“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.
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
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KAUSHAMBI
Project Location
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
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• 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
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• 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
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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
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Example: Counseling on Iron Folic Acid Consumption
ASHAs & CommCare – Glimpses from the field
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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
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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
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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.
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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
• 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.
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Implementation Challenges
• Ensuring continued government support and buy-in for CommCare, including eventual uptake of phone operation and running costs.
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Sustainability Issues
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
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QUESTIONS
For Details:Please try the link : http://www.youtube.com/watch?v=QTjs61L5l2Q
Contact details:Neal Lesh – [email protected]
Deepti Pant – [email protected]