ArticleDigital health
Evaluating the public health impact of digital health technologies: A case study of FamilyConnect for maternal and child health in Uganda.
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Abstract
Background: Digital health technologies hold transformative potential for improving maternal and child health (MCH) in low-resource settings. This study evaluates their impact in Uganda through the FamilyConnect (FC) application-an Unstructured Supplementary Service Data-based mobile platform delivering targeted messages to pregnant women and caregivers, implemented in 42 districts since 2016. Methods: A mixed-methods cross-sectional design was used in nine randomly sampled FC districts. Quantitative data from 83 health facilities (2017-2022) assessed changes in MCH indicators via Interrupted Time Series (ITS) analysis. Additional data included surveys with 317 mothers, interviews with 409 health workers, 34 district managers, 3 national Ministry of Health staff, and 109 focus group participants. Results: FC significantly improved antenatal care (ANC) utilization: total ANC visits rose by 19.35%, with first-trimester visits increasing 85.81%. ITS showed annual ANC attendance grew by 5.5% (vs. 1.5% pre-intervention). HIV prevalence at ANC declined from 5.4% (2017) to 3.4% (2022). However, postnatal care visits declined 15.47%, male partner ANC attendance dropped 33.54%, and postnatal family planning uptake fell 58.50%-possibly due to substitution with remote guidance via FC. Success factors included translation into local languages, use of Community Health Workers (VHTs), and integration with other programs. Key barriers were phone scarcity (35% of women shared devices), poor network connectivity (notably in Karamoja), app downtime, domestic conflict, and health system issues like staff shortages and supply stockouts. Conclusions: FC shows promise in improving ANC and disease prevention, but scale-up requires addressing sociocultural, infrastructural, and systemic barriers, expanding language coverage, engaging men, improving device access, and strengthening health systems.
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