ICT4D Conference – Kigali, Rwanda
28 March 2012
“ReMiND Me Again”
Deploying CommCare to help reduce
maternal and newborn deaths in India
Presentation by:
Deepti Pant - CRS India
Dr. Neal Lesh - Dimagi, Inc.
Project Location
KAUSHAMBI
Uttar Pradesh
Population
- 200 million
Maternal Mortality
- 345 per 100,000
Newborn Mortality
- 50 per 1,000
Infant Mortality
- 71 per 1,000
Kaushambi District
Population
- 1.6 million
Maternal Mortality
- 442 per 100,000
Newborn Mortality
- 59 per 1,000
Infant Mortality
- 83 per 1,000
Slide 2 of 16
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
Technology Requirements
•
CommCare runs on Java enabled phones as well as Android
phones.
-
Minimum requirements for Java enabled phones:
Runs J2ME MIDP2.0 / CLDC 1.1
At least 2MB Java heap
At 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.
Slide 4 of 16
ASHAs & CommCare –
How it works
• Filled as soon
as ASHA learns
of pregnancy
• Collects: ID
details, Last
Menstruation
Period,
previous
pregnancies,
live children,
Tells Estimated
Date of
Delivery
Pregnancy
Checklist
• 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
• Filled after
delivery or
end of
pregnancy
• Collects: birth
outcome
Outcome
Form
Registration
Form
Slide 5 of 16
Example: Counseling on Iron
Folic Acid Consumption
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
ASHAs & CommCare –
Glimpses from the field
Slide 7 of 16
Data & Information Flow
ASHA inputs data in
phone during home
visit
Performance data &
reports shared with ASHA
during monthly meetings
ASHA uploads data to
CommCareHQ using
GPRS
Weekly and
monthly
performance
reports generated
Project staff monitor
individual and group
activity based on realtime data
Slide 8 of 16
Implementation to Date
STAGE 1: Preparation of CommCare Applications (April – May’11)
CRS & local partner
Review
Government
ASHA guidance
& tools
CRS & local partner
Prepare
checklists
aligned with
GoI
Develop mobile
application
Share with
government for
their input
Dimagi
STAGE 2: Beta testing (May-December’2011)
CRS, Dimagi, government & local partner
Train 10 ASHAs
to use
CommCare
Field test forms
and checklists
with ASHAs
Continuous
observation
and monitoring
Multiple
iterations to
refine
application
Slide 9 of 16
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
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 learning
Slide 11 of 16
Implementation Challenges
• 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
Sustainability Issues
• Ensuring continued government support
and buy-in for CommCare, including
eventual uptake of phone operation and
running costs.
Slide 13 of 16
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 timesensitive 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
QUESTIONS
: http://www.youtube.com/watch?v=QTjs61L5l2Q