CommCare for WV BHAMC Child Survival Project
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Transcript of CommCare for WV BHAMC Child Survival Project
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 [email protected]
Neal Lesh, PhD, MPHD-tree International
Dimagi, Incemail: [email protected]
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.