FWA eRegister

The FWA eRegister is the digital version of the FWA Register used by Family Welfare Assistants (FWAs), working under the Directorate General of Family Planning (DGFP).

Duties and Responsibilities of FWA

The FWAs work principally in the rural areas and are located in the upazila (sub-district) set up of DGFP.  Each upazila is subdivided into a number of unions. Each union is subdivided into nine wards. There are 6 or more FWA units in a union depending upon the area and size of population. The FWAs work in the FWA unit. They are directly supervised by the Family Planning Inspector (FPI).

The FWAs have domiciliary responsibilities. They provide services regarding family planning, mother and child care, adolescent health and nutrition programs. They attend satellite clinics, community clinics; and participate in EPI and other activities. They select new couples and distribute oral pills, condoms, emergency contraceptive pill (ECP), and Misoprostol to the clients. They refer the clients willing to adopt permanent methods to the appropriate health facility. They maintain list of all eligible couples and preserve and update them on a regular basis. They also keep records of birth and death events. The distribute Iron-Folic Acid (IFA) tablets, multiple nutrient powder (MNP), and vitamin A capsules to pregnant women and children. All such work is recorded in the FWA Register.

Contents of Paper Register

The register has 21 sections on instructions and educational materials, dedicated registers/lists.  The name and purposes of different sections in the register are as follows:

Functionalities of FWA eRegister

The FWA eRegister is an mHealth app and loaded in a handheld Tablet. The FWA eRegister allows FWAs to conduct all their activities electronically. The app works both offline and online. Work data reside in the local device and synchronized with the central server regularly or whenever Internet is available. Figure 1 shows how sections of the paper register have been converted:

Figure 1: Converting the FWA register into an eRegister

The FWA eRegister is arranged into several panels or sections. Modules are available on eligible couples, children with ages 0–18 months, childcare for those ages 0–5 years, adolescent care, maternal and neonatal information/care list, death list, daily activities list, list of women on injectable, list of distribution and stock, list of household population, list of village-wise population, list of eligible couples on methods and without methods.

Eligible Couples

The Eligible Couple section of the eRegister corresponds to the List of Eligible Couples in the paper Register. The FWAs maintain the particulars of all the eligible couples or ELCOs in their own catchment areas (married woman aged 15–49 years). During each visit to the household, the FWA records the date of visit and the type of services provided, such as birth control, pregnancy, and nutrition services.

Pregnant Mother and neonate

The FWAs enter the status of pregnancy in the register. On entering the date of LMP (last menstrual period), EDD or expected date of delivery is generated automatically by adding 280 days to the LMP. It is used for keeping data on antenatal care, pregnancy outcome or delivery, neonatal care, and postnatal care. The app helps to identify pregnancy with risks on the basis of certain conditions. The results of delivery are also captured (live birth/still birth or abortion). Newborn Data is also collected including postnatal data on mother and child. The system shows the ideal timetable for four postnatal care visits.

Child Care

List of children ages 0–18 months is maintained to record the immunization status of the children. The system is interlinked with the HA eRegister. FWAs can view vaccines given by the HAs. The FWAs can view whether the birth registration has been done.

Childcare (0–5 Years) is used to provide basic care to the children. Decision support systems assist them to review symptoms of disease and refer the clients to health facilities when necessary.

Adolescent Care

Adolescent Care (boy or girl ages 10–19 years) is used to provide counselling to the adolescents, such as effects of child marriage and adolescent motherhood, taking IFA tablets, nutritious and balanced food, awareness about changes during puberty, hygiene during menstruation and its complications, reproductive tract infections, and sexually transmitted infections.

List of Daily Activities

The FWAs prepare a summary of daily activities. They record all household visits, aggregated distribution data for pills, condoms, injectable contraceptives, IUDs, implants and permanent methods etc. The data include old and new method adopters, number of ELCOs, number of pregnant women and distribution of reproductive health commodities. They also record daily visits to Satellite Clinics, the EPI center, and the Community Clinic, meetings attended, and leaves taken. Total number of births and deaths in a month is also counted. The total number of method users, eligible couples, and pregnant women are also reported. Contraceptive acceptance rate (CAR) is calculated using a formula.

List of Women Receiving Injectable

This list is prepared to gather information on all injectable contraceptive users to know when women need subsequent doses and/or referral to a FWV. If the FWA is trained to administer injectable contraceptives, he or she performs this procedure and administers the second dose.

Preparation of Monthly Advance Work plan

A module has been developed to assist FWAs to perform works not included in the register but performed routinely by them, such as preparation of advance work plan.

The FWAs prepare an advance work plan for the next month and submit it to their supervisor (FPI) for approval before the end of current month using a module in the eRegister. The FPI sends approved plan to the upazila office. This FPIs use the workplan for the purpose of inspection. The types of activities performed in a typical month is described in table 3. This tool is effective for reviewing the performance of FWAs.

Table 1: Types of activities performed by FWAs

• ELCO visit
• Provide services from CCs
• Attend the satellite clinic
• Participate in EPI session
• Accompany client to the family planning camp
• Prepare advance workplan
• Attend fortnightly meeting at the UHFWC
• Attend monthly meeting at the UFPO office
• Receive FP materials from UFPO office
• Leave
• Preparation of monthly report (MIS 1 Form)
• Participate in training
• Yard meeting
• Client Motivation/Visit IPC
• Others

Death List

The FWAS record any death that occurred within their catchment areas, which they would learn about during routine visits.

Reporting

Month end report called MIS 1 Form is submitted by the FWAs to the FPI, which is generated automatically from the app. All such forms are aggregated at higher levels to generate national report.

Notification

Notification and job aid tools are new additions to digital FWA eRegister and have been possible due to strength of digital technologies. Notification is generated to alert the users of their pending tasks. These are organized in five sets: migration, collection of data on delivery, collection of data on women whose EDDs have expired, data on delivery and newborn. For example, the FWA can review the list of pregnant women with expired EDD and take a decision to visit the households for collecting data.

Job Aid Tools

Job Aid Tools are predictive and are intended for assisting the FWAs during their visits in the catchment areas or otherwise. They can access list of pregnant women whose EDDs are within next seven days, list of pregnant women identified as with risk, list of women on any method, status of ELCO visits. For example, review of lists can guide their actions for the day, or week, or a month.

Conclusions

The conversion of paper register into electronic register initiated a digital journey for the field workers of DGFP with opportunities for improving the manner they work and to improve the services they render to their clients.