Dear All,
The series of mails we are receiving for mHEALTH-Innovate is simply amazing with everyone sharing their vast experience with the use of mobile phone for both informal and formal communication.
Vaishnavi's short blog post from her thesis is particularly interesting. The points she made align with my own observations during the recent years of collaborative work with Anganwadi workers (on a project looking at Folic acid and Neural tube defects) and our continued work in Community based Inclusive Development of children with disabilities.
The problems with the use of Poshan tracker have been accurately described in her post. I am not directly linked with the work happening with the Poshan tracker but I have been a keen observer of the formal use of mobile phone for data reporting by the Frontline workers in our Anganwadis.
Our own use for capacity building of caregivers using the digital platform has been very encouraging in supporting the families for Family centered services as a part of the disability-related work in the periurban resource constrained settings where health and nutrition deserve much attention. The informal use for teaching-learning has seen much improvement in the quality of care in home management for Early Child Development (ECD) with participatory learning of families and informed choices for dietary practices and nutrition for the children over a period, while adapting with a life course approach.
However, comparing the formal use in a project mode for gathering data (with specific elements prioritised for reporting) as required for the health systems versus the informal use by FLWs as caregivers learning on the job, and working with the families for ECD in the community, I must say that the objectives and processes of training also make a difference.
Looking at childcare workers' use of phone in our own context, I ask myself: can the guidelines for formal use for data collection apply in toto for the informal uses that include training for processes of care (which actually was the main reason for establishing Anganwadis years ago) or rehabilitation in the community?
That said, scalability and fidelity remain difficult to achieve when FLWs are using the phone informally, even when provided phones by an organization for their work in a health program. Evaluation and monitoring with the formal use involves reporting of targets and specific indicators to track progress, but does not say much about the behavioral change or quality of care for child development over time. Both come with pros and cons.
Digitally enabled FLWs in poor communities cannot also be expected to do better than what is currently possible for the health researchers and practitioners in community settings in the face of poor digital infrastructure and weak health systems.
How does one strike a balance between the feasible and the desirable use of the mobile phone in Public Health programmes today in a complex adaptive system (CAS)? Technology can be a facilitator but only if we can address the context- specific challenges in countries where digital literacy is still in its infancy. Even as we try to come up with recommendations and look at implementation with improved guidelines, we need to recognise that there is a spectrum of needs to be met in different contexts, with varying levels of challenges and opportunities inherent to digital health capabilities across the globe.
I know that I am throwing more questions than solutions here, but when experts work on consensus guidelines, it is useful to remember that one size does not fit all.
The HIFA discussion on the subject in the past month has been truly enlightening- with the sharing of experiences, perspectives, an awareness of the developing systems and guidelines emerging from different countries (many that I was not aware of even a month ago), and learning about practices evolving in relation to mHealth today.
My sincere thanks to all.
Best regards,
Sunanda.K.Reddy
Dr. Sunanda K. Reddy
Chairperson (Honorary),
CARENIDHI Trust, New Delhi, India
Phone: +91-9818621980,
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 the HIFA working group on Community Health Workers. http://www.hifa.org/projects/community-health-workers http://www.hifa.org/support/members/sunanda write2sunanda AT gmail.com