Reducing Maternal and Newborn Death (ReMiND) - use of m health technologySharing experiences , April 9, 2015

Farhad AliTechnical Expert HealthCRS, NEW DELHIfarhad.ali@crs.org

Project Duration: 4 Years (FY12 – FY15)

Partners: Vatsalya, Sarthi Development Foundation, Dimagi Inc. & Government of Uttar Pradesh

Area of Intervention: 8 blocks of Kaushambi & 1 block on Lucknow district

Beneficiaries: 13428 women & 12,308 children through 257 ASHAs in two blocks Total beneficiaries – around 1,42,000

Donors: CRS private fund, USAID small contribution DIV 2.0

Reducing Maternal & Newborn Deaths-ReMiND

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ReMiND – What is it?

CommCare as a Job Aid for ASHA:• Track and support woman through Pregnancy and

Postpartum periods

• Track and support baby from birth through first 2 years of life

• Localized and designed for ASHA use

Combines audio and still images for counseling and assessment content based on ASHA Modules 2, 6 and 7

CommCare as a Decision Support tool:• Helps the ASHA identify Danger Signs and make the

appropriate referral

CommCare as a supportive supervision tool• Helps ASHA supervisors to manage ASHA performance

and provide constructive feedback.

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REMIND APPLICATION SUMMARY:

Five Modules to Guide the ASHA Workflow:1. Registration of Pregnant Mothers2. Management of Pregnant Mothers3. Management of Postpartum Mothers4. Management of Newborns & Young Children5. Referral Follow-Up

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- Pregnancy Checklist- Completion of ANC check-ups and Tetanus

Immunizations, Assess Use of Health Services, Assess High Risks Signs in Pregnancy

- Pregnancy Counseling- Information about High Risks and Pregnancy

Danger Signs, Antenatal Care, Nutrition, Rest and IFA, Pregnancy Danger Signs, Birth Planning and Preparedness, Essential Newborn Care

- Pregnancy Outcome- Delivery information, Pregnancy outcome,

Newborn and mother’s health after delivery

- Modify Pregnant Woman Info- Modify identification info for woman, and update

EDD/LMP information

PREGNANT MOTHERS:

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- Mother Postpartum Visit- Completion of Postpartum home visits,

Assessment of High Risks, Visit scheduling

- Postpartum Counseling- Information about High Risks and Postpartum

Danger Signs

- High Risk Follow up- Follow-up on high risks identified, Decision support

for assessing high risks

- Postpartum Review - Review information about status and health of

postpartum mother, high risks identified, and next scheduled home visit

- Close Postpartum- To be filled 42 days post delivery once postpartum

phase is complete

POSTPARTUM MOTHERS:

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- Home-based Newborn Care Visit- Modify identification info for infant and mother, and

update DOB information

- Breastfeeding Assessment- Additional follow-up for any mother/newborn with a

suspected feeding problem.

- Routine Immunization Tracking through 2 years- BCG, OPV, DPT, Boosters, Polio, Measles, Vit A

- Routine Immunization Counsel- Information about vaccines, benefits of

immunization, side effects, how/where to go

- Update Baby Info- Update any details about the newborn case

- Close Baby- To be filled to close the baby case after 2 years of

care and full immunization

YOUNG CHILD:

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Supportive Supervision & Monitoring

Analysis & use of

ASHAs’ real-time data

Outcome:Maternal, newborn & child health outcomes

CommCare HQ

Supportive Supervision Application

Quality:IPC & counseling skills,

Mobile skills

Analysis & use of real-

time supervision

data

Active Data Management

Reports

Output: Frequency & timeliness of ASHA home visits

SMS reminders & missed visit alerts

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Supportive supervision app

ASHA Registration

Form

ASHA Follow-up Form

Home Visit Observation

Form

Mobile Experience

Survey

Technology Issue Form

Tech Issue Follow-up Form

Meeting Form

CommCare HQ – Cloud-based server

All data

uploaded &

accessi

ble in re

al-time

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Program Impacts !

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AGI

Quality of counseling by ASHA has improved significantly

ASHA talked about her next home visit.

ASHA encouraged woman to use next recommended health service.

Families who asked any questions.

Clients who asked any questions.

ASHA encouraged client to speak or ask questions.

ASHA waited for client to respond before moving to next audio message.

ASHA expanded on any of the CommCare audio messages/questions.

ASHA greeted woman

79%

100%

35%

77%

96%

94%

94%

100%

41%

50%

11%

24%

58%

59%

59%

85%

Improvements in ASHA counseling tracked through facilitators’ observations

Sept-12 14-Sep

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ASHA Activities: Home Visit Coverage

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Shift from low to high coverage ASHAs

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ASHA Activities: Counseling and Knowledge

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 Targeted Health Behaviors: Ante-natal Care

• Multi-media app help them more credibility with clients—validates key health messages

• Improved confidence levels in working in the community and improved acceptability by the beneficiaries they serve.

• Half of the functionally

illiterate ASHAs can now type

in Hindi on their mobile

phones.

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Positioning ASHAs in the community

• Birth preparedness doubled from baseline (43.2% to 80.7%)

• The average number of counseling visits made by an ASHA prior to birth nearly doubled, increasing from an average of 1.18 per woman to 1.95 per women

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Outcome level changes

• Tailored handholding support to ASHAs

• Working with ASHAs who have no functional literacy

• Frequent change in the leadership in government at district level

• Technology related issues

– GPRS problems

– Change in the settings in the hand set

• Engaging government in resolving tech issues

• Putting systems in place vis a vie leveraging technology

– Eg – ensuing ASHA visit & then making it ICT enabled

Challenges

• Make app more localized (such as voice of a local lady) and simple. • With low-literate users, the mobile interface must ensure easy

navigation and training strategies must be adapted to maximize learning.

• Immediate post training follow ups sustains interest and motivates to practice.

• Need based supervision helpful in maximizing ASHA outputs.• Strengthening local resources minimizes time in resolving

technology issues • Understand the context well before launching the app

– Such as understanding capacities of ASHAs

Lessons Learned

• Success of a mobile app for ASHAs is dependent on having sufficient supportive supervision for the ASHAs.

• Engagement of the government functionaries from the inception enables easy uptake of intervention and increase their ownership

• Allow sufficient time at every stage – app development, training, implementation and data analysis as well as its use

• Align with government programs and system

• Having tool is good. However, the purpose of using tool needs to be given more importance than the tool itself.

Lessons Learned

Keep it simple

Test, Test, Test & Then Scale

Invest in building local capacities

It takes a team

Share & learn…learn & share

Summary and Close

Thank You !

Thanks for your attention