FMCH (www.fmch-india.org) works on maternal health and malnutrition. Their vision is a world of healthy mothers and thriving
children – where poor nutrition does not come in the way of mothers and children reaching their full
They understand that malnutrition is a complex issue, thus take a systems approach to their work. They work in tandem with the government services (Anganwadi, ASHA, ANM), the family and their influencers (mothers, fathers, and other stakeholders), and community leaders to bring about behaviour change around nutrition and health leading to better maternal health and lowering malnutrition rates. Counselling the stakeholders, data collection and usage is central to their work.
At present they are implementing programmes in under-resourced communities in Mumbai. Through the direct intervention programmes FMCH has empowered over 60,000 women to raise healthy children, improved birth weights to 2.7kgs, increased the breastfeeding rate (up to 70% increase in some of our interventions; 25 PP higher than the national average), prevented children from going into stunting, wasting and underweight and moved children who are malnourished to regain a state of better health. They have over 30 partners across India. The organisation’s extended reach as of today is over 5,00,000 people in Maharashtra. Here is a Youtube video that talks about their work and they post their updates on Facebook here.
FMCH programs focus on in-depth engagement with pregnant women and mothers of new born and young children to reduce infant mortality, improve maternal health and nutrition of mother and child.
There was a need to support the field worker in providing high quality counselling, ensuring consistency and adherence to clinical protocols as the organization scales and adds more partners across India.
In addition, there was a need to collect, track, analyze data and keep track of high risk cases which need special and timely attention.
We developed the NuTree platform, a comprehensive scheduling, counselling and decision tree solution to support the frontline worker and achieve the above objectives.
Field workers supporting maternal and child health need to follow specific workflows during each visit and convey relevant timely information. Ensuring consistent adherence to protocols is a challenge.
This problem is further compounded when an organization is scaling quickly - resulting in higher chances of missing out on key action points/ messages impacting the quality of interaction. Absence of strong systems, result in inconsistency of care and made it difficult to replicate care guidelines both within FMCH and with its partner organisations.
Moreover, in absence of data capture by field worker there was limited data to track high-risk situations and analyse the effectiveness of the program over time.
Koita Foundation worked with FMCH to redesign the current business processes and digitally transform the engagement between FMCH and its beneficiaries.
NuTree - consists of an android mobile app for field officers to support counselling workflow and fully configurable decision trees for each visit based on beneficiary profile and standard FMCH protocols. Decision tree protocol consists of questions to be asked to the mothers in each visits and generate a unique conselling plan. Field officers can use the visual and video content in the app on various topics to provide more details (e.g., breast feeding techniques, sample medication). The dynamic workflows in NuTree enable field workers to ask the right questions, view visit history and record visit data including anthropometry.
NuTree’s SAM/MAM protocol helps the field officers classify the child under moderate acute malnutrition and sever acute malnutrition. And its scheduling feature helps the field officers shortlist visits to be done on that day, based on the number of days left to complete a visit, counts of open, overdue, missed visits and SAM/MAM protocol. The field officer can cancel the scheduled visit and specify the reason for the missed visit.
NuTree’s admin app enables program managers to track the efficiency and effectiveness of the overall field officer operations and as well as track individual cases which need attention by supervisors.
NuTree has led to a higher quality of interventions with better adherence to protocol. Moreover, the availability of data has enabled analysis and the ability to move to data driven decision making for tracking and enhancing care protocols. NuTree made it easier to identify open, overdue and missed visits and increased the productivity of the field officers while lowering operating costs. NuTree is enabling FMCH to roll out its program to partners in a consistent manner while ensuring operational and quality controls. NuTree has been designed to provide multi-lingual support, needed for partners across India.
When we first started developing the app, we envisioned it be a simple decision tree app, to go along with the current system we had been using – solving the problem of quality at scale. However, multiple meetings with the very patient Koita Foundation team led us to think deeply about how technology will connect to us to our vision – making it more than just an app for one function.
Now the NuTree App solves the issue of quality of counselling for nutrition in the first 1000 days of a child’s life, is an accountability and part scheduling mechanism and can be easily used to disseminate resources to the mothers (videos, audios and other IEC material). It is almost like an all-in-one resource for any health worker in MCH. Using the app has led to the connection between us and the communities to strength more easily – in many ways.
It’s been a great learning working with Koita Foundation. Rizwan and Rekha’s constant focus on the end user has made the app so intuitive that we rolled it out during the lockdown despite which, adoption has been easy. The software partner, Designscape, has thoughtfully designed the backend to be modular and to be taken to any context. We are excited about the possibilities this holds for more mothers – directly via FMCH operations and though partnerships.