Catholic Relief Service's Remind Project: Using technology for mother and child survival.

1. REMIND PROJECT
USING TECHNOLOGY FOR MOTHER & CHILD
SURVIVAL
International Reporting Project Presentation
19 February 2013 – Mumbai, India

2. Why Mother & Child
Survival?
 1 out of every 5 children less than 5-years
old on the planet lives in India. (20% of the world’s
children)
 1 of every 4 childrenwho dies, dies in India.
(25% of all child deaths worldwide)
 More than 1 out of every 5 women who die
during pregnancy, delivery or soon after, dies
in India (19% of all maternal deaths worldwide)

3. Why Uttar Pradesh?
•India’s most populous state
• 200,000,000 people
•Almost equal to population of Brazil
•1 out of every 35 people on the
planet lives in Uttar Pradesh
• UP has some of India’s worst
statistics in terms of mother and
child survival
• Mother and child deaths in
UPthreaten both national and
global achievement of MDGs 4
(reduce child mortality) and 5
(improve maternal health)
Make a difference in UP, and you make a difference in the

4. Causes of Maternal Deaths in
India
 Hemorrhage (38%)
 Infection (11%)
 Most mother’s
deaths are
preventable
through safe
delivery and
adequate
maternal care
before and after
birth

5. Causes of Child Deaths in
India
 Newborn causes (33%)
 Prematurity and low
birth weight, birth
asphyxia, infection
 Respiratory Infection
(22%)
 Diarrhea (14%)
 Malnutrition contributes
to one-third of child
deaths
―By taking women into account, child survival can be
influenced where it begins — in the years, months, and
days before a child is born and in the critical

6. Project Overview
 Reducing Maternal and Newborn
Deaths (ReMiND) Project
 Partners: Vatsalya, Dimagi Inc.
 Area of Intervention:
 2 blocks of Kaushambi District, Uttar
Pradesh
 Beneficiaries:
 45,762
 Project Duration: 3 Years (Oct
2011 – Sept 2014)
 Donors: CRS, USAID DIV 2.0

7. Imagine that you are an Accredited SocialHealth
Activist…
 Female community health
worker covering a rural
population of about 1,000
 Estimated 32 pregnant
women & 98 children under-5
 Mostly Low literate and some
are functionally illiterate
 Communities’ first point of
contact with the health system
 Volunteer with financial
incentives
 Have about 28 days of
training and limited
supervision

8. Mobile Application
Customized app using
CommCare software:
 Useful details about
clients retained on
phone for easier case
management
 Culturally-appropriate
images for counseling
and to aid low-literate
users
 Locally-recorded audio
messages for clients as
well as ASHAs
 All text and interface in
Hindi

9. How ReMiND pregnancy application
works?
Pregnancy
Checklist • Counsels on
• Filled as soon Form Outcome
as ASHA learns • Antenatal check up form
of pregnancy - starts I trimester
• Home Care -starts I
• Collects: ID • Filled at least once trimester
each trimester • Filled after
details, Last • IFA - starts II delivery or
Menstrual trimester end of
• Collects:
Period, • Danger Sign starts II pregnancy
Registration with
previous trimester
Auxiliary Nurse
pregnancies, • Collects
Midwife, services • Institutional
live children, birth
availed (Ante Natal delivery - starts III
• Tells Estimated check up, Tetanus trimester outcome
Date of vaccination), Current • Five cleans - starts
Delivery practices (Iron Folic III trimester
Acid, work/rest,
nutrition, birth • New born - - starts
preparation) in 9th month of
Registration pregnancy
Form Counseling
Forms

10. Why Use Technology?
ASHA case management
app:
 Helps in comprehensive
counseling with
standardized messages
 Supports timely and
appropriate counseling
 Supports identification and
referral of women &
newborns with danger signs
 Tracks each woman’s
knowledge, practices and
services received
 Tracks frequency and
coverage of the clients by

11. Why use technology?
Cloud
Infrastructure
 Real-time
monitoring as
data is
uploaded from
the field
 Custom exports
for data
analysis and
reporting

12. Challenges
 Appropriate time and staffing must be available in
the start-up phase to ensure quality content and
initial roll-out of CommCare to ASHAs.
 Initial learning curve of ASHAs who have little or
no previous experience using mobile phones
 Working with ASHAs who have no functional
literacy
 Engaging middle level supervisors of ASHAs to
support them
 Frequent change in the leadership in government
at district level

13. Pleasant Surprises
 ASHAs report multi-media app helps give them
more credibility with clients—validates key health
messages
 Coverage of mobile network agencies is available
even in very remote areas.
 Despite electricity supply issues, ASHAs have
found back-up mechanisms to keep their phones
charged.
 Support is being provided by the family members
of ASHAs who are functional illiterate.
 District project team is able to resolve almost all

14. Questions