India Malnutrition Program: Monitoring Evaluation Part 2

In March 2010, Caitlin and I were driving around Khandwa district on a motorcycle desperately searching for staff to begin operations of our ambitious “Eradicate Malnutrition” program. In our heads, we had a checklist of criteria for potential new staff, mostly focusing on education levels and any experience in the health, nutrition, or NGO sector. As we drove from hamlet to hamlet, over dried streambeds and through fallow, dusty farmland, the checklist was whittled down to one item: literate.

In July of 2011, 5 of our amazing CNEs from Khandwa are now on the cutting edge of technology, helping Microsoft design their Digital Slate technology for data collection in the field. At the same time, the rest of our Khandwa team is collecting information with an application on their phones specifically designed from RMF called Commcare. After a 3 month study, Microsoft Research will publish a paper based on the inputs of our team comparing these solutions to data collection problems. It seems that my initial pessimism, as it so often is, may have been a bit misguided.

On a motorcycle in 100 degree heat, it was hard for me to imagine solutions to the multitudes of challenges our program would face. How would we train our staff? Would they understand the material and the importance of our task? Would they be able to accurately report what they were seeing and doing, and, if so, how would our small team process this information? We knew that none of our team was lacking in passion or enthusiasm, but how well would we adapt to new challenges? I couldn’t imagine, in my own head, solutions to all of the problems I could invent. I should have had more faith in the Korku women of Khandwa.

After our initial consultations, the team from Microsoft decided that a two day training session would be the best to cover all the topics and ensure that our CNEs know how to use the device, since it is a prototype of new technology. It took our team an hour. The rest of the weekend was spent by our CNEs training every member of the hotel staff where the training was held. After that, they also held an impromptu malnutrition awareness raising session, educating everyone and anyone who would listen about our program and the needs of the surrounding community.

As has always been the case over the past year and a half, I am constantly amazed by the abilities of our staff to process new information and technology. Besides the children we help in our program, the empowerment of tribal women is one of the most satisfying aspects of our program. With just a small push, and the framework of opportunity, all of our CNEs continue to inspire us on a daily basis. Their ability to master new technology far exceeds that of even myself; on the long trip back from our initial visit in Khandwa in 2010, I managed to neatly deposit Caitlin from the back of the motorcycle into a rather large pile of mud in front of about 50 people.

Real Medicine Foundation Mobile Data Collection

Currently The Real Medicine Foundation India is running the largest community based malnutrition program in Madhya Pradesh, covering a total of 600 villages across 5 districts with over 65 field staff. RMF’s “Eradicate Malnutrition” program covers over 65,000 children, diagnosing cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) and providing linkages to government of MP treatment services, such as referrals to Anganwadi Centres (AWCs) and Nutritional Rehabilitation Centres (NRCs) for inpatient treatment. RMF’s Community Nutrition Educators (CNEs) also provide counseling services to communities and families at risk or affected by malnutrition.

One of the largest problems facing RMF’s management team is a timely compilation and analysis of data collected by our CNEs. Currently, each CNE uses multiple paper reporting formats covering interactions with the communities and families. These diaries are then collated at weekly meetings and the aggregate data entered into computers by data entry officers. The lag time from data collection to analysis under optimum conditions is 1 month, hampering RMF’s abilities to quickly adapt and respond to unique situations and efficiently supervise field staff.

Streamlining Data Collection with Dimagi’s CommCare Application and Microsoft’s Digital Slate

RMF is currently in the test phase of two new forms of data collection tools utilizing low end mobile phones: Commcare by Dimagi and a prototype of Microsoft’s Digital Slate.

Digital Slate by Microsoft

Microsoft’s Digital Slate is a new form of technology that allows paper records to be copied and the information sent to a central database instantaneously. The Digital Slate is a device that converts written text into digital data. As our CNEs conduct their routine work and record their information, every entry is converted into a digital file by the slate. We have developed a special diary specifically for this application that records:

• Child’s name

• Village

• Mid-Upper Arm Circumference (MUAC)

• Complications such as fever, cough, or rash.

There is also an open field for notes that converts written comments into images that are stored in each case file.

All of the information is sent instantly to our supervisors via sms. Once the information is recorded, we have the ability to instantly process data, giving RMF’s management team a clearer picture of which CNE is handling which case and how many children we currently have enrolled in our program.

Commcare by Dimagi

Using forms developed specifically for RMF’s program and installed on each mobile phone, the CNEs collect information by answering questions in each form that is sent via SMS to a central database in realtime. Commcare provides each CNE with:

• Entry points for child registration such as child name and village, important indicators such as Mid-Upper Arm Circumference (MUAC) and complication history, and verbal prompts from the phone that instruct the CNE to refer the child based on these inputs;

• Easily accessed case histories for repeat visits with children that track previous treatments and counseling given and improvement or deterioration of the child’s nutritional status;

• Referral tools to track recommended treatment for SAM and MAM children and required follow up by dates.

• Counseling and referral tools that follow Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM) guidelines.

RMF supervisors can access this information from any location anytime via an internet based dashboard. The dashboard provides realtime displays of each form submitted by each CNE, a list of cases currently registered by name, village and CNE, and a downloadable excel file of raw data for instant analysis by RMF’s M&E officer. Pockets of malnutrition and complications by village are flagged so that RMF may investigate further. In addition, RMF can monitor staff activities remotely as all entries are visible by CNE and stamped with a date and time, minimizing the need for spot checks.

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education,Treatment and Outreach and help toward our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please visit our website at realmedicinefoundation.org