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Presenter: Chris Smith, MOTIF Lead Investigator, MSIC

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

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Presenter: Chris Smith, MOTIF Lead Investigator, MSIC

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  1. 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

  2. Challenge: low uptake of PAFP and repeat abortion Abortion • 44 million/year, 50% unsafe, 47K maternal deaths (Sedgh 2011) Low uptake of PAFP • No method 32%, condom 24%, pill 20%, injectable 11%, IUD 5%, implant 5% (MSIC data 2011) Repeat abortion • 25% 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

  3. What are the opportunities for mHealth? Of the world’s estimated 7 billion, 6 billion have access to mobile phones

  4. Hypothesis: adding mobile support to the continuum of PA care can increase PAFP At the Facility Level Beyond the Facility • Opportunities • Build on success in PAFP counseling • Wide range of methods available • Opportunities • Information • Reminders • Support (e.g. SE’s)

  5. 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

  6. 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

  7. Overview of intervention developed MOTIF:Mobile Technology for Improved Family Planning VM every 2 weeks Client Provider +/- follow up phone call Pill/appointment reminders Client can call in Service provided for 3 months after which client continue to receive standard care

  8. “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” Voice message as conduit for additional support

  9. Mixing medical services with technology http://instedd.org/blog/marie-stopes-verboice-will-mobile-phones-improve-contraceptive-use-in-cambodia/

  10. Randomised controlled trial overview

  11. 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

  12. 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

  13. Thank you! • Contributors: • Thoai Ngo, Judy Gold, UkVannak, Ly Sokhey, Caroline Free • MSI Cambodia, Innovation and Best Practice & Research Monitoring and Evaluation team MSI If you are interested to learn more about this project, or in funding the next phase, please get in touch: chris.smith@mariestopes.org.kh

  14. Challenges • SIM card switching • Phone sharing • Competition with commercial spam • Timing of VMs • Clients busy • Reaching out to youth/students/EWs

  15. Response to VM: first 100 clients

  16. Appendix: Conceptual framework

  17. Different categories of clients? Voice SMS / App? Urban youth, literate, confidentiality important? Rural, limited literacy, married, disclosed to others re abortion?

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