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Hellomama Implementation Road Map • USAID Aaternal and Child FROM THE AMERICAN PEOPLE / Survival Program HelloMama Implementation Road Map www.mcsprogram.org Document Contributors: Erik Harding, Praekelt Chichi Aigbe, Praekelt Chima Chinda, Praekelt Emeka Mba, Consultant Paul Tuthill, Jhpiego Emmanuel Atuma, Jhpiego Joy Hadiza Marcus, Jhpiego Joseph Enne, Jhpiego Oluwatoyin Adewole, Jhpiego Geoff Prall, Jhpiego Alishea Galvin, Jhpiego Yemisi Ojo, Pathfinder International Ayomipo Edinger, Pathfinder International Irene Pam- Pathfinder International MCSP is a global USAID initiative to introduce and support high-impact health interventions in 25 priority countries to help prevent child and maternal deaths. MCSP supports programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. MCSP will tackle these issues through approaches that also focus on household and community mobilization, gender integration, and digital health, among others. This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government. Cover photo credit: Karen Kasmauski/MCSP March 2019 Table of Contents Abbreviations ................................................................................................................................ iv Acknowledgments ......................................................................................................................... v Introduction ................................................................................................................................... 1 Program Description ................................................................................................................................................... 1 Introduction to the Road Map ................................................................................................................................... 1 Management Structure ................................................................................................................................................ 2 Content Management .................................................................................................................................................. 3 Training, Support, and Engagement .......................................................................................................................... 4 Promotion Support ...................................................................................................................................................... 6 Technology Management ............................................................................................................................................ 8 Monitoring Evaluation and Research ...................................................................................................................... 17 Annex I. Monitoring, Evaluation, and Research Indicators ..................................................... 20 Annex II. Conceptual Overview and Documentation ............................................................. 22 HelloMama Stack ........................................................................................................................................................ 22 Postgres ......................................................................................................................................................................... 24 Puppet ............................................................................................................................................................................ 24 Infrastructure Overview ........................................................................................................................................... 25 Hosting Overview....................................................................................................................................................... 27 Annex III. Partnerships, Roles, and Responsibilities ................................................................ 30 Annex IV. HelloMama Brief ....................................................................................................... 31 HelloMama Implementation Road Map iii Abbreviations ANC antenatal care API application programming interface CHEW community health extension worker DHIS District Health Information System FGD focus group discussion FMOH Federal Ministry of Health GON Government of Nigeria HCW Health care worker HTTP Hypertext Transfer Protocol ICT Information and communication technology IVR interactive voice response MAMA Mobile Alliance for Maternal Action MCSP Maternal and Child Survival Program MNO mobile network operator MNCH maternal, newborn, and child health OBD Outbound dial OS Operating System SMOH State Ministry of Health SMGL Saving Mothers, Giving Life SMS short message service SOML Saving One Million Lives SURE-P Subsidy Reinvestment and Empowerment Program USAID US Agency for International Development USSD Unstructured supplementary service data VM virtual machine iv HelloMama Implementation Road Map Acknowledgments The Nigerian National Health Information and Communication Technology (ICT) Strategic Framework positions health ICT within the current context of the health system, addressing universal health coverage, one of the main priorities of the Government of Nigeria (GON).1 The emergence and rapid proliferation of mobile phones in sub-Saharan Africa presents an opportunity to accelerate progress toward attaining national health goals, especially for maternal, newborn, and child health. Therefore, the opportunity to design and implement a medium- to large-scale digital health messaging intervention for pregnant women and new mothers was anticipated and well received by the GON. In 2015, the Mobile Alliance for Maternal Action in Nigeria, with funding support from USAID and Johnson & Johnson, was launched by the GON and partners as a 3-year program (October 2015–September 2018) and branded as HelloMama for implementation in Cross River (South South) and Ebonyi (South East) states in Nigeria. The tasks of meeting the high expectations and anticipating what many expected to be a game changer in the maternal and child health landscape were daunting, especially as the project ventured into an uncharted terrain, navigating the nation’s unproven ICT infrastructure. The team learned many lessons when implementing this program in Nigeria, including about partnerships, role clarification, technology appropriateness and adoption, and the diverse sociocultural context that affects positive health-seeking behaviors for maternal and child health outcomes. The federal and supported state ministries of health, in collaboration with the HelloMama consortium to develop this document to serve as a road map for ongoing and future digital health implementation in Nigeria, drawing from lessons and experiences gathered during program implementation. Emmanuel Atuma, HelloMama project director, would like to extend sincere appreciation to institutions, including the federal and state ministries of health and of communication/ICT, development and implementing partners, and those that participated in and contributed to program implementation and development of this document. The team especially commend the support and cooperation of the program implementing partners: Jhpiego, Pathfinder International, Praekelt, the family health and ICT departments in the Federal Ministry of Health, and other key stakeholders, such as health care workers in the over 142 facilities in Ebonyi and Cross River states, and over 64,000 subscribers (pregnant women, new mothers, and their families), for whom this service was designed. HelloMama consortium, the team want to thank other active players within the Nigeria digital health ecosystem, whom we learned from and shared with. Special appreciation goes to Dr. Isaac F. Adewole, the Honorable Minister of Health; Dr. Inyang Asibong, honorable commissioner for health in Cross River State; Dr. Daniel Umezurike, honorable commissioner for health in Ebonyi State; Dr. Oniyire Adetiloye, country director for Jhpiego Nigeria; Dr. Farouk Jega, country director for Pathfinder International; and Debbie Rogers, managing director of Praekelt, for providing leadership and unflinching commitment throughout the entire program implementation, making the development of this national road map for digital health implementation in Nigeria a reality. 1 Federal Republic of Nigeria. 2016. National Health ICT Strategic Framework 2015–2020. Abuja, Nigeria: Federal Republic of Nigeria; 12. HelloMama Implementation Road Map v vi HelloMama Implementation Road Map Introduction Program Description The Mobile Alliance for Maternal Action (MAMA), a global consortium with public-private funding, delivered vital health information during its 5 years of operations (2010–2015) to pregnant women, new mothers, and their families through mobile phones with messages specifically designed for behavior change. Through an age- and stage-based model, the messages corresponded
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