CRS supports health systems strengthening work in the state of Uttar Pradesh with a mobile health initiative that works with community level maternal and child health workers. These community workers, known as ASHAs, are members of the village where they work and receive small government stipends for doing outreach to pregnant and lactating women. With private funding, CRS created a mobile health tool that puts ICT4D solutions on basic phones. The app prompts ASHAs on what messages to communicate during each visit. The messages are all given from an audio recording and color coded, allowing illiterate ASHAs to follow the standard government curriculum. They record information about each woman’s pregnancy and delivery in the app. Prior to using a mobile device, ASHAs often forgot which messages to deliver at what time, or they gave all pregnancy messages in one sitting, regardless of where a woman was at in her pregnancy.
Here, ASHA Sunita Prajapati, 26, counsels Nirmala Devi, 26 (green sari). This is Nirmala’s second pregnancy.
Sunita is a single mother of a 6-year-old girl, as her husband left when she was pregnant. She lives in her mother’s home. She had completed 12 years of education when she became an ASHA, but with her earnings as a community health worker, she was able to pay her own tuition for a bachelor’s degree (equivalent of an associate’s degree in the U.S.). She saves every rupee she can for her daughter’s education, and she is also responsible for all of the household expenses. She has helped more than 500 pregnant and lactating women since she started working as an ASHA in 2007.
Jonathan Jackson, Founder and Chief Executive Officer, Dimagi, USA; Social Entrepreneur at the World Economic Forum – Annual Meeting of the New Champions in Dalian, People’s Republic of China 2015. Copyright by World Economic Forum / Sikarin Fon Thanachaiary
I’m writing from Ghana’s far North, right up along the border with Burkina Faso, for a project with UNICEF around communication for development. I just got here a week ago, but it feels like much longer. It’s funny how, no matter how much fieldwork you do, there’s still so much left to learn. On Friday we paid a visit to Bonchaso, a village made up of a few scattered mud huts 15 km down a dusty path from the nearest health center. There, we met a woman shucking peanuts underneath a tree. Her name is Esther.
She’s good-natured, cheerful, practical, and opinionated. She patiently considers all of the questions we ask about why women don’t go to the hospital to deliver their babies or how can we encourage children to wash their hands. We talk about what are the key points in time when a short message over the phone could make a difference – such as a message in the evening to put up a bednet for the night, or a message after childbirth reinforcing the importance of exclusive breastfeeding. We talk about how often we should send the message, so that it’s understood and remembered without being repetitive. Then we thank her for the help she has given us designing this system. And finally, we ask her if she has any comments about how she thinks she would, or would like to, interact with the system herself.
She explains calmly, with a smile on her face, that whatever system we design isn’t going to affect her, because she doesn’t have a phone and will never get a call.
Of course, all the cell phone ethnographers and design-for-development folks have their talk about proximate literacy, shared phone usage, and network effects. We all recognize the value of individual community catalyzers or information hubs.
At the same time, it’s hard to reconcile those arguments with the simple truth which Esther presents. At the end of the day, yes, this line of communication we throw out to the communities might help to save her life during her next labour or prevent her child from getting cholera. But even so, it’s one more conversation we’re striking up only with the relatively privileged phone owners, typically male heads of households, and one more way in which women like Esther are left on the outside, looking in.