A mobile health wallet for pregnancy-related health care in madagascar: mixed-methods study on opportunities and challenges

  • JMIR mHealth and uHealth, Volume 7, No. 3, Year 2019

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Study Justification:
– The study aims to assess the potential impact of a mobile phone-based savings and payment platform, the Mobile Health Wallet (MHW), on financing and payment for maternal health care services in low-resource settings.
– This study is important because it addresses the financial obstacles that limit access to skilled maternal health care in Madagascar.
– By understanding the opportunities and challenges of implementing an MHW, policymakers can make informed decisions about improving access to maternal health care.
Study Highlights:
– 59.3% of women surveyed saved money for the expected costs of delivery, and 64.4% used household cash savings for this purpose.
– 80.3% of women had access to a personal or family phone, and 35.7% had previously used Mobile Money services.
– Financial obstacles, such as saving difficulties and unpredictability of costs, were identified as key barriers to accessing skilled health care during pregnancy.
– The majority of participants perceived the concept of an MHW for saving and payment of pregnancy-related care as beneficial and practicable.
– Design features such as intuitive technical ease of use, clear communication about benefits and restrictions, and accessible customer support were identified as important for the success of an MHW.
Recommendations:
– Implement an MHW for skilled health care during pregnancy to reduce financial barriers among women in urban Madagascar.
– Design the MHW with intuitive technical features to ensure ease of use.
– Develop a communication strategy to provide clear information about the benefits and restrictions of the MHW.
– Provide accessible and personal customer support to assist users of the MHW.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation of the MHW.
– Mobile Network Operators: Provide the technical infrastructure and support for the MHW.
– Health Care Providers: Collaborate with the MHW to accept payments and provide services.
– Financial Institutions: Facilitate the integration of the MHW with existing financial systems.
Cost Items for Planning:
– Technical Infrastructure: Budget for the development and maintenance of the mobile phone-based platform.
– Communication Strategy: Allocate funds for the design and implementation of a comprehensive communication plan.
– Customer Support: Include resources for training and staffing a customer support team.
– Integration with Financial Systems: Consider the costs associated with integrating the MHW with existing financial institutions and systems.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a mixed-methods study, which provides a comprehensive understanding of the topic. The study includes both quantitative and qualitative data, which adds depth to the findings. However, the sample size is relatively small, with 412 participants, and the study was conducted in a specific population in Madagascar. To improve the strength of the evidence, it would be beneficial to replicate the study in a larger and more diverse population to ensure the generalizability of the findings. Additionally, conducting a longer-term follow-up study to assess the actual impact of the Mobile Health Wallet on access to skilled maternal health care would provide more robust evidence.

Background: Mobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services—which commonly require large 1-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings. Objective: The aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone–based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar. Methods: We used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population. Results: 59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support Conclusions: Financial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service.

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Based on the study, here are some potential innovations that could be used to improve access to maternal health:

1. Mobile Health Wallet (MHW): Develop a mobile savings and payment platform specifically designed for maternal health care. This wallet could allow women to save money towards the expected costs of delivery and make payments for pregnancy-related care using their mobile phones.

2. Intuitive User Interface: Ensure that the MHW has an intuitive and user-friendly interface that is easy to navigate and understand. This will make it accessible to women with varying levels of technological literacy.

3. Clear Communication and Information: Provide clear and comprehensive information about the benefits and restrictions of the MHW. This will help women understand how to use the platform effectively and make informed decisions about their maternal health care.

4. Personal Customer Support: Offer personalized customer support to assist women in using the MHW and address any issues or concerns they may have. This could include a helpline or chat service staffed by knowledgeable personnel.

5. Financial Education: Provide education and resources to improve financial literacy among women. This could include workshops or informational materials that help women understand the importance of saving for maternal health care and how to effectively manage their finances.

6. Partnerships with Healthcare Providers: Collaborate with healthcare providers to integrate the MHW into their services. This could involve training healthcare staff on how to assist women in using the platform and accepting payments through the MHW.

7. Awareness Campaigns: Conduct awareness campaigns to promote the benefits of the MHW and increase its adoption among women. This could include targeted advertising, community outreach programs, and partnerships with local organizations.

These innovations aim to address the financial barriers that limit access to skilled maternal health care in Madagascar and provide women with a convenient and accessible way to save and pay for pregnancy-related services.
AI Innovations Description
The recommendation to improve access to maternal health is to develop a mobile health wallet specifically designed for pregnancy-related health care in Madagascar. This recommendation is based on a mixed-methods study that assessed the opportunities and challenges of using mobile savings and payment systems to finance and pay for maternal health care services.

The study found that financial obstacles, such as saving difficulties and unpredictability of costs, were major barriers to accessing skilled maternal health care in Madagascar. To address this, the study suggests the implementation of a mobile phone-based savings and payment platform called the Mobile Health Wallet (MHW). The MHW would allow women to save money specifically for the costs of delivery and make payments for pregnancy-related care.

The study found that a significant percentage of women surveyed saved money towards the expected costs of delivery, and many used household cash savings for this purpose. Additionally, a majority of the participants had access to a personal or family phone, and a significant percentage had previously used Mobile Money services. This indicates that there is potential for the adoption of a mobile health wallet for maternal health care.

The study also identified key design features that would contribute to the success of the MHW. These include intuitive technical ease of use, clear communication and information about the benefits and restrictions of the MHW, and the availability of personal customer support. These design features would address the need for user-friendly technology and accessible assistance, ensuring that women can easily navigate the mobile health wallet and receive support when needed.

In conclusion, developing a mobile health wallet specifically tailored for pregnancy-related health care in Madagascar has the potential to reduce financial barriers and improve access to skilled maternal health care. The success of this innovation will depend on the design of the tool, including its technical user friendliness and the availability of accessible and personal customer service.
AI Innovations Methodology
Based on the provided information, one potential innovation to improve access to maternal health in Madagascar is the development of a mobile health wallet (MHW) specifically designed for pregnancy-related health care. This MHW would serve as a savings and payment platform, allowing women to save money for the expected costs of delivery and make payments for skilled health care services during pregnancy.

To simulate the impact of this recommendation on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific group of women in urban Madagascar who would benefit from the MHW for accessing skilled maternal health care during pregnancy.

2. Data collection: Conduct a quantitative survey to gather information on saving habits, mobile phone use, media consumption, and perception of the MHW among the target population. This survey should include questions related to financial obstacles faced by women in accessing skilled maternal health care.

3. Analyze quantitative data: Analyze the survey data to determine the percentage of women who currently save for delivery costs, the percentage with access to a personal or family phone, and the percentage who have previously used mobile money services. This analysis will provide insights into the potential reach and adoption of the MHW among the target population.

4. Conduct qualitative focus group discussions: Organize focus group discussions with a subset of the target population to gather qualitative data on their perceptions of the MHW and their suggestions for design features that would ensure its success. Themes related to technical ease of use, communication and information about benefits and restrictions, and availability of personal customer support should be explored.

5. Analyze qualitative data: Analyze the qualitative data from the focus group discussions to identify common themes and recommendations for the design of the MHW. This analysis will provide insights into the potential acceptability and usability of the MHW among the target population.

6. Develop a simulation model: Based on the quantitative and qualitative findings, develop a simulation model that estimates the potential impact of the MHW on improving access to skilled maternal health care. This model should consider factors such as the percentage of women who would adopt the MHW, the potential increase in savings for delivery costs, and the potential reduction in financial barriers to accessing skilled maternal health care.

7. Simulate the impact: Use the simulation model to estimate the potential impact of the MHW on improving access to skilled maternal health care. This could include estimating the number of additional women who would be able to access skilled care, the potential reduction in out-of-pocket expenses, and the potential improvement in maternal health outcomes.

By following this methodology, researchers and policymakers can gain insights into the potential benefits and challenges of implementing a mobile health wallet for pregnancy-related health care in Madagascar and simulate its impact on improving access to maternal health.


Statistics:
Citations: 6
Identifiers:
DOI: 10.2196/11420
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Madagascar
Study Design:
Cross Sectional Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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