Working with World Vision, Dimagi is currently developing a Pregnancy, Newborn, and Postpartum module for use by community health workers in Western Afghanistan. Apart from the challenges of working in a post-conflict zone, this project presents unique considerations with regards to literacy and gender, which directly impact when and how mobile phones can be most helpful. For example, many of the female health workers have never had a chance to go to school, and are at a particular disadvantage with regards to learning, recalling, and educating others about critical health practices. In this vein, Dimagi is extending the CommCare platform in a new direction, to support audio and visual prompts which will make it possible for illiterate and low-literate health workers to learn, share, and collect information.

Health workers are presented with a culturally-appropriate icon, which prompts questions about danger signs, interventions, and preventative health practices. For further context, they can press a button on the mobile phone which will deliver a local-language audio prompt loud enough for her to play this information to mothers and children in the community. While this tool helps her to make sure she covers all the relevant topics and recommends appropriate interventions, it is also collecting data about the community and the visits which can be relayed back to supervisors and managers.

Integrating audio and visual prompts has opened up an exciting realm of possibilities for CommCare.

  • Audio prompts are not confined to the limited screen size of the visual prompts. Audio prompts, supplementing icons or text, can provide more contextual information, the ‘why’ and the ‘how’ about community health interventions.
  • A cell phone keypad or screen is targeted at one person, the user of the cell phone. However, initial assessments of CHWs using these phones during site visits reveals that the audio prompt immediately makes the experience of using the phone more inclusive. Instead of a screen which only the CHWs can see, other members of the community can now hear the same message. This presents an interesting opportunity to target specific health education messages directly to communities of any literacy level, while reinforcing the lessons that the CHWs are trying to spread.
  • With images, or even videos, on the phone, it is now possible to draw in the influence of local figureheads, who can advocate for better health practices with greater authority and influence. Particularly with young, female CHWs, who may face resistance from senior male members of the community, the pictures and video has helped to strengthen their voices in the community.