Promotion of Early Childhood Development Using mHealth: Learnings From an Implementation Experience in Haryana.

Pregnancy and the early years of life (0-3 years) are of crucial importance for a child's survival, health, growth and development. Improving care for young children is now considered fundamental to achieving the Sustainable Development Goals by 2030. With support from WHO and Intervida (an international non-governmental organization), implementation on care for early childhood development was carried out by Survival for Women and Children Foundation in 100 villages in Haryana, India. In addition to the implementation of evidence-based interventions, mHealth (phone message (SMS) and phone call) was used as a complementary strategy. The intention was to promote self-care, increase coverage, and improve inter-sectoral collaboration. One message per day was developed (915 messages) and 1564630 SMS were sent to all beneficiaries and providers to facilitate interaction. Based on learnings, the consolidation of this approach into 46 core themes helped to refine interactions. Lot Quality Assurance Sampling was used for evaluation. SMS was received, read and practiced by the caregivers and the care providers in the intervention block, being substantially higher than in the control blocks. There was a remarkable improvement in under-nutrition and wasting; however, the reduction in stunting was modest in the intervention area as compared with two control blocks. This is attributed to implementation of all strategies in the project including the complementary approach of use of mHealth. The application of SMS and phone communication continues to have relevance, since people most in need are poor and require integrated package of services maximally during this crucial period for improving equity and coverage.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.

BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.