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

  • Ariel Higgins-Steele UNICEF, Kabul, Afghanistan
  • A. Camielle Noordam Maastricht University, Maastricht, the Netherlands
  • Jessica Crawford VillageReach, Balaka, Malawi
  • Jean Christophe Fotso With Concern Worldwide US, seconded to UNICEF, New York, USA during the implementation and evaluation of the projec
Keywords: mHealth, Care-seeking, Maternal health, Child health, Malawi


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.