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Bihar’s 200,000 community health workers are key influencers in helping millions of families take advantage of government health services, and to adopt healthier behaviours.

Â鶹ԼÅÄ Media Action research showed that almost all community health workers either own, or have access to, a mobile phone. However, our mobile landscaping study revealed these were mostly basic, 'brick' phones, and digital literacy levels were incredibly low – with only 9% of community health workers having ever sent an SMS. We needed to develop something simple and audio based, so we created a suite of mobile health services for health workers and households in Bihar, using interactive voice response.

Mobile training

Â鶹ԼÅÄ Media Action developed a training course, called , to expand and refresh community health workers' knowledge of 10 life-saving health behaviours and to enhance their communication skills – a service which initially launched in Bihar. Mobile Academy is an anytime, anywhere training course, delivered via mobile phone, intended to expand and refresh community health workers’ knowledge and improve their communication skills.

In 2016 the initiative was scaled up across the country by the Government of India – with the objective of helping 10 million new and expectant mothers lead longer, healthier lives.

The audio course is also delivered via interactive voice response, accessible from any mobile handset. Mobile Academy enabled community health workers to complete the course anywhere, any time at a fraction of the cost of face-to-face training.

A mobile 'key'

Â鶹ԼÅÄ Media Action also developed a multimedia service to enhance the immediate impact of community health workers’ counselling of families. This service, called  (which means 'guide' or 'key' in Hindi), brings together an interactive voice response-based mobile service and a printed deck of cards on a ring. The Kunji cards were designed to look like a mobile phone, with illustrations, supporting arguments and key messages about maternal and child health.

Each card has a unique mobile shortcode printed on it, which corresponds to a specific audio health message. When a health worker dials the number, they can play the health message – voiced by a character called Dr Anita, an engaging but authoritative female doctor – to the family via their mobile phone.

Mobile Kunji and Academy are accessible from any mobile phone handset (no special software is required). Calls to both Mobile Kunji and Mobile Academy are toll free, with the government paying for call costs.

Mobile messages

The community health workers' advice and counselling is further reinforced by mass media, community events and another mobile service we designed called Kilkari (which means a baby’s gurgle in colloquial Hindi).

Kilkari delivers free, weekly, time-appropriate audio messages about pregnancy, child birth, and child care directly to families’ mobile phones from the second trimester of pregnancy until the child is one year old. The project complements Mobile Academy by reinforcing health workers’ counselling of families, and communicating directly with new and expecting mothers and their families to increase the uptake of healthier behaviours.

Our impact

In December 2020, a series of academic papers produced by a team from the Stanford School of Medicine, co-authored by Â鶹ԼÅÄ Media Action, was published in The Journal of Global Health, demonstrating that women who had heard and used our health communication materials were twice as likely to take supplements during pregnancy, two to three times as likely to save money and prepare for delivering their babies in a health-care facility, and twice as likely to maintain exclusive breastfeeding for their babies as recommended by the World Health Organization. All these actions contribute to healthier and safer pregnancies, deliveries, newborns and mothers.

You can read the papers in . 

Project information