Equipping India's community health worker supervisors with a mobile phone based supervisory application

Abstract

Background: India has a network of over 825,000 women who serve as Accredited Social Health Activists (ASHA) in rural communities. Until recently this cadre of community health workers lacked a supportive supervision structure and system. A 2011 evaluation of the program identified incomplete training, limited management and monitoring structures as major barriers to optimizing ASHA's effectiveness in delivering services at community level. CRS India in 2012 piloted a mHealth application for project supported supervisors in Kaushambi district in India that provided real time information to guide supportive supervision of ASHAs. Methods & Materials: From September 2012 until September 2014, the supervisory application was implemented in one block of the district and data on supportive supervision and lessons learnt were shared with the government. In December 2013 Government of Utter Pradesh decided to roll out a new cadre of community health workers, ASHA Sangini's to provide supportive supervision to ASHAs. CRS worked closely with the government to develop a mobile phone based application designed as a tool to improve ASHAs performance. Results: Between September 2012 and September 2014, 16 quality parameters on engagement of ASHAs with clients have shown consistent improvement. The percentage of low coverage ASHAs has reduced from 55% to 15%, and average number of home visits during the antenatal period has almost doubled from 1.18 to 1.95. The application helps colleting functionality data on 10 key performance indicators which is used to provide structured feedback for improvement. Currently the application is helping 139 ASHA Sanginies to keep track of the performance of 2670 ASHAs. Conclusion: Technology can be used to strengthen supportive supervision by providing real-time data on ASHA performance that Sanginis use to provide individualized feedback and guidance for improvement. It seems to have potential for further scale up and replication.