A Technology Based Counseling System for Lady Health Workers in Pakistan Fatima Shahryar, Program Specialist (SBCC) Johns Hopkins Center for Communication Programs

Background  National Program for Family Planning and Primary Health Care  LHWs, the backbone of the health system  100,000 health workers  Health education and services at community’s doorstep

Health Education through Inter-Personal Communication  USAID’s Pakistan MCH Program – Health Communication Component  22 technical content  Roshan Mustaqbil (Bright Future)– an innovative three-step approach  Integration of cognitive-behavioral therapy and positive deviance approaches  The three steps: 1. Active Listening and problem identification 2. Joint problem solving 3. Action and practice

IPC Toolkit Counseling Cards

Roshan Mustaqbil  First of its kind in Pakistan  Counseling tools with a technological interface  Easy to carry and use  Helps LHW register clients and make a counseling visit  Detailed and user friendly structure  Internet connectivity not required for playing downloaded videos

Validated and Curated Store, Curate and Share Adapted and Created Educational Content Review Content Deploy Learn and Counsel Distribute User Centered Design Systematically Applied Address Demand Activities: Outputs: Evaluate & Iterate Digital Content Delivery System

Nigeria: (iDEA) 300 midwives using system to improve counseling techniques; focus group discussion & analytics validate use and effectiveness India: (Gyan Jyoti) Application matures from mLearning to mCounseling as Health Workers discover new respect within community as content provides means for client education & engagement. Ethiopia: (OppiaMobile) Ministry of Health approved health program Pakistan: (Bright Future) Undergoing pilot to adapt both mLearning and mCounseling functions for Lady Health Workers to address entire RMNCH continuum Mass Customization

Methodology Idea presentation and meetings with LHW Program Designed using mPowering’s end- to-end content distribution process Organized along RMNCH continuum Two-day orientation of selected 21 LHWs Seven-days app testing Focus Group Discussions Feedback collection Improvement of app and incorporation of feedback

Achievements  Accepted by LHW Program management  LHWs were able to understand and use it  Liked and appreciated - particularly videos  Helped influence behaviors in short time  Helped deliver message with increased confidence  Feedback including structural improvements and content translation into regional language being incorporated

Issues and Challenges  Macro- Political instability;  Community- Environmental insecurity  Individual- privacy concerns; loss & damage

Next Steps  Areas of Opportunity  LHWs educational needs  Declining costs of smart phones  Scale up for 6,234 LHWs in project districts  Scale up for 22,500 LHWs of Sindh and 100,000 LHWs countrywide  Possible reach  Mobile users: 76% of the total population  Expansion to include other health areas

Next Steps  Collaboration  Development partners working on RMNCH  Partnership with the government to expand the application  Private sector partnerships  CCP has held meetings with UNICEF and private sector organizations

Aspiring for a healthier and brighter Pakistan!