Phone Hotline Spreads Family Planning Information in DR Congo

This case study describes how Population Services International (PSI), under their Family Planning Project, set up and managed la Ligne Verte (which means "hotline" in French) in the Democratic Republic of Congo (DRC). It also explores the lessons learned that may point to the use of cell phone technology as a powerful new tool for health education, especially in countries like the DRC that have little communications infrastructure, such as standard telephone networks and roads.

According to the report, in 2005 the modern contraceptive prevalence rate (CPR) was estimated at 3 to 4% of women of reproductive age in union, less than a third of the rate of a decade earlier and one of the lowest CPRs in all of sub-Saharan Africa. Numerous factors contribute to the low CPR and high unmet need, most notably, the decade of violence and unrest (1994-2003 and ongoing conflict in the northeast) which shattered the health and family planning system throughout the country. Additional factors include the inadequate state of the DRC’s transportation network, poor communication infrastructure, and the population’s low exposure to media such as radio and television. These factors make it extremely difficult to spread health messages.

According to the report, knowledge of two or more methods of family planning is strongly correlated with the uptake of a method. The programme is based on the idea that having a discussion about family planning has an even stronger correlation with uptake of a contraceptive method: A woman is 3 times more likely to adopt a modern method if she has a conversation with a knowledgeable person. To increase the number of such discussions, the FPP launched la Ligne Verte in early 2005. By dialling a toll-free number, callers can speak to a trained educator and get accurate information about birth spacing in general, the correct use of family planning methods and how to avoid unwanted pregnancy, and the nearest Association de Santé Familiale (ASF) partner clinic, labeled under the network name Confiance. An important feature of la Ligne Verte is the assurance of caller anonymity. The system operates via a contract with VODACOM, the largest cell phone service in DRC at the time of the research [2008]. All calls from VODACOM phones are free to the caller; at the end of each month, the FPP pays VODACOM the equivalent of 36¢ per call received. Each call is limited to 2 minutes.

The FPP offers the hotline as one element of an integrated package of services. The phone number for la Ligne Verte is printed on all Confiance pocket calendars, which are widely distributed by mobile educators during the FPP’s mass and individual information sessions; it is included in PSI/ASF clean delivery kits as well. The number is also broadcast in radio and television spots, is printed on many of the product posters that decorate the walls of partner health clinics, and for a time was posted on billboards. The FPP’s trained educators staff the line. The project has a pool of 27 such educators in Kinshasa; all received comprehensive training in family planning and outreach communication, and they carry out family planning education in public places such as markets, and in neighbourhoods and in private homes. The mobile educators rotate from their field positions two at a time for 3-month shifts on la Ligne Verte.

The programme has found that men make up the vast majority of callers to la Ligne Verte and account for over 80% of all calls made to the hotline since its inception. All calls made to the hotline are free, so lack of money to pay for a call is not a factor (although it is likely that men have better access to cell phones in the first place). Likewise, it is unlikely that men are more exposed to information about the hotline than are women, since most of the FPP’s family planning messages are primarily designed for women. The organisers have also found that project activities correlate with hotline calls, and the largest number of calls originates from where the organisation has activities.

Based on experience with the hotline, the organisers make the following conclusions:

• Men in the DRC have a higher unmet need for family planning information than anticipated.
• Two minutes per call is not adequate.
• Call data could be mined to further evaluate and guide programming.

According to the report, the FPP’s experience in the DRC indicates that a hotline is a valuable asset in a programme that aims to increase knowledge, acceptance, and use of family planning methods; it is perhaps especially important where other forms of communication are not readily available. Such a hotline must have trained operators at its disposal to answer calls and should keep regular hours that are easy to remember. The hotline’s number should be widely and consistently distributed through as many channels of communication as possible. Data from calls should be regularly analysed and used.