“Crecer con Salud” is a high-scale health strategy that occurs outside a health institution and can be scaled independently of health personnel in the field.

Where the mass communication strategy can be so personalized and perceived as unique to the user, who share and disseminate the tool without having a health professional as a link.

It is a public policy initiative that will be evaluated with a scientific method and must prove to be effective and safe before being implemented on a large scale. It is innovative that the public health system is going to look for people and not waiting for them inside a hospital.

The first stage of implementation is Pilar, Province of Buenos Aires, that has 4,000 deliveries per year and a infant mortality rate of 11 per 1,000 live births.
We are enrolling a population of pregnant women to see the evolution and adoption of the bot. Field implementation is in charge of a team of 10 university students who act as digital literacy teachers who find pregnant women in the waiting rooms of primary care, in school canteens or social events.
Interviews are conducted, individual or group and printed material is delivered with instructions on how to use the bot.
Obstetricians during controls promote the use of the bot. At the same time, tests of usability and analysis of the platform are carried out (topics consulted, questions asked) that allow to implement improvements in the content and the performance of the tool.
Since July 11, 2018 and until now, 1273 pregnant women and 478 mothers of babies under the age of 1 were contacted. Of these, 670 are using the platform.

Florencia Rolandi works as a health advisor of the Undersecretary of Digital Government. She is in charge of the bot from the initial idea and leads the development of strategy, product and implementation of the solution.
Undersecretary of Digital Government’s UX team that conduct the research and user test.
Epidemiological team of the Ministry of Health of Argentina who designed the research study
National Office of Maternity and Children of Argentina team that provided the contents

Beneficiaires include:

• Pregnant women and mothers of babies under 1 year
• Public Health system

The number of active users in the bot to October 2018 is 847.

The strategy of enrolling users in the bot was focused on a field team of 10 university students who attended 29 Pilar primary care centers daily and worked in conjunction with the obstetricians. In the waiting rooms, the tool was presented to the women who waited their appointment and graphic support material was distributed.

Between July and October 2018, 2657 people were contacted, which represents half of the population of pregnant women attended in the public health system of the town of Pilar: 90% were active users of Facebook.

1 in 5 women who were presented with the tool began using the bot at the time of contact, scheduling their next appointment for prenatal check-ups.

Of those who could only receive a demonstration but were not enrolled at the time, 20% didn't have the phone at that time or have no data plan and / or access to mobile internet on their device, reason why which since September we provide the field team with mobile Wi-Fi devices to facilitate the adoption of the bot.

We will evaluate in a sample of 800 women the sanitary impact of the tool, by measuring the prevalence of women with proper prenatal control.
We designed a non-randomized intervention study with two comparison strategies. One is historical controls reported in a health management system (perinatal information system) employed by the public health services.

During the implementation of the first stage we have the following challenges:
- Mobile phone connectivity problems
- Problems of insecurity, women in vulnerable areas did not bring mobile devices to health centers for fear of being stolen
- Low adoption of the bot by digital divide

To solve these challenges, we created a program of digital literacy teachers (10 university students) who visit health centers enrolling pregnant women in the bot.

With a presence in all health centers and mobile hotspots to provide Wi-Fi access during digital literacy, the literacy teachers had interviews with almost 2,000 pregnant women (50% of deliveries per year that Pilar has).

- Political and health decision by the national health authority for the development of content and bot platform
- Development of a second level of response through physical operators that can answer medical consultations in the bot
- Communication campaign for the promotion of the platform.

The bot can expand to cover the issues of teenage pregnancy, childhood obesity and child care during early childhood.

We have learned many lessons from the initial design of "Crecer con Salud"

During the user research stage we learned that the channel was Facebook and we discarded the use of the text message.

We learned that we had to make printed support material and about the use of Facebook Messenger, it was not enough to say: “it is on Facebook”.

We learned that we had to look for pregnant women not only in health centers.

We learned to monitor the platform to implement small improvements, adding new content, which at the beginning we had not considered relevant as contractions or colics. We discover how important it is to adjust the contents in real time according to the demands of the users.