This project uses mobile phone technology to provide access to health information services and care in Rwanda. Seekers of health information are assisted via Interactive Voice Response (IVR) by dialing 845. If a user wants to meet a medic or get prescribed medication, service tickets are sent to them automatically via their registered mobile phone numbers. The project is implemented by SPIDER partners VIAMO and BABYL. SPIDER research was carried out in April and May 2019 by Sempax LTD (a local research firm in Rwanda) to assess the usefulness of the technology used in terms of enhancing access to health information and care in Rwanda. 136 participants male (58) and female (78) were interviewed.
Findings show that users of the IVR system did not only benefit from access to health information but also information about other topics for example agriculture, sports, weather and legal support.
“That number  is impressive; it is really very helpful, all kinds of information one may want to know is provided there; one is actually updated about the world’s news; it is really good”, a respondent recalls his experience with the service.
Rwandan nationals who were interviewed were accustomed to seeking health care services face-to-face at health facilities thus obtaining information via IVR was a new experience as one of the respondents noted:
“845 is very good. However, its limitation is that using it is like only chatting with a machine; so, this does not allow me to have a direct dialogue with any individual person specialized in a given health problem if for example I need further explanations.”
The research findings further show that the digital health services provided by Viamo and Babyl are delivered efficiently. Users of the digital platforms were very satisfied with how fast and simple the delivery of services is. Health centers in Rwanda usually have long queues of patients seeking medical care. However, with digital services patients receive codes (service tickets) via their mobile phones and these codes automatically give them appointments at a health facility as explained by one of the respondents:
“Surely, I can’t go to the health centre without having called [BABYL] first; because when you do not call [BABYL], you become obliged to queue, which delays you; but when you call first, they [BABYL] provide you with a code and when you go to the health centre, you do not need to queue.”
“That number  is impressive; it is really very helpful, all kinds of information one may want to know is provided there; one is actually updated about the world’s news; it is really good”
“I personally called [BABYL] by using a cell phone that does not belong to me; it actually belonged to our head of family; but this did not bear any fruit because when I brought the code [from BABYL] to the health centre to collect the prescribed medicines, they refused to give me the medicines in question as my identity card was not matching the code-based cell phone registered to someone else [head of family]. The fact that one cannot use somebody else’s cell phone number to access BABYL’s health care services is therefore very unfair.”
Research found that mobile phones are impactful tools for patients with the following three categories of illnesses: (1) “shame-bearing illnesses” or illnesses that patients do not like to reveal for example sexually transmitted diseases, (2) illnesses necessitating urgent health care, for example diarrhea and malaria, and (3) illnesses that do not necessarily require direct contact with a medical care provider. With shame-bearing illnesses, patients feel their privacy is protected since they do not have to queue for health services at health care facilities. For other illnesses the process is fast and convenient.
The research also highlights challenges faced by users of the digital health platforms. Information on some of the health problems especially certain chronic illnesses could not be obtained via the IVR system and as stated earlier, some users did not have the urge of talking to a health provider when they use the automated voice response system. Access to information via IVR system is free in the first 18 days of the month. After that a fee of 200 RWF is charged. Rwandans who cannot afford the service fee of 200 RWF cannot access BABYL’s services. Rwanda has a social class categorization of income earners called Ubudehe categorization. There are six Ubudehe categories where the poorest households are in category one and richest households are in category six. Findings show that those in the poorest categories wouldn’t afford the digital health services. Moreover, the services are personalized. Two or more people cannot use the same mobile phone number. So those who can’t afford a phone can’t access the service. But also, those who are disabled and have to be represented when issued with service tickets or those that have not reached the age of obtaining a national identification card to register a mobile phone number are not able to access the services. Avoiding use of same mobile phone line by different people ensures privacy and authenticity but to some extent bars access to potential users:
“I personally called [BABYL] by using a cell phone that does not belong to me; it actually belonged to our head of family; but this did not bear any fruit because when I brought the code [from BABYL] to the health centre to collect the prescribed medicines, they refused to give me the medicines in question as my identity card was not matching the code-based cell phone registered to someone else [head of family]. The fact that one cannot use somebody else’s cell phone number to access BABYL’s health care services is therefore very unfair.” (35 years old woman).
There are various ways of accessing health information in Rwanda for example through radio, internet, community health workers and through mobile health but what has made mobile health preferable is the flexibility, privacy, effectiveness and efficiency in delivery of health services.