Proposed study aims to implement, and evaluate an innovative intervention based on mobile phone technology to help ASHAs improve coverage of maternal, newborn and child health (MNCH) services in predominantly tribal and rural communities. The intervention will also include tools for medical officers and PHC staff to better monitor and support ASHAs. 

Over the course of last decade, significant evidence has been generated about effectiveness of community based interventions which can reduce maternal, newborn and child mortality and morbidity. To facilitate implementation of the proven interventions, a new cadre of village based Community Health Workers, called Accredited Social Health Activist (ASHA), was created under the aegis of the National Rural Health Mission (NHRM). Many of the community based maternal, newborn and child interventions are expected to be implemented or facilitated by ASHA during her scheduled home visits. Unfortunately, evaluations examining ASHA’s performance have noted that coverage of selected MNCH interventions to be implemented by ASHA is low. One of the most important reasons for low coverage is inadequate information to monitor and support ASHAs’ activities apart from insufficient skills of ASHAs, quality of training, and complexity of tasks to be performed. Also, large numbers of complicated maternal, newborn and child cases are unable to go to a health facility. The non-availability of real time information about such cases to Auxiliary Nurse Midwife (ANMs) and medical officers has limited their ability to respond; hence, such complicated cases at home tend not to receive any care. 

Proposed intervention is an innovative strategy to overcome above problems by using mobile phone technology (called mHealth solutions) to empower ASHAs and PHC staff. The mHealth intervention is named ImTeCHO which stands for “Innovative Mobile-phone Technology for Community Health Operations”. “Techo” in Gujarati means “support”; hence, ImTeCHO means “I am support”. mHealth intervention, ImTeCHO will be used in 3 ways: (1) Mobile phone as a job aid to ASHAs to increase coverage of MNCH care (2) Mobile phone as a job aid to ASHAs and ANMs to facilitate referral and care for mothers, newborns and children with complications (3) Web interface to provide timely information to medical officers for monitoring and supporting program, including accurate and timely reporting of births and deaths. Proposed ImTeCHO intervention will integrate checklist (to insure standardization of services) with other features that mobile technology offers such as ability to transfer data instantly and apply algorithm automatically to data entered along with features to ensure check-and-balance for truthfulness and accuracy of collected information. All this will be possible by using a low-cost phone costing approximately Rs.5,000 (US $ 80). Rather then creating a new model, ImTeCHO intervention will use mHealth solutions to improve implementation of existing responsibilities of ASHAs. ImTeCHO intervention will be implemented within government’s existing primary health care system which will be actively facilitated by SEWA Rural. The duration of study will be 36 months. 

The study will test the effectiveness of intervention to improve: (1) Coverage of maternal, newborn and child health-care services to be provided by ASHA, (2) Coverage of care received by complicated maternal, newborn and child cases and (3) Supervision and support  to ASHA program. This will be a two-arm cluster randomized trial which will be conducted in six high focus, tribal blocks (Population: 450,000) of Bharuch and Narmada districts in Gujarat with 11 Primary Health Centers in each arm. Approximately 33,000 pregnant women, newborn babies and young children will be directly benefitted. Primary outcome of interests will be measured by conducting household surveys at baseline, and post-intervention.

Results of this study will have significant implications on policy. At the end of the study, exact road map for implementation of ImTeCHO in larger system will be ready as following deliverables will be produced: training modules for using mobile phones, implementation plan for introducing mHealth solutions for MNCH care in larger system, a comprehensive report and creation of a demonstration site. Proposed intervention including mobile phone application and web interface can complement existing online Mother and Child Tracking System (MCTS) in use and further enhance inherent usefulness of Mother and Child Tracking System (MCTS). Apart from facilitating provision of services, the intervention will provide timely, reliable and accurate information for birth and death reporting. Lessons learned from this study will be helpful to guide use of mobile phone technology in other disease areas.

This study will be conducted by Society for Education, Welfare and Awareness (SEWA) Rural, Jhagadia. SEWA Rural and Argusoft India Ltd have developed ImTeCHO intervention. The Department of Health & Family Welfare, Government of Gujarat and SEWA Rural will implement the intervention. SEWA Rural will evaluate the intervention with help of experts from ICMR and WHO.

The trial was registered on 3 June, 2015. The first enrollment was done on 26 August, 2015. Therefore, this is a prospectively registered trial. However, the message on the CTRI website states that the trial was registered retrospectively. This has happened because of a human error in stating the date of first enrollment when the trial was registered by the investigators. However, the date of first enrollment is now corrected on the CTRI website and this is in fact a prospectively registered trial.