1. Improving the Quality of Engagement
Between Pregnant Women and ASHAs in
Kaushambi District of Utter Pradesh, India
elin.murless@crs.org / farhad.ali@crs.org
R
R
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Uttar Pradesh
Uttar Pradesh (in red) showing
Kaushambi district (in black).
One in every 35 people in the•
world lives in Uttar Pradesh
Uttar Pradesh has some of India’s•
worst statistics for mother and
child survival
The ReMiND program is in•
Kaushambi district which is one of
25 high-focus districts for health
in Uttar Pradesh. The district
has neonatal, maternal and child
mortality rates far greater than
national averages (respectively,
84%, 92 % and 103 % higher)
Source:WikimediaCommonsUser:HarosPhotobyElinMurlessforCRS
PhotobyAmyEllisforCRS
Method
The usefulness of the supervisory application of SFs
on improving the quality of engagement between
ASHAs and pregnant women was assessed through
a comparison of September 2012, 2013 and 2014
checklists on quality parameters of home‑based
observations. Data was downloaded and percent
responses on quality parameters were calculated.
Results
All 16 quality parameters have shown an overall
increase over the two-year period. It was found
that 17.6 % more pregnant women were greeted
by ASHAs, and that 59.3 % more ASHAs expanded
on any of the audio messages. A 59.3 % increase in
ASHAs who waited for the woman to respond before
moving to the next audio message, and a 65.5 %
increase in ASHAs who encouraged women to ask
questions was observed. Pregnant women who asked
any questions rose by 220.8 %, and family members
who asked questions increased by 218.1 %, a marked
improvement in engagement of ASHAs with family
members. ASHAs who encouraged women to use the
next recommended health service increased by 100 %
and ASHAs who talked about their next home visit
increased by 92.7 %.
Conclusion
ReMiND has responded to a challenge where
the health system has lacked the capacity to
systematically collect and analyze performance
data of ASHAs. Technology and real-time data has
focused the supportive supervision that SFs give, and
improved ASHA performance.
Introduction
The Reducing Maternal and
Newborn Death (ReMiND) project
works with accredited social health
activists (ASHAs) in Kaushambi
District using basic mobile‑phones
operating multimedia job aids
to support client assessment,
counseling, and early identification,
treatment and rapid referral
of pregnancy, postpartum and
newborn complications. Catholic
Relief Services, partnering with
global innovator Dimagi and local
implementing partner Vatsalya,
has strengthened the supportive
supervision structures for ASHAs
through project‑supported
sector facilitators (SFs) that act
as ASHA supervisors. SFs use
mobile‑phone‑based monitoring
tools to guide supportive
supervision, conduct routine
observations of the quality of ASHA
counselling during home visits, and
follow up on poorly performing
ASHAs. All real-time data is
transmitted from the applications
to a cloud‑based server where
project supervisors can monitor and
support ASHA activities.
ASHA greeted woman
ASHA expanded on CommCare audio messages/questions
ASHA waited for client to respond before moving to next question
ASHA encouraged client to speak or ask questions
Clients who asked any questions
Families who asked any questions
ASHA encouraged woman to use next recommended health service
ASHA talked about her next home visit
Improvements in ASHA counseling tracked through facilitator observations
Elin Murless | Program Quality, Health | elin.murless@crs.org
Farhad Ali | Technical Expert, Health | farhad.ali@crs.org
Poster ReMiND 2.indd 1 1/29/15 10:40:49 AM