South Africa: From Maternal Health to COVID-19 - How a WhatsApp Service Became Essential for Millions

15 June 2020
interview

Cape Town — Covid-19 Connect, a WhatsApp service that provides users with relevant information to help make informed and effective decisions during the pandemic, was developed by Praekelt.org for South Africa, but the organisation's experience with digital health technology like MomConnect allowed it to gain the attention of the World Health Organisation. The WHO and Praekelt then launched HealthAlert, the dedicated messaging service in Arabic, English, French, Hindi, Italian, Spanish and Portuguese for the world.

allAfrica spoke with Managing Director of Praekelt.org Debbie Rogers to find out why the Praekelt, founded by Gustav Praekelt in 2007, focuses on digital health services, what led to the development of their WhatsApp services, and how COVID-19 Connect is doing since more than 15 million messages were exchanged during its launch weekend in March.

Excerpts

Why does Praekelt focus on digital health services?

Gustav Praekelt was seeing a prevalence of people being reached through mobile technology, the massive surge of which making it possible to reach people, who never had access before, with personalised communication. That was really the premise on which he founded Praekelt.org; we don't actually give endowments, we rather receive funding to implement programmes. So we've been working in primarily the health space, the health technology space, for 13 years now and we've been developing all kinds of programs using really simple mobile technology like SMS and  WhatsApp messaging to improve the lives of people all over the world.

One of our biggest programs before we started working in the COVID-19 space was MomConnect, which is a program where every mother in South Africa who goes to a public clinic for her first antenatal visit and finds out she's pregnant is signed up for the program. It sends her support messaging throughout her pregnancy up until the baby is, well, it will soon be five years but at the moment it is two years old. And she can also provide feedback on the service she receives and ask questions of the national department of health.

It's a (South African) national department of health program for which we developed the technology and that program has reached over three million mothers providing vital maternal health information for the past five years. That represents about 80% of the women who have given birth in public facilities since 2014. So that's the kind of program we've been doing as an organisation, it's why we get up in the morning and it's what we were building on until we decided to respond to COVID-19.

That's quite a success rate you have on MomConnect. Are there any plans to expand the program to other countries in Africa?

Yes, absolutely. We actually worked with Unicef to develop the platform in Uganda, it's called FamilyConnect there. We're no longer involved as an organisation as it's been handed over to local partners, but we did expand it there. We're busy working on plans to expand into multiple new territories, particularly in Africa, of course. Primarily Mozambique, Malawi, and the DRC are the next countries we hope to expand in over the coming months. Of course COVID-19 has slowed all of that down and sped up some other interventions, but it is definitely something we're planning to implement in other countries.

That's great, and your response to the COVID-19 pandemic, how did that come about?

We were returning from one of our last trips to Kenya to explore a maternal health program there and we started seeing all kinds of misinformation coming across WhatsApp. We have quite a good relationship WhatsApp (the organisation) because they supported us by rolling out MomConnect on WhatsApp as early as 2017 before their public API was available. API being the protocol that allows developers to integrate directly into WhatsApp and being able to send more complicated messaging and receive feedback directly from WhatsApp, rather than using an application to answer questions, which is what you and I are used to using.
So we spoke to them about the opportunity of setting up a WhatsApp line that would provide accurate and timely information that people could trust as a source of truth, you know, just to combat some of this fake news flying around.

We knew we had been using WhatsApp quite successfully as a platform for MomConnect and that we could fairly easily and quickly get up a service that could respond to COVID-19 and so we started to develop a service. We reached out to the World Health Organisation (WHO) to see if they had content that we could use on the platform for its implementation in South Africa. They were very generous and helped with content but also decided to take on the service themselves. So within a couple weeks, we launched the national WhatsApp line here in South Africa, which is 0600 123 456. You can send the message 'Hi' to that number and engage with that application.

Then the WHO's line (HealthAlert), which was launched about a week later, is a global line which was initially launched in English but is now available in, I think, 18 different languages. We launched that pretty quickly using the technology and tools we've used before and been developing for some time for our programs like MomConnect. We got it up primarily as an informational service on WhatsApp where people could start to message in keywords and, based on those keywords, are able to browse the most relevant, up-to-date content. That's kind of the genesis of what happened. I believe we launched it in South Africa around the 14th of March. About the 20th of March, we launched the WHO service.

Since then we have had incredible interest from various countries, we've been able to launch the service with on-the-ground partners and ministries of health all over south-east Asia and Africa. We're live in 10 different countries with the same informational service we started developing here in South Africa. It's based on WHO content but one of the things that makes it highly engaging is that it's updated daily with relevant content for the specific country that it's in, so that people can find the most up-to-date, relevant content for them in their context just by sending a message on WhatsApp.

Do you have statistics from countries where COVID-19 Connect has been introduced?

Overall we've reached 20 million users ... and quite a bit of that has been driven by the WHO global line, but a lot of it is driven by the South African line and other countries that use the service. In South Africa we have over 7.2 million users and 500,000 daily users. That makes it one of the most popular WhatsApp services in the world, both commercial and non-profit, just due to the sheer volume of usage we have every single day on the platform.

The engagement is really high. The countries where we've rolled it out, they're starting to pick up traction. Of course, they started a little bit later; we are in multiple countries including Mozambique, Uganda, Australia, New Zealand, Bangladesh, Madagascar and Ethiopia. Since we've evolved the program from just being simply an informational platform to something more engaging and interactive by adding some additional features and functionality that we've certainly seen in our experience in programs like MomConnect add massive value not only to the citizens but also the health system as a whole.

That makes it one of the most popular WhatsApp services in the world, both commercial and non-profit, just due to the sheer volume of usage we have every single day on the platform.

In particular, we're rolled out in South Africa a service within the WhatsApp platform that's also available for free on USSD called HealthCheck which is essentially a screening tool that people can use to check their symptoms and understand whether they should be moving around as per regulations, if they should be self-isolating, if they should be tested or if they should seek care.

At the same time as people are putting in this information, we're gathering information for the national department of health which shows where there might be high-risk hotspots or particularly vulnerable populations so that they can deploy screening teams or follow up on what's called tracking and tracing. Since that launched we've had about just about a million users complete 1.5 million health checks and that's something we're going to be rolling out to other countries now that we've tested it here in South Africa as a tool that creates a feedback mechanism between citizens and the national department of health.

With services available in Uganda, Mozambique and Ethiopia, are they offered in local languages?

They're in multiple languages. For example, in Ethiopia, it's in Amharic, it's not in English at all. Various other countries have multiple languages that they use so it's very important for us. In South Africa, the service is available in five South African languages and we've certainly seeing through marketing how important it is to have things in these languages, but in other countries it's even more critical and so we work with ministries of health and out on-the-ground partners to translate into multiple languages before we launch.

Are you planning on launching HealthConnect/COVID-19 Connect in other countries given its success in South Africa?

Yes, we are. We have interest from Bangladesh, Uganda and Ethiopia to do so but I'm sure most of them will start to take that on because it's turning into a really useful service in South Africa and as the pandemic progresses in each country, screening is going to become a critical tool more and more so I think it will be in demand by various countries.

I should also mention that one service that we're going to launch in South Africa, hopefully this week or possibly next week, is a similar service for health workers. Health workers obviously need different types of information and they need to be doing checks every single day in order to look after themselves so we're going to be working with the national department of health to launch a health workers' version of the service.

As a South African organisation, and though we do operate globally, it's really important for us to use South Africa as a test bed, if you like, to start to develop services. We have a very good relationship with the national department of health here that we've built up over many years so they do allow us a certain amount of flexibility in developing and rolling out new elements of the service. And then we roll it out to our partner countries - we can do that as quickly and painlessly in each of those countries as possible and so we've worked out all the kinks before it gets to other countries.

HealthConnect/COVID-19 Connect deals with the physical, what are the chances of a project dealing with mental health? With people stuck at home - children are stressed out, parents are stressed out - this is not a situation most people have been in unless they were alive during World War 2.

Absolutely. We do have quite a bit of wellness content on the South African platform that you can take a look at to try and address the various mental health issues that we're all facing at the moment. From a screening perspective, we're looking at multiple screening elements that we can bring in. One of them is mental health, another is around tuberculosis - there is going to be a crisis in many countries where other diseases are going to start to be really negatively affected by the coronavirus pandemic and the fact that so many people are not scared of the virus. We're also adding other screening tools that are going to address some of those other issues. Mental health is definitely one that is on the mind, excuse the pun, which is why we started with the wellness content.

What next for Praekelt and its digital health tools?

I think this platform has allowed us to get health communication tools into the hands of millions of people worldwide in a way that would have taken possibly years previously, and it's very important is to make sure that we're not just addressing the pandemic but that we're setting up tools and platforms that can be used by ministries of health for all kinds of other health issues.
But also we need to be prepared for whatever the next health crisis is in the country; to be able to effectively, efficiently and accurately communicate to their citizens and health workers when that happens. What we're hoping is that it's not just a response to COVID-19 but starts to be seen as a health communication platform for ministries of health all over the world.

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