Taking digital health innovation to scale in South Africa: ten lessons from MomConnect

In the last decade, hundreds of initiatives that send health information messages through mobile phone networks have emerged in low-resource countries. Most of these have been small in scale, with only five having scaled to >1 million beneficiaries: Kilkari and mMitra in India; Healthy Pregnancy, Healthy Baby Text Messaging Service (Wazazi Nipendeni) in Tanzania; Aponjon in Bangladesh; and MomConnect in South Africa.1 ,2 Of these programmes, MomConnect has attained the highest population-level coverage, reaching >60% of pregnant women attending their first antenatal care appointment in 2017. In the final editorial of this MomConnect series, we have adapted the framework provided by WHO’s ‘mHealth Assessment and Planning for Scale’ toolkit3 to summarise lessons learnt across the domains of leadership and partnerships, technology and architecture, content and user engagement, financial health, and monitoring and evaluation. The selected lessons may provide insights to other digital health programmes. Lesson 1 :  High-level government buy-in and leadership is fundamental to any successful national digital health implementation. MomConnect had its origins in several similar mobile health pilot programmes that were aligned and rationalised by the National Department of Health (NDOH) into a single overarching initiative. It officially launched on 25 August 2014 and within 12 months had enrolled >494 140 pregnant women. This rapid deployment was made possible by government leadership at the highest level, including the Minister of Health, Dr Aaron Motsoaledi. He has championed MomConnect from its inception, conducting road shows in all nine provinces in South Africa to stress the importance of its successful implementation, following up on helpdesk utilisation and registration trends during routine provincial visits, and commemorating the achievement of key milestones with public events. MomConnect is under the control of the Deputy Director-General (DDG) in the NDOH responsible for maternal and child health. The DDG is supported in the day-to-day oversight …