How do you deliver critical health-related information to a population of more than 100 million people, 80% of whom live in rural areas and have limited access to even traditional media such as television and radio?
That was the challenge that BBC Media Action, the broadcaster’s international development charity arm, faced when the agency was roped in to anchor a project to significantly reduce maternal and infant mortality in Bihar.
“Most of the people used a basic feature phone, which was often very old and bought second hand,” said Sara Chamberlain, head of information communications technology (ICT) at BBC Media Action.
“We decided to use interactive voice response (IVR) technology to give people easy access to content on their existing phones, rather than investing in technology that would require people to have smartphones or Internet access.” said Chamberlain, who has been associated with the project for the last two years.
The idea was to use existing technology that could be rapidly scaled up across the state, so that the project could start having an impact on people’s lives as soon as possible, she said.
The project wanted to teach the teacher first and the solution was a pre-recorded, audio-based information tool using the IVR system.
The idea of the project, which came to be known as the Mobile Academy, was to enable almost 200,000 community health workers in the state to educate themselves about life-saving information on maternal and child health through a simple voice call from their mobile phones.
Chamberlain is positive about the project’s success with over 27,000 workers already taking the course, which is available across most leading telecom networks. Launched in May last year, the course costs just over Rs.100.
“Before starting the project, people warned us that few health workers would be willing to pay for the training,” said Chamberlain. “But when we did the research, health workers in Bihar told us that they would be willing to pay to increase their knowledge and improve their job security.”
Around 8,000 workers have already completed their training, which can be broken into several chunks throughout the year.
Chamberlain says that the tool is becoming popular with the workers as most of them are neither very educated nor well-off and are limited by remoteness from centres of learning, educational status, and financial constraints.
“Face-to-face training is expensive and challenging to roll out across such a large geographical area, where many villages are difficult to reach. Mobile Academy makes critical health information much more accessible.”
An extension of the project was in the form of Mobile Kunji, which was designed to communicate maternal and child health-related messages directly to the core audience. Around one-fourth of the population of Bihar comprises women of child-bearing age. Mobile Kunji is a combination of the IVR-based mobile service and a deck of 40 illustrated cards on a ring, which can be used by the health workers during their counselling sessions with the families.
“Each card has been given a mobile shortcode that corresponds to a specific audio health message in the IVR service. By dialling the short-code CHW, (the system) can play the message to the families in order to persuade them to adopt positive health practices,” said Chamberlain. She added that as part of the project, the team created a fictional character called Dr Anita, who speaks through the IVR to the families in a language they understand. The character speaks in “Bhojpurized Hindi”, said Chamberlain, adding that the language used has a mix of words from popular dialects in Bihar such as Maithili, Bhojpuri etc.
Chamberlain claims that the usage of Mobile Kunji is very high with 85,000 people having already used the service. While Mobile Academy is a self sustaining project as it is paid for by the users, the government of Bihar is supporting the Mobile Kunji project as it works on a revenue-share model between the telecom operators and the technology providers.
“Initially, the cost of calls to Mobile Kunji is being covered by the Bill and Melinda Gates Foundation, which is working with the government of Bihar to deliver the Ananya programme.”
Chamberlain said BBC Media Action was chosen by the Gates Foundation as part of the overall Ananya Programme to change maternal and child health behaviour and create demand for public health services in Bihar.
While Mobile Kunji and Academy are already accessible across the state of Bihar, Chamberlain says BBC Media Action plans to extend the project in northern states of the country such as Uttar Pradesh. Meanwhile, the government of Orissa has already agreed to support the project. “We should be ready to roll out in the state by October-November this year.”
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