Hello, I'm deepika from the university IIIT-Delhi India. This study comes out from a deployment work
that was conducted in 2019 in India, with the collaboration of an NGO–SWACH, and our research
is supported by Bill and Melinda Gates Foundation. Our study focuses on improving the training and
learning opportunities of community health workers in India who are known as ASHAs by investigating
alternative mobile-based solutions. we identify the training needs of the health workers through
a large-scale deployment of a mobile-based training tool for the training of 500 ASHAs. The
tool is low cost and overcomes the constraints of low literacy and lack of access to computers
and smartphones by ASHAs by using Interactive Voice Response such that trainers can conduct
audio-based online training sessions. The ASHAs just need to have access to basic phones through
which they connect to these audio conference calls where they listen to audio material,
interact with the peers and interact with the expert by giving touchtone inputs. In a period
of six months 500 ASHAs were trained on the six topics of Home-based PostNatal care in 20 batches
which means one batch had a size of around 20 to 25 ASHAs. In total 144 sessions were
conducted. From these sessions we collected 1178 question and answer exchanges between the expert
and the ASHAs, which we analyzed to understand the information seeking of the ASHAs and their gaps in
knowledge. We then mapped the ASHAs' questions with the reference material they are provided
and finally interviewed 48 ASHAs to understand their rationale of information seeking,
their training experiences, and expectations. Our analysis of the questions found 75 percent
of these to show gaps in the basic knowledge to deal with the field cases. We understand these by
developing a detailed distribution of the topics and severity of the health problems. We arrived
at three areas which need attention; first is, improving knowledge on routine care and problems
for which community typically do not consult expert and rather approach ASHAs as a first
point of contact. An important aspect to address these that was highlighted in the queries was
related to the cultural associations that contains various kinds of beliefs and practices and because
of the lack of knowledge ASHAs showed difficulty in using their cultural competence and helping the
fellow community members. The other two themes were on danger signs and breastfeeding support.
On mapping the questions with the reference material we found the coverage to be low only
22% of the questions could be answered, 15% were partially answered and 63% could not be answered
at all. We found basically three gaps with respect to the coverage, presentation, and accessibility.
First is, the material is comprehensive however it is inadequate to answer what ASHAs are currently
seeking for their community needs and second the material is present in form of lessons and
chapter forms whereas from the deployment we found that ASHAs require content in form of Q&A format
which they can easily use by searching the topic of their queries and field cases.
And third requirement that was highlighted by the ASHAs in the interviews is the access to material
in form of audio visual material which which they can use in the fields on on-demand basis,
for example, while interacting with their clients during the home visits. A key challenge that our
deployment faced was related to the poor cellular connectivity. 86% of the participants faced at
least one call drop in every session that means they had to reconnect with the sessions and miss
uh portions of their sessions. Voice quality issue was frequently reported by many of the ASHAs and
ASHAs navigated these challenges by adjusting the locations from where they attended these sessions.
Finally, in conclusion, we draw four implications from our study, we need to improve the design of
reference material in terms of coverage of the common questions ASHAs asked which also
represent the unmet needs of their communities and enable ASHAs to effectively use these materials,
second is, mobile learning platforms fit into the contexts in which ASHAs work and have good scope
for providing learning opportunities on continued basis, third is Interactive Voice Response is
powerful in terms of reachability and overcoming the constraints, however, poses barriers
in user experience that we face in form of call drops. Finally, in order to improve the
knowledge and skills of ASHAs, we need to work on basics and focus on problem
solving and counseling skills. Thank you very much, I am happy to take the questions.