interoperation or data sharing with DHIS



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Objective 3. To build upon and link Hello Mama data systems with existing electronic and paper-based data collection to improve health information systems

3.1 Finalize control interface/dashboard for Hello Mama platform

Functional control/interface dashboard for pilot phase of Hello Mama

Based on indicators for project monitoring plan, complete requirements for Hello Mama control interface and dashboard (including data that must be collected by system for monitoring)

X X Praekelt March 2016

Incorporation of new requirements into dashboard and finalization for partner review and pilot phase


3.2 Analyze possible interoperation between Hello Mama platform and DHIS2

Perform analysis of possible avenues for interoperability between DHIS2 and Hello Mama platform

Review DHIS2 forms currently submitted for MNCH and overlap with Hello Mama data

X X Praekelt, Pathfinder, MCSP September 2016

Identify areas for direct submission of data or exportable reporting, based on Nigeria HIS and South Africa MAMA experience

X X Praekelt, Pathfinder, MCSP September 2016

If relevant, develop requirements document for elements that must be developed/built out of dashboard/control interface for interoperation with DHIS2

X X Praekelt September 2016

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MONITORING & EVALUATION ACTIVITIES In PY1, partners collaboratively developed an overall M&E Plan which included an M&E Framework and Logic Model. The M&E Plan was largely illustrative. At the beginning of PY2, partners developed a program monitoring and performance plan, linked closely with both the planned activities for PY2, the project objectives, and, importantly, designed to reflect the actual “dose” of knowledge will focus on testing the program strategies, components and systems with a long term view for overall programmatic decision-making, learning and reporting that can be applied to the full implementation of the program. PY2 will also include testing of the various M&E components and systems: the methodologies and technological features used to gather, analyze and share data with program partners and managers. Monitoring & Program Learning In PY2, Hello Mama implementation will focus on the pilot implementation and testing the programmatic components and systems designed for long-term implementation, learning and reporting. For M&E, this means identifying existing baselines (if possible) for key clinical services in pilot facilities (such as those facility-based baselines performed by MCSP and Pathfinder), identifying other supporting sources of data and aligning with the District Health Information System 2 (DHIS2), gathering user feedback, developing an integrated dashboard that combines call system data with health clinic data, and collation and analysis of key data for project managers to use for programmatic decision-making. Quantitative data gathered in Year 2 will focus mainly along the output level, focusing on outreach and enrollment strategies, the functionality of the messaging and rating systems and user-feedback results. Much of the user-feedback is expected to be qualitative, thus allowing researchers to explore issues deeper through qualitative methodologies with key user groups. Quantitative data at the clinic-level will be assessed for data quality to determine its reliability to serve as a baseline for uptake of key MNCH clinical services. Assessing the quality of clinical and messaging data in Year 2 will also be crucial for informing the Steering Committee on evaluation study design options. The Program Monitoring and Performance matrix is attached in Annex 1. Evaluation & Research The Hello Mama team is enthusiastic to potentially be able to contribute to the burgeoning evidence based surrounding mobile messaging for MNCH demand generation. It is unclear yet whether or not the funding will be available to perform a rigorous program evaluation. Nevertheless, the M&E team is planning for such an evaluation as part of our overall M&E approach, and will scale back our approach as necessary pending availability of funding. These evaluation and research preparatory activities are reflected below. These options for evaluation will be presented to the funders and management committee on one of the regular Hello Mama funder check-ins and management committee calls. EXPECTED RESULTS

· Testing programmatic strategies, components, and systems in the pilot will inform program learning and improvements for the full project roll out. Expected results in Year 2 include: • Identified baseline data sources from existing data for key clinical services in pilot facilities; • Dashboard that integrates clinical data, call messaging and rating metrics; • Program data management and reporting systems functional; • Data informs program strategies and improvements for full implementation; • M&E Plan is revised in accordance with programmatic improvements and shifts

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• Draft evaluation protocol completed and submitted to local and US-based Institutional Review Board authorities and USAID/Washington for review


J&J-funded

RESPONSIBLE EXPECTED COMPLETION

M&E Planning Finalize M&E Framework (Result Framework)

X All March 2016

Develop and finalize operational definitions of indictors and reporting flow.

X All March 2016

Develop and finalize Performance Monitoring Plan

X All May 2016

Develop reporting templates X All May 2016

Finalize indicators for pilot X All May 2016

Research preparation

Develop research protocol X HealthEnabled February 2016

Review of research protocol by relevant partners

X Pathfinder, MCSP February 2016

Submit research plan to National Hospital Ethical Board, Nigeria

X Pathfinder April 2016

Submit research protocol to USAID/W for review/feedback

X MCSP April 2016

Submit research plan to JHSPH PHIRST for human subjects

X X Pathfinder/MCSP Early April 2016

MANAGEMENT PLAN Management Jhpiego leads the MCSP MNH program in Nigeria and provides technical leadership for maternal health and family planning. While largely autonomous, the MCSP Hello Mama will be co-located with the MCSP MNH program, and will therefore have its administrative home there. The main MCSP country office, where Hello Mama staff will be located, is in Abuja, Federal Capital Territory. MCSP MNH has one satellite program office in each of the program-focused states, Kogi and Ebonyi. Since Kogi and Ebonyi are focus areas for Hello Mama, these state MCSP offices and MCSP’s relationships there will be leveraged as pilot roll-out begins in Ebonyi and continues into Kogi in PY3. The Hello Mama team will sit together in the federal office under the administrative direction of the Jhpiego Country Director. The team will also report on a technical and programmatic level to an MCSP headquarters ICT4D advisor. Selected MCSP headquarters staff will continue to participate in annual planning and program review meetings in Nigeria and the design and implementation of the program’s learning activities. Others will provide short-term technical assistance (STTA) as needed e.g. for quality of care approaches and design/implementation of learning agendas. In addition to MCSP-MNH, the MCSP Hello Mama program will continue to coordinate with the other MCSP programs operating in Nigeria (MCSP-RI and MCSP-Child Health). In addition to other MCSP

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projects, Hello Mama will all ensure continued collaboration with other new and existing USAID projects working in Kogi and Ebonyi. Staffing The Hello Mama partners in Nigeria have highly qualified and experienced management and technical team in place already for project implementation l, but additional recruitment of staff is necessary at MCSP in order to support coordination of the project after the transition to MCSP coordination. The organogram below gives an overview of the main MCSP/Hello Mama staffing structure without including all of the support staff who also play critical functions. Three MCSP staff are being hired specifically to support coordination and leadership of the Hello Mama project. USAID Nigeria has approved the job descriptions and hiring of these positions. Project Director: The Hello Mama Project Director provides vision, leadership, and direction to ensure the strategic, programmatic, technical, and financial integrity of the Hello Mama project. As Hello Mama is a unique project, functioning largely autonomously but co-located with MCSP MNH, the Project Director will have an administrative home in MCSP MNH, but will also report directly to and be overseen closely by headquarters eHealth technical staff (ICT4D Advisor) for technical quality. Senior Program Officer: The Hello Mama Senior Program Officer report to the Project Director. S/he will manage day-to-day operation of program activities for Hello Mama. Working closely with the Project Director, the Senior Program Officer will provide strategic, technical and programmatic oversight for the design, development, and implementation of the project. Program Assistant: The Hello Mama Program Assistant will report to the Senior Program Officer and provide day-to-day support for project and office operations to ensure smooth running of all administrative functions of the project.

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Figure 1. High Level Hello Mama Key Staff Organizational Diagram

Reporting MCSP Hello Mama will adhere to USAID/Washington’s reporting requirements and, within the resources available, will provide timely responses to all requests for information from USAID/Nigeria. MCSP’s reporting requirements normally include: quarterly progress updates and pipeline reports, semi-annual and annual progress reports, and end of program reports. Indicators and other reporting requirements will be specified in the Performance Monitoring Plan (PMP). Branding MCSP operates (or will operate) in Nigeria as a single entity. Partners, including the MCSP lead partner, will use the MCSP name exclusively and follow USAID’s branding guidelines in all instances. When referred to in publications and in presentations, MCSP and the MCSP staff will be referred to as “USAID’s Maternal and Child Survival Program “or USAID’s MCSP”. MCSP’s overarching branding plan is available upon request.

SHORT TERM TECHNICAL ASSISTANCE

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Who What When Duration of Trip

External Technical Assistance Sarah Searle, ICT4D Advisor, MCSP

Provide technical and programmatic oversight and guidance to Hello Mama during the transition and during roll-out. Assist with hiring and on-boarding Hello Mama MCSP staff. Liaise with USAID Nigeria to assist in transition.

November 2015 January 2016 July 2016 September 2016

2 weeks each trip

Marion McNabb, Senior mHealth Advisor, Pathfinder

Provide technical and programmatic oversight and guidance to Pathfinder Hello Mama during the transition and during pilot roll-out. Advise on monitoring and evaluation and integration with Nigerian health information systems.

January 2016 July 2016

2 weeks each trip

Camille Collins-Lovell, Senior Community Engagement Advisor, Pathfinder

Provide inputs to content localization and pre-testing process. Liaise with in-country Hello Mama team to guide planning for pilot implementation.

April 2016 2 weeks each trip

Jacqui Watson, Service Designer, Praekelt Foundation

Communicate Hello user acceptability and pilot evaluation feedback to engineers to integrate into technology platform. Lead user acceptability testing of technology platform. Perform focus group discussions during pilot to inform further program rollout.

April 2016 August 2016

2 weeks each trip

Janie Smit, Project Manager, Praekelt Foundation

Assist with user acceptability testing of platform. Provide administrative support on the ground to day-to-day operations of user acceptability testing and focus group discussions.

April 2016 August 2016

2 weeks each trip

Coordination & Governance As described in the PY2 Phase 1 transition section, the Hello Mama day-to-day management and governance structure has changed in PY2. A description of these committees and task teams appears in the table below.

Management/Coordination Committee: Meets quarterly. A senior management body, this committee guides coordination across the implementing partners. The Management Committee will sign off on decisions that require approval beyond the task teams and serve in an advisory capacity for the implementing teams.

Pilot Implementation Team: The Pilot Implementation team contains representatives from content, technology, and project management work streams to coordinate operations leading up to the pilot launch and after. From February to September 2016, this group will meet weekly in-person or via teleconference to update each other on

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ongoing workplan activities, plan joint activities, and address any ongoing issues or challenges.

M&E Team: The M&E Team contains representatives from the lead M&E partner, Pathfinder, as well as representatives involved in M&E activities from MCSP/Jhpiego and Praekelt Foundation. The M&E team will meet weekly from February to September 2016 to discuss the development of the project monitoring and performance plan, development of research agenda, and advising on the data that will be captured by the technology dashboard and able to be viewed in near time. The M&E team will also take the lead with assessing how to not duplicate health information systems within Nigeria and to strengthen them through the project.

Funder Check-In Call: While not a formal coordinating group, the implementing partners decided to facilitate a regular funder check-in call in order to keep funders (USAID and J&J) up to date on project progress.

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ANNEX 1. PROGRAM MONITORING AND PERFORMANCE PLAN INDICATOR MATRIX The indicator matrix for the program monitoring and performance plan appears below. Due to the nature of our cloud-based data system, these indicators will be monitored at the frequency listed, but will not necessarily be reportable to USAID with that frequency, as it is a large amount of indicators. The matrix contains some indicators that may require an active data collection via interview or survey to assess; PY3 funding levels and research protocol development (ongoing) will determine feasibility of interview and/or phone survey based data collection. These indicators are more relevant to potential evaluation and research, and will not be reportable in quarterly reports.

INDICATOR DEFINITION/ CLARIFICATION Data Source Frequency Responsible Party

Intermediate Result 1: Operational, scalable platform that makes age- and stage-based mobile messages/content available to the target population

1. Number of health facilities enrolling women in the Hello Mama service

Numerator: # health facilities that have enrolled women in the Hello Mama service during the reporting period

Numerator: System Denominator: None

Qtrly/ Annual

Praekelt

2.Percentage of selected health facilities that enrolled women

Numerator: # of health facilities that enrolled pregnant women and new mothers during the reporting period Denominator: Total # of health facilities selected to enroll women in the last quarter X 100

Numerator: System Denominator: Selected project estimates

Qtrly/ Annual

Praekelt Pathfinder/ MCSP

3.Cumulative number of Hello Mama subscribers

Numerator: # of subscribers to date. This number includes subscribers who may have deregistered.


Qtrly/ Annual

Praekelt

4.Number of currently enrolled Hello Mama subscribers

Numerator: # of subscribers (pregnant women, new mothers and gatekeepers) who are currently enrolled as at the end of the reporting period Denominator: None Disaggregated by pregnant women, gatekeepers, new mothers,


Qtrly/ Annual

Praekelt

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5.Number of new registrations in last quarter

Numerator: # new subscribers (pregnant, new mothers, gatekeepers) who registered during the reporting period Denominator: None Disaggregated by pregnant women, new mothers, gatekeepers


Qtrly/ Annual

Praekelt

6.Number of health workers enrolling women in the Hello MAMA service

Numerator: Number (and cadre) of health workers enrolling women in Hello Mama service Denominator: None Disaggregated by cadre of health worker (CHEW, nurse, midwife)

Numerator: System data Denominator: None

Qtrly/ Annual

Praekelt

7.Proportion of currently enrolled subscribers by type

Numerator: # of pregnant women, new mothers and gatekeepers that are currently enrolled as at the end of the reporting period Denominator: Total # of currently enrolled subscribers as at the end of the reporting period X 100 Disaggregated by pregnant women, new mothers, gatekeepers

Numerator: System Denominator: System

Qtrly/ Annual

Praekelt

8.Percentage of estimated number of pregnant women enrolled as subscribers

Numerator: # of pregnant women currently enrolled as subscribers as at the end of the reporting period Denominator: Total # of estimated pregnant women in the catchment area during the eporting period X 100

Numerator: System data (with pull in of population estimates) Denominator: Estimated population data

Qtrly/ Annual

Praekelt Pathfinder & MCSP

9.Percentage of estimated number of new mothers enrolled as subscribers

Numerator: # of new mothers enrolled as subscribers during the reporting period Denominator: Total # of estimated new mothers in the catchment area in the last quarter X 100

Numerator: System data (with pull in of population estimates) Denominator: Estimated population data

Qtrly/ Annual

Praekelt Pathfinder & MCSP

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10.Percentage of subscribers who discontinued the service

Numerator: # of subscribers who opted out during the reporting period Denominator: Total # of subscribers in the last quarter X 100 Disaggregated by pregnant women, new mothers, gatekeepers and reason why subscriber discontinued

Numerator: System data Denominator: System data

Qtrly/ Annually

Praekelt

11. Percentage of SMS delivery failure

Numerator: # of SMSs which permanently failed Denominator: Total # of SMSs supposed to be delivered in the last quarter X 100


Qtrly/ Annually

Praekelt

12.Percentage of failed SMS Delivery

Numerator: # of SMS which permanently failed during the reporting period Denominator: Total # of SMS sent in the last quarter X 100


13.Percentage outbound dials not successfully delivered (OBD cut off rate)

Numerator: # of OBD calls NOT delivered to all subscribers Denominator: Total # of OBD calls supposed to be delivered X 100


Qtrly/ Annually

Praekelt

14. OBD call completion Numerator: average call time Denominator: average total length of voice recordings (including the jingle recording) in the last quarter X 100 Disaggregated by proportion of message listened to (0%, 1- 25%, 26 -50%, 51-75%, 76-100%)


Qtrly/ Annually

Praekelt

15.Percent of subscribers surveyed who express high satisfaction with the Hello Mama Services

Numerator: Total # subscribers surveyed who report high satisfaction with Hello Mama service Denominator: Total # subscribers surveyed X 100 Disaggregated by service rating levels and categories and reasons for satisfaction and/or dissatisfaction

Numerator: Phone or USSD survey Denominator: Phone or USSD survey

Periodic (min. 2X per year)

Praekelt

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16.Percentage uptime of JSbox applications

Numerator: The length of time each of the JSbox applications are running Denominator: The total length of time each of the JSbox applications should be running


Qtrly/ Annually

Praekelt Foundation

intermediate Result 2: Improved MATERNAL health knowledge, adoption of healthy MATERNAL practices and increased use of MATERNAL l health services among Hello Mama pregnant subscribers and gatekeepers Improved knowledge of MATERNAL health practices/services 17. Percent of pregnant subscribers who report maternal danger signs (3) and know that these warrant a visit to health facility. Vaginal bleeding, high fever, or sharp abd pain seizures, leaking of fluid, headache and blurred vision)

Numerator: # of pregnant subscribers who could name 3 danger signs that indicate that they should immediately go to the health facility Denominator: Total # of pregnant subscribers who responded to the survey x100

Survey

Baseline & 1 X per year

Pathfinder- develops survey questions, Praekelt may do the phone survey

18.Percent of pregnant subscribers who report that they should attend 4 ANC visits during pregnancy

Numerator: # pregnant subscribers who report that they should attend 4 or more ANC visits during pregnancy Denominator: Total # of pregnant subscribers who responded to the survey X 100

Survey Baseline & 1 X per year

Pathfinder

19.Percent of pregnant subscribers who report the services that they should receive during ANC visits Specific services: HIV test; IFA; proteinuria test

Numerator: # subscribers surveyed who could name 3 or more services that they should receive during ANC visits Denominator: Total # of subscribers who responded to the survey X 100 Disaggregated by number and type of services identified (spontaneously and then when prompted)

Numerator: Survey Denominator: Survey


Pathfinder & MCSP

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20.Percent of pregnant subscribers surveyed who report benefits of facility birth over home birth Cleanliness/infection, trained doctors/nurses who can help if there are complications in labor/delivery, etc.

Numerator: # pregnant subscribers surveyed who name 2 or more benefits of facility delivery Denominator: Total # of pregnant subscribers who responded to the survey X 100 Disaggregated by number/ type of benefits identified (spontaneously and then when prompted)



Pathfinder & MCSP

21.Percent gatekeeper subscribers who report why a facility birth is safer than a home birth

Numerator: # gatekeeper subscribers who could name 2 benefits of facility delivery Denominator: Total # of gatekeeper subscribers who responded to the survey x100



Pathfinder

22.Percent of pregnant subscribers who report why pregnant women should sleep under bednets

Numerator: # pregnant subscribers who could name 2 reasons why pregnant women should sleep under bednet to prevent malaria Denominator: Total # of subscribers surveyed X 100



Pathfinder

23.Percent pregnant subscribers who report the importance of eating a diverse diet (more nutritious food) Knows that eating a variety of foods including meat, fish and plenty of fruits and vegetables is best for mother and baby.

Numerator: # pregnant subscribers surveyed who could reported that eating more food and having more variety was good during pregnancy Denominator: Total # of pregnant subscribers surveyed X 100 Disaggregate by subscribers reporting a more diverse diet and/or eating more food as good during pregnancy



Pathfinder

Improved adoption of healthy MATERNAL at home practices

24.Percent of pregnant subscribers who report that they arranged for delivery at a facility (e.g. saving, transportation)

Numerator: # pregnant subscribers surveyed who reported that they arranged (saving, transport) to deliver at a facility Denominator: Total # of pregnant subscribers surveyed X 100



Pathfinder

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25.Percent of gatekeeper subscribers who report that they arranged for delivery at a facility (e.g. saving, transportation)

Numerator: # gatekeeper subscribers who report that they arranged (saving, transport) to deliver at a facility Denominator: Total # of gatekeepers subscribers surveyed X 100



Pathfinder & MCSP

26.Percent of pregnant subscribers who report that they slept under a bed net in the previous night.

Numerator: # pregnant subscribers surveyed who reported that they slept under a bed net in the last 24 hours Denominator: Total # of pregnant subscribers surveyed X 100

Numerator: Survey Denominator: Survey data


Pathfinder & MCSP

Increased use of key MATERNAL health services (Antenatal care, skilled delivery, post-natal care)

27. Percent subscribers who report that they took IFA pills

Numerator: # pregnant subscribers who report that they took IFA during pregnancy Denominator: Total # of pregnant subscribers surveyed X 100



Pathfinder & MCSP

28.Percent subscribers who report that they received at least 2 doses of TT

Numerator: # of subscribers who [report that they] received 2 or more doses of TT Denominator: Total # of subscribers surveyed X 100 Disaggregate by number of TT doses received

Numerator: Survey data Denominator: Survey data


Pathfinder & MCSP

29.Percent pregnant subscribers who report that they were tested for HIV (compared to DHIS2)

Numerator: # of subscribers who report that they were tested for HIV during ANC Denominator: Total # of subscribers surveyed X 100



Pathfinder & MCSP

30.Percent pregnant women tested for HIV in the same facilities where pregnant women are enrolled in Hello Mama

Numerator: # of pregnant women who received HIV test during ANC in the last quarter Denominator: Total # of pregnant women in the catchment area in the last quarter x 100

Numerator: DHIS2 Denominator: DHIS2


Pathfinder (Cross River)& MCSP (Ebonyi/Kogi)

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31.Percent of pregnant subscribers who report that they attended 4 ANC visits

Numerator: # of subscribers who report that they received 4 ANC or more visits during their pregnancy Denominator: Total # of subscribers surveyed X 100


Baseline & 1 X per year or

Pathfinder & MCSP

32.Percent new mother subscribers who report that they delivered in a health facility (self-report) compared to the service changes

Numerator: # of new mother subscribers who report that they delivered in a health facility Denominator: Total # of subscribers survey X 100



Pathfinder & MCSP

33.Percent facility deliveries where pregnant women are enrolled in Hello Mama

Numerator: # of deliveries taken by a skilled birth attendant in supported facilities in the last quarter Denominator: Total # of expected deliveries in the catchment area in the last quarter X 100




34.Percent subscribers who report that they went for post-natal care to a health facility

Numerator: # of subscribers who report that they went for post-natal care to a health facility Denominator: Total # of subscribers surveyed X 100 Disaggregate by number of days after delivery (1 day, 3 days, >7 days) .



Pathfinder & MCSP

35.Percent women who received PNC visit (WHEN???) in facilities where pregnant women are enrolled in Hello Mama

Numerator: # of women who had post-natal clinic visits within 7 days of delivery in a health facility in the last quarter Denominator: Total # of expected deliveries in the catchment area in the last quarter x 100


Qtrly/ Annually


36.Percent subscribers who report that they received a modern family planning method at facility

Numerator: # of subscribers who report that they received family planning modern method Denominator: Total # of subscribers surveyed X 100

Numerator: Survey data Denominator: Survey data/


Pathfinder & MCSP

38


37.Percent change in FP coverage in facilities where women are enrolled in Hello Mama

Numerator: # new family planning acceptors in the health facility in the last quarter Denominator: Total # of WRA women in the catchment area


Qtrly/ Annually


Intermediate Result 3: Improved NEWBORN (0-28 days) health knowledge, adoption of healthy NEWBORN practices and increased use of NEWBORN services among Hello Mama subscribers

Improved knowledge of NEWBORN health practices/services 38.Percent of subscribers who report why it is important to give colostrum: know that colostrum or first milk protects newborn from disease and shouldn’t be discarded

Numerator: # of subscribers surveyed who report why it is important to give colostrum Denominator: Total # subscribers surveyed X 100



Pathfinder

39.Percent of subscribers who report how to do proper cord care Know to keep stump clean and dry, not to apply any other substance, except chlorhexidine if provided.

Numerator: # of subscribers surveyed who report proper cord care-- how to keep stump clean and dry and use chlorhexidine Denominator: Total # subscribers surveyed X 100



Pathfinder

40.Percent of subscribers who report importance of immunizations at birth or soon after for baby

Numerator: # of subscribers surveyed who report importance of immunization at birth or soon after for baby Denominator: Total # subscribers surveyed X 100



Pathfinder

Improved adoption of healthy NEWBORN practices 41.Percent of subscribers who report feeding their babies colostrum at birth

Numerator: # of subscribers surveyed who report only giving their babies colostrum at time of birth Denominator: Total # subscribers surveyed X 100



Pathfinder

39


42.Percent subscribers who report that they applied chlorhexidine to the cord

Numerator: # of subscribers surveyed who report that they applied chlorhexidine to their babies umbilical cord Denominator: Total # subscribers surveyed X 100 Disaggregated by home and facility birth



Pathfinder

Increased use of key NEWBORN health services 43.Percent subscribers who report that they brought their babies for a postnatal care visit (WHEN)

Numerator: # of subscribers who report that they brought their babies for postnatal care visit (WHEN??) Denominator: Total # of subscribers surveyed X 100 Disaggregate by number or days after delivery (1 day, 3 days, more than 7 days)



Pathfinder

44.Percent subscribers who report that their babies received BCG at birth

Numerator: # of subscribers who report that their babies received BCG at birth Denominator: Total # of subscribers surveyed X 100



Pathfinder & MCSP

Intermediate Result 4: Improved CHILD (1-12 months) health knowledge, adoption of healthy CHILD practices and increased use of CHILD services among Hello Mama new mothers subscribers and their gatekeepers

Improved knowledge of CHILD health practices 45.Percent subscribers who report the advantages of spacing pregnancies by 2 years Note: Current FP message content does not indicate: 1) Most FP methods safe to use while breastfeeding; 2) Most FP methods can be started soon after delivery, or while at facility for delivery

Numerator: # of subscribers surveyed who report at least one advantage to suing a family planning method to space for 2 years Denominator: Total # subscribers surveyed X 100 Disaggregate by number of advantages reported.



Pathfinder & MCSP

46.Percent subscribers surveyed who report how to prevent/treat diarrhea Hand

Numerator: # of subscribers who report 2 or more ways to prevent/treat diarrhea

Numerator: Survey data


Pathfinder & MCSP

40


washing, breast feeding, boiled water, going to facility, ORS/Zinc

Denominator: Total # subscribers surveyed X 100 Disaggregate by number of ways to prevent diarrhea reported.

Denominator: Survey data

Improved adoption of healthy CHILD practices 47. Percent subscribers surveyed who report exclusively breast feeding for 6 months

Numerator: # of subscribers who report only exclusively breastfeeding their baby for 6 months Denominator: Total # subscribers surveyed X 100



Pathfinder & MCSP

Improved use of CHILD health services

48.Percent subscribers surveyed who report that their infants completed immunizations at one year (BCG, 3 x Pentavalent)

Numerator: # of subscribers [who report that their] infants received all immunization doses by age one Denominator: Total # of subscribers surveyed and/or tracked by facility in aggregate or CommCare as individuals X 100 Disaggregate by which immunizations were received.

Numerator: Survey data/ DHIS2/ CommCare Denominator: Survey data/ DHIS2/ CommCare

Baseline & 1 X per year or on a routine basis

Pathfinder & MCSP

49.Percent of babies who completed immunization by one year in facilities where new mothers are enrolled in Hello Mama

Numerator: # of babies who are fully Immunized before one year of age Denominator: Total # of babies under the age of one year catchment area

Numerator: DHIS2 Denominator:

Qtrly/ Annually

Pathfinder (Cross River)& MCSP (Ebonyi/Kogi

program year 2 implementation plan - united states agency

Documents