By ICTpost Media Action Bureau
Health activism involves a challenge to the existing order whenever it is perceived to lead to a social injustice or health inequality and uses a range of tactics that vary according to the function, structure and purpose of those trying to redress the imbalance of power that has created the situation in the first place. The rural health care system in India, along with many other complex social service institutions operating in India, needs better tracking tools to mark the identity of its beneficiaries. Here we are presenting role of mobile health platform for community health workers.
Since 2005, the National Rural Health Mission has trained and deployed 750,000 Accredited Social Health Activists (ASHAs) to provide health interventions at the community level. In every rural village in India, there is an ASHA who is mandated to monitor all pregnant women in her village, ensure they receive their tetanus immunizations, take proper nutrition and iron supplements, complete at least four prenatal visits, and prepares for a safe delivery in the hospital. ASHAs also ensure that all children from 0-5 years receive full immunizations.
ASHAs have a long list of deliverables, but there are persistent challenges in training, monitoring, supervision, and motivation that make it difficult for her to manage her workload and deliver quality information. In order to realize the true potential of the ASHA program, it needs systems that ensure all beneficiaries, pregnant women, and children, have access to timely, high-quality, and engaging care and that all program managers have access to current and accurate data.
CommCare is a scalable mobile health platform for use by ASHAs or other community health workers (CHWs). The project aims to reduce maternal and neonatal mortalities through effective counseling and increasing awareness about pregnancy danger signs, neonatal danger signs, improving nutrition and iron supplementation, emergency preparedness, encouraging choice of delivering at institutions and de-constructing myths surrounding pregnancy and newborn care practices.
CommCare improves care across four areas: access to care through client lists on the ASHAs phones and SMS reminders when visits are due; client engagement through audio and video clips and improved credibility of the ASHAs; quality of care through checklists, decision support and delivery of sensitive information through recorded voices; and data-driven management through real-time monitoring of the ASHAs’ activities.
A unique feature of CommCare is case management. This workflow supports extension-workers who routinely visit the same clients, so they can manage the entire life-cycle of a case without any need for network connectivity, completely offline. In addition to the mobile-phone application, CommCareHQ can send SMS reminders to users, reminding them of overdue tasks or upcoming care. For example, an SMS can be sent to a health worker to remind her that a certain woman is due for a delivery in next week. Supervisors can log onto CommCareHQ website to download the data, to view each user’s performance, including daily activity, number of clients, length of visits & follow-up rates for supportive supervision.
ASHAs register all pregnant women in their village and complete the safe pregnancy checklist in CommCare, which tracks prenatal visits and immunization history of the pregnant woman. The checklist contains a total of 45 questions which include counseling questions that speak about danger signs, nutrition and iron supplementation, birth preparedness and newborn care. Each question in CommCare is equipped with audio visual prompts, and in effect, CommCare acts like a reminder tool for the ASHA and ensures her counseling is comprehensive and accurate. Additionally, the information in each form is programmed to display in a ‘timed and targeted’ manner. For example, the pregnancy module is designed so information is displayed according to the trimester and expected date of delivery of the pregnant woman. Similarly, the information in the child’s nutrition and health form is displayed according to the child’s age. The initial pilot application involved several iterations of the mother module based on feedback from the health workers, project co-ordinator (IHAT) and program manager. The current version of the application also includes a child module. The complete maternal and newborn module was introduced in January 2012 at the block-level to 70 ASHAs. firstname.lastname@example.org