RE-CAL-L

RE-CAL-L is for the 2.6 million women and children at risk of dying every year because they do not get the antenatal, delivery and postnatal care and immunization services they need. Re-cal is a personalised health appointment reminder system for women and children in remote rural areas. 

RE-CAL-L has been shortlisted for the
OpenIDEO ‘Empowering caregivers in immunisation challenge


Mercy and Feston’s story

Mercy and Feston are a young couple from rural Malawi.

When they got pregnant their joy was mixed with anxiety – tragically Mercy’s sister died in childbirth and Feston’s niece died of measles. So, they approached their community health worker – Florida – who was trained in the Re-cal system.

In 10-minutes they had a personalised wall calendar indicating all their recommended health and immunization appointments before, during and after birth – immediately putting them at ease. The calendar and ongoing support from Florida, ensured they got to all their appointments and Mercy and her baby stayed safe and well.

Re-cal: First iteration prototype of contact calculator and wall calendar

Re-cal: First iteration prototype of contact calculator and wall calendar

The problem

Despite impressive improvements, too many women and their children still die from preventable and treatable conditions. Existing, simple solutions can provide a solid foundation to improve mother and child health and survival. Attendance at antenatal care, delivery with a skilled birth attendant, attendance at postnatal care, and uptake of immunization could save over 2.6 million lives every year.

Unfortunately, coverage of these solutions is still far from universal, particularly in poor countries with the highest rates of mortality. Here behavioural nudges can increase timely and complete uptake of these solutions. Mobile technology provides an important platform for these nudges, but will not reach those who do not have access to a mobile phone – more than 1.7 billion of the world’s poorest women. Analogue reminder systems are also needed. Experience shows that these work best when they are personalised, locally designed and combined with home visits by health workers.

An innovative solution

RE-CAL-L is a simple, analogue, personalised health appointment reminder system for women and children in poor countries, particularly in areas with low mobile phone usage. 

In the RE-CAL-L system community health workers receive basic training to identify pregnant women in their catchment areas and visit them at home to tailor personalised wall calendars, using a paper-based ‘contact calculator’ to ensure accuracy. The calendars display all their recommended health and immunization appointments before, during and after birth in a comprehensive and accessible way – supporting timely and complete uptake of these services. Community health workers also use dates from the calendars to plan their routine home visits, ensuring they are there to provide support and advice when they are most needed.

At scale, the full RE-CAL-L system could cost as little as $3.75 to reach and support a mother/child pair.

Next steps

Women and Children First is looking for funding to continue incubating the RE-CAL-L innovation.

RE-CAL-L has been subjected to several rounds of extensive prototyping by our team with advice from world leaders in mother and child health. Initial cost models have also been built and refined. It is now ready for rigorous pilot testing. In this next step we will consult, collaborate and co-create on a small scale with pregnant women and community health workers in a developing country setting, to refine Re-CAL-L further and make sure it is responding to their needs. We will also refine the business model to successfully bring it to scale - one route with significant potential is via sale of advertising space.

Following this, we will be scale up Re-CAL-L - supporting widespread adoption across developing countries. Conducting this in phased manner will allow us to validate its effectiveness on maternal and child health and mortality at large scale.

Why Re-cal?

1) RE-CAL-L can increase attendance at antenatal care, delivery with a skilled birth attendant, attendance at postnatal care, and uptake of immunization. If these interventions reach 90% coverage, 2.6 million lives could be saved every year.
2) RE-CAL-L can reach the poorest and most marginalised.
3) RE-CAL-L can cost as little as $3.75 per mother/child pair.
4) RE-CAL-L calendars provide an attractive last-mile advertising opportunity.


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