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. 2019 Mar 27;9(3):e025774.
doi: 10.1136/bmjopen-2018-025774.

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation

Sneha Nimmagadda  1 , Lakshmi Gopalakrishnan  1 , Rasmi Avula  2 , Diva Dhar  3 , Nadia Diamond-Smith  4 , Lia Fernald  5 , Anoop Jain  5 , Sneha Mani  2 , Purnima Menon  2 , Phuong Hong Nguyen  6 , Hannah Park  4 , Sumeet R Patil  1 , Prakarsh Singh  7 , Dilys Walker  4
Affiliations

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation

Sneha Nimmagadda et al. BMJ Open. .

Abstract

Introduction: Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes.

Methods and analysis: This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries.

Ethics and dissemination: Ethical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public.

Trial registration number: ISRCTN83902145.

Keywords: child health and nutrition; impact evaluation; mhealth; quality in health care.

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Conflict of interest statement

Competing interests: DD is a Program Officer with the Measurement, Learning & Evaluation (MLE) team at the Bill & Melinda Gates Foundation (BMGF) India Country Office. BMGF has funded this study as well as the support to the scale-up of the ICDS-CAS programme. However, as part of the MLE team, DD has had no role in the ICDS-CAS program design or implementation and was responsible for conceptualizing and commissioning the evaluation. She continuous to advise on study design, analysis and communication of findings to stakeholders.

Figures

Figure 1
Figure 1
ICDS-CAS information flow from the Anganwadi Centre to the Ministry of Women and Child Development. Solid lines correspond to interactions. Dotted lines correspond to data flow. AWW, Anganwadi worker; CDPO, Child Development Project Officer; ICDS-CAS, Integrated Child Development Services-Common Application Software; MWCD, Ministry of Women and Child Development.
Figure 2
Figure 2
Logic model of ICDS-CAS and measurement of outcomes. AWW, Anganwadi worker; CDPO, Child Development Project Officer; DPO, District Programme Officer; ICDS-CAS, Integrated Child Development Services -Common Application Software; LS, lady supervisor; MWCD, Ministry of Women and Child Development.
Figure 3
Figure 3
Sampling of study participants from Madhya Pradesh and Bihar. AWC, Anganwadi Centre; AWW, Anganwadi worker; CAS, Common Application Software; ICDS, Integrated Child Development Services; ISSNIP, ICDS Systems Strengthening and Nutrition Improvement Programme. Sources: # Women and Child Development Department, Government of Madhya Pradesh (MIS) http://mpwcdmis.gov.in/ (See1m5bxnuzmixun00bsctvfj))/DataEntryAwc.aspx (Accessed 8 June 2018); & Integrated Child Development Services, Government of Bihar http://www.icdsbih.gov.in/AnganwadiCenters.aspx?GL=16 (Accessed 8 June 2018); *Programme documentation from implementing agencies.
Figure 4
Figure 4
Sampled intervention and comparison districts. Green areas indicate intervention districts. Blue areas indicate comparison districts.
See this image and copyright information in PMC

References

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