presenter: chris smith, motif lead investigator, msic
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MOTIF: MObile Technology for Improved Family Planning Mobile phone-based support for PAFP in Cambodia. Presenter: Chris Smith, MOTIF Lead Investigator, MSIC Contributors: Thoai Ngo, Judy Gold, Uk Vanak, Ly Sokhey, Caroline Free. Challenge: low uptake of PAFP and repeat abortion. Abortion - PowerPoint PPT PresentationTRANSCRIPT
Promising Innovations to Improve PAFP Women Deliver 2013
MOTIF: MObile Technology for Improved Family PlanningMobile phone-based support for PAFP
in Cambodia
Presenter: Chris Smith, MOTIF Lead Investigator, MSIC
Contributors: Thoai Ngo, Judy Gold, Uk Vanak, Ly Sokhey, Caroline Free
Promising Innovations to Improve PAFP Women Deliver 2013
Challenge: low uptake of PAFP and repeat abortionAbortion44 million/year, 50% unsafe, 47K maternal deaths (Sedgh 2011)
Low uptake of PAFPNo method 32%, condom 24%, pill 20%, injectable 11%, IUD 5%, implant 5% (MSIC data 2011)
Repeat abortion25% repeat abortion within 5 years (CDHS 2010)
4% return to the same MSIC clinic within 1 year (MSIC data 2012)
Repeat abortion negative health outcomes (Curtis 2010)
PAFP interventions are important to reduce repeat abortion
Promising Innovations to Improve PAFP Women Deliver 2013
What are the opportunities for mHealth?
Of the world’s estimated 7 billion, 6 billion have access to mobile phones
In CambodiaMobile Phone access:
->80% of MSIC clients provided a mobile number
-As over 50% of clients (many from rural areas) don’t return to the clinic post-abortion, opportunity to maintain contact
Promising Innovations to Improve PAFP Women Deliver 2013
Hypothesis: adding mobile support to the continuum of PA care can increase PAFP
OpportunitiesoInformationoRemindersoSupport (e.g. SE’s)
OpportunitiesoBuild on success in PAFP counselingoWide range of methods available
Beyond the FacilityAt the Facility Level
Promising Innovations to Improve PAFP Women Deliver 2013
MOTIF programme intervention
MSI Innovation Fund
•October 2012 – December 2013
•Develop, implement and evaluate a mobile phone-based intervention to support PAFP in Cambodia
•Piloted in 4 MSIC clinics
Promising Innovations to Improve PAFP Women Deliver 2013
Formative research to understand the local context
Interviews/focus groups:
Difficult to make PAFP choices at the time of abortion
Concerns about side-effects, want to complete abortion first, need to discuss with husband
Limited literacy, simple phones, prefer to talk
Women prefer voice message to SMS
Promising Innovations to Improve PAFP Women Deliver 2013
Overview of intervention developed
Provider Client
Service provided for 3 months after which client continue to receive standard care
VM every 2 weeks
Pill/appointmentreminders
Client can call in
+/- follow up phone call
MOTIF: Mobile Technology for Improved Family Planning
Promising Innovations to Improve PAFP Women Deliver 2013
Voice message as conduit for additional support
“Hello, this is a voice message from a Marie Stopes counsellor. I hope you are doing fine. Contraceptive methods are an effective and safe way to prevent unplanned pregnancy. I am waiting to provide free and confidential contraceptive support to you”.
Press 1 if you would like me to call you back to discuss contraception.
Press 2 if you are comfortable with using contraception and you do not need me to call you back this time.
Press 3 if you would prefer not to receive any messages again”
Promising Innovations to Improve PAFP Women Deliver 2013
Mixing medical services with technology
http://instedd.org/blog/marie-stopes-verboice-will-mobile-phones-improve-contraceptive-use-in-cambodia/
Promising Innovations to Improve PAFP Women Deliver 2013
Randomised controlled trial overview
Promising Innovations to Improve PAFP Women Deliver 2013
Preliminary Results (using intervention data) PAFP (pill, injection,
IUD, implant) increase from 33-56%
Uptake new methods, support SE’s for existing users (continuation and safe method switching)
Post-abortion support (medical/emotional)
12% cancel 4% cannot contact
Promising Innovations to Improve PAFP Women Deliver 2013
Next steps• Optimise registration process
− Client sign up• Increase automation
− Automatically schedule VMs and redial
• Improve content & delivery− Add SMS option / APP?− Adjust number of VMs
• Offer service in different settings− Private clinics/MOH
• Financial sustainability− Fee for service?− Revenue sharing/sponsorship− eVouchers
Promising Innovations to Improve PAFP Women Deliver 2013
Thank you!
If you are interested to learn more about this project, or in funding thenext phase, please get in touch: [email protected]
Contributors:
•Thoai Ngo, Judy Gold, Uk Vannak, Ly Sokhey, Caroline Free
•MSI Cambodia, Innovation and Best Practice & Research Monitoring and Evaluation team MSI
Promising Innovations to Improve PAFP Women Deliver 2013
SIM card switching
Phone sharing
Competition with commercial spam
Timing of VMs
Clients busy
Reaching out to youth/students/EWs
Challenges
Promising Innovations to Improve PAFP Women Deliver 2013
Response to VM: first 100 clients
Promising Innovations to Improve PAFP Women Deliver 2013
Appendix: Conceptual framework
Promising Innovations to Improve PAFP Women Deliver 2013
Different categories of clients?
Urban youth, literate,
confidentiality important?
Urban youth, literate,
confidentiality important?
Rural, limited literacy, married,
disclosed to others re
abortion?
Rural, limited literacy, married,
disclosed to others re
abortion?
VoiceVoiceSMS / App?SMS / App?