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

Abstract

IntroductionMillions 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 analysisThis 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 disseminationEthical 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 numberISRCTN83902145

Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries

“…These phones are then given to AWWs and a detailed training is provided on the use of smartphones and CAS. Further, helpdesks at sub-districts and district levels are established for ongoing technology-support [38].…”

“…Our team is also wrapping up a parallel CAS impact and process evaluation in two states of India, Madhya Pradesh (MP) and Bihar; details of sampling for the baseline survey of the impact evaluation are available in our protocol paper [38] and the results will be published separately. These two states were chosen for the evaluation because of the ability to select another ISSNIP district as a control district, willingness of the states to support the evaluation and based on suggestions by the MWCD and the funding agency, the Bill and Melinda Gates Foundation.…”

Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

“…In order to discuss the procedure and aims of the G.A.N.E.S.H programme, community health workers of KS and RKM arranged meetings with ASHAs and ANMs in each block. ANMs are village-based female health workers establishing the first contact between the community and health services; in remote areas, ANMs also conduct home deliveries; 15 usually each ANM is supported by four to five ASHAs. ASHAs are local women trained as health educators and appointed by the Ministry of Health and Family Welfare of India.…”

“…Their tasks include trying to persuade women to give birth in hospitals, taking children to immunisation clinics, encouraging family planning, treating basic illnesses and injuries with first aid and improving village sanitation. 15 …”

The development and application of a mobile-based data collection system for a growth monitoring programme in selected primary care centres in the Republic of Mauritius

“…In sub-Saharan Africa, there is increasing interest in the use of mobile and wireless technology (mHealth) for child nutrition surveillance 2 5 6. However, a number of challenges in using mobile and wireless technologies for surveillance have been reported.…”