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Building Capacity to Use M-Health in Maternal, Newborn and Child Health Interventions

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Building Capacity to Use M-Health in Maternal, Newborn and Child Health Interventions Building Capacity to use m-Health in Maternal, Newborn and Child Health Interventions IDRC Grant Number: 107467-00020199-032 Lead Organization: HealthBridge Foundation of Canada Collaborative Partners: Evangelical Fellowship of India Commission on Relief (EFICOR) and University of Ottawa Research Team: Mr. Prashant B. Missal, Mr. Stephen Marandi, Mr. Rahul Kumar Saha and Ms. Binita Kisku (EFICOR), Ms. Lisa MacDonald and Dr. Rachelle Desrochers (HealthBridge). Report Type: Final Technical Report Period Covered by Report: September 1, 2014 – April 30, 2016 Date Submitted: June 9, 2016 This report is presented as received from project recipient. It has not been subjected to peer review or other review processes. This work is used with the permission of HealthBridge Foundation of Canada. © Copyright 2016, HealthBridge Foundation of Canada. Building Capacity to use m-Health in Maternal, Newborn and Child Health Interventions Table of Contents 1. The Research Problem .................................................................................................................... 3 2. Objectives ........................................................................................................................................ 3 3. Methodology ................................................................................................................................... 4 4. Project Activities ............................................................................................................................. 8 5. Project Outputs ............................................................................................................................. 12 6. Project Outcomes ......................................................................................................................... 13 7. Overall Assessment and Recommendations ................................................................................. 20 Annexes: Annex 1: Quantitative Endline Survey Annex 2: m-Health Forum Program Annex 3: Quantitative Research Report Annex 4: Qualitative Research Report Annex 5: Learning Review Report 2 Building Capacity to use m-Health in Maternal, Newborn and Child Health Interventions 1. The Research Problem A basic package of maternal and neonatal health services can save the lives of mothers and newborns during pregnancy, birth, and the post-natal period, including skilled birth attendance, ante-natal care and post-natal care1. However, making such services accessible to all women remains a challenge. Improving maternal, new-born and child health (MNCH) requires more than the provision of services; mothers must be motivated and able to seek health care, and have appropriate self-care practices. The use of mobile technology in MNCH has become increasingly popular and is showing promising results in facilitating emergency medical referrals, point of care support, health counselling and health system monitoring2. Preliminary evidence also suggests that mobile health (m-Health) can effectively promote knowledge and care-seeking behaviour amongst pregnant women through timed messages3. Given that mobile phone ownership is widespread around the globe, m-Health has tremendous potential to reach those living in remote and isolated areas. However, more evidence is needed on the impact of m-Health interventions on MNCH outcomes, as well as understanding of how to effectively implement and scale-up such interventions in low-resource settings. While m-Health is being used around the world, there is still relatively little collaboration and cross-sharing of ideas amongst Canadian organizations using it to improve MNCH. It is well known that support from family members, particularly husbands, is important for enabling women’s access to health care3. However, engaging men is difficult due to time constraints, lack of clinic space and health workers trained in counselling men, and stigma from men’s involvement in “women’s issues”2. With m-Health, information can be delivered discreetly, independent of place or time, thus evading the challenges of direct counselling. There is a dearth of research on the impact of using m-Health targeted to husbands on women’s access to maternal health services. In this project, Canadian and Indian researchers collaboratively piloted an m-Health application to engage and educate husbands, building Canadian and Indian capacity to use m-Health in an MNCH context, and contributing to the global evidence base on the feasibility and impact of this technology. 2. Objectives The long-term goal of this project was to build capacity within Canada and India to effectively use m-Health in MNCH interventions and ultimately, reduce maternal and newborn mortality. To achieve this goal, the project had two separate but complementary components: 1 Surviving the first day: State of the world’s mothers 2013. Save the Children. ISBN I-888393-26-2. 2 Tamrat T & Kachnowski S. (2012). Special delivery: An analysis of m-Health in maternal and newborn health programs and their outcomes around the world. Maternal and Child Health Journal, 16: 1092-1101. 3Davis J, Luchters S, Holmes W. (2013). Men and maternal and newborn health: Benefits, harms, challenges and potential strategies for engaging men. Centre for International Health, Burnet Institute, Australia. 3 Building Capacity to use m-Health in Maternal, Newborn and Child Health Interventions The first component, a Collaborative Research pilot project, contributed to the global evidence base while building local capacity to use m-Health in MNCH interventions. HealthBridge worked with its Indian partner Evangelical Fellowship of India Commission on Relief (EFICOR) and Dimagi India (a mobile technology enterprise) to design, implement and evaluate the impact of using m-Health to engage husbands in their wives’ maternal health care. To our knowledge, there are very few interventions that have evaluated the impact of using m-Health to engage husbands. The objectives of the Collaborative Research component were: i. To assess the feasibility and impact of an m-Health intervention targeted to husbands on women’s utilization of maternal healthcare in rural India ii. To increase capacity of HealthBridge and EFICOR to use m-Health in MNCH interventions Both of the above Collaborative Research objectives were achieved by the project. An m- Health intervention that sent voice messages to husbands of pregnant women was pilot tested in a rural district of India. The evaluation assessed the impact of the intervention on women’s utilization of maternal health care, and also the challenges faced throughout the process of implementation. Lessons learned in designing the research and m-Health application, training field staff and implementing the intervention were also documented. The second component, a Knowledge-Sharing component, convened Canadian researchers and practitioners who have used or are interested in using m-Health for MNCH, to share results, experiences and lessons learned. The objectives of the Knowledge Sharing component were: i. To increase knowledge amongst Canadian organizations of promising approaches for using m-Health to improve MNCH. ii. To identify best practices for designing, implementing and scaling up m-Health approaches in MNCH interventions. The project team organized a half-day Knowledge Sharing Forum which provided a unique opportunity for Canadian organizations to learn and discuss how m-Health has been used to improve MNCH in low and middle income countries. Given how young the field of m-Health is and limitations in the existence of well documented studies, we were not able to identify best practices but rather the Forum enabled us to identify promising practices and approaches for using m-Health in an MNCH context. In addition to identifying promising practices, the Forum identified lessons learned and key gaps in m-Health evidence and recommendations for future research. 3. Methodology Collaborative Research Component This project pilot tested an m-Health intervention to educate husbands of pregnant women about maternal health care and increase their involvement in supporting maternal health. 4 Building Capacity to use m-Health in Maternal, Newborn and Child Health Interventions The intervention was called “3M: Men using Mobile phones to improve Maternal health”. Men were sent timed voice messages with health information, recommended actions to take and reminders of their important role in supporting the health of their pregnant wives. The research project was implemented from September 1 2014 – April 30 2016 in Pakur district, Jharkhand State, India. The research protocol was finalized by the research team and ethics approval was obtained from the Institutional Ethics Committee at St. John’s National Academy of Health Sciences, Bangalore. Research Design: The research design comprised a before-after-control-impact quasi- experimental design. The project took place in 50 villages of Hiranpur block; 25 intervention and 25 control villages. The inclusion criteria for husbands’ participation in the project were: a) his wife must be 12-20 weeks pregnant; and b) he must own a functional mobile phone. The project team aimed to recruit 230 husbands (115 each in intervention and control blocks) who met these criteria to participate in the project. In both the intervention and control blocks, ASHAs4 counselled pregnant mothers using Smartphones and Dimagi’s CommCare5 application which included interactive messages and videos with health information.
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