Child Mortality
The World Bank just made open their database of 2,000+ development indicators at data.worldbank.org. The site, done by our talented friends at DevelopmentSeed, does a powerful job of exposing with data how important the work to improve child and maternal health is.
Python, Django and RapidSMS have been my bread and butter since one Sunday afternoon, the 1st of August, 2009. I had just spent about 18 months on corporate business application development and was now venturing into the world of NGOs and open source software development–things that had had much influence for me to take the leap forward into the next adventures of my life.
It had not been an easy decision, but the prospect of working in an environment where I get to see my input work in improving health care, the opportunity to contribute to open source software and the fact that whatever code I wrote will be exposed to scrutiny by a lot more people all over the world was more than enough motivation. And of course, the chance to escape the traffic jams and concrete gardens of our capital, Nairobi, was icing on the cake. That afternoon, I was excited to be in Kisumu City to meet my boss as he outlined the work ahead of me and the promise that was in front of me to learn new things and make visible change.
On hand to make this transition for me successful was Matt Berg, Dr. Patrick Mutuo and Dr. James Wariero, my immediate supervisors, the MVP Sauri health team and the entire MVP Sauri Team. And of course, we had the Sauri Community Health Workers (CHWs), whom I have come to work closely with as they are the people on the ground utilizing the ChildCount+ system.
One friend and colleague, Samson Gejibo, really made it far much easier for me to hit the road running. ChildCount+ had just been on for close to a month, and I just joined in and continued with the CHW training and follow-up. The CHWs were excited to get immediate feedback from the system, and since Samson kept them on their toes, whenever we got a wrongly formatted message in the system we had to call them and remind them of the format. This saw considerable improvement in the quality of information that was collected and less mistakes.
Samson Gejibo explaining the Patient Registries to the CHWs
Thinking about it now, one of my first programming tasks was to generate a performance report that among other information indicated the accuracy of the CHWs in terms of the number of messages that were well formatted compared to the total number of messages that were sent per CHW. This performance report was shared with the CHWs by their Facilitators on weekly meetings; it was easier to identify which CHWs needed more training and also pushed them to be more accurate with their SMS reporting. All this experience enabled me to learn a lot about the python programming language as well as RapidSMS, the application framework that ChildCount+ is built upon.
Then came the measles campaign, the most hectic time so far and one of my most exciting and busy times with the project. The health team had the idea that they needed to know which children in the system were eligible for measles immunization, which among them had been vaccinated during the campaign period and which children the CHWs should concentrate on in trying to go to their homes to ensure that they were brought to the outposts and health facilities. We came up with a message format where CHWs could send the patient IDs of children who had been vaccinated: this message was communicated to the CHWs when they received a complete list of Children who were 9 months and older that they would be targeting in their outreach. It was simple enough for them to understand and those who had difficulty simply called in and the message format was explained to them. I received the most calls per day ever; it was a one-man call center, but it was worth it. With all the calls, the feedback exchange between the CHWs, facilitators and health team, the campaign was very successful.
Matt, Samson and I
It has been quite an experience: did one system rewrite and participated in another ChildCount+ implementation, took my first trip outside the country (to Uganda) as well as my first flight ever, participated in trainings (and at least now I can speak in front of a crowd), did demonstrations, as well as met very important people including Professor Jeffrey Sachs, and had an opportunity to make an impact on the Sauri cluster community through technology and my passion in programming.
Dickson’s work was recently mentioned in the NYTimes article: Shower of Aid Brings Flood of Progress. Samson is beginning a PhD program where he will focus on mobile health.
The Lancet estimates that 200 million children under-five in developing countries do not reach their cognitive, physical and social potential due to a number of biological, environmental and social risk factors that they are exposed to during the critical early stages of their development. For example, stunting, a direct result of chronic malnutrition and infection, is directly linked to poor cognitive and educational performance. It has been shown that for every 10% increase in stunting, the proportion of children reaching the final year of primary school drops by 7.9%. Correspondingly, with every 10% increase in the prevalence of poverty there is a 6.4% decrease of children entering their final year in school.
Children are also exposed to a number of psychosocial risks including under-stimulation, maternal depression, exposure to violence and environmental contamination (unsafe drinking water, smoke inhalation and heavy metal exposure), and lack of access to education. Such risks are often linked to extreme poverty and are exacerbated by high fertility rates.
On Tuesday, we had the pleasure to present ChildCount+ to a group of the world’s leading researchers on early childhood development (ECD) research conference hosted at by UNICEF. It was terrific to learn about the current research in this emerging field. While great strides have been made in recent years, the participants also identified critical knowledge gaps where there is still so little known.
ChildCount+ focuses primarily on child and maternal survival and addresses some of the core health risks like malnutrition, malaria and preventable diseases that affect early childhood development. We were, however, able to use our time at the retreat to identify some potential ways ChildCount+ could be adapted to more directly support ECD.
Health and ECD Messaging
One of the most important techniques available to promote ECD is simply raising awareness to parents, health workers and teachers on best practices for basic sanitation, nutrition, health and cognitive stimulation. In addition, it is helpful to provide parents and primary caregivers with pragmatic advice on how to look for the key physical and cognitive stages of development in their children.
One phenomenal resource for this is the Facts for Life program by UNICEF. Besides providing key lessons on breastfeeding, nutrition and growth, immunization, malaria, HIV/Aids, injury and prevention, disasters and emergencies, it also has an important section on child development and early learning. Included in this section are child development milestones that provide a parent with clear guidance on what a child should be able to do by specified ages (1 month, 6 months, 12 months, etc); it also provides concrete examples on how to stimulate the child and provides warning signs for the parents to watch for.
Source: Facts for Life
Since the hard work of developing proven content is complete, ChildCount+ could be used to send Facts for Life messages by SMS directly to CHWs and the parents of children registered in the system. This could be a means of providing effective, and potentially fun, supplementary and continuous education on ECD best practices (to foster better parenting).
School Safety Net
Working with our education team, we have also looked at how ChildCount+ could be used to create a School Health Safety Net program. Since ChildCount+ creates a living registry of all the children in a community (complete with their ages) it should be possible to provide schools with a list of all the community’s school age children at the beginning of each school year. The schools could then use ChildCount+ to ensure that all children (especially girls) are enrolled for at least their first two years of school – the critical period where most drop-outs occur.
In addition, the School Health Safety net would strengthen the link between community health care workers and teachers — important secondary caregivers to all children. Through a simple report, a teacher would be able to notify a CHW when a child has been absent from school for an extended period of time, if they become sick or injured or if the teachers suspects maltreatment (abuse, malnutrition, sanitation) problems at the home. Similarly, a teacher could be notified by the CHW when a child is found sick at home.
Cash Transfers or Mobile Based Incentives
While the value of cash transfers in ECD is still hotly debated, mobile platforms like ChildCount+ could be used to facilitate the transfer of money or vouchers to primary caregivers of children. SMS based news feeds of crop pricing, soccer scores, etc. could be used as a non-monetary incentive to reward caregivers (especially fathers) for good parenting.
Notes
There are quite a few informational videos that highlight the successes within the different Millennium Village sites. One of the videos highlights not only the partnerships that the mHealth project has initiated, but also the benefits that have resulted from the use of mobile phones within the health sector. Please check it out and share your thoughts!
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