OVATE EVALUATE ALE UP IMPROVE ALTH RESEARCH ALUATE SCALE UP PROVE INNOVATE ALUATE SCALE UP PROVE HEALTH
Improving maternal and child health in India – SERP’s Nutrition Day Care Centers mobile app India has a high maternal mortality rate, with over 100 000 women dying in childbirth every year. India also struggles with child mortality: the country represents about one quarter of the global burden of infant and underfive deaths (1). Poor access to health and nutrition services for mothers and children is at the root of these high mortality rates. One out of every five children under age of 5 years is wasted and 43% are underweight for their age, outcomes which are closely related the nutritional status of their mothers. Children whose mothers are underweight (with a body mass index less than 18.5 kg/m2) are much more likely than other children to be stunted, wasted and underweight (2). To break the cycle of malnutrition in mothers and children, the Society for the Elimination of Rural Poverty (SERP) has created over 4200 Nutrition Day Care Centers (NDCCs) in rural Andhra Pradesh. SERP’s mobile (mNDCC) device provides an innovative approach to increase communication between village-level community workers (referred to as health activists) and programme officers at the headquarters. The approach also helps to track the health status and behaviour of individual clients. How SERP’s mNDCC system works SERP has piloted a members-wide programme which would allow for the generation of a monitoring and evaluation feedback loop between local and state-level actors through mobile-based management information, client-wise tracking of nutrition and health behaviour change, and for action to be taken locally though software generated alerts. The mNDCC device (a Symbion-based mobile handset) includes the Poorest of the Poor Survey, an enrolment module where mNDCC can track monthly haemoglobin for women and adolescents, immunizations and infant and young child feeding (IYCF) for children up to 2 years old, and growth monitoring for children up to 5 years of age. In addition, mNDCC tracks daily client attendance at the NDCC, a Nutrition and Health Days module for decision support and counselling tools for immunizations, antenatal and prenatal care, anaemia testing, growth monitoring and IYCF sub-modules. Lastly, mNDCC includes a module for the health activists to track the trainings they have led at the NDCC, as well as a module for tracking financial information on the NDCC, including support for decision-making for financial sustainability. The above information is aggregated and shared with headquarters to facilitate communication and decision-making. In addition, the mNDCC provides notices and alerts designed for every module of mNDCC in order to enable the health activist to take on-the-spot decisions with minimum external intervention. Health activists are thus more easily able to impart timely preventive and promotive care to the target population.
Supporting national public health programming Established by the Government of Andhra Pradesh, SERP supports the other line departments by promoting social mobilization for the department work areas and by providing data on members, including tracking of those who are accessing services. SERP is a unique government institution
Health education is critical to breaking the cycle of malnutrition in mothers and children
Health activist finds newly pregnant woman or new birth during routine home visit and notifies the local self-help group
SHG encourages families to enroll in Nutrition Day Care Centers, which provide monthly ANC, PNC, immunization, nutrition, and growth monitoring services
Health activist receives alerts if a mother misses a service or if child is malnourished, and schedules new appointment
Women are followed for 18 months (pregnancy + lactation) and children up to 2 years of age to ensure proper nutrition
due to the fact that it works exclusively on the demand side. It ushers in a new paradigm of poverty elimination by empowering the rural poor through the creation of women’s self-help groups and their federations. By using mNDCC, the Government has also realized the importance of real-time data in helping them make quick decisions. The government is considering scaling up the use of mNDCC for reporting and is in the process of using the same application to develop an integrated database that will be used by every service provider in the state.
Andhra Pradesh Currently: 4260 4260 95 694 104 248 100 050
By December 2014: 5260 5260 123 536 118 157 128 719
Partnerships for support and sustainability The partnerships with community-based organizations (CBOs) are the biggest strength of this model. Capacities of these CBOs are strengthened from time to time to ensure mNDCC efforts are sustained beyond the project period. The exception reports generated through mNDCC are a very effective tool, allowing the CBOs to review the progress of users and to take timely action if they are not accessing health services. In addition, SERP is engaged in a public-private partnership with software provider Bluefrog Technologies. As well, there are 22 support engineers stationed at every district headquarters across the state, attending to all of mNDCC’s technical issues.
India Number of NDCC facilities using the mobile app Number of HAs using the mobile app Number covered by the mobile application: Pregnant women Children Lactating women
IWG catalytic grant for mHealth programme scale-up SERP was awarded a grant to scale up the use of mNDCC in India by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance. SERP was successful in the grant competition because it employs an effective delivery strategy for an evidence-based maternal and child health intervention, combined with creative financing strategies to
promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5.1 Through IWG, SERP is receiving specialized assistance from WHO’s Department of Reproductive Health and Research to optimize the scale-up of mNDCC while contributing to the mHealth evidence base and best practices on implementation and scale-up. Technology provider: Bluefrog Technologies Pvt Limited For more information please contact: Rajsekhar Budithi, Chief Executive Officer (brajsekhar@gmail.com) or Lakshmi DurgaChava, Director, Community Managed Health & Nutrition (lakshmidurgac@gmail.com) 1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www. unmillenniumproject.org/goals/gti.htm)
References: 1. Black RE, Morris SS and Bryce J. Where and why are 10 million children dying every year? Review. Lancet 361(9376):2226–2234, 2003. (http:// www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13779-8/abstract). 2. Arnold F et al. Nutrition in India National Family Health Survey (NFHS 3), 2005–2006, Mumbai, India, International Institute for Population Sciences, 2007. Credits: Icons from The Noun Project designed by: OCHA Visual Information Unit, Megan Strickland, Edward Boatman, Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, Jamie Cowgill and Jim Bolek, Matt Daigle, OCHA Photo: Chelsea Hedquist, mHealth Alliance Editing, design and layout: Green Ink (www.greenink.co.uk) WHO/RHR/13.27 © World Health Organization, 2014 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.