1. A mHealth Intervention “ImTeCHO” to Improve Delivery of Proven Maternal, Newborn and Child Care Interventions through Community Based Accredited Social Health Activists (ASHAs) by Enhancing Their Motivation and Strengthening Supervision in Tribal Areas of Gujarat, India
A joint initiative of SEWA Rural and
Department of Health and Family Welfare, Gujarat
SEWA Rural

2. SEWA Rural: A Voluntary Service Organization
Providing Medical, Health and Educational Services
Rural, Poor and Tribal Community of Bharuch and Naramda Dists. in
South Gujarat, India

3. About SEWA Rural A Voluntary Development Organization Established in 1980
200 beds General Hospital
Comprehensive Eye Care Programme
Out Reach Community Based Health and research Programme
Health Training and Resource Center
Vocational Technical Training Center for Rural Youth
Promotion of Women Development and Empowerment

4. Initiative is in Partnership with Dept. Health, Govt. of Gujarat
Intervention “ImTeCHO” (Innovative mobile-phone Technology for Community Health Operations)
Initiative is in Partnership with Dept. Health, Govt. of Gujarat
“ImTeCHO is a platform based on mobile phone technology…
to improve coverage of proven MNCH interventions……
through improving performance of CHWs/ASHAs and PHC staff……
by ensuring effective support, supervision and motivation…
Every ASHA will be given a low cost phone which will be General Packet Radio Service (GPRS) enabled and have multimedia feature available. Based on SEWA Rural’s and Argusoft India Ltd’s research, Nokia ASHA 3115 which costs Rs. 6,000 (Rs, 6,500 with all accessories) will be used for this study. Mobile phone application will have following features: Home visit forms, log cases details, work log, announcements, SMS information channel. Detailed description of these features will follow in next paragraph. ASHA will fill out forms on her mobile during home visits. Data will be sent using GPRS network to a server where data will be stored. In case GPRS is not available, data will be stored in mobile phone and it will be sent to server when GPRS becomes available; thus, data will not be lost even in absence of GPRS. Data entry time will be “time stamped”.

5. ImTeCHO: Conceptual framework and hypothesis
ImTeCHO= Better support, motivation, supervision to ASHAs and ASHA program Better performance Increase in coverage of proven interventions
SEWA Rural

6. ASHAs ASHAs/FHWs/ Helpline
“ImTeCHO”
(3 COMPONENTS)
Mobile phone as
job aid to….
ASHAs
for ensuring her
routine MCH services
Mobile phone as
a job aid to…..
ASHAs/FHWs/
Helpline
for better
morbidity management
Web interface at…
PHC level to
provide timely and
accurate information
for better
Support to ASHAs
From publication
SEWA Rural 6 6

7. Data Flow across Network
ImTECHO Program
An interactive job aid to support and supervise efficiently
Task Scheduling and Tracking
PHC Dashboard provides an overview of ASHA performance data, calculation of incentives, tracking use of medical supplies
Data Flow across Network
Task completion rates, details of activities performed, health data
Task scheduling,
Tabulating ASHA incentives, tracking medical stock
Behavior Change Communication
Data collection and diagnostic tool to allow the ASHA to respond to the need of the beneficiary
SEWA Rural Helpline
Helpline staff provide ASHA with information in emergency cases and facilitates referrals to medical facilities. 7

8. Operational since May, 2013 Gradually Expanding in Bharuch, Valsad and Narmada districts, Gujarat (High Priority Blocks). >50,000 beneficiaries registered, >5,00,000 m-transactions, population: 8,00,000
May 2013
Initially we started Imtecho project in 2 phc of bharuch district than expanding in selected high priority blocks in valsad and Narmada district.
September 2014
March 2014& Feb 2015 8

9. MONITORING TOOLS AND SYSTEMS

10. Input/output (Adherence to technology intervention)
What do we monitor?
Input/output (Adherence to technology intervention)
Health outcomes
Or…Both
FINDING AND USING INNOVATIVE INPUT/OUTPUT/PROCESS INDICATORS WHICH ARE STRONGLY ASSOCIATED WITH OUTCOMES

11. Conceptual framework for monitoring tools
ImTeCHO (Input) Better support, motivation, supervision to ASHAs and ASHA program (Output) Better performance (output) Increase in coverage of proven interventions (outcome) Better health outcomes (Impact)
SEWA Rural

12. Monitoring tools- Example of NMR
ImTeCHO (Input) Increase in Home-based Newborn Care (output) Increase in coverage of EBF, Hygiene, Mgmt of complications(outcome) 30-60% reduction in NMR (Impact)
SEWA Rural

13. HOME BASED NEWBORN CARE
REMINDER FOR HOME VISIT
JOB-AID: VIDEOS, DECISION TREE
HOME BASED NEWBORN CARE
INNOVATIVE MONITORING TOOLS
LINKED TO INCENTIVES

14. Innovative process/monitoring indicators
Task completion rate= Proportion of assigned tasks completed by the ASHA/CHWs (n=299)
Proportion of deliveries reported on the day of delivery (n=288)

15. Innovative process/monitoring indicators
Mean duration of home visit suggestive of quality of home visit (n=288)
Supervision by the medical officer in form of task completion rate
SEWA Rural

16. Innovative process/monitoring indicators
Digitized performance based incentives
SEWA Rural

17. Monitoring “SYSTEM” Who is going to monitor whom? When? How?
ISO 9001:2015 certification to ImTeCHO for its Quality management system
SEWA Rural

18. EVALUATION/ RANDOMISED TRIAL
SEWA Rural

19. Study overview
Study areas: 6 tribal blocks Baseline household survey (4 months/2,000 respondents) Randomization with PHC as cluster Intervention area (11 PHCs/300 ASHAs) Control area (11 PHCs) Training (5 months) Delivery of intervention (18 months) 50,000 pregnant women & children End line house hold survey (5 months/7,000 respondents) Analysis and reporting writing (4 months) S U R V E I L A N C
This will be a two arm, parallel, stratified cluster randomized trial in which unit of randomization will be a PHC. Stratification is required to ensure that prevalence of primary outcomes are similar in the intervention and control groups along with almost equal selection of PHCs from from the most backward Dediyapada block. Stratification will be also done to improve power and precision. The randomization will be done after baseline survey. Along with primary outcomes, randomization would help to balance cluster size across both groups. The allocation ratio will be 1:1. The allocation concealment will be done using sequentially numbered sealed, opaque envelopes.
SEWA Rural

20. Lessons learned
Finding and using tech-driven process indicators which are closely related to health outcomes
Monitoring tools and user motivation
Monitoring “Systems” is critical

21. Acknowledgements ASHAs, PHC staff, local health department staff
Department of Health and Family Welfare
Argusoft India Ltd
ICMR, WHO, MacArthur Foundation, Jamsetji Tata Trust, Anupam Rasayan Pvt Ltd
SEWA Rural

22. THANKS….SEE YOU AT THE “APPY HOUR”
SEWA Rural