In Cambodia, How Voice Messages Improve Newborn’s Health

This is an unedited interview with Tracy Yuen, a Maternal and Child Health Program Manager at People In Need (PIN).

Could you describe the work of People in Need in Cambodia?

Photo courtesy of People in Need

People in Need Cambodia is a diverse organization. We have programs in health, livelihoods strengthening, disaster resilience, and urban poverty reduction and have been operating in Cambodia since 2008. Within the health program we work mostly in maternal and child health and nutrition through capacity building of midwives, community level health promotion and our Village Baby Care mHealth service. We work in several provinces and try to focus on improving the lives of those most in need.

Could you please tell me about People In Need’s project that helps Cambodian young mothers and pregnant women using the mobile technology?

Our most innovative and interesting program at the moment is related to mHealth. The Village Baby Care service uses a normal mobile phone to deliver health related voice messages directly to our target audience, the mothers of new babies, with message topics such as breastfeeding, cord care and recognizing danger signs. It has been operating in Kampong Chhnang province since 2013 and we have seen some great results so far in mothers improving their health knowledge and practices. In our next phase, we will expand the program to include pregnant women and mothers of children up to 2 years old that will contain many more interesting and helpful topics. It will be launched later this year as the “Healthy Family Community”.

What are some of the key technologies being used for this project?

The whole service is currently built on InSTEDD’s Verboice platform with help from Open Institute to develop and set up the right call flows. It is an IVR (interactive voice response) platform that lets users interact with the system through voice and the keypad.

Why voice message as an integral part of this project?

Voice messages are a key to the success of the program. In Cambodia we are faced with two problems if we want to use phones to send information. The first is that in many parts of the country, adult literacy rates are still quite low; and secondly, many phones do not support khmer text. As a result, voice messages were chosen instead of text messages, and this allows us to access almost all every woman in Cambodia.

When and how did you hear about this technology?

I heard about this technology after joining PIN in 2014.

The mHealth program had just completed its pilot phase and both InSTEDD and the Verboice platform had been a very important part of the process.

How has this technology been utilised?

When mothers are registered onto the program, their midwife needs to put their phone number into the system. They do this by calling a specific phone number and interacting with the voice prompts loaded onto Verboice. For example in the first step, the prompt will ask the midwife if they are registering on the mother’s phone (if so, it will record the calling number), or from the midwife’s phone (and it will ask her to input the mother’s phone number in the next step). Also, when we send the health messages to mothers, they can interact with voice prompts to choose to repeat the message or deregister.

Many phones do not support Khmer text. Verboice-powered voice messages allow organisation like People In Need to access almost all every woman in Cambodia.

How do you find this technology important? Why?

Verboice has been a very important technology because it automatically coordinates both the registration of mothers to the system, and also the sending of voice messages to mothers’ phones.

When we are dealing with thousands of registrations, this really simplifies the calls and makes our program possible. The platform we use has had some features customized for us by InSTEDD’s technical team which has made it much easier to use and monitor.

Could you describe the impact of this project? Can you give an example of a family who has been benefited from this intervention?

We have seen some really great results from the program so far. Our highlight was seeing that mothers using Baby Village Care took their sick babies to the health center 2.6 times more than mothers who did not. This is important because currently many mothers treat their babies at home instead of the health center and this can be more harmful than good. We also saw a 64% reduction in mothers using traditional remedies on their baby’s cord stump, a one third reduction in diarrhea with fever, and twice the number of mothers able to detect 3 or more danger signs in their baby.

We hear positive stories from the field all the time. For example, one mother Mrs Channa said that she’d learnt a lot of information on how to take care of her children from mHealth.

“I registered the service after visiting the medical center where nurses told me about it, now I get one message per week with information about hygiene, breastfeeding and child care… I have learned to wash my hands before touching the umbilical cord. And after I bath the baby, I have to make sure the cord is clean and dry. Also I learnt about the position and attachment for breastfeeding. Now I know that the baby has to have its mouth all over the nipple to make sure it´s feeding properly. Finally, I learnt how often to feed my baby”.
mHealth Intervention — Newborn Health Messaging: Case study

What are the 3 most important things to share with others who might want to implement a project using this technology?

1) make sure you have the right technology to suit your needs. Know its features and limitations and make customisations early if possible.

2) monitor your system thoroughly for bugs when you begin implementation or when you change any elements of your program. Being prepared for these things means you can detect and fix them early.

3) have the best quality content you can have. Messages need to be clear, to the point, and yet make people want to listen to them. This is something PIN has invested a lot of work into to make sure the message content is really strong.

Any plan to implement this technology in other future projects?

Yes, we will be helping our partner Magna — Children at Risk to develop a malnutrition specific mHealth service that will help mothers of children diagnosed with acute malnutrition to receive advice and treatment reminders. It will also be trialed in Kampong Chhnang this year.

To learn more about InSTEDD iLab Southeast Asia, please visit our website or follow us on Twitter: @iLabSEA.