Click to edit Master title styleCommCare forWV BHAMC Child Survival Project

Dennis Cherian, MS, MHA, BHMSDirector of Operations | Health and Hope | Resource Development and Management

International Programs Groupdcherian@WorldVision.org

Neal Lesh, PhD, MPHD-tree International

Dimagi, Incemail: neal@equalarea.com

WV BHAMC Child Survival Project

• Better Health for Afghan Mothers and Children

• Herat Province- four districts

• Innovation category

• September 15, 2008 – September 14, 2012

• Funded by USAID CSHGP

Why Afghanistan?• 2nd worst maternal mortality rate and the

highest infant mortality rate• Only 24.3% of mothers receive skilled

delivery assistance during delivery• Only 20.8% mothers received post natal

check by skilled health personnel after three days of delivery

• Almost half of all deaths of women in reproductive age result from complications of pregnancy and childbirth.

Mobile Health in Afghanistan• Rural Healthcare systems suffer greatly because of

distance– Nearly 40-45% of the population cut off from health

facilities during winter season• There are only 15 nurses in the project area

– 1 nurse to 17,500 people• Only 313 CHWs

– 1 CHW to 832 people

• Successful experience using mobile phones in Indonesia - TEA Midwifery assistance program

Operations Research ObjectiveTo test if the use of CommCare can:

• Increase uptake of Healthy Actions • Increase knowledge of Important Information

points• Improve communication and coordination by

CHWs with higher-trained health workers. • Improve pregnancy and newborn outcomes in

remote villages of Herat province through improved routine care

• Document the socio-cultural, gender and other community factors influencing the effective use of phone-based applications.

Key OR Components

• Safe pregnancy

• Newborns

• Emergency tele-medicine

Decision Making Framework

Expected Outcomes

• Utilization - Increased percentage of Healthy Actions taken by pregnant women

• Knowledge - Increased knowledge by pregnant women of the Important Information points.

• Access - Increased use of midwives and expert services via phone calls.

Operational challenges

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

health issues• Understanding and use of the research tool by

CHWs• Healthcare worker capacity and knowledge• Community access and use of health facilities

Implementation

Supervision

Tools

Training

Life-saving intervention

CHW CLIENT

RemindersChecklistsDecision SupportClient lists

CHW

FIELD SUPERVISOR, LOCAL CLINIC

CLIENT

PROGRAMMANAGERS

SMSAlertsActivity reportsHealth stats Coordination

CommCareHQ

• Improve adherence to protocol.

• Better, faster data.• Improve supervision.• Easier to update.• More sophisticated

protocols.

Why automate algorithms?

e-IMCI (preliminary) results

Clinical StepCurrent practice

adherence

e-IMCI adherence

p-value

Vomiting 66.7% (n=24) 86% (n=28) -

Chest indrawing

75% (n=20) 94% (n=18) -

Blood in stool 71% (n=7) 100% (n=3) -

Measles in the last 3 months

56% (n=9) 95% (n=21) < 0.05

Tender ear 0% (n=1) 100% (n=5) -

All 61% (n=299) 85% (n=359) < 0.01

Design Under the Mango Tree

• ict4chw discussion (groups.google.com/group/ict4chw)• JavaROSA codebase (EpiSurveyor, GATHER, Cell Life..)• OpenROSA consortium

– 4th meeting in Dar, TZ in July 2009

Collaboration

Summary

1. Afghanistan is a difficult and important area to test mHealth tools.

2. CommCare automates protocols & checklists for CHWs

3. We will assess clients served by CHWs using CommCare vs. those not using it.

4. Field refinement of tools is important

5. Open standards are important.