On average, one in five children in Sub-Saharan Africa does not survive their first year of life
(1). Many malaria-related deaths are due to a lack of knowledge on malaria prevention or to late detection. In the slums of Yirimadjo, Mali and in Fatick, Senegal, where malaria treatment accounts for 65% of the health care demand, these factors have caused unnecessary morbidity and mortality. Pregnant women and children under the age of five comprise the bulk of these patients, as they are most vulnerable to malaria.
By making regular house-visits to check up on the health of young children and pregnant women in particular, community health workers (CHWs) play a vital role in the screening and prevention of common diseases such as malaria and diarrhoea, and encourage clients to seek care in health facilities. The
Ma Santémobile application allows CHWs to collect and share data and communicate with health centres to improve monitoring and treatment for malaria.
How the Ma Santé system works
The locally developed Mamans Mobiles contre le Malaria au Mali (MAMMA) app is a simple application based on FrontlineSMS (a free text messaging software) and pre-installed on ‘feature’
phones (low-cost mobile phones with limited web access), which are distributed to CHWs. The app consists of a questionnaire that lists various malaria-related indicators, which is filled out by CHWs during their house calls. The collected data are sent by SMS to a database with a web interface that allows the health centres in the area to monitor patients’ situation on a daily basis and respond when needed. If a patient needs treatment, the health specialist either calls or sends an SMS to the CHW, who then informs the patient and arranges for transportation by calling or texting taxi companies. The system also allows CHWs to more quickly contact health clinics for advice and to refer patients that need care. Patients are thus better able to seek timely treatment, and health specialists are better able to respond to malaria outbreaks.
Supporting national public health programming
The Ma Santé programme is working to achieve the national priorities of Mali and Senegal with respect to achieving MDGs 4 and 5.1 Since children under five and pregnant women are particularly vulnerable to malaria, the countries have developed national programmes to combat this disease.
In Mali, the Programme National de Lutte contre le Pallud (PNLP) has expressed an interest in implementing the MAMMA app in a larger number of community health centres to improve the monitoring and prevention work of thousands of CHWs. To ensure that the Ma Santé activities align with the PNLP programme, it has included representatives from PNLP in its steering group.
In Senegal, Ma Santé is integrated in a larger data collection project called Djobi, which monitors additional child health indicators. One of its partners is the Division for the Alimentation, Nutrition
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Saving the lives of mothers and children: how mobiles help to make malaria
monitoring more effective –
the Ma Santé programme
Regular house visits improve monitoring and
treatment for malaria’s most vulnerable patients
CHW arranges for a taxi via SMS to bring patients
for treatment CHWs use the pre-installed
MAMMA mobile app to record malaria-related indicators during house calls
Data are sent by SMS
to central database Local health centres monitor patients daily, signalling CHWs when patients need treatment
and Survival of Children of the Ministry of Health (MoH). In addition to this, the Réseau Africain pour l’Éducation, la Santé et la Citoyenneté (RAES), the local community health organization implementing the activities, may partner with the National Service of Sanitary Information, which is in charge of data collection within the MoH, to see whether Ma Santé or Djobi can contribute to their data collection activities.
Partnerships for support and sustainability
To make the MAMMA app ready for multi-country scale-up, the Ma Santé programme is collaborating with mobile operator Orange (Orange, Orange Mali and Orange Sonatel). Orange offers an open source platform called Emerginov, which allows talented local software developers from the Université de Gaston Berger and Ecole Supérieure Multinationale des Télécommunications in Senegal to further improve the app. They are currently working to have MAMMA run on various platforms (e.g. SMS, USSD, Speech Technology) and operating systems (e.g. Android) in order to enable other countries to use the app. If the application succeeds in both Mali and Senegal, Orange will help to introduce it in other francophone countries in Africa.
To make the MAMMA app financially sustainable, collaboration is sought with mutuelles – public-private partnerships between the health-care provider, local health organization (e.g. Muso Ladamunen), local authority and health insurance company – in both Mali and Senegal to offer micro-health insurance. This will cover the costs of periodical screening for malaria and the health specialist consultation, and it also provides a discount on malaria medication. The revenues generated by the micro health insurance will help sustain the existing mobile-enabled monitoring and prevention activities of the Ma Santé programme.
IWG catalytic grant for mHealth programme scale-up IICD was awarded a grant to scale up the use of its MAMMA app in Mali and Senegal by the United Nations Innovation Working Group’s
(IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance.
IICD was successful in the grant competition because it employs an effective delivery strategy for an evidence-based maternal and child health intervention, combined with creative financing strategies to promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5.1 Through IWG, IICD is receiving specialized assistance from WHO’s Department of Reproductive Health and Research to optimize the scale-up of its MAMMA app while contributing to the mHealth evidence base and best practices on implementation and scale-up.
Partners: IICD, Muso Ladamunen, Orange, Orange Mali and Orange Sonatel, RAES
For more information please contact: Hilde Eugelink, Community Relations Officer / Sector developer ICT4health, IICD (Heugelink@iicd.org) or François Laureys, Country Manager Mali and Burkina Faso, IICD (Flaureys@iicd.org)
References:
1. Levels & Trends in Child Mortality Report 2012: estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. New York, United Nations Children’s Fund, World Health Organization and the World Bank, 2012 (http://www.who.int/maternal_child_
adolescent/documents/levels_trends_child_mortality_2012.pdf).
Credits:
Icons from The Noun Project designed by: Matt Daigle, Sergio Luna, Jens Tärning Photo: Djoumé Diakité of Muso Ladamunen
Editing, design and layout: Green Ink (www.greenink.co.uk)
WHO/RHR/13.30 © World Health Organization, 2013
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1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www.
unmillenniumproject.org/goals/gti.htm) Regular house visits
improve monitoring and treatment for malaria’s most vulnerable patients
CHW arranges for a taxi via SMS to bring patients
for treatment CHWs use the pre-installed
MAMMA mobile app to record malaria-related indicators during house calls
Data are sent by SMS
to central database Local health centres monitor patients daily, signalling CHWs when patients need treatment
Senegal Fatick
50 000 MaliYirimadjo
50 000
Senegal / Mali
Population covered Number of CHWs trained 50
125
