Msakhi: Putting Technology Into the Hands of Community Health Workers

The World Health Organization estimates that in India, 136,000 maternal and 900,000 newborn deaths occur annually. These numbers could significantly decrease if health workers were better equipped to educate women and their families to recognize obstetric and neonatal danger signs and promptly seek health care. Although India has over 800,000 trained community health workers (CHWs), the training is insufficient, of poor quality, and poorly attended. Our study tested whether the use of a mobile phone-based interactive multimedia (illustration and sound) tutorial—called mSakhi—could significantly improve the maternal and newborn health knowledge among 25 Accredited Social Health Activists (ASHAs), a cadre of community health workers in India. At baseline, ASHAs’ knowledge and practices were assessed on 32 danger signs related to antenatal care, delivery, postpartum and newborn health. After receiving training on the application and using it for 8 weeks, ASHAs’ knowledge and practices were assessed again. Results reveal significant improvement with at least 70% of ASHAs able to identify at least 3-5 danger signs in all categories compared with 48% of ASHAs at baseline. ASHAs identifying 6 or more danger signs increased from 4% to 20% and the percentage of ASHAs recognizing fewer than 2 danger signs dropped from 48% to 10%. Qualitative data indicates increased self-confidence among ASHAs as a result of ready access to key health messages on the mobile phone, improved beneficiary counseling during home visits and increased credibility of ASHAs among the community. These preliminary results suggest that using interactive mobile tools like mSakhi may increase CHWs’ knowledge while interactively engaging community members for improved health practices. A more comprehensive study begins November 2011 and will include an assessment of mSakhi’s impact on the knowledge and behaviors of women visited by the ASHAs using mSakhi.