For women across the globe the experience of pregnancy is normally one filled with happiness and excitement. However for those in remote and poverty stricken regions the experience can be filled with anxiety, especially due to the general lack of education in health and in particular pregnancy, labour and childcare.
One of these areas is Bihar. Situated in Northern India, the state is known for its high mortality rates among women and children during childbirth. The maternal mortality ratio in Bihar is 371 per 100,000 live births which is the fourth highest in the country and above the national average of 301.
The state also has one of the highest rates for infant mortality (61 per 1,000 live births) in the country. This compares with just 15 per 1,000 in Goa and Kerala. The under-five mortality rate in Bihar is 85 deaths per 1,000 child births compared to the average of 74 for the whole country.
Although only 32 per cent of adult women in the rural state of Bihar own their own mobile phone, 83 per cent have access to a phone. BBC Media Action, the BBC’s international development charity, is using OnMobile’s platform to deliver information to the mobile phones of those living in difficult-to-reach rural areas.
The aim is to use mobile phones to provide cost effective training and job aids to community health care workers. The majority of community health workers in the state of Bihar are rural women with low levels of technical literacy – however 85 per cent do own their own phone.
The ownership level among health workers is higher than for adult women generally because the latter have a source of income – either a salary from the government or incentive payments linked to performance from the government.
OnMobile provides BBC Media Action with the technical platform to run Mobile Academy, an IVR training course that enables the health workers to expand their knowledge of life saving maternal and child health behaviours.
All the community health worker needs to do is make a phone call from their existing mobile phone to take the course – from anywhere, at any time, at their own pace. The course is divided into chapters and lessons, with a quiz at the end of each chapter. All those who gain an accumulative pass score at the end of the course receive a printed certificate from the government of Bihar.
The service is supported by the Bill & Melinda Gates Foundation and was developed in collaboration with Bihar’s government. Health workers pay for Mobile Academy at the rate of 50 paise (less than 1 US cents) per minute. This is approximately a 90 per cent reduction on what a commercial IVR service typically costs. The total charge for the course is Rs100 ($2) which covers the cost to the mobile operator of delivering the service, including taxes. Operators also share revenues with BBC Media Action and OnMobile to help cover operational costs.
OnMobile’s platform also powers Mobile Kunji, another BBC Media Action service that allows health workers to playback information about maternal and child health via their mobile phones. During their counselling sessions with families, health care workers dial short codes printed on a deck of cards to play IVR audio content that support the sessions.
Mobile Kunji is free to the end user. The first year costs are being covered by the Bill & Melinda Gates Foundation.
But do these services genuinely work? Well, Mobile Kunji has already acquired 85,000 unique users since its launch in May 2012, who have played more than 2.3 million minutes of health content. Mobile Academy has had similar success; 27,000 community health workers have called the service, listening to 2.8 million minutes of educational content; 27 per cent of users have already completed the course. Currently more than 8,000 health workers are eligible for certificates for passing the course.
The results speak for themselves in terms of take-up and if we continue to provide these services efficiently and cost-effectively then we hope to see a marked improvement in the health of pregnant women, mothers and babies in the state.
Next we hope to see the services appear elsewhere in India. BBC Media Action is working to expand the service to Odisha (also known as Orissa) with the support of the state government. And there are discussions to roll it out to other parts of northern India.
Vijay Sai Pratap is director of business development with OnMobile Global.
The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.