HelloMama — From Conception to Delivery
The HelloMama Programme has been like a baby to me. This blog chronicles my excitement when it was conceived, through the process of nurturing it as a programme manager to ensure it’s safe delivery, and how I feel having to hand it over to another caregiver.
When I was a clinician in Nigeria, I had first-hand experience with losing mothers and newborns due to complications from deliveries taken by unskilled birth attendants, and from delays in accessing healthcare. Some of the root causes of these issues stem from poverty and lack of access to correct health information. HelloMama, our maternal and child health platform, fills this information gap.
The Programme started officially in October 2015 after being stalled for a few months due to a change in government and the uncertainty surrounding the fate of the then Programme lead, SURE-P MCH. At this point, we had experienced quite a number of hiccups with the technology and so the pressure was on for us to prove that we could get this voice service off the ground.
I’ve been on this Programme from the very beginning and I would often remember the excitement in the room at the kick off meeting with all the partners. Everyone was raring to go because we were glad that the GSM boom in Nigeria would finally be used to impact lives of vulnerable groups positively. Moreso, we did not have to worry about literacy levels, as we would also be providing a voice based service. So like a newly pregnant mother, filled with excitement, I ensured I did everything to nurture HelloMama.
I quickly found that this pregnancy would be a complicated one. I was new to the technology sphere, and so I had to take my time to learn all I could about our technology, the technology terrain in Nigeria and it’s players, and also how to deal with the new partners on the Programme. The excitement of conception quickly wore off as just like the experience of morning sickness, I began to understand the challenges of voice based programmes in Nigeria. This was the first voice based platform that Praekelt would build and so there were some hiccups with initial deployment as would be expected. Also, at the initial stage, we were only able to integrate with one mobile network operator, and so in areas where that mobile operator did not have any presence, the healthcare workers would not be able to register anyone causing them to lose interest in the Programme.
After a few months, I felt the baby start to kick, and this brought renewed excitement when we successfully integrated with two more mobile operators. This greatly improved registrations by healthcare workers at the facilities, and also renewed their confidence in the programme. Another huge success was getting a dedicated shortcode for the programme, this was achieved alongside Jhpiego with the help of the Federal Ministry of Health.
The mHealth space in Nigeria is newly evolving, and so for a Programme of this scale we had assumed that we could deal with the Mobile Network Operators directly since this was a social Programme and we could negotiate a reduction in inventory costs. With each operator we approached we realized we needed to work through an aggregator to help negotiate fair tariffs and also act as our liaison. With the benefit of hindsight, This has not necessarily reduced our costs, because we still need to pay the aggregator monthly service fees as well as other incidental fees which are quite steep, but it helped ease the communication channel, and helped us get integrated on 3 out of 4 networks within 9 months. At this point, we were behind schedule on our go live date. This put additional strain and pressure on us being the technology partners. The programme eventually went live in September 2016, and after a long and challenging pregnancy, it felt really good to push out the baby.
Post September, it seemed the baby was failing to thrive. While we recorded very good success rates in the delivery of SMSs, there were complaints of most of the users not receiving their calls. We solved this problem by getting an API with our aggregator partner which tells us which calls failed due to network issues (which is out of our control), and which calls users failed to answer or rejected. Armed with this information, we worked as a consortium to increase sensitization and awareness of the programme and the shortcode to reduce the number of “no answers” and “rejected” calls. We also enhanced the system to retry unsuccessful calls up to 10 times. There were also some invalid numbers which were reported as “network failure”, these numbers were taken out of the system. Since then, we have received a lot of testimonials from the users on how the HelloMama messages have been beneficial to them. Below are some examples:
“Since I registered for HelloMama in the hospital, I have been receiving messages every week. My baby is special because I got the right information when I needed it and did not go through any stress. I will advise every pregnant woman to register for HelloMama, so they too can benefit.” — Mother, Cross River State
“There were things I didn’t know before even as a health worker. But with HelloMama messages, I have known a lot more. For instance, I didn’t know that staying close to smokes or flames is a big deal for pregnant women. Until I got a message from HelloMama that the smoke could affect the oxygen reaching the baby.” — Healthcare Worker, Ebonyi State
“I used to have leg cramps. Anytime it happened I would scream, and my husband would rub my legs but it wouldn’t really ease off. Then I got a message from HelloMama that if I had cramps, I should stretch my legs, walk around, or put my legs on a cold material. I started doing all these and they are all working for me.” — Pregnant woman, Ebonyi State
“I have 3 children and I never knew most of the things I learnt from HelloMama” — Mother, Cross River State
“I received a message saying that labour could start soon, I discovered that even when I thought that it’s not labor, it was labor, As soon as we got to the hospital, my wife delivered. Within a few minutes, she delivered!” — Father, Cross River State
“It has been an interesting experience. It’s a new innovation and it is going to help a lot of women. Incidentally I have been with her [pregnant wife] to a few antenatal and people tell you experiences that if it would not have been for the messages. The last antenatal we went to we met a lady who didn’t know her water broke. She didn’t know until she got that message. She got the message that if her water breaks she should rush to the hospital. She got to the hospital and she had no water and had to be rushed to the emergency room.” Father, Ebonyi state
We have learned many lessons and constantly ensure that we manage expectations on the client’s side, resolve issues escalated to us in a timely manner and also propose and implement enhancements to the technology, one of which is the recently developed “call back” feature that allows the users to dial a shortcode which prompts a call back with their message if they missed it. This will also help to reduce the number of “no answer” and “rejected” calls.
Slowly but surely, we have weathered the storm and it has been getting better. The number of women registered since September 2016 have grown from 1,438 unique users to 52,670. We are not completely there, but we are excited about how far we have come.
With our involvement in the programme coming to an end in September 2018, and the entire programme coming to an end in December 2018, I feel like just when my baby has started to thrive, and even taken its first steps, I am being asked to hand it over to another parent. HelloMama has the potential to scale nationally if given the right backing, and as a technology partner, we can only ensure that we handover this baby properly to it’s new parents, and hope that they allow it reach its full potential.
My highlights are:
- Successfully completing integration with 3 MNOs
- Getting a dedicated HelloMama short-code
- Going live in September 2016
- Hearing success stories on how more women are receiving their messages, and how these messages are impacting their lives positively
Read more here about lessons learned from the Mobile Alliance for Maternal Action programmes.
