Last week, the Government of India launched a nationwide mobile health (mHealth) programme designed by BBC Media Action, the BBC's international development charity, to train one million Community Health Workers (CHWs) and help nearly 10 million new and expecting mothers in India make healthier choices and lead longer, healthier lives.
Mobile Academy is designed to refresh CHWs' knowledge of simple steps families can take to improve the health of mothers and babies, and to improve their ability to communicate these steps clearly to mothers and their families.
Kilkari (a baby's gurgle) delivers free, weekly, time-appropriate audio messages about pregnancy, child birth, and child care directly to families' mobile phones from the second trimester of pregnancy until the child is one year old.
These services leverage the massive penetration of mobile phones in India to reach the most marginalised, hardest to reach communities. These are communities where something as normal and regular as getting pregnant and having babies can be 24 times more life-threatening than giving birth in the United Kingdom!
The statistics are pretty stark. Globally, every five minutes, three women die from complications related to pregnancy or childbirth, while 60 others will be left with debilitating injuries. Of these deaths, India accounts for the greatest number of women dying - over 150 every day. But we all know how many of these health risks that pregnant women and their newborns face are preventable.
In a country where nearly a billion people have access to mobile phones, the potential to save lives through insightful, innovative communication marks a paradigm shift.
Mobile Academy and Kilkari were originally designed for Bihar in North India, where BBC Media Action, in partnership with the Government of Bihar and supported by the Bill & Melinda Gates Foundation, works to improve health outcomes for mothers and children. Read more.
In India, CHWs deliver last mile health information and services to families. But these health workers can struggle to get their messages across. They're usually women from the community, educated to a high school level; often inadequately trained and rarely taken seriously by the families they visit. They want training and tools that enable them to do their jobs more effectively.
So we looked at appropriate technology and found, encouragingly, that virtually all CHWs either owned or had access to a mobile phone. But we also found that only 9% of them had ever sent a text message. So while they have phones, they use them for making and receiving phone calls - nothing else.
This research indicated that we needed to develop something accessible and audio based, in order to avoid problems related to the lack of technical literacy. So we created Mobile Academy, an anytime, anywhere training course, that can train hundreds of CHWs simultaneously, at a fraction of the cost of face-to-face training. Once registered, the CHW accesses the course via a simple mobile number. She then listens to lessons, takes quizzes and if she passes, she receives a certificate of completion from the government.
Kilkari complements Mobile Academy by reinforcing health workers' counselling of families; communicating directly with new and expecting mothers and their families to increase the uptake of healthier behaviors. For over-stretched CHWs, Kilkari provides vital support in getting relevant and timely information to families, reinforcing the messages they communicate and acting as a reminder service.
Designing content for Kilkari that could be understood by women in rural Bihar was an eye-opener. Comprehension levels of even the most basic concepts were often much lower than anticipated. Indeed, among the poorest women, not used to accessing information from anywhere but their mothers or mothers-in-law, the concept of accessing health information on a mobile phone was completely alien to them.
The amount of information provided also affected comprehension among illiterate women, in particular. Comprehension was much better among men, perhaps because of their wider exposure to movies, soap operas and locally televised sports matches, leading us to conclude that the more media exposure a person has, the better they are at comprehending pre-recorded health information on a telephone.
What helped make our content more accessible was Dr Anita - a fictional character created as the voice of our mobile services. Dr Anita is designed to be trusted and respected by CHWs and families alike. She is the voice of authority, but has great bedside manner and speaks in the local language. For families who rarely have the opportunity to see a doctor face to face, Dr Anita is a powerful tool.
Kilkari is now making calls to 850,000 families in six states and will rapidly scale to reach almost 10 million new and expecting mothers a year. Mobile Academy is currently accessible to 150,000 health workers across four states and will scale to reach nearly a million health workers. The national scale up is driven by the Government of India, who are making these services available free of cost to health workers and families. The initiative is supported by an alliance of donors, including the Bill & Melinda Gates Foundation, USAID and the Barr Foundation.
So that's how it works. No text messages, no literacy requirements, no special phones or laptops, just life-saving information from the very phones that people use, right now. It's about using appropriate media and technology to enable people to take action to improve their own lives or the lives of people around them.