Improving care-seeking for facility-based health services in a rural, resource-limited setting: Effects and potential of an mHealth project

Ariel Higgins-Steele, A. Camielle Noordam, Jessica Crawford, Jean Christophe Fotso


The aim of this paper was to investigate the impact of a toll-free hotline and mobile messaging service on care-seeking behaviors. Due to the low uptake of the services, the treatment on the treated estimate is used. For maternal health, the intervention had a strong, positive impact on antenatal care initiation and skilled birth attendance. No effect was observed for postnatal check-ups, receiving the recommended four antenatal care visits and vitamin A uptake. A negative effect was observed on tetanus toxoid coverage. For child health, no change was seen in child immunization, and a significant decrease was observed for care-seeking for children with fever. Different factors are associated with care-seeking, which may explain in part the variations seen across care-seeking behaviors and possible influence of exogenous factors. Introduction of mHealth services for demand generation require attention to local health systems to ensure adequate supply and quality are available.


mHealth; Care-seeking; Maternal health; Child health; Malawi

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ISSN 2308-7854 (online); ISSN 0850-5780 (print)

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