A protocol for a pilot cluster randomized control trial of e-vouchers and mobile phone application to enhance access to maternal health services in Cameroon

Abstract

Background: Cameroon still has relatively high maternal mortality rate (MMR) of 596/100,000 live births. Approximately 40% of births are unattended by skilled healthcare personnel with high out-of-pocket expenditures. Poor resource allocation, poorly functioning referral systems, long trekking distances to health facilities, all of which lead to low rates of use of maternal health services. Objectives: The aim of this pilot study is to explore perception and acceptability of mobile health (mhealth) and e-voucher and to determine the feasibility of conducting a large cluster randomized trial to determine the effects of combining e-vouchers and a mobile application compared with usual care in improving access to and use of maternal health services. Methods: This is a multimethod study that comprises two phases. The first phase is the development of the mobile phone app, which includes a qualitative formative study through in-depth key informant interviews and focus group discussions. The second phase is a cluster randomized control trial assessing the combination of evouchers and a mobile application compared with usual care in improving access to and use of maternal health services. Feasibility will be determined based on evaluating randomization, contamination, enrollment rate, complete follow up, compliance rate, success in matching data from different sources, and data completeness. Ethics and discussion: Ethics approval has been granted, and the trial has been registered in the Pan-African Clinical Trials Registry. We will disseminate our findings through peer-reviewed manuscripts and conference presentations. Findings from this study will inform the design and conduct of a larger randomized trial. Trial registration: PACTR201808703097367. The trial on the Pan African Clinical Trials Registry.

Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review

“…Two programs in Uganda adopted the mobile phone system midway through the implementation [ 35 , 116 ], whereas three programs in Kenya were initially designed for using mobile money or a mobile e-voucher platform [ 75 , 76 , 78 ]. One study from Cameroon was discussed as a pilot protocol for the mobile e-voucher [ 29 ] and another program in Tanzania provided mobile phone credit vouchers for direct two-way communication between pregnant women and healthcare providers [ 79 , 80 ].…”

“…For cross-validation purposes, the logic model developed from this interpretive synthesis of evidence was compared with a logic model published in a previous study on the mobile maternal health e-voucher program in Cameroon [ 29 ]. All the elements identified from their study were already included in the logic model developed from this systematic review.…”

“…Additionally, mobile money has already proliferated many LMICs and changed the mechanism for financial transactions in everyday life [ 118 ]. Given this situation, the mobile e-voucher programs have already been started in a few LMICs such as Cameroon or Kenya [ 29 , 78 ]. By taking advantage of the most popular mode of telecommunication in LMICs, the mobile maternal health e-voucher programs can still demonstrate the proven effectiveness of the traditional voucher programs while improving their efficiency.…”

“…The logic model was developed under the assumption that the key elements identified from the traditional maternal health voucher programs, as well as mobile e-voucher programs, should be considered for a mobile maternal health e-voucher programs, because the fundamental structure or cycle of the program would not be drastically changed by the transition from paper-based voucher to mobile e-vouchers [ 23 ]. The developed logic model was cross-validated with another logic model that was recently published as part of a protocol for a mobile maternal health e-voucher program in Cameroon [ 29 ]. This study is the only published protocol with a logic model so far.…”

Community participation for reproductive, maternal, newborn and child health: insights from the design and implementation of the BornFyne-prenatal management system digital platform in Cameroon

“…These mHealth interventions reduce the myriads of constraints such as distance, time, access that are typical of RMNCH service delivery in sub-Saharan Africa ( 8 , 9 ). While studies have shown the effectiveness of mHealth in delivering RMNCH services ( 4 , 7 – 9 ), there is little information about stakeholder's involvement in the design and implementation of mhealth interventions including factors that enhance mHealth services utilization in low-cost settings, as access to mobile phones does not guarantee RMNCH service utilization ( 1 , 10 ).…”