Impact evaluation of Super Abbu: A speech based MNCH platform in Pakistan

项目摘要 问题：巴基斯坦的新生儿死亡率在世界上排名第三（每1 000名活产49人），是该区域产妇死亡率最高的国家之一（每100 000名活产276人）。尽管政府和非政府组织尽最大努力利用现代做法和技术改善孕产妇、新生儿和儿童健康，但这些指标仍然很高。为此，巴基斯坦旁遮普省雇用了48 000名妇女保健工作者，采用了多种基于信息通信技术的健康监测系统，并开通了旁遮普健康热线，配备了150名医生，每周7天每天24小时工作。然而，鉴于旁遮普的规模（1亿多人），LHW的有效性有限。预计LHWs每天访问9个家庭，并在40分钟内完成一个很长的教学大纲和执行几项任务。同样，农村地区部署成本高、智能手机普及率低和识字率低也限制了基于信通技术的干预措施的有效性。旁遮普卫生热线由于采用情况不佳而没有效果。 解决方法：我们的团队已经开发、试行并提议扩大和实验性评估一项基于语音的服务，该服务通过一个简单的电话将准爸爸与医生联系起来。这项服务被称为Super Abbu（英语：Super Dad），以几种新的和重要的方式解决了现有努力所面临的挑战： 1- 这项服务的对象是父亲。目前，旁遮普的整个公共卫生基础设施都致力于向妇女提供信息。这种信息差距在Super Abbu的一个试点中表现得淋漓尽致--88%的关于MNCH的问题来自男性。 2- 它通过提供LHW访问之间的信息来补充LHW。 3- 它以适合那些文盲和没有智能手机的人的方式这样做。 4- 它不需要同步电话。准爸爸们可以留下问题等待回答。他们可以访问自己和其他用户过去提出的问题和答案。 5- 它有一个社会方面。准爸爸们不仅可以从医生那里寻求问题的答案，还可以分享自己的经历，评论、分享和评价其他用户的帖子，只要打个电话就行了。经验表明，这些互动将提高采用率。 具体目标：我们试图通过在巴基斯坦旁遮普省进行的一项全省范围的随机对照试验，评估Super Abbu对孕产妇和婴儿死亡率以及这些死亡率的主要驱动因素的影响。

Project Summary Problem: Pakistan has the third highest neonatal mortality rate in the world (49 per 1000 live births) and among the worst maternal mortality rate in the region (276 per 100,000 live births). These indicators remain high despite the best efforts of the government and NGOs to leverage modern practices and technology to improve maternal, newborn, and child health (MNCH). To this end, the province of Punjab, Pakistan has hired 48,000 Lady Health Workers (LHWs), has introduced multiple information communication technology (ICT)-based health monitoring systems, and has launched the Punjab Health Line staffed by 150 doctors 24/7. LHW effectiveness has been limited, however, given the size of Punjab (100+ million people). LHWs are expected to visit nine homes per day and in 40 minutes cover a long syllabus and perform several tasks. Similarly, high deployment costs, low smartphone penetration, and low literacy rates in rural areas have limited the effectiveness of ICT-based interventions. The Punjab Health Line has been ineffective due to poor adoption. Solution: Our team has developed, piloted, and propose to expand and to experimentally evaluate a speech-based service that connects expectant fathers to doctors and to each other over a simple phone call. This service, dubbed Super Abbu (Super Dad in English), addresses the challenges faced by existing efforts in several new and important ways: 1- The service targets fathers. Currently, the entire public health infrastructure in Punjab is geared towards providing information to women. This information gap shined through in a pilot of Super Abbu—88 percent of the questions asked about MNCH were from men. 2- It supplements LHWs by providing information between LHW visits. 3- It does so in a manner appropriate for those who are illiterate and do not have smartphones. 4- It does not require synchronous phone calls. Expectant fathers can leave questions to be answered. And they can access past questions and answers asked by themselves and other users. 5- It has a social aspect. Expectant fathers will not only be able to seek answers to their questions from doctors, but they can share their own experiences, and comment, share, and rate posts by other users, simply through a phone call. Experience suggests these interactions will improve adoption. Specific aim: We seek to evaluate Super Abbu’s impact on maternal and infant mortality rates, and on key drivers of these rates, through a province-wide randomized control trial in Punjab, Pakistan.