title: Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries.
abstract: Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India.
  
  
  
  The CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services.
  
  
  
  The implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting.
  
  
  
  By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.
authors.affiliation: CARE India, Patna, India.
authors.forename: Ramkrishnan
authors.initials: R
authors.lastname: Balakrishnan
authors.affiliation: Department of Community Medicine, ESIC Medical College & PGIMSR, KK Nagar, Chennai, 600078, India. vijay.gopichandran@gmail.com.
authors.forename: Vijayaprasad
authors.identifier: 0000-0003-2635-9583
authors.initials: V
authors.lastname: Gopichandran
authors.affiliation: CARE India, Patna, India.
authors.forename: Sharadprakash
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: CARE India, Patna, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Chatterjee
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90095, USA.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.affiliation: CARE India, Patna, India.
authors.forename: Indrajit
authors.initials: I
authors.lastname: Chaudhuri
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards*; D017216:Telemedicine / Q000592:standards*
keywords: Efficiency; Health system; Maternal and child health; Quality; mHealth