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.
Research on the effectiveness of Super Abbu will not only help understand how such speech-based public health information delivery services might overcome MNCH challenges in Punjab but will generalize to public health service delivery across the developing world where many of the same challenges exist. Super Abbu will also generate useful information on frequently asked questions for public health professionals to better understand their population. Additionally, Super Abbu itself, if found to be successful, could easily be scaled up to reach other developing countries to improve public health.