CommCare for WV BHAMC Child Survival Project

CommCare for WV BHAMC Child Survival Project Dennis Cherian, MS, MHA, BHMS Director of Operations | Health and Hope | Resource Development and Management International Programs Group [email_address] Neal Lesh, PhD, MPH D-tree International Dimagi, Inc email: [email_address]

WV BHAMC Child Survival Project
Better Health for Afghan Mothers and Children
Herat Province- four districts
Innovation category
September 15, 2008 – September 14, 2012
Funded by USAID CSHGP

Why Afghanistan?
2 nd worst maternal mortality rate and the highest infant mortality rate
Only 24.3% of mothers receive skilled delivery assistance during delivery
Only 20.8% mothers received post natal check by skilled health personnel after three days of delivery
Almost half of all deaths of women in reproductive age result from complications of pregnancy and childbirth.

Mobile Health in Afghanistan
Rural Healthcare systems suffer greatly because of distance
Nearly 40-45% of the population cut off from health facilities during winter season
There are only 15 nurses in the project area
1 nurse to 17,500 people
Only 313 CHWs
1 CHW to 832 people
Successful experience using mobile phones in Indonesia - TEA Midwifery assistance program

Operations Research Objective
To test if the use of CommCare can:
Increase uptake of Healthy Actions
Increase knowledge of Important Information points
Improve communication and coordination by CHWs with higher-trained health workers.
Improve pregnancy and newborn outcomes in remote villages of Herat province through improved routine care
Document the socio-cultural, gender and other community factors influencing the effective use of phone-based applications.

Key OR Components
Safe pregnancy
Newborns
Emergency tele-medicine

Decision Making Framework

Expected Outcomes
Utilization - Increased percentage of Healthy Actions taken by pregnant women
Knowledge - Increased knowledge by pregnant women of the Important Information points.
Access - Increased use of midwives and expert services via phone calls.

Operational challenges
CHW literacy
Security in the province
Cultural acceptability of using mobile phones to health issues
Understanding and use of the research tool by CHWs
Healthcare worker capacity and knowledge
Community access and use of health facilities

Implementation Supervision Tools Training Life-saving intervention

Client lists
CHW CLIENT Reminders Checklists Decision Support

CHW FIELD SUPERVISOR, LOCAL CLINIC CLIENT PROGRAM MANAGERS SMS Alerts Activity reports Health stats Coordination CommCareHQ

Improve adherence to protocol.
Better, faster data.
Improve supervision.
Easier to update.
More sophisticated protocols.
Why automate algorithms?

e-IMCI (preliminary) results Clinical Step Current practice adherence e-IMCI adherence p-value Vomiting 66.7% (n=24) 86% (n=28) - Chest indrawing 75% (n=20) 94% (n=18) - Blood in stool 71% (n=7) 100% (n=3) - Measles in the last 3 months 56% (n=9) 95% (n=21) < 0.05 Tender ear 0% (n=1) 100% (n=5) - All 61% (n=299) 85% (n=359) < 0.01

Design Under the Mango Tree

ict4chw discussion (groups.google.com/group/ict4chw)
JavaROSA codebase (EpiSurveyor, GATHER, Cell Life..)
OpenROSA consortium
4 th meeting in Dar, TZ in July 2009
Collaboration

Summary
Afghanistan is a difficult and important area to test mHealth tools.
CommCare automates protocols & checklists for CHWs
We will assess clients served by CHWs using CommCare vs. those not using it.
Field refinement of tools is important
Open standards are important.

CommCare for WV BHAMC Child Survival Project

by jehill3 on May 04, 2010

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CommCare for WV BHAMC Child Survival Project — Presentation Transcript