Program Evaluation of the WASHmobile PICHA7 Mobile Health and Chlorine E-Voucher Program in the Democratic Republic...

Targeted water treatment and hygiene (WASH) programs for those residing near diarrhoea patients can be a cost-effective approach during outbreaks to reduce diarrhoea spread by targeting those at highest risk. We designed the WASHmobile mobile health (mHealth) program for high risk populations for diarrhoea. In our previous randomised controlled trials in the Democratic Republic of the Congo (DRC) (PICHA7) and Bangladesh (CHoBI7), WASHmobile delivery to diarrhoea patient households through a healthcare facility visit and mobile messages from a doctor significantly reduced diarrhoea, cholera, and improved child growth. Building on this, we adapted WASHmobile for large scale implementation through a mHealth and e-voucher program for diarrhoea outbreak areas. A pilot program evaluation of this approach was conducted in DRC health areas with ongoing diarrhoea outbreaks among 2022 participants. Voice and SMS messages from a doctor were sent to those within 500 m of diarrhoea patients stating there was a diarrhoea outbreak nearby and emphasising the importance of treating and safely storing household drinking water and handwashing with soap for the next 7-day high-risk period. The SMS messages contained an e-voucher to redeem for free chlorine tablets at a pharmacy or shop. Unannounced spot checks assessed WASH behaviours 7 days after program initiation. Fifty-seven percent of WASHmobile households redeemed e-vouchers. Compared to control, WASHmobile households redeeming e-vouchers had higher stored drinking water with free chlorine concentrations > 0.2 mg/L (Odds Ratio: 6.93, [95% Confidence Interval: 1.76, 27.24]) (64% [WASHmobile] vs. 20% [control]), higher stored drinking water completely covered (4.55 [2.68, 7.70]) (73% vs. 38%), and higher presence of a cleansing agent within 10 steps of latrine and cooking areas (latrine: 3.64 [1.47, 9.02] [70% vs. 39%] and cooking: 2.50 [1.31, 4.77] [70% vs. 49%]). The WASHmobile PICHA7 mHealth and e-voucher program significantly increased water treatment, safe water storage and hygiene behaviours in diarrhoea outbreak areas in DRC.