Article Text

Download PDFPDF

Unpacking the performance of a mobile health information messaging program for mothers (MomConnect) in South Africa: evidence on program reach and messaging exposure
  1. Amnesty E LeFevre1,2,
  2. Pierre Dane3,
  3. Charles J Copley4,
  4. Cara Pienaar3,
  5. Annie Neo Parsons3,
  6. Matt Engelhard4,
  7. David Woods5,
  8. Marcha Bekker6,
  9. Peter Benjamin7,
  10. Yogan Pillay8,
  11. Peter Barron8,9,
  12. Christopher John Seebregts2,3,
  13. Diwakar Mohan1
  1. 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  3. 3 Jembi Health Systems, Cape Town, South Africa
  4. 4 Duke Department of Psychiatry & Behavioral Sciences, Durham, North Carolina, USA
  5. 5 University of Cape Town, Cape Town, South Africa
  6. 6, Johannesburg, South Africa
  7. 7 HealthEnabled, Cape Town, South Africa
  8. 8 HIV/AIDS, TB and MCWH, National Department of Health, Pretoria, South Africa
  9. 9 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Amnesty E LeFevre; aelefevre{at}


Despite calls to address broader evidence gaps in linking digital technologies to outcome and impact level health indicators, limited attention has been paid to measuring processes pertaining to the performance of programs. In this paper, we assess the program reach and message exposure of a mobile health information messaging program for mothers (MomConnect) in South Africa. In this descriptive study, we draw from system generated data to measure exposure to the program through registration attempts and conversions, message delivery, opt-outs and drop-outs. Using a logit model, we additionally explore determinants for early registration, opt-outs and drop-outs. From August 2014 to April 2017, 1 159 431 women were registered to MomConnect; corresponding to half of women attending antenatal care 1 (ANC1) and nearly 60% of those attending ANC1 estimated to own a mobile phone. In 2016, 26% of registrations started to get women onto MomConnect did not succeed. If registration attempts were converted to successful registrations, coverage of ANC1 attendees would have been 74% in 2016 and 86% in 2017. When considered as percentage of ANC1 attendees with access to a mobile phone, addressing conversion challenges bring registration coverage to an estimated 83%–89% in 2016 and 97%–100% in 2017. Among women registered, nearly 80% of expected short messaging service messages were received. While registration coverage and message delivery success rates exceed those observed for mobile messaging programs elsewhere, study findings highlight opportunities for program improvement and reinforce the need for rigorous and continuous monitoring of delivery systems.

  • child health
  • maternal health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • PB, CJS and DM are co-senior authors.

  • i System generated data on careseeking and practices were not available across all provinces and thus not included in this analysis.

  • Contributors AEL wrote the first draft of the manuscript and conducted the analysis. PD obtained the data, conducted extensive cleaning, provided support to analyses and manuscript writing. CC obtained the data on message delivery, helped generate figures. CP, ANP and ME supported the analyses, contributed to interpretation and manuscript writing. DM, PBa and CJS oversaw the analysis and contributed to all facets of manuscript preparation. All other authors met ICMJE requirements for authorship. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval National Department of Health-South Africa.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available on request from the corresponding author.