FamilyConnect, a digital health platform in Uganda, has demonstrated a positive impact on maternal and child health (MCH) services, according to a recent study.
The platform was developed to address the challenge faced by mothers and their next of kin, particularly in underserved and hard-to-reach areas, who often struggle to access crucial health information and advice during the critical first 1,000 days of life.
FamilyConnect utilizes basic mobile phone technology, specifically SMS and USSD, to allow easy registration and interaction, providing pre-packaged health information relevant for this crucial period.
The study, led by Dr. Simon Ndira, aimed to assess how FamilyConnect influenced behavioral changes leading to improved uptake of MCH services and disease prevention, while also identifying contextual factors for its success. It employed a cross-sectional study design with a mixed-methods approach, combining qualitative data from Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with quantitative analysis of FamilyConnect usage statistics and routine MNH indicators.
Data was collected from 9 study sites across 42 districts and one division in Kampala Capital City where FamilyConnect was in use. At the time of the study, 73,071 women and 21,397 health workers were enrolled in the application. Retrospective data from the pre-implementation period (2017-2019) was compared with post-implementation data (2020-2022) to evaluate changes in health indicators.
The findings indicate several significant improvements. There was a 19.35% increase in total Antenatal Care (ANC) visits, rising from an average of 175,035.33 to 208,897.00.
Notably, first trimester ANC visits saw an 85.81% increase, jumping from 12,122.33 to 22,525.00, suggesting earlier engagement with care. Fourth ANC visits also increased by 25.97%.
In terms of disease prevention, the study observed a 68.79% decrease in positive syphilis testing results and a 30.46% decrease in positive ANC HIV testing results.
The platform’s benefits were widely acknowledged by users and healthcare providers. 90.8% of mothers reported that messages from FamilyConnect motivated them to seek MCH services. Furthermore, 79.5% found the application most helpful for appointment reminders, and 89.9% used it to learn about their babies’ development. Healthcare workers confirmed that the messages increased awareness among mothers about available services, promoted hygiene, encouraged seeking medical care for danger signs, and motivated hospital births.
A midwife from Kasese shared a direct testimony of the platform’s impact: “We have increased numbers of supervised deliveries, and mothers have been able to prepare for delivery in time via the messages; for example, there is a mother who received a message in the morning that she should prepare to go to the hospital for delivery, she went and bought mama kit, and in the evening she started getting labor signs, rushed to the hospital and gave birth at 9 pm, she came and gave us a testimony and she was very happy”.
A District Health Team member from Kaberamaido also affirmed, “Mothers have been able to get some information and yeah, actually that one compels them to go for ANC services and also prepare for scheduled delivery within the facilities”.
Despite these successes, the implementation of FamilyConnect faced a number of challenges. Beneficiary-related issues included a lack of phones, poor network connectivity, domestic violence, language barriers, distance to health facilities, poverty, and illiteracy among community members.
Health facilities experienced overcrowding due to increased attendance, communication gaps between staff and Village Health Teams (VHTs), limited human resources, and supervision challenges.
Systemic weaknesses of FamilyConnect included its reliance on donor funding for SMS/USSD costs, insufficient infrastructure, human resource constraints for user support and maintenance, its predominantly one-way communication design, lack of a smartphone version, and limited language options (supporting 14 of 28 gazetted national languages).
The study also noted a decrease in male partner attendance by 33.54% and Postnatal Care (PNC) attendance by 15.47%.
Lessons learned from the study emphasize that “Trust in digital health solutions is crucial for adoption” and that “Provision of information is a great asset in creating mindset change”. FamilyConnect was found to have improved information flow and the relationship between health workers and the community, while also serving as a mode of capacity building for health workers and a source of data for national planning.
To enhance and ensure the sustainability of FamilyConnect, several recommendations were put forth. These include expanding the number of languages supported, increasing efforts toward male involvement, and continuously incorporating user feedback for program optimization.
The study also recommended building the capacity of implementing teams like VHTs, providing them with financial support, and increasing facility staff. For long-term sustainability, addressing funding consistency and improving infrastructure are crucial.
Opportunities exist for FamilyConnect to interoperate with other Ministry of Health platforms, expand to cover other notifiable diseases and Non-Communicable Diseases (NCDs), and potentially leverage AI for language translation and lobby telecom companies for zero-rated USSD codes.
Further research comparing FamilyConnect districts with non-implementing districts using an RCT approach, and focusing on urban areas like Kampala, is also recommended.
