An intervention leveraging technology to improve quality of health care service in community settings has won an MIT Solve Novel Measurement for Performance Improvement in Primary Healthcare Challenge award. The approach was developed by Alive & Thrive working closely with health system stakeholders in India and Bangladesh. Alive & Thrive is implemented by FHI Solutions.
“Our solution strengthens the quality of healthcare services through improved supportive supervision, strategic use of data and decentralized problem-solving,” said Binu Anand, Alive & Thrive’s India Country Director. “It’s very gratifying to win recognition for the solution we developed, which involved close collaboration with our partners in the health systems in India and Bangladesh.”
The Alive & Thrive team was led by Thomas Forissier, Regional Director, South Asia; Binu Anand, Country Director, India; Priyanka Bajaj, Nutrition Specialist, India; and Kristen Kappos, Associate Director of Asia programs. Praveen K. Sharma and Sunil Kumar in Uttar Pradesh and Jagdish Sathe and Bharat Gothi in Gujarat also supported the project.
Read our original story about the app’s development from May 2022
The MIT global challenge sought solutions that will offer innovative ways of measuring primary health care performance improvement in low- and middle-income countries. A panel of judges comprised of cross-sector and proximate leaders from around the world reviewed over 350 applications received from around the world for this round of the challenge and selected six winners.
“We developed SAHYOG by working closely with stakeholders in the health system to understand the challenges they face and then co-design appropriate solutions,” Anand said. “The SAHYOG app is an important piece of the solution. It is in the hands of supervisors and health worker to effectively utilize this simple yet effective tool to provide better quality services to the mothers and caregivers.
“The app also sets up a feedback loop between supervisors, health workers and mothers and caregivers that identifies service delivery issues so that they can be addressed.”
SAHYOG is, essentially, a simple Android app with two key functions:
- Real-time support to frontline health workers, providing them access to mentors and dedicated supervisors to boost morale, build their capacity with on-site training and answer questions that arise throughout the day.
- A mechanism that allows users to provide anonymous feedback on their experience with a particular health worker, which empowers service beneficiaries and incentivizes health workers.
But the app is part of a broader approach the team used to improve the quality of service delivery.
“Technology has an important role to play in improving service delivery quality to be sure,” said Thomas Forissier, Alive & Thrive’s South Asia Regional Director. “IT solutions can make collecting and analyzing data from visits much easier and efficient, for one.
“But people use technology and how they use it, how it can incentivize their behavior, these are behavior change issues which we had to consider very carefully. Our solution has an important change management component, too, that supports adoption of the technology’s use by creating an enabling ecosystem or environment.”
The payoffs for improving service delivery quality make taking on that difficult task worth the effort. Improving the quality of primary healthcare delivered in community settings during the critical 1,000 days from conception of a child to age 2 is crucial to improve health outcomes in low- and middle-income countries. Evidence is mounting that transforming the way community health workers (CHWs) are supervised is associated with improvement in quality of services.
SAHYOG, which means “help” in Hindi, improves the quality of service delivery through two channels targeting supervisors:
- Supportive Supervision, understood as an improved method to supervise government CHWs that balances the administrative, coaching/on-the-job training and support roles of frontline supervisors and their managers, and
- Strategic Use of Data, understood as a new focus of monthly review meetings on reviewing data on service coverage and quality, understanding, resolving/escalating for resolution and tracking the issues precluding effective service delivery in the field.
The technology-based solution was developed using a Human-Centric Design approach adapted from the CREATE and DECIDE methods (O’Reilly, 2013, Designing for Behavior Change). Each step of the process, from “Defining the problem”, “Exploring the context” and “Crafting the solution,” involved structured and unstructured consultations with stakeholders (supervisors, CHWs and beneficiaries) to refine understanding of the root causes of issues, identify probable solutions and stress test solution design options.
Improving quality of PHC services is a priority for governments in India, Bangladesh and globally. However, while the number of initiatives to improve the quality of service delivery in health facilities is growing fast, there remain important gaps.
Evidence on what does and does not work to sustainably improve the quality of community-based PHC activities is mounting. A lack of focus on quality of services, coupled with low CHW motivation levels and poor support mechanism for decision making at lower levels in the health system, leads to poor service quality and beneficiary experience.
The MIT Solve award will bolster Alive & Thrive’s efforts to replicate the solution in other contexts, Forissier said.
“We would like to adapt SAHYOG to other contexts because we know, around the world, quality of service delivery is an important issue,” he said. “We hope this award brings attention to SAHYOG, and others recognize its transformational potential.”
This is super exciting!!! Kudos to Alive & Thrive. This needs to be adapted in other countries...
I am intrested to associate with for collaboration for community based activies offering unique solution to many problems faced by mother/ pregnant women or children in Nutrition.