How Text Messaging Curbs Infant Mortality in Africa’s Biggest Urban Slum

Digital-Diversity-BannerAlmost half of Kenyan mothers do not give birth in a hospital and, thus, receive little professional care or education on basics such as how long to breast feed, what to do in the case of diarrhea and vomiting, or where to go for an emergency. In this issue of Digital Diversity, Cayte Bosler looks at an innovative text messaging service which helps parents differentiate between normal behaviors and signs that something might be wrong.

Digital Diversity is a series of blog posts from featuring the many ways mobile phones and other appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives.

By Cayte Bosler

Veronica’s 6 month-old daughter, the youngest of her two children, was severely dehydrated. In the U.S., that might precipitate a quick web search or a trip to the pediatrician. But Veronica lives in Kiberia, an area of Nairobi, Kenya, that is frequently cited as Africa’s biggest urban slum. Nairobi’s infant mortality rate is 40 out of 1000 – compared to 6 in 1000 in the U.S. – and like millions of others in Kenya, Veronica lacks access to basic healthcare.

Veronica could have been at a loss for how to respond to her child’s sickness. But on this occasion, she opened her cell phone and sent a text asking for help. She was using Totohealth, an SMS service designed to help guide mothers through the first few years of their children’s lives. The service sends weekly texts, based on a child’s birthdate, to alert parents to developmental milestones and things to look for.

Veronica with her daughter accessing the Totohealth service. Photo: Cayte Bosler
Veronica with her daughter accessing the Totohealth service. Photo: Cayte Bosler

“Even in low income settings like Kibera, the majority of people have basic phones,” explains Malele Ngalu, marketing director for Kenya-based Totohealth. “We utilize SMS technology to help reduce maternal mortality and child mortality and to detect developmental abnormalities in early stages.”

The company was founded in 2014 by Felix Kimaru for who wanted to apply his background in computer science to solving one of the continent’s biggest problems. Users subscribe to the service for free; the cost – about 25 cents per person a month – is covered by county governments, who see it as a way to improve community health. Once they’ve registered, users get weekly messages about what to expect from their children.

“It’s amazing,” Veronica says. “Sometimes I feel like Totohealth is actually watching the baby because I receive messages that describe almost exactly what my baby is going through. Yesterday, I got a message about what to pay attention to as my baby begins to crawl and the next day she started crawling.”

In addition to the weekly text messages, users also have full-time access to a help-desk feature for specific questions and concerns.

“Some of the questions we receive are life threatening,” Ngalu says. “We have a staff of trained medical professionals who respond within minutes.”

Naglu says he hopes the help desk feature, accessible from anywhere someone has a mobile phone, will help drastically reduce the number of infant and mother deaths.

“Instead of building an app, we take advantage of what’s already used,” Ngalu says. “That’s the difference between what’s happening here and in other countries. SMS is still king in an African environment because over 50 percent of our communities are still remote.”

For Ngalu, working for Totohealth is part of a personal journey. He says he wishes this healthcare platform had existed for his own mother who lost his twin brother.

“I often wonder what my brother would be doing if he were alive,” he says. “The feeling of seeing Totohealth come full circle in my own life has been incredible. My wife and I were able to use the service with our own children.”

The company plans to reach 120,000 parents by the end of 2015 and will continue to market in greater East Africa.

cayteboslerCayte is a journalist based in Brooklyn, New York. She travels to study and write about entrepreneurs in unlikely places solving the world’s most pressing problems. She freelances on a variety of subjects including science, technology, international development, foreign policy and travel. She possesses a great affinity for snails. You can follow Cayte on Twitter @caytebosler

Digital Diversity is produced by Ken Banks, innovator, mentor, author, anthropologist, National Geographic Emerging Explorer and Founder of, FrontlineSMS and Means of Exchange. He shares exciting stories in Digital Diversity about how mobile phones and appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. You can follow him on Twitter @kiwanja



Meet the Author
Ken Banks is an innovator, mentor, anthropologist and National Geographic Emerging Explorer. Founder of and now Head of Social Impact at Yoti, he spends his time applying Yoti's digital identity solutions to humanitarian problems around the world. His earlier research resulted in the development of FrontlineSMS, an award-winning text messaging-based field communication system designed to empower grassroots non-profit organisations. He shares exciting stories in "Digital Diversity" about how mobile phones and other appropriate technologies are being used around the world to improve, enrich, and empower billions of lives.