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 potential.
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 behavior 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 and Bengaluru. Through the direct intervention programmes FMCH has empowered over 100,000 families 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 10 partners across India. The organization'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.
Creating a Scalable Mother & Child program by Digital Transformation of the Field Workers Operations
Innovation during the Covid-19 pandemic
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 timely 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 objective.
NuTree has been designed to provide multi-lingual support to enable easier adoption by field workers.
- Field workers supporting maternal and child health need to meet women in different stages of pregnancy and convey relevant, timely information. Ensuring high-quality interactions and consistent adherence to protocols was a challenge.
- NuTree app provides counselling support to the field officers with structured and configurable workflows with decision trees - consisting of questions to be asked to the mothers during each visit based on the stage of pregnancy and age of child.
- There is a separate flow for counselling high-risk SAM / MAM cases.
- This ensures consistent adherence to protocols by guiding field workers to ask the right questions during each visit and recording visit data.
- Each field officer was responsible for supporting approximately 200 families. It was challenging for them to efficiently plan daily visits while considering variables such as high-risk cases and distances of homes.
- Nutree’s scheduling feature generates a prioritized list of mothers to be visited based on factors like the last visit date and the condition of the mother/child, including if the mother is high risk or the child is SAM/MAM. This assists field officers in identifying visits for the day efficiently. Additionally, they have the flexibility to cancel scheduled visits and specify the reason for any missed visits as required.
- Scheduling has simplified the process of identifying open, overdue and missed visits, thereby enhancing the productivity of field officers and reducing operating costs. This has resulted in a threefold increase in the number of families reached and a 20% decrease in missed visits.
- The children afflicted with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) required specialized attention, necessitating more frequent visits. Their counseling requirements also differed, meriting a distinct decision tree protocol.
- NuTree’s SAM/MAM protocol helps the field officers classify the child under moderate acute malnutrition and sever acute malnutrition, shortlist visits to be done on that day based on the number of days left to complete a visit, ability to cancel the scheduled visit and specify the reason for the missed visit.
- The implementation of SAM/MAM protocol has optimized care for high-risk cases, ensuring timely interventions facilitating preventive measures. Last year, FMCH moved 77% of SAM / MAM children to healthy.
- The frontline workers facilitate group education sessions aimed at educating mothers on pregnancy expectations known as Pregnancy Club (PC), and optimal eating and feeding practices during the crucial first 1000 days referred to as the Nutrition Course (NC). Assessing the efficacy of these programs and their impact on key nutritional milestones within the community posed significant challenges.
- NuTree's PC/NC feature provides field officers with the tools necessary to effectively manage these sessions, including the organization of sessions, dissemination of Information, Education, and Communication (IEC) content and administration of knowledge surveys.
- NuTree's PC/NC feature improves monitoring and evaluation of programs, facilitating more effective nutrition interventions and yielding better community health outcomes.
Implementation of NuTree app has ensured higher quality of interventions, with fewer instances of missing key questions, paving the way for a plug-and-play adoption model. This results in improved program outcomes, including the successful transition of 77% of SAM/MAM children to a healthy state, a threefold increase in the number of families reached, a reduction in missed visits for high-risk mothers from 58% to 37%, and significant improvements in Infant and Young Child Feeding (IYCF) practices.
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.
Ms. Shruthi Iyer
CEO