The department is a lively community that is recognised internationally as one of the top centres for research and teaching in development studies.
The texts, which are personalised with the baby’s name and written so as to fit into one message of 160 characters when translated into Swahili, take into account regional and district variations, for example in dietary habits or cultural beliefs and practices. Parents can also send individual questions directly to Totohealth’s experts via an SMS helpline and there will be a voice messaging option for subscribers who cannot read.
As well as reducing mortality, the service – which is free to users – aims to ensure early detection of developmental delays or disabilities in babies, conditions such as club foot, autism, epilepsy, or hearing and visual impairments. Some of the texts require a ‘yes/no’ response from parents regarding the baby’s progress that can trigger a suggestion to seek further help, depending on the answer.
The system is useful not just for those who have difficulty accessing existing healthcare facilities, but also because it provides an alternative, more relaxed, way of interacting with health experts.
‘Culturally people treat healthcare providers with great respect and this barrier often does not give clients the freedom to feel comfortable and restricts questions during the brief time they have together,’ Tayeb explains. ‘In small communities it is also difficult to ask sensitive questions in fear of being judged by healthcare providers who typically live in and are an important part of the community.’
As well as permitting parents to ask questions privately and anonymously, the service enables them to refer back to messages multiple times, rather than relying on advice delivered orally during sometimes rushed clinic visits, and provides a source of information that is different from that traditionally passed down by elders in their communities. It also allows for greater involvement of fathers, who are generally excluded from maternal health discourses, both at home and at health facilities – fathers are free to sign up for the Totohealth text messages too.
The texts are just part of a package of measures that Totohealth offers. In addition, it supplies clinics with Clean Delivery Kits (CDK), which provide clinicians with supplies to use during labour to ensure a safe and hygienic delivery and a ‘Totokitbox of essentials for the mother and baby after delivery. The CDK and Totokitbox are available only via healthcare facilities – during delivery or at the postnatal care visits – so act as a ‘pull factor’ to encourage parents to opt for a clinic-based delivery and attend the four recommended check-ups after the birth.