JOHANNESBURG, South Africa – After landing in Johannesburg following a 19-hour flight from New York, I hop in a taxi heading towards the city center. As I look out the window, the nation’s largest city seems calm. The streets are clean, children are playing in the parks, and family homes and business complexes dot the landscape. The grass is parched a golden hue as winter rolls in. People stroll down the streets, shielding themselves from the cool weather with winter caps and sweaters.
But the quiet calm conceals a troubling concern in this nation of over 52 million people. South Africa is failing its mothers and newborns. Across the country, 4,300 women die each year as a result of complications that arise during pregnancy and childbirth. For babies, it’s even worse. Some 20,000 are born stillborn and another 23,000 babies die within their first month, according to UNICEF. Yet another 75,000 children don’t make it to their fifth birthday. While the South African government has made efforts to improve maternal and child health outcomes in the nation, still over 60 percent of deaths of children under 5 years old are avoidable, due to failures of the health system, such as poor assessment and management of care in hospitals.
The culprits are HIV and AIDS, says UNICEF, as well as inadequate implementation of health care programs. While South Africa has been successful at expanding the number of HIV-positive people receiving antiretroviral treatment and reducing mother-to-child transmission, it has also seen a rise in HIV prevalence in recent years. The national HIV prevalence rate rose from 10.6 percent in 2008 to 12.2 percent in 2012. Seventy percent of all women tested for HIV who died during pregnancy, childbirth, or following birth were found to be HIV-positive.
While foreign aid has been pumped into reversing these alarming trends, maintaining donor interest in sustained efforts like these is a concern. Facing this challenge, the public health community must get creative in its response.
Increasingly, a collaborative model for funding health care has gained prominence in countries like South Africa that falls in contrast to the traditional models of foreign aid where money is often transferred on a government-to-government basis. This model is the public-private partnership (PPP), a venture that aims to synergize the strengths of both the public and private sector in order to fund or offer expertise to projects.
One of the more recently launched health PPPs in South Africa, focusing on educating mothers in order to improve maternal and child health, is the Mobile Alliance for Maternal Action (MAMA). The initiative, launched here in May 2013, delivers medical advice via SMS to pregnant mothers to guide them through their pregnancy and the first year of their child’s life.
Currently, MAMA reaches 12,000 women in the country via SMS through a public-private partnership founded by the United States Agency for International Development (USAID), Johnson & Johnson, the mHealth Alliance, the United Nations Foundation and a subsidiary of J&J called BabyCenter. An expectant mother signs up for the program, indicates the stage of her pregnancy, and receives two relevant SMS messages per week. She also can access a weekly quiz and recommended websites to receive vital information about her health and the health of her baby. About 22 percent of the women that receive text messages from MAMA have opted to receive HIV-related messages.
The spread of mobile technology across the African continent was the inspiration for the MAMA project, which also has projects in India and Bangladesh. In June 2013, there were 213 million unique mobile subscribers in Sub-Saharan Africa, out of a population of 911.5 million. This has been a compounded annual growth rate of 18 percent since 2007. But nowhere in the region has the mobile revolution been as robust as in South Africa. Here, the unique subscriber penetration is at 64.6 percent, while the SIM card penetration is 134.7 percent—meaning there are more SIM cards than there are citizens.
MAMA has capitalized on this mobile technology boom. While only six inner city clinics in Johannesburg are participating in MAMA currently, there are plans to scale up the program. I am here to report on the lessons learned from MAMA so far, its long-term prospects and to investigate the potential this program has to be scaled up and expanded to other countries in the region. Can mobile technology help improve access to health care? How are public-private partnerships like this transforming the health sector? Stay tuned.
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