Using CommCare to Monitor a Conditional Cash Transfer Scheme

Last month, a woman, let’s call her Satya, was registered for the Bihar Child Support Programme. In many aspects, Satya is my peer, but at age 22 she is pregnant for her third time and is expecting to deliver in January. Her husband, an agricultural labourer, came along with her as she registered for the Bihar Child Support Programme through CommCare, used by Aanganwadi Workers (AWWs) throughout the Gaya District of Bihar.

Designed and implemented by Oxford Policy Management, the Bihar Child Support Programme is a maternal-child health conditional cash transfer program that has the potential to significantly influence the volume of prenatal and postnatal services received by mothers and to improve the nutritional status of newborns and children up to three years. The scheme also largely affects AWWs, the CommCare users, who receive financial incentives for using their application for monitoring child nutrition and service availability at their village health centres.

Every time an AWW registers somebody like Satya, she is opening up opportunities – each AWW’s mobile has the power to report if pregnant women like Satya have received the conditions to deem them eligible for approximately a $5 USD monthly payment. Through the financial incentives determined through the data in CommCare, in addition to behavioural change communication messages in the application in the local language Magahi, AWWs hold an extremely powerful opportunity to incentivize pregnant women to fulfil their requirements for a safe pregnancy and to secure child nutrition.

During one of my first site visits for the project, I visited one AWW’s health centre, which was hands down the most welcoming health centre I have ever been to in my life (no offense to my childhood paediatrician in New Jersey). This AWW’s health centre includes a garden of the best vegetables and fruit for the children in her village, each with a remedy for an illness or symptom. Despite lacking adequate resources at the centre, which included a malfunctioning child weight scale in her closet and a cabinet of medicine with directions in English (which she couldn’t read), the AWW was extremely keen on improving child health, one way or another. She even (accurately) developed algorithms to calculate child weight from a functioning adult scale that she calibrates herself!

Through this AWW’s internal motivation, despite resource constraints, the end of child malnutrition in her village in Gaya District, Bihar could be near. Another piece of the puzzle, beneficiary motivation and their capabilities, could also be rapidly changing through implementing the scheme. Across the hundreds of villages in three blocks in Gaya District, Bihar, the Bihar Child Support Programme will enable and motivate pregnant women to attend their village health centre to ensure healthy children and pregnancy.

Kids collecting guavas from the health center!