Tag Archives: evidence-based

Evidence-Based, Data-Driven

Calcutta Kids has always been focused on a data-driven approach to improve the status of maternal and child health and nutrition in Fakir Bagan. We have been collecting, monitoring and evaluating data from the field regularly to inform our programmatic interventions. We teamed up with a creative and passionate group of individuals from the Social Impact Program at ‘Thoughtworks’, a software company in the US with offices across India. They worked with us to enhance our old database, review the existing monitoring systems and helped create an updated and user-friendly tool.
The new ‘MYCHI database‘ is a tool to enhance the provision of health and other services to groups of pregnant women, mothers and children. The database collects and stores health and other information about women and children, displays the information on individual dashboards and uses visual representations of data and series of predefined reports to guide program management on the ground. The database is open source software, meaning its code is free and with the help of a developer, it can be tailored to the needs of a wide range of organizations.

The MYCHI database was developed around three overarching objectives

    1. To empower implementers with the tools to practice “developmental evaluation” and make evidence-based adaptations to a program, and maximize the impact on the beneficiaries.
    2. To monitor and guide day-to-day organizational operations and focus on beneficiaries in need of special attention.
    3. To identify beneficiaries who may fall through the cracks as they may not independently show up to receive the preventative care.

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MYCHI’s foundation is built around information most public health organizations collect about their beneficiaries such as: i. monthly weight and height of children and pregnant beneficiaries, ii. attendance at immunization sessions and iii. incidences of illness to name a few. Once uploaded, MYCHI displays this information on graphs and in reports and uses it to guide day-to-day program management.

Building on this foundation, MYCHI can be tailored to collect a vast amount of additional information about beneficiaries relevant to an organization’s focus and interests. Using beneficiary survey data collected in adaptable online forms, an organization can capture data points as varied as socioeconomic status, medical history and access to government services. This information can be analyzed to identify correlations between demographics and health indicators, red flags in beneficiary health and health seeking behavior, even the success or failure of a programmatic intervention.

Key Features

Dashboard

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A personalized dashboard is generated for every beneficiary immediately following his or her registration. The dashboard displays basic information, familial relations and links to any previously submitted forms. A child’s dashboard displays weight and height records from all GMP sessions on growth charts for growth tracking and captures a child’s personal immunization schedule in a color-coded table that indicates immunization status, (i.e. given, due, critical, overdue.)slide3

 

 

 

 

 

 

 

 

 

Growth Monitoring and Promotion (GMP) and Immunizations

MYCHI makes tracking and encouraging attendance for GMP and Immunization sessions easy using reports that display the names of all beneficiaries due for an upcoming session. Over the course of a three-day GMP session, a report is filled with the height and weight or absent reason of every beneficiary. An Immunization report will be similarly filled during an immunization session as beneficiaries receive their inoculations. When the reports are uploaded, GMP and Immunization data is stored, displayed on beneficiary dashboards and accessible for analysis.

Jasper Reports

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Data is pulled from the backend using reports written in SQL and generated in Jasper. These predefined reports fall into three broad categories, program management reports, status reports and reports for analysis. The first category includes reports that track our progress completing regular tasks like ANC visits for all pregnant women over the course of a month. An ANC status report will identify those beneficiaries who have not been visited so we can complete their visit in the time allotted. These reports help us stay accountable to our beneficiaries in providing the services integral to our program.

The second two categories, status reports and reports for analysis, display information pulled from forms and uploaded reports that a program manager can use to develop new programs and organize work flow.

The MYCHI Database has streamlined the work and improved the monitoring and evaluation systems at Calcutta Kids. As a result, our approach is more targeted and we are able to focus our attention to those who need it the most.

– Post by Lilian Olson

CK’s Child Development Corner

The child development corner project, which was initiated last year, is almost complete. The corner is now a bright spot in our community center, Ma o Shishu Shiksha Kendra, with yellow colored walls, shelves filled with toys and books, and comfortable foam mats for the children to explore and play. Display boards have been put up to exhibit children’s artwork and important child development messages. Once the curriculum has been finalized for child development sessions—due to be completed this month—child development sessions within the child health community meetings will be initiated. In the meantime, during community meetings (which take place almost every afternoon) the space is being used for play by children whose mothers are attending the meetings.

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In February, Calcutta Kids organized a training workshop on child development to achieve the following goals:

1.) To provide a foundation on child development for Calcutta Kids’ health workers who will be working with mothers and children during the child development sessions. The health workers will use the lessons to teach mothers how to stimulate their children through play.

2.) To solidify curriculum development for the child development sessions to be started in April. This will ensure that the messages and counseling given to Calcutta Kids’ beneficiaries are standardized and evidence-based.

Jane Thompson, a child development and education specialist, and Director of Next Step Early Intervention, conducted the two-day training, “Helping Children Grow” for our health workers. The training started with an overview of ‘secure and nurturing attachment’, and the importance of the emotional bond between the child and the mother (or primary caregiver) which is critical for a child’s growth and development. She also spoke about ‘active learning’, a process by which children develop and learn through interaction with their environment. She emphasized that the most optimum form of multi-sensory learning is achieved through play, which is the major goal of the Calcutta Kids’ child development corner project.

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The rest of the training workshop was divided into age groups: 0-3 months, 3-6 months, 6-9 months, 9-12 months, 12-18 months, 18-24 months, 24-30 months, and 30-36 months. For each age range, Jane discussed key milestones in different areas of development including: cognitive, communicative, social/emotional, adaptive, and physical. She demonstrated activities that could be done during each age range, using materials that she had brought, along with materials that we had procured for the child development corner. A summary of the training and key topics can be viewed on the workshop presentation here.

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We are very appreciative of Jane, for conducting such an informative workshop on child development. The lessons learned will be applied when we hold child development sessions with the beneficiaries (mothers and children) and when we use the space to entertain children while mothers are attending community meetings. —Danya Sarkar

The Art and Science of Diagnosis

A professor from Ohio State e-mailed me the article with the deceivingly understated subject line of all-lower case “fyi.” The Hindu write-up’s headline, though, didn’t mask the shocking contents: “Appalling condition of primary healthcare services” it read. (1) Short and potent, it described the lurid details of a study carried out across the health sector in India, rural and urban, private and public. The details showed a fundamental lack of ability by medical professionals to diagnose even the most common conditions (asthma and dysentery, for example) or ask the most basic questions (whether there was “pain radiation” for an unstable angina). The result was a low rate of diagnosis, whether it was in rural Madhya Pradesh or Delhi.

Overall, healthcare providers provided the correct treatment only 30.4% of the time. (2) Even worse, 41.7% of the time the clinics provided unnecessary or even harmful treatments for “patients” that the research study trained (“from the local community”, the article notes). Many providers, even in public clinics, were unqualified. Medical guidelines and treatment protocols were followed at low rates; providers only asked 33.7% of the recommendations. In Madhya Pradesh, doctors spent 3.6 minutes with patients, while Delhi medical professionals spent a marginally better but still terrible 5.4 minutes. For reference, the Medical Council of India recommends doctors spend at least 10 minutes with each patient. (3)

The article highlighted tough facts that Calcutta Kids has been tackling for years. Through our experiences with the health clinic, we’ve worked to combat the norm of primary health in India: brief, non-comprehensive visits and a disregard for protocols and checklists. We’ve uploaded to the resources section of our website our child health World Health Organization’s IMCI and IMPAC-based Child Health and Pregnancy and Maternal Health protocols and checklists which our doctors are trained and demanded to use. Our two health clinic physicians, Drs. Pal and Sen, work with our management staff to ensure that the protocols we have provided them matches their process for diagnosing patients. See the above-mentioned resources below:

Child Health Protocol (0-2 months)
Child Health Checklist (0-2 months)
Child Health Protocol (2 months to 5 years)
Child Health Checklist (2 months to 5 years)

Pregnancy and Maternal Health Checklist and Protocol

It’s an important process that Calcutta Kids has to do to ensure our beneficiaries get not just quantity but truly quality care. It hasn’t been an easy process to bring in this cultural change into our clinic over the years, but it’s a necessary one. In addition, the creation of standardized protocols ensures a consistent level of care that our beneficiaries can expect, regardless of personnel changes. As Atul Gawande noted in his Harvard Medical School commencement, it’ll require an understanding of a team of healthcare providers- a “pit crew” that includes our health workers- not just the lone cowboy physician:

“The work is rooted in different values than the ones we’ve had. They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.” (4)

Many rightly criticize the low rates of spending on health per GDP in India, ranking 171st out of 175 countries according to a WHO study. (5) But the situation is even grimmer: it is not enough to just increase spending, build more primary health centers or even to write diagnostic protocols at a national level. The groundwork of implementation at a doctor to patient level must be accomplished. At our health clinic, we work on this ground level to make sure that provision of the highest level of primary healthcare is a reality for the mothers and children of Fakir Bagan.–Pranav Reddy

Citations:

  1. Appalling condition of primary healthcare services. The Hindu. R Prasad. December 6, 2012. Retrieved from http://www.thehindu.com/health/medicine-and-research/appalling-condition-of-primary-healthcare-services/article4167677.ece on Jan 1, 2013.
  2. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. J Das, A Holla, V Das, M Mohanan, D Tabak, B Chan. Health Affairs. December 2012. 31(12):2774-84
  3. MCI wants docs to spend at least 10 mins with each patient. The Times of India. K Sinha. September 1, 2011. Retrieved from http://articles.timesofindia.indiatimes.com/2011-09-01/india/29953546_1_opd-patients-doctors on Jan 1, 2013.
  4. Cowboys and Pit Crews. The New Yorker. Atul Gawande. May 26, 2011. Retrieved from http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html#ixzz2H02jhJMO on Jan 1, 2013.
  5. World Health Statistics 2011 Report. World Health Organization (WHO). 2011; 127-139. Retrieved from http://www.who.int/whosis/whostat/2011/en/index.html on Jan 1 2013.