health policy that interacts outside the health system

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To tackle this problem, Secretary of Health of Argentina made a plan in 2016 to contact women during their pregnancy and send them emails to communicate the importance of attending these prenatal check-ups. The emails were unpersonalized, cold, the language used was technical and sometimes even you can feel that Government was yelling at you.

The Undersecretary of Digital Government of Argentina is in charge of building the Government digital platform to interact with citizens, after several meeting with the National Office of Maternity and Childhood of Argentina to analyzed their approach and we concluded that sending email was not the right way to get communicate with women during their pregnancy. We needed more information to understand what the solution was, and the most important thing was that it should be the solution that users needed, not what the government supposed it should be.

So we set up a team of anthropologists, psychologists, designers and process analysts, lead by Florencia Rolandi, who is a MD Cardiologist and senior advisor of health and disability at the Undersecretary of Digital Government, to conduct a 6 month research effort, visiting health centers in different parts of Argentina to understand how women interact with the public health system and what were the reasons no to attend to the check-ups. Our team built a user-profile based in interviews (with patients and obstetrician) and observation that allowed us to have some conclusions about the users conduct and behavior during pregnancy.

There are almost 40 million mobile phones in Argentina, and 90% of the population own a phone. However, 70% of these phones are prepaid. For this reason, sending an SMS was not an option for us. But through interviews with potential users we discovered that 90% of them were active users of Facebook and Facebook messenger.

The interviews showed us users with many doubts about their pregnancy and controls, with the need to access information simply and quickly. Women did not attend the controls for lack of reminder but also for lack of information or fear. The telephone is something that always accompanied them in the waiting rooms of the health centers.

At the same time we started working with the National Office of Maternity and Childhood of Argentina to develop the necessary content for a tool that could inform women about the health-aspects of pregnancy, and guide them during their pregnancy and during the first year after the baby is born.

We decided to build a virtual assistant that could work outside the health system, building an interaction channel with women via their phones and provide them with information and check-ups reminders so they can follow up on their pregnancy.

Chat Crecer is a virtual assistant — a bot — based on Facebook Messenger that works independently of the health system, identifying and recruiting pregnant women where they are.

The bot is designed to accompany women during their pregnancy and the baby’s first year with personalized information and reminders to attend pre- and post natal check-ups.

Because the bot provides simple access to health information and it’s easily scalable — as it not constricted by being in a physical location and does not have any additional costs per user — it has been a bridge to access health services for a population that are otherwise isolated from these services.

We first implemented the project in Pilar, Buenos Aires, where 4,000 women give birth each year and the infant mortality rate is 11 per 1,000 live births. We enrolled a population of pregnant women to test the evolution and adoption of the bot.

A team of 10 university students led the field implementation, and they acted as digital literacy tutors (this initiative is part of our National Plan of Digital Inclusion) who find pregnant women in the waiting rooms of primary care, in school canteens or social events.

Obstetricians also promote the the bot when they meet women for check-ups. At the same time, usability tests and analyses of the platform were carried out (topics consulted, questions asked) that allowed us to implement improvements in the content and the performance of the tool.

We implemented a guerrilla communication strategy, creating graphic material to use in health centers to promote the use of the bot such as: posters, reminders of next control, tutorial on how to download and install Facebook Messenger or prescription form. And we decided not to use the Government brand in any piece of communication, we believe that this tool is agnostic of the political context, so to facilitate its acceptance and to be able to measure its impact as a public policy this action was necessary.

From July 11, 2018 to June 1, 2019, 4,000 pregnant women and 1,260 mothers of babies under the age of 1 were contacted by the digital literacy tutors. Of these, 4,200 are now using the platform.

The users took full control of the platform, our team watched the conversations and every missing topic was a requirement to the health team to create and make it available. We discovered that women consulted at all times on thousands of issues that the Government did not have on radar, we launched awareness campaigns on vaccines, influenza, lactation and healthy eating.



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