mCare Project Results follow up 2018

The mCare project, implemented by mPower Social Enterprises Ltd aims to reduce maternal mortality and child mortality which results from untimely and insufficient antenatal and postnatal care (ANC and PNC) of pregnant mothers in rural areas of Bangladesh. By digitizing the health register system maintained by the the Family Welfare Assistants (FWAs) it is meant to ease the work of the FWAs. The mCare project will also measure the improvement of the FWAs’ productivity with regards to health care system betterment. The regions in Bangladesh are also referred to as registers which is comparable to a commune/zone elsewhere and the mCare project is concentrated in 9 registers. FWAs cover an average of 1000 households on pregnancy related issues in about 9-10 days, hence they tend to manage a huge volume of information manually which becomes challenging and significantly affects the quality of services rendered.

Their responsibilities range from health promotion, disease prevention and collection of health-related data. Specifically, FWAs implement family planning programs at the field level, provide service at the lowest tier of the health service delivery system such as the community and satellite clinics, visit households, attend regular meetings and assist health managers at district and sub-district level in carrying out special health camps like immunization days.

Material informing the baseline is from the FWAs existing data, surveys, focus group discussion and in-depth interviews with select groups from the same sub-district; and includes FWAs and supervisors, pregnant and lactating mothers along with some relatives and policy makers. The study reveals several gaps and disparities in the register records such as ANC dates some of which are after the dates of delivery and PNC dates some of which are prior to delivery; in some cases, the ANC and PNC dates are the same. Others include duplicate household IDs, missing household IDs and incomplete data entry in the register.

Of the 509 lactating mothers examined, 7.8% households had duplicate household IDs and 2.8% household IDs are missing from the registries.

Additionally, 78.9% (402 children) are reported as live births. 27% of these are within the intervention while 51.9% are not within the control group. Less than 1% are reported to have died after delivery according to the data from the registers of FWAs. Information on the remaining children is missing. Furthermore, information on miscarriages was not available in the registers and yet there were mothers who reported having had miscarriages and still births.

Live births outside the control group

Live births from the control group

Ideally, the FWAs are expected to inform expectant mothers on their next visit date, but research shows that 86% mothers (41% benefit from the FWAs’ intervention) reported that they had not been informed about their second visit date during their first ANC visit. Comparison between dates of deliveries from the two datasets (the register data collected from the FWAs and baseline survey conducted among selected mothers) revealed only 25% (17% from intervention by the FWAs) matched. Further analyses reveal another 32% mothers (15% from the FWA intervention) reported a different date of delivery which is within two months range from the stated date of delivery in the registers.

Interactions with the FWAs revealed that they receive regular refresher trainings, attend bi-monthly meetings for revision of their tasks and submit monthly reports on their activities. The baseline sought to understand reasons for the inconsistencies and the low quality in register records, because as by their own admission the FWAs skills and capacity are regularly updated. Field surveys revealed that FWAs often do not carry the registers with them. Instead, they maintain a separate diary where they record their daily visits and later they re-enter the records in the main register. Each register is maintained for a period of 3 years after which, they are provided a new register and the FWAs have to once again, re-enter all the information from the old register to the new one. All these factors raise the chance of error in record keeping. Erroneous entry of dates of ANC visits will lead to missed ANC visits or incorrectly timed visits. Lack of effort to re-enter the data in the main register from the daily used diary will also lead to erroneous reporting. Hence, it is safe to say this is due to the amount of manual work each FWA has to perform which is directly related to the number of households they cover on any given day.

Drawing on the baseline findings:

The mCare project aims:

To digitize the registers per households maintained by the FWAs to ease and ensure quality of data recorded/maintained and;
To train the FWAs to ensure proper usage and implementation of the technology deployed. The goal is to reduce or totally eliminate the poor quality of ANC and PNC given to pregnant women, lactating mothers and children which results from the low quality in register records of the FWAs. It will improve the timeliness and completeness of ANC and PNC for the mothers through early registration, tailored client reminders, workflow support and improved client communication to become a decision support tool as opposed to the traditional data collection tools.

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