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.
Repurposing LNG terminals for Hydrogen Ammonia: Feasibility and Cost Saving
ICT4D 2012 Conference - ReMiND Me Again
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. 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. 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. • 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. • 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. 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. 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. 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. 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. 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. 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
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.
