Learning from routine data

Using routine monitoring and evaluation data to understand why innovations are not being used can help local maternal and newborn health service providers to adjust their implementation practices to take into account local needs. The IDEAS Technical Resource Centre aims to support the measurement, learning and evaluation activities of Bill & Melinda Gates Foundation maternal and newborn health implementation projects. It was in this capacity that I began looking through the routine data collected by Society for Family Health from monitoring systems and a continuous household survey over a period of nearly two years. The data clearly showed that between January 2013 and September 2014, knowledge of the call centre increased among women who’d had a live birth in the six months prior to being interviewed for the continuous survey :

• from 15% to 41% in urban areas
• from 12% to 26% in rural areas

But the use of the call centre remained low:

• 1% to 3% in urban areas
• 1% in rural areas In-depth interviews show cultural factors impeded use

  

In December 2014, Society for Family Health commissioned Childcare and Wellness Clinics to carry out in-depth interviews with local stakeholders – State level officials, SFH employees, drivers, frontline health workers, call centre operators and families – in Akko and Yamaltu Deba local government areas to understand why the call centre was underused.

The study showed the call centre could be a fantastic resource due to its large reach, well-thought out radio promotion strategy and its location within the hospital. However, there were challenges to overcome to improve its use:

• Poor connectivity: Villages and rural areas that need support most also have the greatest network connectivity problems. Many women do not have telephones and find it difficult to save numbers given to them.
• Reluctant to call a stranger: women (and men) feel reluctant to call a “stranger” to discuss personal issues. They prefer to call the frontline health workers they know, who then have the responsibility of either solving the problems themselves or connecting the women to the call centre.
• Concerns about the confidentiality of callers: Call centre operatives are not trained to counsel callers and may not know about the need for confidentiality.
• Difficulty responding to multiple calls at the same time: the infrastructure needs to be improved so there are more call centre operatives and the technology to respond to several calls at the same time.

Using data to improve maternal and newborn health innovations

What struck me most about the challenges was the reluctance of families to talk to call centre operatives about their personal maternal and newborn health issues.

Without these data and research Society for Family Health would not have known the call centre, with its huge potential, was not being used or why it wasn’t being used. Armed with this information they can now address some of the challenges by, for example, training call centre operatives as counsellors and working with local radio stations to show they are not strangers.

Data and research are essential for the ongoing improvement of maternal and newborn health innovations. Society for Family Health staff have shown how they can use data to make changes to their call centre and better serve the families in Gombe State.