Mobile technology to improve maternal and newborn health

outcomesKaruk district

Herat province, Afghanistan

Better Health for Afghan Mothers and Children project

2008-2013Dennis Cherian, BHMS, MHA, MS, Senior Director Jahera Otieno, MPH, Program Management Officer, Health

and HIV/AIDS

Introduction – Program Overview

• Project Goal: Achieve sustained improvements in the survival and health of mothers, newborns and children

• Partners: The DOPH in Herat, MOPH, BDN, USAID Mission in Kabul and Dimagi

Introduction – Program Overview

• Location: 74 villages in Chisht-e-Sharif Karukh, Kohsan, Zindajan districts of Herat province

Technical Interventions and LOE

• Maternal and newborn care, MNC (35%) • Infant and Young Child Feeding (20%) • Prevention and Control of Diarrhea (20%) • Pneumonia Case Management (15%)• Immunization (10%)

Overall strategies -Overview

• Home Based Life Saving Skills (HBLSS) • Baby Friendly Hospital Initiative (BFHI)• Positive Deviance (PD)-Hearth • Timed and targeted counseling (TTC)• Improve CHW capacity and outreach

campaigns

Introduction – OR Objective and Outcomes

To test if the use of CommCare can:• Increase uptake of Healthy Actions by

pregnant women- Utilization• Increase knowledge of Important Information

points-Knowledge• Improve communication and coordination by

CHWs with higher-trained health workers- Access

• Improve pregnancy and newborn outcomes through improved routine care- Access

• Document socio-cultural, gender, and community factors influencing effective use of mphones apps

Decision Making Framework

Research Design & Process

• Study Design: Case-Control • 5 remote village pairs in Karuk

district• Baseline and endline studies • 20 months of implementation

• Study population: CHWs, mothers of children age 0-23 months, and health facility staff in both intervention and control sites

Research Design & Process

• 2009 Assessment trip with Dimagi • 2010 Baseline

Module Design & Refinement• 2011 CommCare Module

Training• 2012 Observation and field

support• Jan 2013 Endline

Findings

Referrals:Antenatal 2,035 Postnatal 34 Emergency 57

Findings

Operational challenges

• CHW literacy • Security in the province• Cultural acceptability of using mobile phones

for health issues• Understanding and use of the research tool by

CHWs• Healthcare worker capacity and knowledge• Community access and use of health facilities• Need additional manpower to support OR study• Overall lengthy and labor intensive process

Lessons Learned

• Facilitated dialogue with families on the need for facility births and helping them plan better for births

• mHealth tool helped facilitate dialogue with families and key community leaders

• Having flexibility in design and rollout of tool was helpful

• Take time to find the most appropriate partner

• Tool was job aid, communication tool, and monitoring system—especially in remote locations

Next Steps

• WV Afghanistan secured CIDA funding

• Scale up plans to additional locations• Lessons learned applied within WV

mHealth interventions: •Mozambique•Motech

mHealth Theory of ChangeNatl & Intl Goals to which project contributes

Improved linkages between facility and community

services for quality

improvement

Improved linkages between facility and community

services for quality

improvement

Develop Operating

Plan

Develop Operating

Plan

Refine business needs &

requirements

Refine business needs &

requirements

CHW/V adherence to

behavior change communications

protocols

CHW/V adherence to

behavior change communications

protocols

CHW/V adherence

to case management protocols*

CHW/V adherence

to case management protocols*

Foundational activities

immediate outcomes

Outcomes to which project primarily contribute

Finalise M&E plan

and conduct baseline

Finalise M&E plan

and conduct baseline

Consolidate

sustainability plan and

partner relationshi

ps

Consolidate

sustainability plan and

partner relationshi

ps

Establish programme manageme

nt

Establish programme manageme

nt

Training, curriculum and partner

development

Training, curriculum and partner

development

Improved preventive health behavior among pregnant

women and caregivers at the household level

Improved preventive health behavior among pregnant

women and caregivers at the household level

Access to health

information and

complementary social services

Access to health

information and

complementary social services

Build and sustain user capacity & ownership

Build and sustain user capacity & ownership

Communicate project- roadmap,

benefits, project management

Communicate project- roadmap,

benefits, project management

More timely and effective use of health services on the part of pregnant women

and caregivers

More timely and effective use of health services on the part of pregnant women

and caregivers

Deployment activities

Develop solution based on

user needs

Develop solution based on

user needs

Activity tracking,

monitoring & evaluation

Activity tracking,

monitoring & evaluation

Appropriate and timely

use of program

monitoring information

Appropriate and timely

use of program

monitoring information

Design budget & sustainable financial

model

Design budget & sustainable financial

model

Undertake user

acceptance testing

Undertake user

acceptance testing

Train users on all

aspects of solution

Train users on all

aspects of solution

• Lower maternal and child U5 mortality rates• Lowered child U5 morbidity

• Improved maternal and child U5 nutritional status

• Lower maternal and child U5 mortality rates• Lowered child U5 morbidity

• Improved maternal and child U5 nutritional status

Millenium Development Goals

mHealth Theory of Change

CHW/V motivation & retention

CHW/V motivation & retention

More sustainable and effective

CHW/V workforce

More sustainable and effective

CHW/V workforce

Referral closure rates

between CHW/V and

facilities

Referral closure rates

between CHW/V and

facilities

* i.e. ttC visit schedule or CCM clinical case management protocols

WV Program Coordination Unit Structure: A small team of dedicated professionals will coordinate the mHealth programming and work with the Motech Suite Team. The following Program Coordination Unit (PCU) will provide the management, coordination, strategic and technical support to existing and future mHealth programs.

DM&E ExpertsDM&E Experts

Project ManagerProject Manager

Project SponsorProject Sponsor

Health ExpertsHealth Experts PPP ExpertsPPP Experts ICT ExpertsICT Experts

Technical PartnerTeam

Technical PartnerTeam

Business Advisory Group

Business Advisory Group

WV National Office Project Structure & Management

Program/Project Governance Processes & Documentation:•Program & project charters•Annual planning process•Communications plan•Stakeholder management plan

WV Implementation Models prioritized for Motech Suite

• CHW – Timed and Targeted Counseling (ttC)

• Community Case Management (CCM)

• cPMTCT

• Community Care Coalitions (CCC) / Village Health Committees (VHC)

• Citizen Voice & Action (CVA)

Community

Environment

Yellow shading - Secondary priority

Blue lettering - specialized or context-specific adaptations of models

Program Areas for mHealth Solutions

Health System Strengthening Country Ownership Linkages to Health System & Services

Community Community Mobilization & Sensitization CHW Recruitment, Training, Supervision,

Incentives & Performance Evaluation CHW & Beneficiary Registration

Household/Individual Home-Based Care Referral System Counseling & Behavior Change

Communication Response to Urgent Care Scenarios Monitoring & Evaluation Data Collection Provision of Health Commodities Household based

diagnostics/screening/case management tools

KEY SOLUTION FUNCTIONALITYRegistration Referral Process Alerts/Notifications Reporting Behavior Change MessagesIntegration with HMISTesting/Rapid DiagnosticsUrgent Response Supply Chain/Logistics CHW training, supervision, performance evaluation

Phase II (Summer/Fall 2013)Stock Out Tracking*Urgent Response*CHW training, supervision, performance evaluation*Integration with HMISTesting/RDT

Prioritized WV Functional Blocks

Phase I (Spring 2013)1.Registration*2.Referral Process*3.Alerts/Notifications*4.Reporting*5.Behavior Change Messages*

WV Customization: White = live; Gold = Being finalized; Aqua= Initial preparation

* Functionality already exists in Motech Suite

Second Priority Functionality

Current Phasing

First Priority Functionality

Phase I ImplementationsDATES: January - March 2013PROJECTS: Sierra Leone - ttC

Uganda - ttC & CCM/malaria

Zambia - CCM/malaria & ttC

Tanzania - ttC

Phase III ImplementationsDATES: TBD & Proposal StagePROJECTS: -Ghana - ttC

-Jerusalem/West Bank/Gaza – ttC & PS

-Mozambique – CCM/Malaria & RDT

-Haiti – HIV/AIDS -Niger – CCM & Nutrition -India – ttC/CCM &

Advocacy

Phase II ImplementationsDATES: April - September 2013PROJECTS: India - MNCH

Afghanistan - MNCH & Nutrition

Sri Lanka – Nutrition Mozambique - ttC

Malawi - ttC Zimbabwe - ttC

Key WV Collaborations Globally

Thank you!