As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
A mobile application that supports access to information on family planning, sexual and reproductive health, and other public health areas.
Miriam N Nkangu
University of Ottawa
University of Ottawa
Grand Challenges Canada funded the proof-of-Concept which ended in 2019. Currently submitted for additional support and waiting for results
Client, Health Care Provider, Health System Manager, Data Services Provider
Leadership and Governance, Strategy and Investment, Legislation, Policy, and Compliance, Services and Applications, Infrastructure, Workforce
Demand Generation, Service Delivery, Supply Chain Management, Policy and Enabling Environment
Bornfyne uses graphics that consider local reality to help pregnant women, and especially non-literate women, easily communicate with their providers through a simple click on their phones. It also uses local dialects to tailor family planning messages to targeted groups of the population using social and behavioral change approaches and uses geographic information systems which utilize geo navigation to reach out to pregnant women during emergencies.
Unintended pregnancy in Cameroon and Zambia has been attributed largely to low utilization of contraception, particularly modern methods. Contraceptive use in Cameroon is currently at 29 percent.  Most women tend to get sensitized to family planning during antenatal or postpartum clinic visits, which a cross-section of the population cannot adequately access. Cameroon and Zambia are lower-middle-income countries with a relatively high maternal mortality rate (MMR) – 596 deaths per 100,000 live births and 396 deaths per 100,000 live births, respectively. [2,3] Poor emergency and referral services and long travel distances impede access to Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services in most sub-Saharan African countries.
Reducing poverty and improving livelihoods requires bold and innovative approaches for delivering healthcare services that can transform and integrate best practices into health system delivery at global, regional, national, and sub-national levels. Generating quality, highly disaggregated, and comprehensive data is relevant in understanding the health needs of poor and vulnerable populations, program design, and policies. Achieving universal health coverage requires digital technologies that can transform the way health data is collected and used and contribute to more equitable, rights-based health policies and primary health care services.
BornFyne is a Grand Challenges Canada-funded mobile application connected to a real-time web portal prenatal management system (PNMS).  BornFyne user interface has six features connected to the PNMS including four online features and two offline features. BornFyne prompts behavior change mechanisms from the user (BornFyne) interface and the provider (PNMS) interface. The approach uses prompts and cues to trigger behavior change and persuade change using both the user interface and provider interface. It uses graphics as an alternative mode of communication to connect with pregnant women, especially those who cannot read or write.  The application helps connect women with providers during emergencies using geospatial information systems.
Additionally, audio messages for family planning are uploaded in various local dialects for women and households to listen to in the comfort of their homes.  These audio messages are developed using a gender-based approach and behavioral change model. The advisory feature is designed to support public health messages, such as risk communication for COVID-19, in various local dialects to ensure a continuous learning, educational platform to engage the community and households.
PNMS sends personalized reminder text messages for antenatal care (ANC), skilled birth delivery, and vaccination to women. The family planning and advisory features are available offline for women to constantly listen to family planning messages and any other advisory messages, including those on COVID-19. Community engagement, continuous education, and awareness support the health system and respond, track, and monitor health facilities, providers, districts, and regional activities. BornFyne collects highly disaggregated and timely data, which are remotely stored in a secure server to inform rapid decision-making and continuity of quality RMNCAH services.
The community health workers (CHWs) report suggested that at least 49 percent of women shared the messages with their families, estimating an average of four persons per household. We estimate that at least 274 family members have listened to audio messages directly from the BornFyne feature at the time of reporting. A total of 15 health care providers were trained in using the digital platform BornFyne-PNMS and an additional 16 providers trained with support from the performance-based financing program. In addition, 40 CHWs were trained and five health facilities installed PNMS. Phones and solar chargers empowered poor women and households and the lives of over 50,000 inhabitants. The results noted here are limited to family planning, and not the entire project.
Engaging the community from the onset in the design and implementation of the project, using existing structures, working with district medical officers and district team facilitates acceptability, integration, and adaptation [8,9].
The importance of follow-up training and supervision to strengthen capacity building
Women in most rural areas are primarily farmers and unlikely to listen to family planning messages through the radio as they spend most of their time on the farms . Also, the cost of commuting to the health facility and financial barriers implies that if a woman doesn’t visit a health facility, she may not have the opportunity to hear family planning messages. We observed that making family planning messages available in local dialects on mobile phones, making it possible for women to listen in the comfort of their homes, helped increase the level of awareness and knowledge on family planning and empowered women in making informed choices.
The proof-of-concept in the Bali district in Cameroon generated remarkable results in improving the quality of care of the providers, district, and content quality of care for RMNCH. This motivated the performance-based financing program to support the project at the proof-of-concept phase . The next steps include leveraging additional funding to support the transition-to-scale phase and testing the effectiveness of the platform and our business model which is designed using existing platforms. BornFyne is pursuing a performance-based financing program to ensure sustainability. We planned to test the effectiveness within four districts in Cameroon with over 1,200 women, and one district in Zambia with over 200 women. In addition, we have started training additional health care providers in the Bangem district in Cameroon and we plan to engage an additional three districts for the transition-to-scale phase as we continue to leverage additional funding. We have also had initial discussions with the Ministry of Health in Zambia and are in the process of pilot testing in the Mumbwa district as we continue to look for additional funding to expand to other districts in both Cameroon and Zambia.
Available at https://www.youtube.com/watch?v=UPy-zeaJ2CU&feature=youtu.be
9. Charles Dickson (2017). BornFyne connects pregnant women to their doctors. World solar fund Available at https://www.worldsolarfund.com/bornfyne-connects-pregnant-women-with-health-providers/