Assessing CommCares Impact on Antenatal, Postnatal, and Immunization Uptake: Evidence from Falaba Community Health Center, Sierra Leone.

BackgroundRural districts in Sierra Leone struggle with timely and complete maternal-child health service use. CommCare, a mobile health (mHealth) platform deployed through partnerships with government and NGOs, supports tracking, reminders, and follow-up. MethodsA cross-sectional quantitative study at Falaba CHC (Sulima Chiefdom) assessed CommCares effects on (i) timeliness and frequency of ANC, (ii) PNC follow-up and care quality, and (iii) immunization uptake among children <2 years. Data were collected from n=288 participants using a structured CommCare questionnaire aligned with five sections (A-E) and extracted CommCare indicators; analysis used descriptive statistics and chi square {chi}{superscript 2} tests (=0.05), with effect sizes where applicable. ResultsFirst-trimester ANC initiation increased from 45% to 65% ({chi}{superscript 2}=8.34, p=0.004); completion of [&ge;]4 ANC visits rose 55%[-&gt;]78% ({chi}{superscript 2}=7.72, p=0.009). PNC improved: first-week postpartum follow-up 40%[-&gt;]80% ({chi}{superscript 2}=6.12, p=0.014). Immunization adherence increased 60%[-&gt;]82% ({chi}{superscript 2}=11.34, p=0.002); missed vaccination appointments declined by 24%. CommCare reminders showed strong associations with timely attendance (e.g., PNC {chi}{superscript 2}=28.451, p<0.001) and fewer missed immunization appointments ({chi}{superscript 2}=55.524, p<0.001; {Phi}=-0.439, Cramers V=0.439). ConclusionCommCare substantially improved timeliness and continuity of maternal and child health services at Falaba CHC. Findings support CHW-mediated, reminder-driven mHealth as an effective strategy in similar rural settings. Author SummaryThis study evaluates the role of CommCare, a mobile health (mHealth) platform, in improving maternal and child health service uptake at Falaba Community Health Center in Sierra Leone--a rural district marked by logistical, cultural, and infrastructural barriers to care. Using a cross-sectional quantitative design with 288 participants, the study assessed CommCares effect on antenatal care (ANC), postnatal care (PNC), and immunization adherence. Findings demonstrate consistent and significant gains across the continuum of care. First-trimester ANC initiation improved from 45% to 65%, and completion of at least four visits rose from 55% to 78%. PNC attendance within the first week postpartum doubled from 40% to 80%. Immunization adherence increased from 60% to 82%, while missed appointments declined by nearly a quarter. Strong associations were observed between CommCare reminders and timely service use, with most respondents rating the reminders as "extremely useful." Importantly, the interventions impact was mediated through community health workers (CHWs), meaning phone ownership was not a barrier to equitable reach. These results highlight CommCares potential as a scalable, CHW-mediated digital tool to strengthen rural health systems by enhancing timeliness, continuity, and confidence in maternal-child healthcare. However, persistent gaps such as transport barriers, socio-economic constraints, and limited health system capacity suggest that digital reminders must be complemented by structural supports for sustained impact. The study contributes to the evidence base on mHealth in low-resource settings, underscoring that digital interventions are most effective when embedded into health system workflows and coupled with investments in CHWs, logistics, and culturally attuned communication strategies.