Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India.

Suzan L Carmichael ,Kevin T Pepper,Hina Raheel,Tanmay Mahapatra,Anu Rangarajan,Dana Rotz,Yingjie Weng,Anitha Sivasankaran,Usha Kiran Tarigopula,Yamini Atmavilas,Rajani Kaimal,Debarshi Bhattacharya,Evan Borkum,Swetha Sridharan,Sharad Chaturvedi,Indrajit Chaudhuri,Ramkrishnan Balakrishnan,Sridhar Srikantiah,S P Trehan ,Kala M Mehta ,Gary L Darmstadt

doi:10.7189/jogh.09.020424

Abstract

BackgroundmHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource – especially hard-to-reach – settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes.MethodsThe Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups.ResultsThe ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted.ConclusionsImportant improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.

Highlights

Correspondence to: Background mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource – especially hardto-reach – settings
Referred to as mHealth, these applications involve the use of mobile communication devices such as mobile phones, personal digital assistants and tablet computers to facilitate and record data on the provision of information and health services and on population health status. mHealth is promising for improving the effectiveness of frontline health workers (FLWs), who provide most primary health care services, especially in hard-to-reach, low-resource settings
As demonstrated by prior studies, mHealth tools may enhance the effectiveness of FLWs by improving tracking and service provision, the completeness and equity of coverage of their target populations, and the quality and consistency of the health-related information they provide [3-5]

Summary

Methods

The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICTCCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. The ICT-CCS intervention was introduced as a supplement to reinforce the delivery of the health messages of the Ananya program, which was concurrently implemented throughout Saharsa and seven other districts in Bihar. The basic content being administered via the ICTCCS tool was no different than Ananya; the purpose of this intervention was to determine whether the ICT-CCS mobile health tool could enhance FLW performance and health impact by facilitating access to relevant content, beneficiary tracking, delivery of appropriate services, and supervision at scale in a low-resource, remote setting

Results

Discussion

Conclusion