Mobile Phones and mHealth in Mozambique. The use of mobile phones has increased rapidly in Africa, with 64 per 100 population having a mobile cellular subscription as at 2013.5 As little as two decades ago, few people had access to mobile phones in Africa. In 1999, only 10 percent of the population, mostly in North Africa, had phone coverage (only Egypt, Morocco, Senegal and South Africa had coverage rates of over 40% at that time.)6 What has generally been accepted as the mobile phone revolution in Africa is relatively recent. The number of subscribers on the continent grew from 5.4 million in 2003 to 375 million in 2008.7 By 2005, demand for mobile phone subscriptions in the developing world began to exceed that of the developed world. By 2014, 78% of mobile-cellular subscriptions were in the developing world.8 In Mozambique, mobile phone subscriptions have also undergone an incredible surge since the government opened the telecommunications market—subscriptions increased from 152,652 in 2001 to 12,401,290 in 2013, and subscriptions per 100 inhabitants increased from 0.81 to 48.5,10 The majority of phones are prepaid models which users are required to register by name.11 There are three mobile phone operators in Mozambique: mCel, Vodacom, and Movitel. Rapid developments in the technology and use of mobile applications to advance health, both in developed and developing countries, are breathtaking. mHealth—the use of mobile applications to improve health—has been successfully integrated into public health and clinical care activities in many different countries.12 Within Mozambique, there are approximately 22 mHealth interventions with funding from USAID, DFID, the United Nation’s Children’s Fund, the Centers for Disease Control and Prevention, the Gates Foundation, and Doctors without Borders. The majority of these mHealth interventions use mobile phones for a variety of functions that include data collection, community health worker performance monitoring, management of commodities, SMS messaging between providers and patients, appointment reminders, and mobile money. The focus has mostly been on HIV and AIDS prevention and treatment (including ARV adherence and circumcision promotion), but nutrition and antenatal and postpartum care have also been addressed using mHealth approaches. As of the time of starting the SMS intervention study in Mozambique, none of the mHealth interventions in Mozambique was designed to improve youth’s knowledge, attitudes, beliefs, and norms related to contraceptio...
