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Page 1: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

“ReMiND Me Again”Deploying CommCare to help reduce

maternal and newborn deaths in India

ICT4D Conference – Kigali, Rwanda28 March 2012

Presentation by:Deepti Pant - CRS India

Dr. Neal Lesh - Dimagi, Inc.

Page 2: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Uttar PradeshPopulation- 200 millionMaternal Mortality- 345 per 100,000Newborn Mortality- 50 per 1,000Infant Mortality- 71 per 1,000

Kaushambi DistrictPopulation- 1.6 millionMaternal Mortality- 442 per 100,000Newborn Mortality- 59 per 1,000Infant Mortality- 83 per 1,000

Slide 2 of 16

KAUSHAMBI

Project Location

Page 3: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Challenge• Accredited Social Health Activists (ASHA) struggle to

provide timely, comprehensive counseling to women throughout the pregnancy and postpartum periods.

• Supportive supervision of ASHAs is limited

ICT4D Solution• CommCare – an innovative mHealth platform that

allows ASHAs to track and support every pregnant woman, mother and newborn

Slide 3 of 16

Page 4: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

• CommCare runs on Java enabled phones as well as Android phones.

- Minimum requirements for Java enabled phones:Runs J2ME MIDP2.0 / CLDC 1.1At least 2MB Java heapAt least 1MB max jar size

- Example: Nokia C2-01

• Dimagi maintains a central cloud server, CommCare HQ

- All data is privacy-protected, backed up, and made accessible to relevant stakeholders.

- Accessible through web browsers over the internet.

Technology Requirements

Slide 4 of 16

Page 5: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

• Filled as soon as ASHA learns of pregnancy

• Collects: ID details, Last Menstruation Period, previous pregnancies, live children, Tells Estimated Date of Delivery

Registration Form

• Filled at least once each trimester• Collects: Registration with Auxiliary

Nurse Midwife, services availed (Ante Natal check up, Tetanus vaccination), current practices (Iron Folic Acid, work/rest, nutrition, birth preparation), current knowledge

• Counsels: care practices, health seeking, danger signs

Pregnancy Checklist

• Filled after delivery or end of pregnancy

• Collects: birth outcome

Outcome Form

ASHAs & CommCare – How it works

Slide 5 of 16

Page 6: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Mobile application: “Do you consume Iron Folic Acid?”

Pregnant woman: “No.”

ASHA: Inputs the response in the mobile application and probes for the reasons.

Mobile application describes: - Where it can be accessed- Why it is important - How and when it needs to be consumed

Slide 6 of 16

Example: Counseling on Iron Folic Acid Consumption

Page 7: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

ASHAs & CommCare – Glimpses from the field

Slide 7 of 16

Page 8: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Data & Information Flow

ASHA inputs data in phone during home

visit

ASHA uploads data to CommCareHQ using

GPRS

Project staff monitor individual and group

activity based on real-time data

Weekly and monthly performance reports

generated

Performance data & reports shared with ASHA during monthly meetings

Slide 8 of 16

Page 9: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

CRS, Dimagi, government & local partner

CRS & local partner

Dimagi

CRS & local partner

Review Government

ASHA guidance & tools

Prepare checklists

aligned with GoI

Develop mobile application

Share with government for

their input

Train 10 ASHAs to use

CommCare

Field test forms and checklists

with ASHAs

Continuous observation

and monitoring

Multiple iterations to

refine application

STAGE 1: Preparation of CommCare Applications (April – May’11)

STAGE 2: Beta testing (May-December’2011)

Implementation to Date

Slide 9 of 16

Page 10: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Outcomes & Impact

Global

• Published studies documenting how CommCare can improve access, quality of health services

• Randomized control study: timeliness of community health worker visits can increase by 86% through reminders delivered to CommCare users.

Kaushambi• ASHAs report that CommCare:

- Helps them manage their workload- Improves the quality of their counseling- Increases families’ receptiveness to key MNH messages

• Pregnant women report CommCare’s interactive format makes it easier for them to remember key messages.

Slide 10 of 16

Page 11: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Future Plans

• Joint planning with District and State health authorities to ensure their early buy-in for CommCare and their participation in new content development

• Scale-up CommCare with 130 ASHAs in Kaushambi District• Iteration of CommCare applications for:

- Facility-based counseling targeting recently delivered women and mothers-in-law, on Home based newborn & postpartum care

- Detection and referral of maternal and newborn danger sign- SMS reminders to ASHAs and missed-visit alerts to supervisors

• Capacity building of health authorities and communities on the use of real-time data to inform evidence-based decision making

• Monitoring, evaluation, and learningSlide 11 of 16

Page 12: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

• Appropriate time and staffing must be available in the start-up phase to ensure quality iteration of content and initial roll-out of CommCare to ASHAs.

• Initial learning curve of ASHAs who have little or no previous experience using mobile phones

• Overcoming the perception among some ASHAs that CommCare will increase their workload.

Slide 12 of 16

Implementation Challenges

Page 13: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

• Ensuring continued government support and buy-in for CommCare, including eventual uptake of phone operation and running costs.

Slide 13 of 16

Sustainability Issues

Page 14: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

Lessons Learned• Successive iterations of application content are necessary to

ensure usability on the part of the ASHA and maximize client engagement and understanding.

• Involvement of ASHAs in refining content increases their ownership of CommCare

Ongoing Technical Programming and Support Requirements• Retooling CommCare’s reminder technology for the time-

sensitive post-partum period.• Back-end support from Dimagi for technical trouble shooting,

capacity building and technical assistance to CRS in building applications

Slide 14 of 16

Page 15: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

QUESTIONS

Page 16: “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by:

For Details:Please try the link :  http://www.youtube.com/watch?v=QTjs61L5l2Q

Contact details:Neal Lesh – [email protected]

Deepti Pant – [email protected]


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