Launched: August 2015
The Government of Mexico promotes poverty reduction and the attainment of social rights and equal opportunity through a programme called Prospera. To be part of Prospera, the households' per capita monthly income must be below the Minimum Welfare Line (LBM in Spanish), which is around USD $55 for rural areas and USD $85 for urban areas. Prospera provides almost 6 million households living in extreme poverty with conditional cash transfers, benefiting approximately 30 million people. Every other month, the heads of beneficiary households - over 95% of them women - receive these payments in exchange for their children’s regular school attendance and household visits to the health clinic. These conditional cash transfers have been credited with decreasing poverty and improving health and educational attainment.
Despite this innovation in poverty reduction, disparities persist within Mexico. In the disadvantaged southeastern states, maternal mortality is five times higher than in the industrialized northern states. Women from these smaller, less developed communities are delayed in their decision to seek care due to social norms and cultural beliefs. They are also delayed in reaching care and in the receipt of adequate care once they reach a facility. These limitations in access to emergency obstetric care translate to a disproportionate amount of maternal mortality. UNICEF Mexico and partners wanted a way to address this health disparity.
Prospera Digital aims to reduce maternal and childhood mortality through practical and personalised SMS reminders that encourage mothers to take action in the areas of antenatal care, nutrition, delivery, postnatal care, breastfeeding, and immunisation.
Progresa is an example of an evidence-based policy, so Progresa Digital will follow suit. An eight month randomised control trial (RCT) is planned for 2015/16 to evaluate the effect of the two-way SMS mother reminder system. In an RCT, participants are randomly assigned to receive the standard practice (CCT through Prospera) or a treatment arm. In this study, there are two treatment arms: one will receive two-way SMS messages with ad hoc content. The second treatment group will include ad hoc content (CCT + mother reminders through Prospera Digital) and a mechanism for beneficiaries to assess the quality of their medical care (CCT + mother reminders through Prospera Digital + satisfaction surveys).
Pregnant Prospera beneficiaries will be eligible to participate in the RCT if they live with the catchment area of a clinic:
- that has connectivity to mobile networks
- with a low ratio of inhabitants that ONLY speak an indigenous language
- with a relatively high ratio of pregnant women.
From the selected clinics, all women who have reported their pregnancy will be included in the pilot. These women will continue to visit the clinic for antenatal care.
The pilot will utilise matched pairs at the clinic level, through which groups of clinics with similar characteristics will be formed. Using a closed lottery, clinics will be randomised into the control group or one of the treatment arms. To avoid spillovers and contamination between groups, there will be a protocol on the minimum distance between pairs of clinics.
The study team will analyse:
- Changes in the demand for medical attention and an increase in compliance with care recommendations for pregnant women measured through the medical attention card. Every pregnant woman in Mexico has a medical attention card which summarises appointments and care.
- Pregnancy and childbirths. To measure these outcomes, the programme will use the information reported by the clinics at delivery, which includes height, weight, and general health condition of the newborn. Additionally, the immunisation carnet and other administrative records from the clinics will provide information regarding pregnancies and child health. Finally, records from the National Health System Information (SINAIS) will provide information to analyse the impact on child and maternal mortality.
- Changes in the medical attention received by Prospera’s pregnant women. To measure this outcome, participants will receive flows about the quality of the service they received.
- Feasibility through interactions with RapidPro and mobile phone activity.
Progresa Digital will utilise a campaign to send pre-set messages and flows scheduled around dates provided by the expecting mother. The campaign includes around 150 events, including information on antenatal care, nutrition, pregnancy danger signs, postnatal care, breastfeeding, and immunisation.
UNICEF and partner organisations are working to adapt mother reminder messages for Mexico. They will then test the content of the questions and reminders, revise as necessary, and conduct a pre-pilot that includes the delivery of mobile phones to beneficiaries. The full pilot will be conducted for 8 months, and then the results from the randomised control trial will be analysed to determine the impact of mother reminders on the outcomes of interest compared to Progresa. If effective, Mother Reminders will be fully integrated into the Progresa programme in 2016, reaching 7.5 million women in Mexico.