Project Mwanachallenges-chat

Using mobile phones to improve early infant diagnosis of HIV and post-natal follow-up and care.

©UNICEF/Zambia2010/Merrick Schaefer


Start Date: 2010-04


Focus Areas: ,

Region: Eastern and Southern Africa

Country: ,

Keywords: mHealth, mobile phone...


Large numbers of infants in Zambia are infected with the human immunodeficiency virus (HIV) in the womb, at delivery, or when breastfeeding. Among the infants who contract the virus, about 30% die before the age of one and 50% before the age of two, if no interventions for paediatric HIV care and support are provided. These deaths contribute significantly to the national under-five mortality rate. Survival rates are up to 75 per cent higher for HIV-positive newborns that are diagnosed and begin treatment within their first 12 weeks of life. However, many children born to women with HIV are not being systematically monitored, and many are identified as infected with HIV only when they become very sick.

Exposed infants need a special type of HIV detection test, which differs from the standard antibody test for adults and older children because infants still have their mother’s antibodies in their bloodstream. Only three laboratories in Zambia possess the capability to perform the required test. Transport of the samples and the test results, especially for rural clinics, is therefore one of the biggest obstacles facing early infant diagnosis and initiation of antiretroviral therapy (ART) for HIV-positive infants, significantly reducing their chance of survival.

After a preparatory phase in 2009 which included district level gap analysis workshops, local partnership creation, and meetings with the MoH EID Sub-technical working group, the project aimed to address gaps in health service delivery where mobile tools could have a large impact.

In June 2010, Project Mwana, a mobile health (mHealth) initiative implemented by the MoH with support from UNICEF and collaborating partners, Boston University affiliate the Zambia Centre for Applied Heath Research and Development (ZCHARD) and the Clinton Health Access Initiative (CHAI) launched the Project Mwana RapidSMS pilot to reduce delays in transmitting results from the HIV test laboratories to rural health facilities via SMS message.

The mobile solutions developed for Project Mwana were created with specific health objectives, aligned with the national health strategies for Zambia:

(1)  Strengthen early infant diagnosis, aiming both to increase the number of mothers receiving results and to reach mothers in a faster, more efficient manner using the ‘Results160’ SMS application.

(2)  Improve the rate of postnatal follow-up, increasing the number of birth registrations for clinic and community births, while also raising the number of clinic visits for mothers through community-health worker tracing using the ‘RemindMi’ application.

To date, the project has been piloted in 13 predominantly rural districts of Zambia (Map). The system is designed using the Free and Open Source code-base called RapidSMS, which was originally developed by the UNICEF Innovation Team in 2007. The system relies on communication among rural health workers in remote clinics and community-based agents supporting health services in rural communities. These participants own mobile handsets, which they use to send and receive Results160 and RemindMi messages via SMS.

Zambia is in a position now to start scaling up the system. A national scale-up plan has been developed, commencing with a preparation phase and then shifting to an iterative phase where clinics are trained and added to the system and the problems and successes evaluated. The aim is to achieve national scale by 2013, with health facilities offering early infant diagnosis services.

The preparation phase will focus on solidifying the technical, physical, monitoring and human infrastructure to allow the system to handle stresses of scale. Throughout the scale-up process, the project will be closely monitored to ensure the systems are having a positive effect on the targeted health challenges.

The preliminary monitoring and evaluation analysis of Project Mwana sites indicates that:

  • SMS delivery of results can increase turnaround times by 50% on average, with a greater positive impact in rural facilities.
  • The birth registration component of the RemindMi application has been adopted enthusiastically by community health workers, registering the majority of births in their catchment areas.
  • It is too early to know if SMS reminders have significant impact on increasing adherence to post-natal appointments.
  • It has not yet been established whether the faster turnaround time for results leads to earlier ART access for exposed infants.

With national mobile phone penetration growing at an unprecedented rate in Zambia, there is an enormous opportunity to utilise this platform to support recognised health interventions and explore other areas of need.  After the pilot, all of the computer hardware, system software, partnerships with telecom companies and software developers are in place to make scaling the system a matter of training.  The cost of the development of the system was large upfront but with the will of the MoH to scale the system nationally the potential health impact will be significant.

Experience from the development of the Project Mwana system can serve as the basis for future mHealth projects. The system could potentially be extended to maternal and child health areas such as the prevention of mother to child transmission (PMTCT) and nutrition, as well to other results-delivery and diagnostic mechanisms or national health programmes for women and children. There is currently much discussion about how to build upon the platform of hardware, software and trained provincial staff, district staff, facility staff, and community health workers who are using the system.

Additionally the entire system and supporting processes and materials were designed in a way to make a single package that can be easily replicated in other countries.  By taking the existing code and tools and re-implementing it in other countries facing similar issues with EID and post-natal visits the investment UNICEF made in the innovation will continue to pay off.



Meet The Team

  • Elin Murless
    Health and Nutrition Section, UNICEF Zambia
    HIV and AIDS Officer
  • Trevor Sinkala
    Lead Software Developer


Clinton Health Access Initiative

CHAI  is a global health organization committed to strengthening integrated health systems in the developing world and expanding access to care and treatment for HIV/AIDS, malaria and tuberculosis.

Boston University

Boston University affiliate the Zambia Centre for Applied Heath Research and Development (ZCHARD).

Read more here


Project Updates

Programme Mwana coverage

At present Mwana is in 62 facilities of approx.  766 EID facilities (8 % coverage)
The aim is to scale to 200 additional facilities by end-2012 (26% coverage)

See Resource "Programme Mwana Coverage July 2012" for map and more details.

1 year 39 weeks ago by jhowardbrand

Lessons learned: the guiding principles for scaling up Project Mwana

1. Government leadership

- Involve the MoH from the beginning.
- Integrate the project into long-term planning.
- Leverage the existing national health systems and tools rather than creating your own.
- Integrate data into district reporting.

2. Locally sourcing
Employ a permanent local software development team.
- Have a permanent project manager who can coordinate partners.
- Create government-led working groups.

3. Cost control
- Negotiate with telecom companies for scale, not pilots.
- Utilise the phones people have rather than purchasing and supporting a national phone system.
- Create district-level training teams.

4. Co-creation
- Make decisions based on identified needs of the end users.
- Create the tools with the people who are going to use them.

1 year 42 weeks ago by jhowardbrand


Project Evaluation document

Project Evaluation document

Project Mwana blogspot

Read the blog on this project here

WHO report

UNICEF and Boston University co-authored this piece on the research which examines the design, implementation and evaluation of the initiative for early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results

See Resource "Programme Mwana Coverage July 2012"

A map showing coverage as of July 2012

Trainer of Trainers

The first ToT was held in Luapula Province (also where the UNICEF initial Mwana pilot took place)on the 18th-20th September, and supported by ZPCT II, ZCHARD, UNICEF and the MoH ICT unit. 17 participants from the province and its districts were successfully trained over 3 days.