Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation.

INTRODUCTION:Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes. METHODS AND ANALYSIS:This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries. ETHICS AND DISSEMINATION:Ethical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public. TRIAL REGISTRATION NUMBER:ISRCTN83902145

Lifeline: Tech innovations for maternal and child health - Part 2

At 16% and 27%, India contributes the highest global share of maternal and new-born deaths. Most of these are preventable through simple, proven and low-cost solutions. With close to a billion mobile phones and over a million broadband connections, Information and Communication Technologies (ICTs) can address the key informational and process challenges to RMNCH+A in India.Dasra's report, Life Line, lays out the key challenges and solutions, alongside the work of scalable and impactful social organizations for funders' consideration

Biological, Programmatic and Sociopolitical Dimensions of Child Undernutrition in Three States in India

The recently developed India State Hunger Index 2008 highlights the continuing sorry state of hunger in India, and shows that children underweight makes the largest contribution to hunger index scores for most of India. In this article, we apply an assessment framework developed by the Mainstreaming Nutrition Initiative to understand three dimensions of child undernutrition in India: (1) the biological/epidemiological aspects of the nutrition situation, (2) the programmatic interventions and environment and (3) the sociopolitical environment for nutrition. We conduct this assessment for three states in India, each of which offers a distinct typology: (a) Bihar, an extremely poor northern state with high levels of undernutrition; (b) Karnataka, a southern state with high economic growth, but high child undernutrition rates; (c) Tamil Nadu, a southern state portrayed as an example of successful health and nutrition programming, but with rates of undernutrition that are still very high

Body of Knowledge: Improving sexual and reproductive health for India's adolescents

Comprising one-fifth of India's population, adolescents are a significant demographic transitioning into adulthood. Adolescents making this transition experience rapid change and heightened vulnerability. The onset of puberty is a period wrought with challenges that impact an adolescent's sexual and reproductive health and rights (SRHR). Dasra's report, Body of Knowledge, highlights the challenges that adolescents face, the efforts of key stakeholders and the specific steps implementing organizations are taking on the ground to improve outcomes for adolescents. During this research, Dasra mapped 192 organizations working to improve sexual and reproductive health outcomes in India. This report profiles 22 organizations, whose work effectively represents the scope and breadth of the adolescent SRHR sector in India

Lifeline: Tech innovations for maternal and child health - Part 1

At 16% and 27%, India contributes the highest global share of maternal and new-born deaths. Most of these are preventable through simple, proven and low-cost solutions. With close to a billion mobile phones and over a million broadband connections, Information and Communication Technologies (ICTs) can address the key informational and process challenges to RMNCH+A in India.Dasra's report, Life Line, lays out the key challenges and solutions, alongside the work of scalable and impactful social organizations for funders' consideration

Role of Information Technology in Policy Implementation of Maternal Health Benefits in India

Fifty thousand women died during childbirth in India in 2013, the highest total in the world; that is, one maternal death every 10 minutes. India and Nigeria account for almost one-third of total global maternal deaths. In pursuit of the Millennium Development Goals, the government of India directed efforts to improve maternal health and was able to reduce maternal mortality rate from 437 per 100,000 live births in 1990 to 140 per 100,000 in 2015, albeit missing the target of 109. Moreover, estimates for maternal morbidity are three to four times that of the mortality rates with even more pronounced regional disparities. Universal access to free public healthcare for maternal health has been a national goal since 2005, but its quality of service and utilization rate of maternal healthcare remains an elusive dream for many of the rural women even after a decade of substantial efforts. In a stark contrast, mobile technology has become more pervasive than the most basic infrastructure across the world. There are over 7 billion mobile phones subscriptions worldwide, but only 4.5 billion people have access to basic sanitation facilities, implying more people have access to mobile phones than toilets in the world, including India. The ubiquity of mobile phones can no longer be ignored. According to the 2011 census of India, 47 percent of the rural households owned mobile phones, and mobile phone network coverage spanned over 99 percent of the rural landscape, but only 31 percent of these rural households had a toilet. This exponential growth in mobile phone ownerships and adaptation has captured the imagination of academic scholars, public administration and the private sector to push for mobile based solutions and services in almost every aspect of public, social and personal life. M-governance has gained prominence too, aimed at improving service delivery, transparency, policy monitoring, public engagement, combatting corruption and poverty, especially in the developing world, leap-frogging poor-resource and low-income constraints. Today there is a mobile app for everything and the solution to any problem is a mobile app, including maternal health. However, amidst this optimism, it is surprising that the potential of mobile phones to improve social policy awareness is yet to be fully exploited. There are initiatives toward health literacy and mobile based cash transfers but few initiatives are geared toward improving awareness of social welfare policies, informing people about eligibility, enrollment and entitlements. Here lies the uniqueness of this research. Motivated to find solutions to actual policy implementation problems in practice, this research lies at the intersection of information communication technology, maternal health benefit policies and public management. In India, low maternal health benefits policy awareness imposes an administrative burden on rural women and leads to uptake of cash and public health service benefits. This research explores if mobile phones can be used as an effective medium to increase maternal health benefit awareness; thereby increasing the claiming of benefits. Using mixed methods of research, insights are drawn from a longitudinal case study in Melghat, a tribal belt of Amravati District in Maharashtra, India; a region that suffers from high maternal morbidity and high infant mortality rate. Forty-two percent of total childbirths take place in the home despite four different maternal benefit policies promoting institutional delivery and safe motherhood. In this dissertation, customized audio messages about maternal healthcare benefit policies were designed and broadcasted to 82 pregnant tribal women and followed up with qualitative interviews to examine any improvements in claiming of the policy benefits in 2013. The research provided an in-depth view of how information was disseminated through mobiles phones, and what factors and trade-offs, beyond information, were actually considered by the households in claiming the policy benefits. This research offers four contributions. First, it provides a deeper understanding of maternal health policies, how incentives work and the impact of conditions attached to these incentives, providing a plausible explanation for why the policies remain only partially effective. Second, in an era of m-governance, it illuminates the potential and limitations of the mobile phones in policy implementation and civic engagement, through a gendered lens. Third, it yields a caution to the technological optimistic use of mobile phones. By evaluating the causal mechanism of whether and how information awareness led to greater claiming of benefits, the findings revealed that information awareness alone was insufficient to improve claims when there were structural and systemic deficiencies in the policy design and management. Fourth, it advances the theory of administrative burden, by using mobile phones to reduce learning costs and by expanding the concepts of compliance costs and psychological costs, and highlights the relative interaction and trade-offs between components of administrative burden in an international context. The research concludes that although mobile phones have the potential to trigger demand for policy benefits and public engagement, and reduce learning cost, they are not the “silver bullet” because they cannot bypass the fundamental challenges of other administrative burdens, policy design deficiencies and bureaucratic processes

Birthright: Saving newborns is everybody's business (short version)

Every hour, 84 newborns die in India, which accounts for the highest burden of newborn deaths in the world. 75% of newborn deaths are preventable without intensive care. Birthright highlights the opportunities and models for corporate engagement in newborn care in India. It analyses India's newborn mortality crisis through the six focus areas identified in the Lancet series on newborn survival; health workforce, service delivery, community ownership and participation, health financing, health information systems, and essential medical equipment and drugs. Dasra highlighted 14 non-profits with the most impactful and scalable programs addressing newborn care in India

State of the Young Child in India

This Report is one of the first comprehensive studies on young children in India. It focuses on children under 6 years of age and presents key aspects of their well-being and development. With the highest number of neonatal, infant and under-5 deaths in the world, there is an urgent need to address issues that continue to affect the young child in India. This volume: Introduces two young child indices aggregating selected indicators to separately track child outcomes and child circumstances. Provides an account of the current situation of the young child in terms of physical and cognitive development, access to care, disadvantaged children and major issues that have led to the continued neglect of this age group. Explores the policy and legal framework, fiscal space and the role and obligations of key stakeholders, including the state, private sector, civil society, media and the family. Highlights key recommendations and action points that can help to improve the ecosystem for early childhood care and development. Drawing on specially commissioned technical background papers, supplemented by extensive field experience of Mobile Creches in childcare, this Report will be of interest to practitioners, policymakers and influencers, think tanks and researchers of public policy, development studies, human rights, sociology and social anthropology, as well as general readers.　 The Open Access version of this book, available at http://www.tandfebooks.com/doi/view/10.4324/9781003026488, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license.