“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.

Uttar Pradesh Population million Maternal Mortality per 100,000 Newborn Mortality - 50 per 1,000 Infant Mortality - 71 per 1,000 Kaushambi District Population million Maternal Mortality per 100,000 Newborn Mortality - 59 per 1,000 Infant Mortality - 83 per 1,000 Slide 2 of 16 KAUSHAMBI Project Location

Challenge Accredited Social Health Activists (ASHA) struggle to provide timely, comprehensive counseling to women throughout the pregnancy and postpartum periods. Supportive supervision of ASHAs is limited ICT4D Solution CommCare – an innovative mHealth platform that allows ASHAs to track and support every pregnant woman, mother and newborn Slide 3 of 16

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 Slide 4 of 16

Filled as soon as ASHA learns of pregnancy Collects: ID details, Last Menstruation Period, previous pregnancies, live children, Tells Estimated Date of Delivery Registration Form Filled at least once each trimester Collects: Registration with Auxiliary Nurse Midwife, services availed (Ante Natal check up, Tetanus vaccination), current practices (Iron Folic Acid, work/rest, nutrition, birth 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 Slide 5 of 16

Mobile application: “Do you consume Iron Folic Acid?” Pregnant woman: “No.” ASHA: Inputs the response in the mobile application and probes for the reasons. Mobile application describes: - Where it can be accessed - Why it is important - How and when it needs to be consumed Slide 6 of 16 Example: Counseling on Iron Folic Acid Consumption

ASHAs & CommCare – Glimpses from the field Slide 7 of 16

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 Slide 8 of 16

CRS, Dimagi, government & 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 (April – May’11) STAGE 2: Beta testing (May-December’2011) Implementation to Date Slide 9 of 16

Outcomes & Impact Global Published studies documenting how CommCare can improve access, quality of health services 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 manage 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. Slide 10 of 16

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, on 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, and learning Slide 11 of 16

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. Slide 12 of 16 Implementation Challenges

Ensuring continued government support and buy-in for CommCare, including eventual uptake of phone operation and running costs. Slide 13 of 16 Sustainability Issues

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 Slide 14 of 16

QUESTIONS