“Warm-Ware” to Help Reduce Mother-to-Child HIV Transmission in South Africa

I recently returned from a field trip to East London and Mthatha, South Africa, where I had the opportunity to support a training session with Small Projects Foundation (SPF), an organization that aims to improve lives of South Africans, “economically, physically, and socially.” SPF has made significant contributions to development and healthcare in South Africa, with a particular focus on the prevention and treatment of HIV and AIDS. Today, SPF utilizes CommCare on a Prevention of Mother-to-Child Transmission (PMTCT) of HIV project in the Eastern Cape.

I had the privilege of sitting down with Dr. Paul Cromhout, managing director of SPF, to discuss SPF’s work, the evolution of mother-to-child HIV transmission rates in South Africa, why SPF is utilizing CommCare, and his advice for organizations who are considering adopting an mHealth tool.

Dr. Cromhout is a veteran champion for public health in South Africa. When he founded Small Projects Foundation in 1988, it was at the height of the HIV/AIDS epidemic in South Africa. Support programs Dr. Cromhout helped implement have prevented up to 8,500 children from contracting pediatric HIV to-date.

Mother-to-Child HIV Transmission Rates in South Africa

For background, Mother-to-Child HIV transmission is largely preventable. With proper care and medical treatment, the risk of mother-to-child HIV transmission can be reduced from a 15 to 45 percent chance to less than one percent. Despite the vastly reduced risk, many HIV-positive mothers living in the Eastern Cape default on their treatments due to a variety of factors—from lacking the money needed to travel to a clinic to suffering from depression, which makes it difficult to seek treatment.

When Dimagi first engaged with SPF on this project, the Mother-to-Child transmission rate was 2.7 percent to 7 percent, depending on the specific village. This marks significant progress considering the transmission rate in the Eastern Cape was estimated at 40 percent during the ‘80s and ‘90s, and near 14 percent in 2004 (more background on the improvements can be found here). More recent SPF research has shown that up to 40 percent of HIV-positive mothers were defaulting on treatments, according to Dr. Cromhout. This holds a grave risk for future increased transmission of HIV to children and treatment failure for mothers.

SPF and Dr. Cromhout believe there is more progress to be made.

Every HIV-positive mother who has a baby without HIV is a victory. But what will bring me joy is if we can reduce mother-to-child transmission to less than one percent. And then we want to eradicate pediatric HIV. We’re not there yet,” Dr. Cromhout said.

Dimagi training session

Community health workers learning the SPF app built on CommCare in a training session led by Dimagi.


Connecting HIV-Positive Mothers to Care with “Warm-Ware”

SPF turned to Dimagi to help bring them closer to this goal.

With the use of CommCare, SPF hopes to better track HIV-positive pregnant women and mothers and their babies (an inseparable dyad) during the first 18-months after birth, which is the critical timeframe for medical treatment to prevent mother-to-child HIV transmission. The mobile technology allows SPF to create a feedback loop where local hospitals and clinics, through CommCare, can send automated SMS reminders to the Community Health Workers (CHWs), who are caring for these women at the village level.

The idea is to make it easier for the community health workers to track and follow-up with the HIV-positive mothers to ensure they are getting the proper care they need. SPF believes the technology supports “human-to-human connections,” which is what Dr. Cromhout maintains is the key to reducing the default rate — and ultimately, the mother-to-child HIV transmission rate.

Dr. Cromhout calls the solution “warm-ware.”

Warm-ware is what it’s all about. This is when you use technology as a bridge to human relationships —because the only way people can change behavior is through relationships.”

mobile technology enabling connections

CommCare helps to connect providers and patients, while enabling oversight from SPF.

Dr. Cromhout’s Advice for Organizations Adopting mHealth Solutions

Dr. Cromhout offered three tips for organizations looking to adopt an mHealth solution on a project.

1. Start small and focus on the beneficiary

While mobile solutions such as CommCare offer many advanced features today, Dr. Cromhout advises organizations to start small and focus on the beneficiary who will be using the tool.

“Within the African context, we need to recognize that most healthcare professionals are not necessarily highly technologically competent. We need to offer simple tools that help them treat their patients, and which offer supervisors useful data to improve workforce performance,” Dr. Cromhout said.

Dr. Cromhout stressed the importance of connecting everything back to the patient. “Always put the patients first. If the solution won’t help patients in a measurable way, don’t do it.”

2. Be prepared if technology fails

Dr. Cromhout also highlighted the importance of making sure your system works even if the technology fails.

“Whatever you’re going to do in an app, do it in a hard copy. Make the system work with or without the technology so that health worker can continue their work if something goes wrong. This is what we call having a belt, suspenders, and a piece of string holding up your trousers.”

3. Ensure technology can scale

Once your solution works and you can demonstrate impact, you will need to prove the system can be scaled to a national level, Dr. Cromhout said. “You need to make sure that it can link to the national healthcare system. If you can’t, you’re blown out of the water.”

In that vein, Dr. Cromhout considers affordability as one of the key considerations to take into account. This input resonates with Dimagi’s Maturity Model, which helps organizations learn how to develop and grow their mobile systems, from the pilot phase through scale.

Dr. Cromhout’s Final Thoughts on the Project

Dr. Cromhout believes that the cornerstone of behavior change is through relationships. With CommCare, SPF hopes to help CHWs strengthen relationships with their patients, so they can help mediate challenges during critical times of need.

We want to change behaviors, change lives, and to start a counter infection of love, hope, and care,” Dr. Paul Cromhout said.


Image credit: SPF



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