Going Mobile for Maternal and Child
Survival
India
March 20, 2013
ICT4D Conference
Accra, Ghana
Mobile Services that Empow...
Opportunity & Issues
ASHA (CHW) have limited
training
ASHA have limited
supervision and monitoring
ICT4D project creates
o...
ICT4D in ReMiND
Baseline &
Endline
Surveys
Monitoring
Tools
Job Aids &
Beneficiary
Details
ICT4D Solution
• Dimagi’s open-
source CommCare
software &
• Cloud
Infrastructure:
CommCareHQ.
Platform Used and
Supported...
Key Successes
• Efficient & cost effective
• Improved data quality
• Data Validations
• No Data entry
• Quality control on...
Key
Issues/
Challenges
Procurement
Delays
Delay in
preparing
training
materials
Delay in
Finalizing
Survey Tool
Strengthens ASHA’s confidence & credibility
with rural communities.
Enables ASHA to provide higher quality care
to vulnera...
It takes a
team
Allow
enough
time
Be
committed
& don’t be
shy
Summary and Closing Notes
Thanks
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ICT4D 2013 Conference - Going Mobile for Maternal and Child Survival in India

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The ReMiND Pilot Project team from Catholic Relief Services' in India presented their experiences to date using ICT to support program implementation, monitoring and surveys in the ICT4D 2013 Conference held in Accra, Ghana.

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  • What is your project? What sector?ReMiND (Reducing Maternal and Newborn Deaths) Project. Health sector, focused on maternal newborn and child healthWhere is it located?Two blocks (similar in size to a county or commune) of Kaushambi District in the state of Uttar Pradesh (UP) in IndiaWho are you partnering with (e.g. other NGOs, government, private sector)?Dimagi, Inc. is CRS’ technology partner in the project.Vatsalya is the local implementing partnerCRS also has an MoU with the government of UP for the project, since it works directly with government’s community health workers (called ASHA) and local health authorities in the target area.Additional Information: Beneficiaries: 45,762Direct – 331 including 271 ASHA (CHW) Indirect – 45,431 pregnant women & infantsProject Duration: 3 Years (FY12 – FY14)Funding: CRS, USAID DIV 2.0Opportunity / What issue is being addressed?1. The project seeks to improvement maternal and child survival by strengthening community health workers (ASHA) outreach to pregnant and postpartum women, newborns and infants. ASHA have limited training and support to carry out effective home visits. Common practice was for ASHA to conduct home visits only when a woman needed to be reminded to go for ANC or to take her child for routine immunization. This represented a significant missed opportunity for ASHA to provide both targeted counseling to women/families and screening/referral for maternal and newborn danger signs—particularly during the pregnancy and postpartum periods.2. Incorporating ICT as part of the solution for strengthening ASHA home visits, highlighted further opportunities for the project to use ICT for routine monitoring, baseline and endline evaluation.
  • Why did you feel that this opportunity / issue could be addressed through ICT4D?1. (Opportunity/Issue 1 = ASHA) ICT in the form of multi-media job aids operating on basic mobile phones, are part of the solution to the issue of improving the quality of counseling and care that ASHA provide during home visits to pregnant and postpartum women. The job aids help ensure the ASHA’s consistent assessment and screening of the woman and newborn as per government guidelines. The job aids also help the ASHA to provide accurate and culturally appropriate counseling messages tailored to woman/child’s needs. 2. (Opportunity/Issue 2 = M&E) With the project’s focus on mHealth, it seemed counter-productive to revert to paper-based tools for project monitoring and evaluation. With the knowledge that the CRS team had already gained through working with Dimagi in the development of mobile applications, CRS used the same CommCare software platform to develop a monitoring tool application and then to adapt the KPC2000+ tools into a mobile application for the project’s baseline survey. This presentation will focus primarily on ReMiND’s experience using ICT to support the project’s 1,100+ household baseline survey conducted over 4 weeks in December 2012 – January 2013.
  • What is your software / vendor?The ReMiND project uses Dimagi’s open-source CommCare software as its platform for both the project’s M&E and ASHA related ICT4D solutions. The project also uses Dimagi’s cloud infrastructure (CommCare HQ) for data compilation and management, building applications, managing mobile workers and web-users. In terms of hardware, Samsung Galaxy Tab 2 tablets were used for data collection using the CommCare-based survey app for the baseline survey in December 2012 – January 2013.The baseline Questions/Answers were often lengthy and this device had a large display.The device has a very good battery life and the touch sensitivity was very good.This device was easily available locally and had good support structure.Additional Information:The ASHA application and the monitoring tool applications used by project staff use CommCare running on Nokia C2-01 mobile phones.What sort of technological support does it require?CRS/India led all of the app design and development for the ReMiND baseline study. Existing paper-based KPC2000+ tools were initially adapted to meet the project’s data collection needs. This Word-based document was then adapted into an Excel-based definition file for the baseline application. The app was then built on CommCare HQ by CRS/India’s IT Director. Any technology issues that came up during the app build that CRS could not resolve were addressed to Dimagi staff in India or to the web-based CommCare users group. Additional information (time permitting)A similar CRS-led process was followed for the development of the project’s monitoring tool appThe CommCare based job aids used by ASHA were developed with more direct involvement from Dimagi. CRS led content development for the ASHA’s pregnancy app with Dimagi doing the app build. For a new postpartum app, CRS led content development and shared app development responsibilities with Dimagi.What sort of staff support does it require?The required staff support to develop this ICT4D solution (baseline app) included staff with strong health and M&E expertise to develop the content and logic for the app. Staff with IT expertise were needed to first identify the best available ICT hardware for baseline data collection and then to build the application.Additional staff inputs to implement the baseline survey:Administration staff to ensure procurement of tablets and other survey logistics. 1-week training of baseline survey enumerators was done jointly with CRS/India’s M&E and IT staff under the leadership of the Regional Technical Advisor (RTA) for M&E20 female enumerators were hired for baseline data collection. All had some kind of previous health and/or survey experience, but none had ever used an ICT solution for surveys or other data collection.Separate data-entry staff were not required since survey data was uploaded directly from the enumerators’ tablets to CommCare HQ (Dimagi’s cloud-based server).CRS/India survey supervisors conducted daily quality checks of survey data via CommCare HQ.CRS’ Senior Technical Advisor (STA) for M&E ensured analysis of survey data that was exported in an Excel file from CommCare HQ. Analysis was then done using STATA.Survey write-up was done by the RTA for M&E and PQ Manager for Health.
  • What were the key successes in implementing this solution? (programmatic, technical, partnership-related or other)ProgrammaticMore efficient and cost-effective than paper-based surveys. Using an ICT solution for the baseline survey saved significant time as well as material and staffing costs associated with data entry from paper-based forms by totally eliminating this step in the process. While the cost of initial hardware purchase was high, over time this cost will be balanced through the elimination of high stationary and printing costs associated with multiple large surveys in addition to the environmental benefit of going with a paperless system for survey data collection. The tablets are now part of CRS/India’s IT equipment pool for use across programs, which reduces the need for new hardware investment for future surveys. Using an open-source rather than paid software also made CommCare a more cost-effective option than some other platforms.Improved data quality. Using an ICT solution allowed for data controls/checks to be built into the baseline survey tool application. Required single or multi-select options, pre-set ranges for numeric data entry and automated skip logic helped to ensure that no required question was unanswered and that all responses were within acceptable limits. The ability to review uploaded data on a daily basis for errors also helped in the early identification of errors and allowed the survey team to adapt quickly to avoid repeats of those errors. Technical/TechnologyHaving not only developed the baseline application with in-house capacity, but also having the app developer on-site during baseline training/field testing and the early days of data collection allowed for rapid (immediate) revisions to be made in the application based on initial field testing and use.TheCommCare-based application on tablets was a user-friendly combination that allowed the survey enumerators—all of whom were first-time users of tablets and had not previous experience with ICT for data collection—to easily become proficient with the technology during the period of the 1 week training and field testing.Samsung Galaxy Tab 2 was a good choice for tablet in terms of battery life, resolution and usability.- No case reported of low battery/battery discharging No technological glitch reported during data collectionNo problems with battery life or damage due to a strict routine for daily issue, return and charging of tablets and a contract with enumerators regarding hardware loss/damage. Assigning one member for issuance and charging helped keep tablets safe and chargedIssuing (start of day) and receiving (end of day) the tablets with sign-in at both timesensuring tablets plugged nightly and fully charged before issue each morningA contract was signed by each data collector. Clauses of contract were that the data collector is receiving a Samsung Galaxy tablet along with the charger for the use of protocols on the field and will return it back after completion of survey. its data collector’s responsibility to properly use tablet and charger for the time period. she understands that she will only receive full compensation for her work as a data collector upon return of the tablet and charger in good working condition. Tablet configuration with limited access to other applications prevented users from playing with or changing (intentionally or accidentally) settingsPartnership-relatedThe strong partnership between CRS and Dimagi and the organizations’ close work on previous application development allowed CRS to have significant in-house capacity to lead CommCare application development for the baseline survey.Through the survey, CRS now has a ready pool of female enumerators with strong experience in ICT-enabled data collection who can used for future surveys.Researchers affiliated with Harvard University and University of Washington are currently leading operations research in the ReMiND project area. The research team had previous experience using CommCare on tablets and were able to share the ICT challenges and lessons they faced with the ReMiND team. This helped CRS to be better prepared and to avoid certain pit-falls related to battery life and resolution during data collection. Adequate planning/preparation for charging tabs,Procuring appropriate materials/supplies for charging (multi-porter chargers, etc.)
  • What can you say about how your solution has helped to empower vulnerable communities?Related to the first opportunity that ReMiND is address through and ICT4D solution, it has been found that use of multi-media job aids on basic mobile phones help to strengthen ASHA’s confidence & credibility with rural communities. This ICT4D solution also enables ASHAto provide higher quality care to women and children during the pregnancy and postpartum periods with the risk of maternal and newborn morbidity and mortality is high. Using ICT for project M&E helps to establish quality data to eventually contribute to global evidence on mHealth’s potential to help improve MNCH outcomes. Using ICT4D to enable timely, high quality data for project monitoring, baseline and (eventually) endline can help the project generate much needed on the effectiveness (or not) of mHealth it improve survival.What are the sustainability issues for this solution in terms of capacity, support, cost, addressing need, etc.?Invest in staff and partner capacity. Because of the wide range of skills and knowledge required, it is important to develop skills (developing definitions, building apps, data use on CommCare HQ, etc.) across CRS and partner staff to ensure CommCare knowledge and capacity is sustained throughout and across projects. If all of the knowledge/expertise is concentrated in an individual or small group of individual, both the project and organization are at risk of not being able to sustain ICT4D solutions in the medium and long term.
  • What are the key messages you want participants to take away with them about your solution?It takes a team. Successful application development and roll-out requires cross-sectoral (health, M&E, etc.), technology, translation, training and implementation expertise. Take this into consideration and plan accordingly when developing your ICT4D solution.Allow enough time. To maximize ICT4D solutions for M&E, allow sufficient time at every stage of the process: application development, hardware procurement, training prep and roll-out, implementation, data analysis and use. Be committed and don’t be shy. Using ICT for monitoring and survey data collection is less difficult than it might seem. Reach out to other country programs or organizations with experience and commit to investing the necessary time and resources to make the most of what it offers. Then share your experience!
  • ReMiND baseline survey team (December 2012, Kaushambi)
  • ICT4D 2013 Conference - Going Mobile for Maternal and Child Survival in India

    1. 1. Going Mobile for Maternal and Child Survival India March 20, 2013 ICT4D Conference Accra, Ghana Mobile Services that Empower Vulnerable Communities
    2. 2. Opportunity & Issues ASHA (CHW) have limited training ASHA have limited supervision and monitoring ICT4D project creates opportunities for M&E Area of Intervention 2 blocks of Kaushambi District Partners Dimagi Inc. Vatsalya Govt. of Uttar Pradesh Reducing Maternal and Newborn Deaths (ReMiND)
    3. 3. ICT4D in ReMiND Baseline & Endline Surveys Monitoring Tools Job Aids & Beneficiary Details
    4. 4. ICT4D Solution • Dimagi’s open- source CommCare software & • Cloud Infrastructure: CommCareHQ. Platform Used and Supported • Samsung Galaxy Tab 2 • Nokia C2-01 for ASHA & Monitoring Tool apps. Devices Used and Supported • Application built by CRS IT & PQ Teams with Dimagi backstopping • Training Enumerators • Field Testing app Support and Training Requirements
    5. 5. Key Successes • Efficient & cost effective • Improved data quality • Data Validations • No Data entry • Quality control on data collection • Increased interest from enumerators • Bias-free randomization • Environment Friendly Programmatic • On-site support & rapid app revisions • Selection of appropriate device – Galaxy Tab 2 • User friendly app & hardware • No hardware damages or battery backup challenges • Hardened tablet configuration • Strong partnership with Dimagi & in-house app developments • Pool of ICT-enabled female data collectors for future surveys • Feedback from OR team Technical Partnership
    6. 6. Key Issues/ Challenges Procurement Delays Delay in preparing training materials Delay in Finalizing Survey Tool
    7. 7. Strengthens ASHA’s confidence & credibility with rural communities. Enables ASHA to provide higher quality care to vulnerable women and children. Contributes to global evidence on mHealth’s potential to help improve MNCH outcomes. Invest in staff and partner capacity. Lessons Learned
    8. 8. It takes a team Allow enough time Be committed & don’t be shy Summary and Closing Notes
    9. 9. Thanks

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