Using a mobile technology platform to empower community health workers to improve newborn care at the household level

Objective: To develop mobile applications to strengthen community-based neonatal health efforts.

Background: CommCare is a mobile phone application designed to support community health workers (CHWs) during home visits. In Tanzania, where there is a high neonatal mortality rate, CommCare stands well-poised to improve consistency and effectiveness of newborn care through automated checklists, multimedia prompts, and collection of useful data.

Methods: In Dodoma, Tanzania we developed a neonatal CommCare module containing the following elements: emergency signs for referral; newborn health promotion checklists; multimedia prompts featuring pictures from Hesperian materials and audio clips.

We assessed and improved the module through hundreds of uses, both during home visits immediately after a birth and under more controlled conditions with women of reproductive age. In the controlled environment, we quizzed 91 women before and after sessions with a CHW to assess client knowledge. We compared the results across sessions conducted with and without the CommCare application.

Results: While our data is insufficient for quantitative analysis, our investigation suggests that mothers appear much more engaged during the picture sections of the CommCare module, which seems to elicit more thoughtful responses. There is a need to prompt CHWs to cover each element, which the audio prompts could potentially fill. Despite initial worries over screen size, we have found that the pictures are still useful even on smaller phones.

Conclusions/Implications: Mothers and CHWs respond well to the use of images for health promotion. Health content is just one part of an effective module; our next step will focus on behavior change. Structuring the content and narrative material of a community health visit, with or without ICTs, may help improve the interaction between the CHW and their clients.