Hello, everyone !
It is wonderful to be back on HIFA to join the conversation on exploring how the use of mobile phone by healthcare workers in community settings can help shape service delivery for healthcare and more, based on my experiential learning.
How we have been using the phone as an informal channel of communication to begin with and gradually widened the applications over the past five years, looking at the challenges, the opportunities, the strengths and the scope to strengthen Family Centred Services (FCS) in the framework of Early Child Development and Health for All in primary care settings is the subject of an article underway for publication. For the purpose of sharing on HIFA, I shall briefly touch on the salient points that will perhaps answer most of the questions related to mHealth Innovate here. I shall try also to elaborate on the question of this week on HIFA in a communication to follow but I feel it would help understand the evolution of the informal use of the phone in the time-context-place of application even when the work is not in a formally structured project mode.
The year 2016 was when we first created a small whatsapp group with the intention of helping the Coordinator of our Community projects to efficiently serve as a bridge between the community based rehabilitation workers and the office-based community staff to meet the supervision and reporting needs of a growing community initiative that did not have the resources to enlarge our human resource pool. In a sense, the beginning was from a management level due to the felt need to share information quickly, manage the situational work reports, registry of new children entering the program or awaiting appointments.
We were already using the whatsapp platform to disseminate messages quickly, coordinate teamwork better for community mobilisation but in the summer of 2017, ideas were flowing in from community workers with greater engagement. The hot summer months in Delhi generally see a decreased frequency of home visits but in 2017, the field staff in North East Delhi (urban slum settlement colonies) continued to give timely progress reports, selectively visited homes where parents conveyed a need, and transmitted messages about children requiring appointments by consultants at our Centre or referral to the nearest Government Hospital.
2017, 2018 also were the years when the community staff built on the linkages established earlier with the local Anganwadi workers (AWW) or the Community staff in the national Flagship program ICDS (with a focus on Child nutrition and health in addition to other elements for Child Development) - by virtue of our participation in a research project that involved the AWW as Key Informants for early identification of children with disabilities in the previous year. The rapport established between health workers in the system and CBR workers of our grass roots organisation led to a natural 2-way referral system, and we realized that the scope to work towards Rehabilitation inclusive Healthcare for ECCD was immense.
2018-2019 saw our staff at all levels using the phone in multiple ways. Caregiver training in a cascade model was already developing well in the CARENIDHI Community Initiative, but that involved frequent workshops and training sessions for staff and parents in the early years. Now, with practically 75 - 80% of our community workers also having a smart phone (at least, one android phone per family), I started capacity building with specific training modules developed by CARENIDHI in 2008-2009 to contextualise the evidence based methods to deliver FCS for Early intervention of children with disabilities.
We were also having one group exclusively for older children who required school support and Social education (IEC) or Non-formal education (NFE). This was also acquiring the nature of parent mediated learning with siblings also participating in some Inclusive activities during school holidays.
We next added parents with an interest to learn basic management of their children to the Staff capacity building group. This proved to be a boon in the Covid phase when Community work had to slow down in the months to follow.
2020 saw us do much Covid Education for staff and parents together over phone (dos and don'ts) and reach out to allay the fears and anxiety of children and families during the lockdown.
Our resource consultants (a small group) and I did teleconsultations and counselling over the phone for these children and flowed up with Goal directed therapy VIRTUALLY for the first time.
I noticed that a few of our community workers (now referred to as caregiving staff) who used to participate well in the community meetings in the precovid phase were less active at this juncture as compared to the rest in the group. It turned out that some of our workers (particularly the ones with practical experience but did not complete high school) were not adept at writing long sentences and did poorly in the capacity building lessons. Some families were not participating in the videocall sessions for teleguidance and the monthly zoom meetings to the desired extent because of a single phone in the house shared by all in the house. The inequity and the digital divide were even more when it came to the virtual world (as was the divide between grass roots workers in resource constrained settings and some of the bigger Civil Society Organisations).
That was when we came up with a few innovative solutions to ensure participation by all staff and parents. We taught them to use voice notes to convey important information as well as to be a part of the ongoing capacity building. The lack of paucity of phones per house was partly circumvented by pairing a CW with a parent in the neighbourhood, so the recorded voice notes and IEC could be shared at mutually convenient times.
The CW caregivers are now also able to attend zoom meetings (when in Hindi, the local language), and conduct parent meetings in a hybrid mode.
By the end of 2021, our Community workers were back to work full steam (with Covid appropriate behaviour, of course) ! The year saw the staff and parents working together to celebrate the Environment day and Disability day virtually over the zoom platform with several parents and siblings watching the children perform. New parents are being helped to learn together in a self-help mode for basic early intervention (just begun) that includes training for ADLs.
The school readiness programme is also happening in a hybrid mode. The critical functions of Communities of Practice with particicipation by community caregivers is being worked out in a mix of the formal and the informal use of mobile phone.
Today, the administrators of the whatsapp groups are the Senior community workers. We wish to scale up the work and take the work forward and are trying for a project grant-in-aid with interested partners- for, sustaining and scaling up work of this nature can be time and resource intensive. Hope to find support for the CWs to utilise their learning to optimise the potential of all children in these changing times.
Thank you, HIFA, for the opportunity to share and learn.
Best regards,
Sunanda
HIFA profile: Sunanda Kolli Reddy is a Developmental Paediatrician from New Delhi,India, with a special interest in Early Child Care and Development of children with neurodevelopmental problems in underserved communities. She is actively involved in health promotion, community-based research, care provider training for promoting abilities of children with special needs, through the various programmes of Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability-related Health Initiatives (CARENIDHI), which she heads (www.carenidhi.org). Her work in the community settings to widen the disability-in-development model of CBR encompasses the wider determinants of health and human capabilities and issues which impact the lives of the poor. She combines her experience in developmental paediatrics with the core work of CARENIDHI's grassroots convergence programmes in partnership with groups working in the area of Implementation research and policy. She is a member of two HIFA working groups: Community Health Workers and mHEALTH-INNOVATE.
http://www.hifa.org/support/members/sunanda
http://www.hifa.org/projects/community-health-workers
https://www.hifa.org/projects/mhealth-innovate-what-can-we-learn-health-...
write2sunanda AT gmail.com
