PENSA *660#

Mozambique (like many LMICs), performs poorly in health indicators due to factors such as distant health facilities and inadequate health workforce. Exacerbating this problem is that the majority of citizens live in remote areas, with limited access to data networks and with few possessions. Except one, the cellphone.

To cater to the needs of this under-served demographic, we developed an mHealth platform that they can access without any barriers of entry. It works on any cellphone (even the most basic without Internet) through USSD and is free of charge on all national operators. Through this menu-like interactive structure, our multi-channel and bi-directional platform delivers pertinent MOH-approved health information, collects & answers users questions, performs surveys/self-screening, and avails data and reports on the back-end for the MOH and partners.

This cloud-based and modular platform (growing at over 300,000 new users per month) can easily be translated and extended to other countries. 

Mozambique ranks as 180 (out of 189) in terms of HDI and is considered a least developed country (UNICEF, 2018). Of the 28 million citizens, 68% live in the rural areas (UNDP, 2018) with limited access to basic services. As for health in particular, we have an inadequate health workforce, with 0.055 physicians and 0.401 nurses and midwives per 1000 people, relative to the minimum recommended ratio of 2.3 of all healthcare workers (WHO, 2019).

This above situation leads to an environment of where the vast majority or ill-informed and un-prepared to adequately deal with their health issues, and they often become apathetic and seek medical advice when the situation is dire. While many attempts are made to improve the populations health, they generally focus on un-scalable and costly methods: TV campaigns, face-to-face community outreach awareness, emails, smartphone apps, etc.

Simply put, these methods do NOT reach the most vulnerable demographic.

According to our telecommunications operator, over 70% of the adolescent and adult population possess cellphones, albeit many are basic or feature phones. We developed a solution that allows even the most basic handset to access our mHealth platform PENSA *660# with no barrier to entry: it is free of charge, available on all operators 24/7, works on any cellphone, and even works in areas with no data network.

Our solution provides pertinent Ministry of Health-approved health information across multiple-channels (responsive website and USSD)and is bi-directional. So while a user can get the latest information on preventive Covid19 measures or contact details for the nearest health facility, they can also subscribe to receive notifications of particular health topics, submit health questions, receive SMS campaigns on important health issues, etc. We are even now including Covid19 self-screening tests, vaccination surveys, and more.

All of this is accessed at any time and the information is stored in our database. In the back-end, we availed a web interface where the Ministry of Health and partners can access anonymized and geo-referenced data/usage reports to help stay informed on what issues affect citizens in different areas of the country, to help guide decisions and policies.

Our solution serves all Mozambican citizens, particularly the under-privileged in the rural areas and with low-tech phones. 

We are feeding the platform with relevant information, and have received positive feedback having just reached over 300,000 news users/month with a quarter of a million visits per day. We have a voluntary self-registration section where the citizens provide their gender, age, and location, for us to understand how the usage and needs vary based on the users demographic. While we do have a free questions section (answered by the Ministry of Health’s call center), we plan on introducing satisfaction surveys in the near future to ensure we are constantly meeting the users expectations and providing the content they want.

As for the Ministry of Health (MOH), they have grown to rely heavily on our platform. It is front and center of their posters and campaigns, particularly during the Covid19 pandemic where travelling and community meetings are discouraged. At the request of the MOH we have sent out SMS awareness campaigns on rabies/vaccinations, performed surveys, provided self-screening, etc. Most importantly, we also provided usage data/reports to help guide their decisions and policies.

PENSA *660# is completely aligned with the challenge as it is an affordable (i.e. free) solution that focuses on information for prevention and mitigation of health issues of the Covid19 pandemic and beyond. Besides Coronavirus, the platform is filled with other relevant information such as HIV/AIDS, Maternal Child Health & development, malaria, diabetes, strokes, etc. We are introducing disease surveillance now through self-screening. Finally, our solution exists within the National Health System ecosystem as we are integrated with the Ministry of Health contractually and technically.

The innovation of our platform comes from its user-centric approach. Rather than building an app our website to avail this information to the user, we looked at what they had readily available, and build everything around that. This allowed us to provide relatively "advanced" features to an often ignored or unreachable demographic.

Another innovation is the back-end database. We are providing the Ministry of Health (MOH) with information on users that they do not have on any other channel (especially no channel with 1.5 million users and counting). Also, we provide services, also not previously made available to the demographic, such as surveys and tests.

Finally, the modular build of the software, facilitates extension and integration with other platforms.

PENSA is build on a hardened cloud-based LAMP architecture configured with security in mind: Host Intrusion Detection/Prevention, firewalls, VPN's, anti-virus, backups, etc. We are using Apache, MySQL, and Tomcat.

From an application perspective we developed everything using Java, following the Model-View-Controller architecture. The code itself follows several of the Gang of Four design principles to deliver consistent quality. Test-driven development was used, to further help guarantee code quality.

The application has Adapters to abstract away the variations/complexities of the USSD and SMS gateways of each Mobile Network Operator, and the core PENSA application uses a REST interface.

Our solution was created in partnership with the Ministry of Health (MISAU), launched in November 2017, to provide free health information for all those in Mozambique, but focusing primarily on the under-privileged, by dialing the number *660# from any mobile operator. We currently have 1.5 million users with 14 million views and are now growing at 300,000 users/month.

Below is an example of how reliant the Ministry of Health is on our platform, as it is prominently advertised/used to help keep citizens involved on the best Covid19 preventive measures. Our National Health Institute is also prominently promoting the use of our platform (see https://covid19.ins.gov.mz/ ). Local partners and donors like UNICEF are also making a point of telling citizens to get correct health information on our platform (https://www.unicef.org/mozambique/comunicados-de-imprensa/unicef-alerta-para-circula%C3%A7%C3%A3o-de-mensagens-falsas-que-aumentam-o-risco-de).

A 3rd party research conducted by the University of Chicago using anonymized data of PENSA users, showed that during the Idai and Kenneth cyclones last year, users in the affected areas increased their access of PENSA. This was an early indication of how the platform is positively altering and affecting the health behaviour of the population. 

With this report and increased usage of the platform, we would like to perform further studies to show how positively we are affecting the lives of the underprivileged.

At this time, it is possible to verify the impact on our Covid-19 pandemic solution, as our solution was created to provide information on infectious diseases that most attack the country and on Maternal and Child health. However, since the discovery of Covid-19, we started to include information on this disease on the platform (such as causes, prevention methods, quarantine, among others). And since the introduction of information about Covid-19, in January 2020, the average daily views/queries on the PENSA were about 2,000, but this increased to 150,000 in May. We have now reached the historic milestone of over 1 million visitors/users with 10 million views.

Our solution currently serves 1.5 million people, and with the current growth rate we will reach 5 million within a year. After 10 years we'd like to reach 10 million. 

Within the next year we need to make the platforms, and systems surrounding it, more sustainable and efficient. This involves first creating a clear processes for content insertion and guaranteeing it meets the needs of the user. Content involves not just the information and features provided, but also the way it's delivered (i.e. local languages, voice, etc). Second, we would like to generate revenue that is organic to the platform. We are exploring SMS campaigning of health events, renting of space on the platform for private health facilities/clinics as well as pharmacies, and additional services linked with pharmacies.

Within 5 years, after we have perfected a sustainable model, we would like to expand the solution internationally, particularly in the African region, but hopefully later to Asian and Middle Eastern countries with a similar demographic to ours.

The main barrier we face are resources and guidance. The first is legal guidance to navigate the tricky waters of how to renew the Ministry of Health contract in a manner that facilitates revenue generation, as well as with the operators. We would also like to do better with regards to patents and trademarks.

Second we would like to explore the revenue generation with more energy. Third we would like to increase the functionalities and features of the platform in alignment with the needs of the users and the revenue generation.

We ideally would like to receive non-equity based grants to address the barriers above. In the absence of such grants we are willing to pursue equity-based support, and partnerships (we have already initiated one with a local business development company).

The team is compesed by 7 people.

The team is lead by Valter Cumbi who has a Masters in Computer Engineering with 15 years experience in software development and 10 in telecommunications. He is the PENSA project manager and software architect, also counts on Dr. Marta Cumbi an economist with a Masters in national development and project planning with over 30 years experience of development in Mozambique and beyond. She provides social development advice to PENSA. At the other hand we have Valdumar Walters a software developer, involved in the design and development of PENSA software components, and Denise Lemos, a female with a Bachelors in Law, as the Content Manager for PENSA, they are both young and energetic. 

Our organization has the support of the Ministry of Health, the National Innovation Fund (FNI) that financed the development of the initial project, and all the mobile operators: TMCEL, VODACOM and MOVITEL.

The Ministry of Health is our (contractual) partner in the PENSA project, regarding the insertion and dissemination of health information.

So far we have not started generating revenue off the solution, as the goal was to increase usage. In the near future, however, we will introduce:

• Paid SMS campaigning of health events;
• Renting of space on the USSD menu for private health facilities/clinis;
• Renting of space on the USSD menu for pharmacies, and ordering of materials through the platform.

We are currently funded purely by the company (through other projects). But will sell equity, if necessary, to fund the work. Ideally we will receive a grant before reaching this stage, however.

We are pplyin to Solve because 

We need partners or support on solutios technology, funding and revenue model and marketing, media, and exposure, because we have a solution that already shows public utility, already implemented, but we need to improve services, improve the marketing strategy in order to reach more people, in a short time, and for that we need support, both financial and technical.

Our mHealth platform PENSA *660# already has more than 2 million active users, from our population of 28 million. This is particularly impressive given that over 65% of our population live in rural areas with limited access to Internet, and over 60% are under 15. PENSA *660# has thus managed to reach and engage an often ignored demographic.

We intend to leverage our extensive and growing user base to better understand user behaviors/patterns and potential even provide early detection/prediction of disease outbreaks. We hope to learn things that help guide public health policy in Mozambique and other Low & Middle Income Countries.

With usage data ranging back to November 2017, we already have a vast source to perform this analysis that has spanned several significant events. For instance, a recent (but yet unpublished) study done using anonymized PENSA *660#, shows that usage of our platform increased in the aftermath and in the areas of the deadly Idai cyclone that hit Mozambique in 2019, helping to shed insight on how people react in light of these natural disasters.

Source Code is a for-profit software development company, and our solution impacts millions. Despite living in one of the poorest countries in the world, through our mHealth platform PENSA *660# we already have more than 2 million active users, from our population of 28 million. This is particularly impressive given that over 65% of our population live in rural areas with limited access to Internet, and over 60% are under 15. PENSA *660# has thus managed to reach and engage an often ignored demographic.

We intend to leverage our extensive and growing user base to deliver a suite of revenue generating products and services, while still delivering a free service to the under-privileged. These range from paid B2C advertising, paid listing of private health facilities on our contacts list, user surveys, selling data, and more.

We are also in talks to expand our technology to other areas such as mAgri and mFin.