Johns Hopkins Bloomberg School of Public Health
MSPH - Global Disease Epidemiology and Control
In late August of 2014, the National Department of Health (NDOH) South Africa announced the introduction of MomConnect – the first mHealth program to be introduced at scale in South Africa and one of few globally. The goal of MomConnect is to subscribe and register 1 million women into the system over two years. MomConnect has three objectives: (1) register pregnancies in government health facilities; (2) send stage-based personalized messages to registered women; and (3) provide a forum for women to engage with the health system through help desk tools and services. The program works by having women register to receive health information on their mobile phones at the time of pregnancy confirmation. At the health facility level, nurses instruct women at the point of service to dial *134*550# to register and then answer a few basic questions about their pregnancy. At the community level, Community Health Workers (CHWs) or the women themselves may register directly to review a limited number of messages.
The University of Witwatersrand’s Reproductive Health and HIV Institute (Wits RHI) is currently evaluating the implementation of MomConnect in 2 sites in Johannesburg. JHU-GmI with support from WHO is presently supporting the conduct of an economic evaluation of MomConnect, with an emphasis on Wit RHI sites. This activity will aim to determine whether the early implementation of MomConnect is cost effective.
GHEFP Mentor/PI: Amnesty Lefevre, Assistant-Scientist, Department of International Health
My initial feelings upon descending to OR Tambo Airport were a mixture of excitement and anxiety. It was just a couple of months after an eruption of xenophobic attacks in and around the city which targeted Ethiopians like myself and other non-South African Blacks. Joburg’s notorious reputation for crime was already a cause for concern as well. But after spending a semester at the University of Cape Town the year before, I had always been determined to return to South Africa. Having fallen in love with the energy, people and culture, I was excited this time to experience the City of Gold. Like most urban cities, there are areas safer than others. I took the same street-smart precautions I would have taken anywhere else and thoroughly enjoyed my stay. I learned so much in my two months there, both in and outside of my practicum. The city is really striving to create a new image for itself, with youth at the forefront leading the charge in creating a vibrant and growing creative environment.
For my GHEFP, I was working on an economic evaluation of the mHealth program MAMA (Mobile Alliance for Maternal Action) at the Wits Reproductive Health and HIV Institute (WRHI). The MAMA program uses text-based messaging on careseeking and maternal and child health outcomes among a cohort of pregnant women and new mothers in multiple sites in the city of Johannesburg. The goal of the retrospective cost effectiveness analysis is to generate evidence on the incremental health systems costs of implementing MAMA. Our findings would have implications for a national scale up of MAMA called MomConnect, which is the first mHealth program to be introduced at scale in South Africa and one of few globally. To be part of this effort alone was a great experience, but working with the team on the ground and understanding a little more about how global partnerships often work was eye opening.
I hadn’t taken any economic evaluation course or had any experience conducting cost effectiveness analysis prior to my practicum, so the learning curve was quite steep. The impetus was on me to read up on what I could before I arrived and to be comfortable in knowing that I would make mistakes. That was the most challenging part of the experience—being in a constant state of uncertainty that what I was doing was correct. The best thing to do in these cases is to always ask for feedback. My supervisors weren’t onsite most of the time so I made extra efforts to connect with other colleagues and ask for help when needed. There’s no shame in understanding and being honest about your limits; I think it allowed me to be an excellent learner and have the most fulfilling experience I could.
I am thoroughly grateful to the Center for Global Health for the opportunity to see an example of what current global health looks like in practice. It certainly allowed me to understand the type of environment I thrive in, and what I could rule out. As someone who had always been overwhelmed by an interest in everything, this was certainly a positive step forward.
A view of Johannesburg from the Nelson Mandela Bridge, which connects the neighborhoods of Braamfontein and Newtown:
A view of Esselen Clinic, one of the clinics where MAMA users were recruited:
There are two maternity clinics I frequented most, each separated by what was once a grand hospital—completely abandoned for decades now. Furniture and equipment either left intact indoors or at the mercy of the weather outside: