Improving maternal and child mortality in largely media-dark Bihar required a paradigm shift in the way behaviour change innovations were designed and implemented. Emphasis needed to be on increasing the demand and uptake of life saving family health behaviours, which meant empowering woman to protect their own health and that of their children and to demand better public health services.
Could we reach millions of pregnant women and new mothers with life-saving information just when they needed it? Could we reach women who lived miles away from the nearest health centre and who have hardly ever seen a doctor in their lives?
Life-saving information at your finger-tips.
We developed Kilkari – an audio-based mHealth service linking families in rural areas to life-saving reproductive, maternal , neonatal and child health (RMNCH) information via their mobile phone. Kilkari (a baby’s gurgle in Hindi) delivers weekly, time appropriate audio messages about pregnancy, child birth and child care via Interactive Voice Response (IVR). Messaging begins in the second trimester of pregnancy and continues until the child is one-year-old. Audio messages for Kilkari are delivered by Dr Anita- our fictional doctor character who features across all our mHealth products – creating surround sound and building credibility for all the services.
We spoke to thousands of poor, rural mothers and fathers to identify a digital solution to overcome barriers of illiteracy and reach even the most basic phones. We worked with health experts and government officials to create a standardized health content, aligned with government guidelines. Multiple rounds of iterative user-testing were done to ensure that content, functionality and navigation met the needs of the audience.
In 2013, when we first launched Kilkari in Bihar, although we primarily wanted to reach women, it was mainly men who owned phones with the credit needed to receive messages from Kilkari – initially a paid subscription-based service – so we used tactics to prompt men to share information with their wives. For example, calls were scheduled for the evening when men were more likely to be at home, increasing the chances that they’d pass on what they heard. To drive up subscriptions, we also ran promotions targeting men, which presented the Kilkari subscriber as a smart and engaged role model father, who cared about the health and well-being of his family.
Below the line marketing initiatives were used, such as rural activation via agents at street theater performances and targeted digital marketing via SMS and OBD by MNOs. We also used Kilkari branded vans, equipped with audio-visual aides and a Kilkari theme song which was played in the villages they visited. Other branding initiatives included wall paintings, stenciling, tin plates, posters and stickers in villages, and posters and danglers displayed in 60,000 top up shops across Bihar. When it quickly became apparent that most of the subscribers were young men who were just curious about the service, we changed our marketing approach to focus instead on frontline health workers (FLWs), who were regularly in touch with pregnant women and young mothers. An incentive program was devised where every FLW who helped a family become a loyal Kilkari subscriber received talk time credit on her mobile phone. An extensive face-to-face training program was carried out to educate FLWs about Kilkari, and to teach them how to promote the service.
Reach and impact
Kilkari is India’s first maternal messaging service and now the largest of its kind in the world. By January 2016, over 168,800 requests for subscription and more than 3.1 million calls were made to subscribers in Bihar.
In 2016, Kilkari was adopted by the Ministry of Health and Family Welfare, and has since been rolled out in 13 states, in five languages. The service is now free to every pregnant woman or young mother registered in the government of India’s public health system. Until March 2019, Kilkari reached over 9.9 million subscribers, and over 210 million minutes of content has been played.