Hayat is an mHealth innovation, which aims to empower frontline health workers with digital health technologies in efforts to increase coverage of and access to routine immunisation maternal, newborn and child care (MNCH) and child growth services in select areas of Afghanistan and Pakistan.
Initiated on October 2018, Hayat is a transition-to-scale project, funded by the Grand Challenges Canada (GCC) and the Aga Khan Foundation Canada (AKFC) and led by Saleem Sayani, Director, AKDN Digital Health Resource Centre. Meaning life in the local Urdu and Dari languages, it consists of the implementation of a novel, digital health mobile application for health workers and a web portal for the government. It aims to explore the effect of digitalisation of healthcare worker activities on subnational rates of stunting, malnutrition, vaccine preventable diseases, Neonatal Mortality Rate, under-5 Mortality Rate, antenatal care provision, uptake of family planning services and other maternal, newborn and child care (MNCH) indicators in the targeted regions.
It was successfully implemented in 56 health facilities and their catchment populations in Afghanistan and Pakistan in collaboration with implementing partners, Aga Khan Health Service (AKHS) in Afghanistan and Pakistan; the government health departments of Khyber Pakhtunkhwa (KPK) and Gilgit-Baltistan in Pakistan and the Ministry of Public Health (MoPH), Afghanistan.
The primary beneficiaries of Hayat include children under 2 years of age (for the immunization and child growth and illnesses component), and women of reproductive age - 15-49 years - (for the maternal care component) in select areas (the catchment populations of 56 health facilities) of Bamyan and Badakhshan in Afghanistan and Gilgit-Baltistan and Chitral in Pakistan.
Hayat Application Functionality
Hayat is being used by frontline health workers and allows them to log details of the services provided during the field visits, track patients and raise awareness in communities during field visits. Its supervisory application allows supervisors of community health workers and vaccinators to monitor field activities and quality of services provided and verify monthly reports. Hayat’s robust web portal enables health care supervisors and government officials to access essential information in real-time and conveniently track and monitor field activities and health workers and generate meaningful performance reports, improving transparency and accountability. Hayat aims to provide an overall improved governance structure to stakeholders.
The following modules are incorporated in Hayat:
|Child Health Care||Maternal Health Care|
|Immunization Services||ANC, PNC, Delivery Services|
|Child Growth & Illness Tracking||Family Planning Services|
|Stock Management of Vaccines and Medicine||Referral Tracking and Management|
|Referral Tracking and Management||Educational, awareness-raising videos|
|Educational, awareness-raising videos||Stock Management of Vaccines and Medicine|
During the first year, Hayat has demonstrated immense potential in achieving higher utilizations of services by the population by improving the transparency and accountability mechanisms linked with health worker performance and creating a demand for services by generating awareness and interest through the awareness sessions.
The close-to-real time monitoring through the digitised system, along with the comprehensive database, allows government stakeholders to identify gaps and challenges, enabling them to allocate resources appropriately in a timely manner. A key component of Hayat’s training sessions was the empowerment and capacity building of health workers, many of whom often lack digital literacy due to limited exposure in remote settings.
One of the main successes of Hayat were the interactive awareness sessions. Previously, a health worker would relay health education messages orally to a patient, but felt that this often lacked impact, as the participant would quickly lose interest. Under Hayat, the awareness sessions are met with great interest in the field, and other family members (such as the husband and mother-in-law, who are the primary decision makers in these settings) oftentimes participate, leading to a greater audience and impact. Awareness sessions are highly helpful in creating a change in their awareness, attitudes and ultimately, behaviors. Furthermore, with the usage of Hayat, the EPI and LHW Program health workers are now working with greater coherence. For example, a lady health worker is now informing a vaccinator about child births in their village, helping reduce the number of zero dose children and tracking defaulters.
Results - TTS2
The Way Forward
Based on positive results of the scaling-up the vaccination component of Hayat in 56 sites and the piloting of the maternal care component of Hayat at 7 sites during the TTS2 phase, Hayat has been approved for another phase (TTS3) with joint-funding from GCC and AKFC for a period of 13 months, i.e., from December 1, 2019 to December 20, 2020. In the TTS3 phase, the maternal care component is to be scaled to remaining 49 sites while vaccination is continued at the 56 sites. AKU now aims to hand this over the government to be absorbed into their national/provincial budgets in Afghanistan and Pakistan. A quantitative endline survey is planned, which will evaluate the effect Hayat has achieved in relevant MNCH indicators recorded at the beginning of the project through a baseline survey.
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