A new app designed to strengthen supportive supervision of frontline workers and improve nutrition service quality has been launched as a pilot in Gujarat State in India, the result of a partnership between the state government and Alive & Thrive.

In India, the coverage of health and nutrition services for mother and child dyad has improved over the decades. However, the quality of these services varies from state to state. 

As per a data note released by IFPRI in 2018, Gujarat has a fairly high coverage (≥75%) of interventions before and during pregnancy, like iodized salt, antenatal care (ANC) visits, mother and child protection (MCP) cards, iron and folic acid (IFA) supplementation, weighing, and tetanus toxoid injection. However, the coverage of interventions like consumption of IFA for more than 100 days, deworming, breastfeeding counselling, and health & nutrition education is below 50%. This ultimately impacts the service quality. 

Also, the National Family Health Survey (NFHS)-5 in India shows that nutrition and health indicators in Gujarat have not reached the desired outcomes. In Gujarat, 79.9% children (between 6-59 months) and 65% of women aged 15-40 years are anaemic. 

While the Government of Gujarat has made consistent efforts to improve the coverage as well as quality of nutrition services, gaps still plague the system, impacting the overall service delivery and beneficiary experience.

An initial barrier analysis revealed that frontline health workers in Gujarat need structured and focused support for improving their performance (and thereby improve quality of services).  

“The team, during their interaction in the field, observed that health workers had too much to do with little support in limited time, leading to low motivation and ultimately poorer service quality,” said Priyanka Bajaj, an Alive & Thrive nutrition specialist. 

“We realized that there was a need to strengthen supportive supervision component in the field with a ‘coaching and mentoring’ approach and steer all the cadres towards using data for problem solving to improve service quality,” said Binu Anand, country director of Alive & Thrive in India. “We felt that while supportive supervision was already built-in into the system, it needed additional tools and revamped processes to achieve its full potential.”

The Gujarat Supportive Supervision App, a simple Android app, provides support to supervisory cadres while also gathering valuable data that can facilitate broader health systems strengthening. The app has two key features:

1. It provides real-time support to frontline health workers, through their supervisors, to undertake problem solving and answer questions that arise throughout the day, conduct hands-on trainings and boost their morale. The app also enables feedback from beneficiaries on the quality of critical services they are receiving from service providers through checklists. 
2. It offers supervisees a platform to provide anonymous feedback on the supportive supervision they receive from their supervisors through an SMS-based link, which empowers health workers and gives them a voice. 

The app focuses on improving service delivery through Anganwadi centers – community-based centers providing nutrition services to pregnant women, lactating mothers, children up to six years of age and adolescent girls. 

While coverage of services in Gujarat has improved, gaps often occur in correct reporting of all the entitlements; no mechanism currently exists to measure the quality of nutrition counseling and services being provided. The app is expected to address these gaps.  

The app also collates and analyzes data collected during supervisory visits and makes it accessible via a dashboard. This feature allows concerned government officials to monitor program quality over time, including coverage of services, quality of counseling during home visits, identification of gaps in service delivery and action taken to close identified issues. The app will also help identify gaps in performance of service providers. In addition, the in-built mechanism in the app helps supervisors to carry review meetings as per prescribed mandates using prompts. 

The supervisory cadres who are using the app so far have responded enthusiastically. 

“A great thing about the app is the checklists,” said Sonalben, an ICDS functionary. “Now, when we go for field visits, we can use this app as a ready reckoner to assess service quality and provide appropriate feedback to Anganwadi workers.”

“We are hoping that the Supportive Supervision App would aid our supervisory cadres to conduct meaningful assessment of service quality during field visits and provide effective mentoring to their supervisees for performance improvement, leading to better beneficiary experience,” said Alpa Solanki, Additional Director, MIS branch, ICDS said. “This is another step in our efforts to leverage technology to improve nutrition outcomes."

The Alive & Thrive India team completed field testing in October 2021 to ensure the app is easy to use, glitch free and contextualized to local requirements. The app has been launched by the Gujarat government and the pilot has commenced. The Alive & Thrive team aims to have the endline survey completed by July of 2023. Based on the results of pilot phase, the Gujarat government plans to maintain and scale the app moving forward.