A qualitative, participatory study to identify barriers and facilitators to women’s uptake of National Health Hotline Solutions in Malawi and Mozambique

Gender disparities in digital health service utilization remain significant, particularly in low-resource settings. In 2024 in Malawi and Mozambique, women constituted only 30% and 10% of callers, respectively, to national health hotlines, which provide health information via hotline agents and Interactive Voice Response (IVR) messages. This study explored factors influencing women's uptake of health hotline services in Malawi (Lilongwe and Mzimba North districts) and Mozambique (Quelimane) using a community-based participatory approach. Methods included key informant interviews with hotline agents and Ministry of Health stakeholders and in-depth interviews and voice diaries with women in the study sites. Jhpiego's Gender Analysis Framework guided tool development and coding, and data were analyzed using ATLAS.ti v23. Findings were mapped to a user journey based on UNICEF's Journey to Health and Immunization framework. Key barriers included low awareness of services, lack of access to personal phones, household responsibilities, socio-cultural preferences for in-person care, infrastructure limitations, and call center staffing shortages. Unique barriers in Mozambique included limited language options and narrow IVR message topics. Facilitators included strong social networks enabling phone access, trust in government services, the perceived value of health information, 24/7 service availability, and positive interactions with hotline agents. While focused on the health hotline implementations in Malawi and Mozambique, these findings are broadly applicable to enhancing women's engagement with digital health solutions in similar contexts.