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Crecer con Salud – Virtual Assistant for pregnancy and early childhood

crecer con salud bot - Promote breastfeeding

In Argentina 30% of women do not comply with prenatal check-ups and almost 1 in 10 have their first contact with the health system at the time of birth.
"Crecer con Salud" is a virtual assistant based on Facebook Messenger that works outside the health system, identifying and recruiting pregnant women where they are. The bot is designed to accompany women during their pregnancy and the baby's first year with personalized information and reminders of attendance to pre and post natal check-ups.

Innovation Summary

Innovation Overview

The reduction in three quarters of the ratio of maternal mortality (RMM) in 2015 was the 5th of the Millennium Development Goals. Argentina assumed this commitment, in order to fulfill it, the RMM of 2015 should have reached 1.3 x 10,000 live births. However, the ratio for that year was 3 times higher than desired. Infant mortality rate in Argentina is also higher than expected, reaching 9.7 per 1,000 live births during 2016. 70% of these cases of infant mortality are preventable.

One of the most successful strategies to reduce morbidity and mortality of pregnant women and their babies is to have at least 5 prenatal check-ups, being the first within 13 weeks of gestation. In Argentina more than 30% of women do not comply with these prenatal check-ups and almost 1 in 10 have their first contact with the health system at the time of birth.

"Crecer con Salud" is a virtual assistant (a bot) based on facebook messenger designed to accompany women during their pregnancy and the baby's first year with personalized information according to the week of gestation and to baby’s age when born, and reminders of attendance to pre- and post-natal check-ups.

“Crecer con Salud” aims to:
- Increase the number of prenatal check-ups in women who use it.
- Reduce the absence to check-ups by tackling the fear of going through check-ups
- Empower women
-- Respected labor
-- Know what is the basic standard of practices that should receive and when.
- Promote breastfeeding
- Provide personalized official information about pregnancy, baby's first year and health care
- Simplify the access to social benefits linked to pregnancy

More than 20 million people do not have health coverage in Argentina, "Crecer con Salud" targets pregnant women and mothers with babies under 1 years of age in Argentina.

We chose the communication channel for the bot thinking about the needs of women in Argentina, looking for a simple, direct and easy way to interact.

Argentina has 40 million mobile phone lines of which 70% are prepaid, which showed a low predisposition to send text messages due to the cost to the user.

Our research in maternity hospitals and interviews with pregnant women revealed that 90% used facebook and whatsapp on their mobile phones.

This result led us to think and develop the bot based on Facebook Messenger, given that more than 30 million users are Argentines.

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. Together with the epidemiological team of the Ministry of Health of Argentina, 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.

If the result obtained from the first stage of implementation shows an positive impact will continue to the stage of expansion, deploying the bot nationwide.

"Crecer con Salud" is simple to access and easily scalable (does not require geographic adaptation or additional cost). It bridges accessibility to health services for a population that is away from it.

Innovation Description

What Makes Your Project Innovative?

“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.

What is the current status of your innovation?

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.

Innovation Development

Collaborations & Partnerships

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

Users, Stakeholders & Beneficiaries

Beneficiaires include:

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

Innovation Reflections

Results, Outcomes & Impacts

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.

Challenges and Failures

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).

Conditions for Success

- 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.

Replication

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

Lessons Learned

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.

Year: 2018
Level of Government: National/Federal government

Status:

  • Implementation - making the innovation happen
  • Evaluation - understanding whether the innovative initiative has delivered what was needed
Call for Innovations Call for Innovations
This case was submitted as part of the Call for Innovations, an annual partnership initiative between OPSI and the UAE Mohammed Bin Rashid Center for Government Innovation (MBRCGI)

Innovation provided by:

Media:

Date Published:

2 April 2018

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