It seeks to harness the power of the cell phone to reach pregnant women and new mothers to promote better infant and maternal health.
East Timor has one of the world's highest rates of maternal and infant deaths.
Correspondent: Liam Cochrane
Speaker: Beth Elson, Health Alliance International
ELSON: We discovered through our household survey that mobile phone ownership is rapidly increasing, so we thought that this could be the perfect opportunity to combine traditional approaches to improve health outcomes with an innovative one using mobile phones.
COCHRANE: What's the coverage like in East Timor? I mean I've used phones in and around Dili and it's OK, but what about when you get into the districts. What's Timor's mobile coverage like?
ELSON: It's also increasing, I wouldn't say it's 100 per cent penetration yet, but the recent survey shows that it's about 97% coverage. The mobile phone monopoly has just been broken, so actually we now have more than one operator, and there are two new telecommunication companies that are going to start in January, with promises of 100 per cent coverage.
COCHRANE: That's certainly good news for this program. What about another issue to do with SMS-ing and that is East Timor's literacy levels. What sort of literacy will women need to be able to understand the messages that are being sent?
ELSON: Well, this was very important, as you mention, in terms of the feasibility of a mobile phone project. So we conducted a household survey earlier this year in March to ascertain information about coverage, literacy, was also a key part of that project. We discovered that in fact literacy isn't a barrier to utilising SMS messages. In the Manufahi District, which is the intervention district that we're implementing the project in, 73 per cent of women reported that they read tetum. Although that's not 100 per cent, we asked them if they were unable to read tetum was there somebody in their family that could actually read the message to them and 100 per cent of people said either husband, family member or one of their children and for us, that's a really actually powerful positive component of mobile phone messages, because the messages are not just for the pregnant woman. They're actually designed obviously for other decision makers in the house and culturally in Timor, often it's the husband or the mother-in-law that makes some decisions about health seeking behaviours. So the more people reading those health messages in the households, the better.
COCHRANE: And tell us about the kind of messages that you want to send to new mothers and pregnant women in East Timor?
ELSON: They are messages to convey information about nutrition, nutrition during pregnancy, they are messages that give some simple information about danger signs during pregnancy. They're reminders to go to anti-natal visits, birth planning, which, of course, is crucial. And one of the key barriers in Timor is accessing health services. Although it's a small nation, it's actually very mountainous and so a lot of people live in very remote parts and so one of the difficulties is how do they get to the health facilities. And so some of these messages are reminders throughout the pregnancy, much earlier before a woman goes into labour about the things that they can do in terms of either transport, whose going to look after their other children when they go into labour and need to deliver in a facility, things like that. So that it just provides encouragement for planning before an emergency situation potentially arises.
COCHRANE: And so are these timed for each woman's pregnancy, once you understand where they are at in their pregnancy, so at a certain point, a certain message comes sort of tailored to them, I guess, and their situation?
ELSON: That is exactly what happens. When a woman accesses ante-natal visits and her interaction with a health professional, predominantly a midwife, but a midwife or a doctor. She will be registered using a very simple process which will register her name, her mobile phone number and her estimated date of delivery. Then the system that she's registered into is already preprogrammed with approved SMS messages throughout the duration of a pregnancy to six weeks postpartum. So a woman based on her due date enters that stream and then gets gestationally appropriate messages throughout her pregnancy. And those messages as I say have been approved with the Ministry of Health here and there've also been field tested with the community to ensure clarity, clarity of understanding, appropriate use of language, and so we're ready to go live registering women in January.
COCHRANE: Now, and did you say that it was just within one district that you're trialing this to start with?
ELSON: Yes, although we are very optimistic about the effectiveness of mobile phone technology, we need to know for certain, so there's a strong research arm in this project. So rather than roll out in 13 districts without really knowing for sure the effectiveness, we have an intervention district and a control district. So the intervention district has the SMS technology and I must say the SMS technology is only one part of the innovation.
The mobile phone technology is also used to enable communication directly between the midwife and the community. So the automated SMS messages are based on estimated due date, but also if a woman actually has a concern, a question or is going into labour, she can directly communicate through the mobile phone with the midwife, who will then that triggers a response by health staff.
The other control site doesn't have the SMS technology, but does have the other components of the project, which are the traditional, the more traditional health approaches in terms of mobilising community volunteers to deliver household level health messages, as well as ensuring basic emergency obstetric care is available in all health facilities. So the traditional arms are in both sites, both districts, but the intervention sites only has the SMS messages, so that we can conduct some robust (word indistinct) to evaluate whether SMS messages are effective.
COCHRANE: And just finally, which two districts. Are they the control and the intervention?
ELSON: The control site is Ainaru and the intervention site is Manufahi and so we collected data through household surveys in both of those districts to ensure that they were well matched and we've actually also matched subdistricts within those districts in terms of population, number of health staff facilities, average distance to a site and mobile phone ownership to ensure the quality of our data is robust enough for us to feel confident as to whether SMS messages are an effective means of delivering health messages and behaviour change.