Bangladesh has a myriad of social challenges, including low literacy rates, child malnutrition, poor access to electricity and a significant urban-rural divide. However, it has demonstrated tremendous success in achieving MDG Goal 4 (reduce child mortality) in its various indicators like reduction of under-five mortality rate. The role of behavioral change communication has been well established in this MDG goal achievement. While the infant, under-five and maternal mortality rates are better than other countries, still nearly half of children have chronic malnutrition, therefore dying at the age of under-five.
Child survival, as well as newborn survival and health, are intrinsically linked with the health of women before conception, during pregnancy, and around the time of birth, and recognizing limitations in human resources for health, Aponjon developed as a mobile-based behavior change communication program to increase health-seeking behavior at the household level and use of health facilities to improve the newborn, child survival deaths and under-five mortality.
photo from Aponjon website
The innovation, named ‘Aponjon’, which means ‘dear ones’ in English – is the largest maternal Health service that serves more than 1.85 million expecting and new mothers aiming to reduce child and maternal mortality in Bangladesh. The service currently offers health awareness through texts and voice messages over mobile phones from the 6th week of pregnancy up to 1 year of the child’s age. A mother and her family can receive important weekly health messages. Aponjon offers free service to poor urban slums and those who are significantly below the poverty line.
Aponjon is a unique mHealth initiative because it functions through all of the country’s six telecom operators. About 81% of Aponjon users are from rural areas; 60% of women users have their own mobile phones. Technology stakeholders in the program include the telecom operators and value added services platform aggregator. In addition, the service offers a 24/7 doctors’ line through which subscribers can avail expert medical advice over phone calls. The primary audience (expecting and new mothers) are delivered two messages per week while the gatekeepers (husband, mother-in-law etc.) receive one per week. The voice messages are a mix of direct messages and mini-skit playing the role of a doctor, pregnant woman, mother, and mother-in-law. Gatekeepers’ information reinforces messages provided to the mother and encourages the family involvement in healthy decision-making around pregnancy, birth and child care.
photo from Aponjon website
Another unique feature of Aponjon is the text messages and voice messages that are carefully crafted and mapped according to with subscriber’s gestational age or age of the child. Users are also able to select a preferred time of day for message delivery so that the message is received when it is most convenient. Aponjon offers free service to poor families living in hard-to-reach-rural areas and urban slums and those who are significantly below poverty line through sponsorship of USD 15 for one mom to get the whole length of service, free of charge.
In addition, a mobile application is available on google play store and will have a web interface for registration and value addition. Moreover, Aponjon partners with the field forces of BRAC, Infolady, MaMoni, Social Marketing Company, Smiling Sun, and several local non-government agencies for costumer acquisition.