IMG_20140403_115835With funding from the USAID’s Development Innovation Ventures (DIV), Dimagi has expanded CommCare to 40 new programs throughout India in health and other social sectors since August of 2012.

Over the last year, each of the 40 partner organizations has worked closely with Dimagi staff to design, develop, and implement a CommCare project. The resulting CommCare applications support programs across numerous sectors, including maternal and child health, financial inclusion, nutrition, energy, family planning, and tuberculosis.

Following the successful deployments of these projects, all 40 participating organizations were asked to apply for additional support from Dimagi to scale up and improve the performance of their CommCare projects. A total of 12 were selected. Last week, three of them  went on an “exposure visit” to Catholic Relief Service’s (CRS) CommCare site in the Kaushambi district of Uttar Pradesh, India. The purpose of these visits was for new CommCare-using organizations to see firsthand what a scaling, larger CommCare project looks like.

CRS’s ReMiNd project is a Maternal and Child Health program using CommCare to strengthen the Accredited Social Health Activist (ASHA) system in Kaushambi. The project started as a pilot with 10 ASHAs and has now successfully scaled with quality to about 255 ASHAs in two blocks in Kaushambi. The team has been able to generate a successful model consisting of components like ASHA supervisors (and their roles), tech troubleshooting hierarchy, performance monitoring driving ASHA feedback, etc.

During the exposure visit, CRS staff talked about their CommCare application and the monitoring system that they have developed. Their app consists of forms for tracking pregnant women over course of her pregnancy, counseling messages, danger signs evaluation, etc., while the child module tracks young children for their immunizations, etc.

The CRS team has also created a monitoring and supervision system for the ASHAs. They have a team of supervisors, with each supervisor monitoring around 22 ASHAs. A weekly performance report is automatically generated on CommCare based on the data submitted by ASHAs and is emailed every Monday to the CRS team. The report has statistics about each ASHA, how many cases she followed up with, etc.

Supervisors plan their visits for the week based on this data from the reports. Low performing ASHAs are visited at least twice a month and all others at least once a month by their supervisors. Supervisors also shadow ASHAs during some of their home visits, and evaluate their performance through a supervisory CommCare app. Things like, did ASHA greet mother or not, did she counsel properly or not, etc. are recorded in the app based on supervisor’s observation. This targeted feedback to the ASHAs by their supervisors has been immensely useful in improving their performance and gaining confidence. ASHAs whose hands trembled at beginning of program just by holding a mobile, can now confidently navigate through CommCare and do a great job.

After the presentations, we split up into small groups and drove to the two field sites where the program has been running. Each group visited two ASHAs each in different blocks to see how they use CommCare while visiting pregnant mothers. We also met their supervisors who talked about how they work with the ASHAs. Lots of inspiring stories came up, including that many ASHAs shared that after using CommCare for a year, their reading and writing capabilities have greatly improved.

The day ended with a debrief together, where all participants shared their experiences and learnings, including what they took away for their own programs

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