Urbanization is rapidly increasing neonatal mortality rates in Bangladeshi slums. A study showed neonatal mortality was over twice as high in slums compared to non-slum areas. BRAC's Manoshi program aims to combat this issue by training community health workers to provide essential newborn care and refer patients in slums to health facilities. ClickDiagnostics has partnered with BRAC to develop a mobile health system to help community health workers more efficiently track patients, prioritize at-risk cases, and improve health outcomes in slums. An initial pilot project suggests the mobile system can significantly increase community health workers' work efficiency and quality of care.

2. Urbanization is happening rapidly in Bangladesh and by 2015, it is estimated that
out of 50 million, 21 million people will be living in slums1. Although healthcare is
available, neonatal deaths are higher in slums than in non-slum areas.
1: “Newborn care practices among slum dwellers in Dhaka, Bangladesh” BMC Pregnancy Childbirth. 2009; v9: 54.
In this photo: The bird’s eye view of slum from the BRAC building in Dhaka.

3. In this photo: Maternal health awareness billboard in Dhaka by BRAC, the world’s biggest NGO.
Maternal, newborn and child health (MNCH) has been a major challenge to
overcome in Bangladesh, and the figure is significantly worse in slum areas. A study
showed that between 2002 and 2006, neonatal mortality was 43.7 per 1000 live births
in slums compared to 20.1 per 1000 live births in non-slum areas2.
2: Bangladesh Urban Health Survery (UHS). Volumes I and II. 2008.

4. In this photo: A community health worker (CHW) makes her daily round to slum households.
BRAC has been combating the issue of maternal, newborn and child health in urban slums through
Manoshi program since 2007, funded by the Bill and Melinda Gates Foundation. CHWs are trained to keep
track of all birth records, provide essential newborn care, and refer mother and child to pre-selected health
facilities in the case of complication.

5. CHWs walk door to door and visit 30-45 households daily. They had been manually
recording all pregnant related information on the register book or health card. Patient
information then waited until the end of each month to be collected and submitted.
In this photo: A BRAC community health worker manually fills out a patient data form.

6. In this photo: Mridul (CEO), Maya (Program Manager),
Rubayat (Chief of Operations) from ClickDIagnostics discuss
the mHealth training module for CHWs with Taku (far left) from
the Alliance Forum Foundation, our project partner.
ClickDiagnostics has
partnered with BRAC
Manoshi to integrate mobile-
phone based healthcare
system for a more cost-
efficient, resource optimizing
and financially sustainable
healthcare model. We
launched our first pilot
project in July 2009 for the
duration of 7.5 months. We
were able to alleviate
several bottlenecks in the
BRAC Manoshi prject
through reengineering their
healthcare system.

7. Our model provides CHWs with simple JAVA script enabled mobile phones with
built-in medical algorithms. Once patient information has been inserted using mobile
phones, they are digitally sent to the centralized medical information system (MIS) in
real-time.
In this photo: ClickDiagnostics’ management team leads the training of pilot group of CHWs.

8. Using mobile phones to collect data can significantly cut the time it takes for a CHW
to fill out a paper form, which can take well over 30 minutes for each household.
In this photo: Using mHealth application for the first time at a training, CHWs were able to
comfortably navigate through the medical algorithm on mobile phones within just a couple of hours.

9. ClickDiagnostics’ automated risk assessment algorithm keeps track of pregnant
mothers and assess the level of their risks, enabling CHWs to prioritize their tasks and
visits. A specialist can also access the real-time data from CHWs to monitor conditions
of risky patients and address them in a timely manner.
In this image: A screeshot of the central medical information system (MIS).

10. In this photo: A CHW takes a snapshot of the patient with the built-in camera in her mobile phone.
ClickDiagnostics’ mHealth mechanism has empowered CHWs in several ways.
It increased their work efficiency, minimized mistakes commonly made in manual
recording on paper, and elevated the level of credibility CHWs receive from patients
as an effective medium of health services.

11. ClickDiagnostics will
continue to work with BRAC
Manoshi to monitor the
program’s on-going success.
Stay tuned for the upcoming
news (August 2010) on
scaling up the current project
in Bangladesh to 64 branches
nationwide, aiming to cover
more than 5.7 million people
in the slums of 6 metropolitan
cities in next 2 years.
In this photo: In a slum on the banks of the Buriganga River,
Dhaka. (Photo credit: Jessica Mudditt)