1) The ReMiND project in Uttar Pradesh works to improve maternal and child health outcomes by training functionally illiterate community health workers known as ASHAs to use mobile phone applications to counsel pregnant women. 2) To help low-literate ASHAs learn the skills needed to use the mobile applications, the project provided tailored training and support from facilitators using monthly skills assessments. 3) Between 2013 and 2014, the percentage of ASHAs able to demonstrate essential skills like entering dates and navigating between screens on the mobile applications increased significantly, indicating that the additional support helped empower illiterate ASHAs to better use the technology.

1. Empowering Functionally Illiterate
Community Health Workers to
Use Mobile Phone Applications to
Counsel Pregnant Women
elin.murless@crs.org / farhad.ali@crs.org
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:Haros
257
Elin Murless | Program Quality, Health | elin.murless@crs.org
Farhad Ali | Technical Expert, Health | farhad.ali@crs.org
Methods
Poorly performing
ASHAs received tailored
handholding by sector
facilitators (SFs) and
training designed for low
literacy users. SFs use
a mobile-phone-based
monthly Mobile Experience
Survey (MES) to assess
ASHAs’ mobile technology
skills. The MES covers
‘essential’, ‘important’
and ‘nice to know’ skills
to successfully use the
application. An analysis
comparing July‑September
2013 with July‑September
2014 essential skills MES
data was done.
Introduction
The Reducing Maternal and
Newborn Deaths (ReMiND)
mhealth project works with
257 accredited social health
activists (ASHAs) in the
under‑served Kaushambi
district of Uttar Pradesh. Using
basic mobile phones, ASHAs
are equipped with job aids to
counsel, offer appropriate care
and timely referral to pregnant
women. Roughly one-third of
the ASHAs are functionally
illiterate or low literate and
find it difficult to write in Hindi,
input numbers on mobile
phones, and navigate between
questions on the job aid
applications. To overcome this
challenge and improve ASHAs’
performance, ReMiND refined
the applications with audio,
color and image content.
Working closely with the state
government of Uttar Pradesh,
Catholic Relief Services
partnered with global innovator
Dimagi and local implementing
partner Vatsalya to improve the
quality of maternal and infant
care given by ASHAs.
Results
By September 2014, more ASHAs
demonstrated essential skills for using
mobile phones. The ability to enter a
date (an essential skill) has increased
from 49% to 69% for all ASHAs, and
81% of ASHAs can move back to the
case list from the case detail screen,
compared to 55% in 2013. With regular
screening of their mobile‑phone skills
and the handholding provided by the
project, about half of illiterate ASHAs
have learned to fluently type in Hindi
on their mobile. Most of these cannot
write words on paper. Qualitative
information shared by ASHAs
indicates the mobile‑phone‑based
tool helps them better manage their
workloads, improving the quality of
their counseling.
Conclusion
Regular and need-based
support to low literate
ASHAs has improved the
essential skills necessary
for handling a mobile
phone and navigating the
counseling applications.
Technology and
real‑time MES data has
focused the supportive
supervision that SFs
give, and empowered
the functionally illiterate
ASHA with additional
support to improve
performance.
ASHAs’ mobile literacy has improved
Summary of ASHAs’ mobile experience skills (FY13)
Indicator ReMiND project total
Jul-Sept ’13
n = 25
Jul-Sept ’14
n=257
Median number of ‘essential’ skills successfully demonstrated (maximum score = 18) 16 17
Median number of ‘important’ skills successfully demonstrated (maximum score = 7) 6 7
Median number of ‘nice to know’ skills successfully demonstrated (maximum score = 8) 4 6
Median total MES score for all skills (maximum score = 76) 64 72
ASHAs’ essential skills
• Assess network
• Assess battery
• Increase volume
• Understand difference between login
and demo mode
• Log in with password
• Type in Hindi
• Enter numeric values and date
• Select an option from a list
• Select the correct case from a list
• Move back to the case list from the
case detail screen
• Move from case list to forms menu
• Open the Pregnancy Checklist form
• Play audio messages for questions in
a form
• Move to the next question in a form
• Move back to a previous question in a
form
PhotobySatishSrivastavaforCRS
Poster ReMiND.indd 1 1/28/15 4:31:29 PM