Case Study

Continuum of Care Services: A Holistic Approach to Using MOTECH Suite for Community Workers

  • Provided By: Dimagi
  • October 31, 2014

CARE India, Dimagi and Grameen Foundation deployed the MOTECH Suite to improve delivery of family health interventions and quality of health services in rural India. The system, called the Continuum of Care Services (CCS), offers a comprehensive tool for mobile workers, providing coordinated care for one million people in Bihar, India. Its aim is to cover the 1000-day window of pregnancy through the child’s second year of age, to deliver ‘the right messages at the right time’ to pregnant women and newborn children within the community.


Located in northern India, Bihar’s population of 104 million faces some of the poorest health indicators and highest levels of poverty in the country. Over 42% of the state’s children under the age of five are underweight. Maternal health is at risk from steep maternal mortality rates, India’s highest fertility rate, and limited access to antenatal care. Currently, only 1 out of 3 pregnant women receive appropriate care at a clinic. 

To address challenges related to MNCHN, the Bill & Melinda Gates Foundation and the Government of Bihar entered into a five-year partnership in 2010 centered on achieving Millennium Development Goals 4 and 5. The resulting Ananya Partnership currently reaches 30 million people and works with 46,000 health workers. With support from CARE India, these efforts have been successfully integrated into the government’s overarching MNCHN intervention in Bihar, under the Integrated Family Health Initiative (IFHI). IFHI, specifically, seeks to improve the health of pregnant women, infants and children less than two years of age, across the continuum of care, by enhancing essential health and nutrition services. 

In support of IFHI, CARE India is working to identify, test, and scale up multiple innovative solutions for improving delivery of impactful family health interventions. One such innovation is the Continuum of Care Services (CCS), where mobile technology has been leveraged to increase the number of client-provider contacts and quality of service to improve MNCHN care. It covers a population of over 400,000 through 35 health sub-centres in four blocks of Bihar with a vast network of Frontline Workers (FLWs) and supervisors. Before CCS, their impact was challenged by a lack of coordination of FLWs in these catchment area; limitations of paper-based tools for planning their work; poor job-aids for counselling; a lack of supportive supervision from supervisors currently unable to monitor FLWs’ services and patient care; and the unavailability of real-time data for program management. 

As a result, CCS was created through a collaborative effort of CARE India, Dimagi, and Grameen Foundation, designed to increase the capacity of over 500 frontline workers (FLWs) to deliver essential health and nutrition services to underserved women and children. 

CSS was launched in 2012 in Saharsa district of Bihar, and includes a two-year randomized control trial (RCT) that will directly measure the effect of mHealth tools’ impact on health indicators. 

Read the case study below. 

Case Study:

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