ICT4D 2012 Conference - ReMiND Me Again


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Deepti Pant (CRS) and Dr. Neal Lesh (Dimagi, Inc.) presented the ReMiND Pilot Project's early experience and learning of deploying CommCare with community health workers at the ICT4D 2012 conference held in Kigali, Rwanda.

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  • As part of context, give brief description of ASHA Program:Accredited Social Health Activists (ASHA)1 ASHA per 1,000 populationNon-salaried government community health workers.Receive financial incentives from government for completion of certain health promotion and prevention activities—including accompanying pregnant women to facilities for delivery.
  • CommCare was developed by Dimagi, Inc.
  • ASHAs are the primary users of CommCare. They use basic mobile phones on which the CommCare software is installed. CommCare includes different forms or checklists (Registration form, pregnancy checklist, outcome form, etc.) that use a multimedia format to provide real-time guidance to ASHAs during home visits through key counseling and assessment points adapted to the woman’s stage of pregnancyThe maternal and newborn health content for CommCare applications being used in the ReMiND Project is being developed by CRS with input from Vatsalya (local implementing partner). Content is being developed to align with current Government of India guidelines and training resources for ASHAs’ care of pregnant and postpartum women and newborns.Electronic forms are extensively filed tested to ensure appropriate translation in the local Hindi dialect using ASHAs to do the audio recordings for the multi-media content.
  • The data collected by the ASHAs through the CommCare forms and checklists is uploaded in real-time to CommCareHQ—Dimagi’s cloud-based server.Currently monitoring and follow-up with 10 ‘pilot’ ASHAs is being done by project staff. CRS and partners are in discussion with government health authorities to clarify government supervision structures for ASHAs and identify government counterparts to target for capacity building on the use of CommCareHQ and performance reporting.
  • Stage 1: April – May 2011Stage 2: May – December 2011- Cell phones were provided to ASHAs during beta test
  • - Globally, CommCare has been used by over 20 organization in 10 different countries.
  • ICT4D 2012 Conference - ReMiND Me Again

    1. 1. “ReMiND Me Again” Deploying CommCare to help reduce maternal and newborn deaths in India ICT4D Conference – Kigali, Rwanda 28 March 2012 Presentation by: Deepti Pant - CRS India Dr. Neal Lesh - Dimagi, Inc.
    2. 2. 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
    3. 3. Challenge • ASHAs struggle to provide timely, comprehensive counseling to women throughout the pregnancy and postpartum periods. •Supportive supervision of ASHAs is limited due to… ICT4D Solution • CommCare – an innovation mHealth platform that allows ASHAs too track and support every pregnant woman, mother and newborn
    4. 4. • 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. Technology Requirements
    5. 5. • Filled as soon as ASHA learns of pregnancy • Collects: ID details, LMP, p revious pregnancies, li ve children, Estim ated Date of DeliveryRegistration Form • Filled at least once each trimester • Collects: Registration with ANM, services availed (ANC, TT), current practices (IFA, work/rest, nutrition, birt h 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
    6. 6. 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
    7. 7. 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 STAGE 2: Beta testing Implementation to Date
    8. 8. Outcomes & Impact Global • Published studies documenting how CommCare can improve access, quality and experience of care • 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 manager 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.
    9. 9. 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, - 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, learning, operations research
    10. 10. 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. Sustainability Issues • Ensuring continued government support and buy-in for CommCare, including eventual uptake of phone operation and running costs.
    11. 11. 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
    12. 12. QUESTIONS