Empowering Functionally Illiterate Community Health Workers to Use Mobile Phone Applications to Counsel Pregnant Womenelin.murless@crs.org / farhad.ali@crs.org

UttAr PrAdEsHUttar Pradesh (in red) showing Kaushambi district (in black).

• One in every 35 people in the world lives in Uttar Pradesh

• Uttar Pradesh has some of India’s worst statistics for mother and child survival

• The ReMiND program is in Kaushambi district which is one of 25 high-focus districts for health in Uttar Pradesh. the district has neonatal, maternal and child mortality rates far greater than national averages (respectively, 84%, 92 % and 103 % higher)

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Elin Murless | Program Quality, Health | elin.murless@crs.orgFarhad Ali | technical Expert, Health | farhad.ali@crs.org

Methods Poorly performing ASHAs received tailored handholding by sector facilitators (sFs) and training designed for low literacy users. sFs use a mobile-phone-based monthly Mobile Experience Survey (MES) to assess ASHAs’ mobile technology skills. The MES covers ‘essential’, ‘important’ and ‘nice to know’ skills to successfully use the application. An analysis comparing July-September 2013 with July-September 2014 essential skills MEs data was done.

Introductionthe reducing Maternal and Newborn Deaths (ReMiND) mhealth project works with 257 accredited social health activists (ASHAs) in the under-served Kaushambi district of Uttar Pradesh. Using basic mobile phones, AsHAs are equipped with job aids to counsel, offer appropriate care and timely referral to pregnant women. Roughly one-third of the AsHAs are functionally illiterate or low literate and find it difficult to write in Hindi, input numbers on mobile

phones, and navigate between questions on the job aid applications. To overcome this challenge and improve ASHAs’ performance, ReMiND refined the applications with audio, color and image content.

Working closely with the state government of Uttar Pradesh, Catholic Relief Services partnered with global innovator dimagi and local implementing partner Vatsalya to improve the quality of maternal and infant care given by ASHAs.

results By september 2014, more AsHAs demonstrated essential skills for using mobile phones. the ability to enter a date (an essential skill) has increased from 49% to 69% for all AsHAs, and 81% of ASHAs can move back to the case list from the case detail screen, compared to 55% in 2013. With regular screening of their mobile-phone skills and the handholding provided by the project, about half of illiterate AsHAs have learned to fluently type in Hindi on their mobile. Most of these cannot write words on paper. Qualitative information shared by AsHAs indicates the mobile-phone-based tool helps them better manage their workloads, improving the quality of their counseling.

Conclusion Regular and need-based support to low literate ASHAs has improved the essential skills necessary for handling a mobile phone and navigating the counseling applications. technology and real-time MES data has focused the supportive supervision that SFs give, and empowered the functionally illiterate AsHA with additional support to improve performance.

ASHAS’ mobile literAcy HAS improved

Summary of ASHAs’ mobile experience skills (FY13)

Indicator ReMiND project total

Jul-Sept ’13n = 25

Jul-Sept ’14n=257

Median number of ‘essential’ skills successfully demonstrated (maximum score = 18) 16 17

Median number of ‘important’ skills successfully demonstrated (maximum score = 7) 6 7

Median number of ‘nice to know’ skills successfully demonstrated (maximum score = 8) 4 6

Median total MES score for all skills (maximum score = 76) 64 72

ASHAS’ ESSENTIAl SKIllS • Assess network• Assess battery• Increase volume• Understand difference between login

and demo mode• log in with password• Type in Hindi• Enter numeric values and date• Select an option from a list• Select the correct case from a list• Move back to the case list from the

case detail screen• Move from case list to forms menu• Open the Pregnancy Checklist form• Play audio messages for questions in

a form• Move to the next question in a form• Move back to a previous question in a

form

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Poster ReMiND.indd 1 1/28/15 4:31:29 PM