Where There Are No Landlines: Mobile Technology, Community Health Workers and Family Planning
Access to family planning has powerful health, social and economic benefits for families and communities. Family planning use protects the health of women and their children by spacing births, preventing unwanted or high-risk pregnancies, reducing the need for abortions and helping to fight HIV/AIDS. Further, family planning use supports women's rights and opportunities for education, employment, and full participation in society, and protects the environment by stabilizing population growth. In high fertility societies, slowing rapid population growth through voluntary means greatly facilitates economic and social development. While significant progress has been made in the provision and uptake of family planning, an estimated 222 million women around the globe who want to avoid pregnancy are not using an effective, modern method of contraception. Community based family planning (CBFP) programs can successfully reach remote, resource-constrained populations with high unmet need for family planning. The most common approach to CBFP is the community based distribution of contraceptives, in which community health workers (CHWs) provide family planning education and counseling, contraceptive methods, and referrals for clinic-based services.
The past decade has seen worldwide rapid growth in the delivery of health services via mobile communication devices, collectively known as mHealth. With the increased availability, adaptability and capability of mobile phones come new prospects for improving the quality of and access to health care. Increasingly, these new technologies are being developed, tested, and deployed with CHWs in developing countries. mHealth tools could enhance community based approaches to family planning, yet this potential is only beginning to be explored. Accordingly, FHI 360, the Tanzania National Institute for Medical Research, Pathfinder International, and D-Tree International collaborated on the development of a mobile phone job aid for family planning service delivery by CHWs in Tanzania. The introduction of this mobile job aid presents an exciting, innovative opportunity to increase knowledge about, access to and use of family planning information and services. This dissertation aims to provide data that can improve the design, implementation, monitoring and evaluation of mHealth projects targeted for CHWs, and can inform program and policy decisions to implement mHealth technologies into future family planning efforts, in Tanzania and beyond.