Digital Integrated Solution for Communicating Health (DISCH)

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A digital health initiative for supporting access to family planning services and educating married and women of reproductive age about birth control and other health services in Pakistan.

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CONTACT

Syeda Nateela Tirmizi
Assistant Project Manager
Email

CASE STUDY SOURCE

Digital Care Company, Pakistan

PROJECT STATUS

Completed

IMPLEMENTATION PARTNERS

Digital Care - Technology partner
HANDS - Owner

GEOGRAPHIC SCOPE

Pakistan

Target Users

Decision Support, Referral Services, Client, Health Care Provider

Enabling Environment Building Blocks

Services and Applications, Infrastructure, Workforce

Family Planning Program Classification

Demand Generation, Service Delivery, Supply Chain Management, Policy and Enabling Environment

INTRODUCTION

Pakistan’s mortality for under-five remains the highest among the South Asian (SA) countries. High maternal mortality (deaths) combined with high fertility (birth) results in a ratio of 1:89 women dying from pregnancy-related causes. [1] In addition, the increasing burden of non-communicable diseases now compounds the persisting burden of infectious diseases.  

Digital Care, the pioneer and leader in the field of digital health in Pakistan, provides technical support to HANDS Pakistan one of the largest non-profit organizations in the country to initiate a program for improving maternal health of married & reproductive women of Pakistan by educating them on birth control programs and family planning services through using telehealth services.

ABOUT DISCH

The prime objective of the DISCH project is to enable Noor workers of HANDS (who can be any woman who completed primary education) to do electronic visits and engage their clients, who are known as married women of reproductive age (MWRAs) and educate them on family planning techniques and their maternal health. Electronic visits are carried out through an Android mobile application that is installed on Noor workers’ mobile phones. [2] Through this application, every Noor worker captures data of the MWRA that she is supposed to visit along with the intra-uterine contraceptive device (IUCDs) that she has to show to the client.

The same application is installed in the Android tablets of lady health visitors (LHV) who are doctors and family physicians. Every LHV will have data of the Noor workers that are assigned to her along with the details of all the Noor workers’ MWRA clients. The Digital Care administration will have access to the data of all the LHV, Noor workers, and clients. This program took place at Muzzafar Garh in Punjab under the supervision of government representatives. Noor workers go door to door, perform a survey and register married women provide maternal health guidance to MWRA’s and educate them to understand what are the safer ways to maintain their reproductive health and guide them on birth control programs including how to use pills, condoms, injections, IUCD, TL methods.

Initially, when MWRA wants to involve in any family planning program and is interested in using birth control methods, Noor worker will register that MWRA as a client, and then the Noor worker will meet LHV at the HANDS office where she will provide her all the information about MWRA’s and what family planning services they want to use. Then, depending upon the need, LHV will visit registered clients along with the Noor worker and facilitate each MWRA with family planning inventory. [3]
Noor workers always find issues in educating MWRA’s due to lack of insufficient tools to remember and monitor their routine tasks and this issue is also leading an incomplete data monitoring on the administration’s (lady health visitor) end.

  • Noor worker tasks included:
  • Enter data of MWRA
  • Educate MWRA by showing educational content provided by HANDS on family planning methods.
  • Register MWRA as a client if she wants to use any family planning method
  • Notify the lady health visitor about the data she gathered.

Lady Health Visitor tasks included:

  • Educate Noor workers so that they can educate the MWRA’s.
  • Manage family planning inventory.
  • Provide family planning services to MWRA’s.
  • Fill out & manage the visiting forms.
  • Data management of all MWRA’s & Noor workers.
  • Due to this long and complex process, Digital Care presents an idea to digitize every step of all activities and provide technical support to HANDS for managing gaps between communication, Data transferring, and inventory management.

Using telehealth technology provided by Digital Care, HANDS established an effective and real-time monitoring system for their Noor workers (at the spoke side) and for the Lady health visitors (at hub side) to access information on family planning and other health topics.

The Digital Care objective is to carry out:

  • Content management
  • Logistic management
  • District management
  • Portal and mobile application management
  • Performance monitoring
  • Real-time monitoring and technical support.

Electronic visits are carried out through an Android mobile application that gets installed on Noor worker mobile phones. Through this application, every Noor worker can manage data of the MWRA and the educational content (videos, lectures in rural language) that she will present to their registered clients. Furthermore, the same application is installed in the Android tablets of LHVs to monitor all the information (articles, pictorial presentations, family planning techniques) and the data (maternal information, time frame of using contraceptive, method use) which she assigned to every Noor worker.

HANDS have the administration rights to access the data of all the LHV, Noor workers, and the clients to analyze, schedule & monitor further activity and follow-up tasks.
Through technology, Noor workers, and LHV facilitate and monitor MWRA more effectively.

EVALUATION AND RESULTS

The results and outcomes (measured based on the number of clients Noor worker make i.e, the MWRA who uses any family planning method) show a significant acceptance and success story of this project, up till now we have more than 41,343 mothers who are beneficiaries of this program, 160 registered trained workers and around 14,627 new clients enrolled.

  • Number of registered clients = 34093
  • Number of Noor workers = 160
  • Number of LHV = 5
  • Number of inventory list/items = 8

The following table provides additional information on the impact of the DISCH project:

LESSONS LEARNED

Managing MWRAs database for tracking the potential clients and using paperless reporting decreases staff workload during client generation and follow-ups.
Real-time monitoring with the Global Positioning System (GPS) dashboard will enable us to visualize data trends and analyze the performance of health workers and project staff.
Efficient and effective management of contraceptives and other health supplies through Logistic Management System (CLMIS & BLMIS).

  • It increased research opportunities.
  • Tracking Critical Performance Indicators
  • Measurement of Informed decision-making based on accurate data.
  • Support data collection data from the field – then share and analyze it in real-time across the organization. [4]

The government is looking to scale this project, however, we are also planning and working on its expansion to other locations in Pakistan as well as international locations. The technology collects the data and also assist in the learnings of the users

CONCLUSION

Digitalization is making the tasks easier and helping the workers which motivates them to do their jobs in a better way. Digitalization has the power to minimize gaps between communication and monitoring. Through this approach, the field workers felt empowered as they had a tool that assisted them in communication in delivering the services. Additionally, the administration could see the activities and the data in real-time. Based on the data the administration structured the processes in order to make sure that the KPIs are met and to scale it to different regions.

REFERENCES

1. Sehat Kahani (2021). Addressing the Social Phenomenon of Doctor Brides, HealthManagement, Volume 21 – Issue 3, 2021 <https://healthmanagement.org/c/healthmanagement/issuearticle/sehat-kahani-addressing-the-social-phenomenon-of-doctor-brides>
2. Digital-care (2021) HANDS, website available at <https://digital-care.net/index.php/hands/>[Last accessed on December 4th, 2021]
3. HANDS (2021) Empowered Marvi as a Change Agent, website available at <https://hands.org.pk/our-services/health/#Empowered-Marvi-as-a-Change-Agent> [Last accessed on December 4th, 2021]
4. Digital Care (2021) 2-Misali Information-Final formLJ.FH10, MISALI an ICT Based Application for innovation, Available online <https://digital-care.net/wp-content/uploads/2021/09/2-Misali-ICT-based-application-inserter.pdf> [Last accessed December 4th, 2021]