Over the course of this academic year, I intend to work alongside D-Tree and Dimagi on developing a sustainable deployment and scale-up model for CommCare, a mobile-based scheduling, monitoring, and referral application for community health workers (CHWs).  Through its “Safe Pregnancy” module, CommCare aims to routinize antenatal care by providing CHWs and their supervisors the ability to monitor, in a consistent and standardized fashion, the progress of pregnancies within a defined geographic area.  Examples of the types of capabilities CommCare can provide include, but are not limited to, real-time data collection, complication readiness checklists, decision support mechanisms, check-up reminders, and scheduling capabilities.

The question that follows, then, is how best can these types of mobile applications be deployed in a scalable manner?  Even more importantly, how can a mobile health (mHealth) application like CommCare serve as a vehicle for  empowerment, both at the individual and community level, by enabling community health workers to take ownership over the health of their individual communities?  There is considerable debate regarding whether technology limits CHW agency by over-standardizing and mechanizing decision-making, or whether it serves to supplement these existing practices by augmenting the capability of CHWs to make more informed, timely decisions.  How can we ensure that the latter holds true?

The other question that arises involves the vehicle through which mHealth applications can best be deployed.  Ideally, any development initiative should ultimately be sustained by the public sector – the nonprofit sector, in my opinion, should only play the role of developing, piloting, implementing, and eventually transferring effective social service delivery models to the government.

In the case of mHealth, what vehicles, in your experiences, have worked best as the starting point for the launch of a particular mobile application?  How have you leveraged community-based organizations’ capacities to deploy the application in a locally relevant, culturally sound manner?

I realize I’ve asked more questions in this post than I’ve answered, but that’s because this is an emerging field where the experience of practitioners is immensely valued.  So please, send us your thoughts!

I’ll be going away to Gujarat, India this summer to work with ClickDiagnostics, a health & technology start-up that focuses on designing and implementing telehealth mobile solutions, specifically with the aim of enhancing the capabilities of community health workers to deliver cost-effective, high quality health services. In order to develop, pilot, and implement mobile health (mHealth) solutions that are sensitive to local needs, Click works directly with in-country partners.  For the purposes of this project, Click will be partnering with SEWA Rural, a community health organization based in rural Gujarat, India.

The main aim of SEWA Rural’s Family Centered Safe Motherhood and Newborn Care Project (MNCP) is to reduce maternal and neonatal mortality and morbidity in rural Gujarat through its Community Health Project, which covers 168 villages and 171,000 rural and tribal inhabitants.  The most critical component of the MNCP are CHWs, who are responsible for conducting home visitations with mothers in every village within SEWA Rural’s mandate. These women provide the following services: prenatal care and counseling, maternal and newborn monitoring and care, timely identification of complicated deliveries, and post partum care for mothers and young babies followed by family planning-centered counseling.

SEWA Rural has requested ClickHealth’s help and expertise in setting up appropriate health technology platforms to support community-based interventions related to their community health workers, specifically with respect to the development of the following:

1. Tracking mechanisms for every pregnant mother and her newborn to ensure appropriate and timely delivery of health services
2. Timely identification of the complications related to maternal or newborn care, in addition to provision of guidance to front line workers to appropriately manage such cases at the field level
3. Prompt referral system for complicated cases to the base hospital
4. Supervision and monitoring tools for tracking the work performed by the front line workers at the village level
5. Generation and aggregation of CHW health reports at regular intervals

Based on these needs, the primary aims of this project are:

1. to assess the knowledge base and existing responsibilities of community health workers (CHWs), specifically with respect to maternal, neonatal, and child health service delivery;
2. to understand the field-level health data collection mechanisms, specifically in terms of what kind of information is collected, how, and for what purpose(s); and
3. to identify potential mobile phone products and services that can sufficiently address the needs of the organization, CHWs, and local community.

As my work progresses, I will keep you updated with new insights – in the meantime, if you would like to meet up and / or learn more about the project, please do not hesitate to get in touch with me directly!