Utilizing ML to Increase Engagement with a Maternal and Little one Well being Program in India


The widespread availability of cellphones has enabled non-profits to ship essential well being info to their beneficiaries in a well timed method. Whereas superior functions on smartphones permit for richer multimedia content material and two-way communication between beneficiaries and well being coaches, less complicated textual content and voice messaging companies could be efficient in disseminating info to giant communities, significantly these which might be underserved with restricted entry to info and smartphones. ARMMAN1, one non-profit doing simply this, is predicated in India with the mission of enhancing maternal and baby well being outcomes in underserved communities.

Overview of ARMMAN

One of many applications run by them is mMitra, which employs automated voice messaging to ship well timed preventive care info to anticipating and new moms throughout being pregnant and till one 12 months after beginning. These messages are tailor-made based on the gestational age of the beneficiary. Common listenership to those messages has been proven to have a excessive correlation with improved behavioral and well being outcomes, equivalent to a 17% improve in infants with tripled beginning weight at finish of 12 months and a 36% improve in ladies realizing the significance of taking iron tablets.

Nevertheless, a key problem ARMMAN confronted was that about 40% of ladies steadily stopped partaking with this system. Whereas it’s potential to mitigate this with dwell service calls to ladies to elucidate the benefit of listening to the messages, it’s infeasible to name all of the low listeners in this system due to restricted assist employees — this highlights the significance of successfully prioritizing who receives such service calls.

In “Discipline Research in Deploying Stressed Multi-Armed Bandits: Aiding Non-Earnings in Bettering Maternal and Little one Well being”, revealed in AAAI 2022, we describe an ML-based resolution that makes use of historic knowledge from the NGO to foretell which beneficiaries will profit most from service calls. We handle the challenges that include a large-scale actual world deployment of such a system and present the usefulness of deploying this mannequin in an actual research involving over 23,000 contributors. The mannequin confirmed a rise in listenership of 30% in comparison with the present normal of care group.

Background
We mannequin this useful resource optimization drawback utilizing stressed multi-armed bandits (RMABs), which have been effectively studied for utility to such issues in a myriad of domains, together with healthcare. An RMAB consists of n arms the place every arm (representing a beneficiary) is related to a two-state Markov determination course of (MDP). Every MDP is modeled as a two-state (good or unhealthy state, the place the nice state corresponds to excessive listenership within the earlier week), two-action (corresponding as to whether the beneficiary was chosen to obtain a service name or not) drawback. Additional, every MDP has an related reward operate (i.e., the reward accrued at a given state and motion) and a transition operate indicating the likelihood of shifting from one state to the subsequent below a given motion, below the Markov situation that the subsequent state relies upon solely on the earlier state and the motion taken on that arm in that point step. The time period stressed signifies that every one arms can change state no matter the motion.

State of a beneficiary could transition from good (excessive engagement) to unhealthy (low engagement) with instance passive and lively transition possibilities proven within the transition matrix.

Mannequin Improvement
Lastly, the RMAB drawback is modeled such that at any time step, given n whole arms, which ok arms must be acted on (i.e., chosen to obtain a service name), to maximise reward (engagement with this system).

The likelihood of transitioning from one state to a different with (lively likelihood) or with out (passive likelihood) receiving a service name are due to this fact the underlying mannequin parameters which might be essential to fixing the above optimization. To estimate these parameters, we use the demographic knowledge of the beneficiaries collected at time of enrolment by the NGO, equivalent to age, revenue, training, variety of youngsters, and so forth., in addition to previous listenership knowledge, all in-line with the NGO’s knowledge privateness requirements (extra beneath).

Nevertheless, the restricted quantity of service calls limits the info akin to receiving a service name. To mitigate this, we use clustering strategies to study from the collective observations of beneficiaries inside a cluster and allow overcoming the problem of restricted samples per particular person beneficiary.

Particularly, we carry out clustering on listenership behaviors, after which compute a mapping from the demographic options to every cluster.

Clustering on previous listenership knowledge reveals clusters with beneficiaries that behave equally. We then infer a mapping from demographic options to clusters.

This mapping is helpful as a result of when a brand new beneficiary is enrolled, we solely have entry to their demographic info and haven’t any information of their listenership patterns, since they haven’t had an opportunity to pay attention but. Utilizing the mapping, we are able to infer transition possibilities for any new beneficiary that enrolls into the system.

We used a number of qualitative and quantitative metrics to deduce the optimum set of of clusters and explored totally different mixtures of coaching knowledge (demographic options solely, options plus passive possibilities, options plus all possibilities, passive possibilities solely) to attain probably the most significant clusters, which might be consultant of the underlying knowledge distribution and have a low variance in particular person cluster sizes.

Comparability of passive transition possibilities obtained from totally different clustering strategies with variety of clusters s = 20 (purple dots) and 40 (inexperienced dots), utilizing floor reality passive transition possibilities (blue dots). Clustering based mostly on options+passive possibilities (PPF) captures extra distinct beneficiary behaviors throughout the likelihood house.

Clustering has the added benefit of decreasing computational price for resource-limited NGOs, because the optimization must be solved at a cluster degree reasonably than a person degree. Lastly, fixing RMAB’s is thought to be P-space exhausting, so we select to unravel the optimization utilizing the favored Whittle index method, which in the end offers a rating of beneficiaries based mostly on their possible good thing about receiving a service name.

Outcomes
We evaluated the mannequin in an actual world research consisting of roughly 23,000 beneficiaries who had been divided into three teams: the present normal of care (CSOC) group, the “spherical robin” (RR) group, and the RMAB group. The beneficiaries within the CSOC group comply with the unique normal of care, the place there are not any NGO initiated service calls. The RR group represents the situation the place the NGO typically conducts service calls utilizing some systematic set order — the concept right here is to have an simply executable coverage that companies sufficient of a cross-section of beneficiaries and could be scaled up or down per week based mostly on accessible sources (that is the method utilized by the NGO on this specific case, however the method could differ for various NGOs). The RMAB group receives service calls as predicted by the RMAB mannequin. All of the beneficiaries throughout the three teams proceed to obtain the automated voice messages unbiased of the service calls.

Distributions of clusters picked for service calls by RMAB and RR in week 1 (left) and a couple of (proper) are considerably totally different. RMAB may be very strategic in choosing just a few clusters with a promising likelihood of success (blue is excessive and purple is low), RR shows no such strategic choice.

On the finish of seven weeks, RMAB-based service calls resulted within the highest (and statistically important) discount in cumulative engagement drops (32%) in comparison with the CSOC group.

The plot reveals cumulative engagement drops prevented in comparison with the management group.
   RMAB vs CSOC       RR vs CSOC       RMAB vs RR   
% discount in cumulative engagement drops    32.0% 5.2% 28.3%
p-value 0.044 0.740 0.098

Moral Concerns
An ethics board on the NGO reviewed the research. We took important measures to make sure participant consent is known and recorded in a language of the group’s selection at every stage of this system. Information stewardship resides within the arms of the NGO, and solely the NGO is allowed to share knowledge. The code will quickly be accessible publicly. The pipeline solely makes use of anonymized knowledge and no personally identifiable info (PII) is made accessible to the fashions. Delicate knowledge, equivalent to caste, faith, and so forth., should not collected by ARMMAN for mMitra. Due to this fact, in pursuit of guaranteeing equity of the mannequin, we labored with public well being and area consultants to make sure different indicators of socioeconomic standing had been measured and adequately evaluated as proven beneath.

Distribution of highest training obtained (prime) and month-to-month household revenue in Indian Rupees (backside) throughout a cohort that obtained service calls in comparison with the entire inhabitants.

The proportion of beneficiaries that obtained a dwell service name inside every revenue bracket moderately matches the proportion within the total inhabitants. Nevertheless, variations are noticed in decrease revenue classes, the place the RMAB mannequin favors beneficiaries with decrease revenue and beneficiaries with no formal training. Lastly, area consultants at ARMMAN have been deeply concerned within the growth and testing of this method and have offered steady enter and oversight in knowledge interpretation, knowledge consumption, and mannequin design.

Conclusions
After thorough testing, the NGO has presently deployed this method for scheduling of service calls on a weekly foundation. We’re hopeful that this may pave the way in which for extra deployments of ML algorithms for social impression in partnerships with non-profits in service of populations which have to date benefited much less from ML. This work was additionally featured in Google for India 2021.

Acknowledgements
This work is a part of our AI for Social Good efforts and was led by Google Analysis, India. Due to all our collaborators at ARMMAN, Google Analysis India, Google.org, and College Relations: Aparna Hegde, Neha Madhiwalla, Suresh Chaudhary, Aditya Mate, Lovish Madaan, Shresth Verma, Gargi Singh, Divy Thakkar.


1ARMMAN runs a number of applications to supply preventive care info to ladies by means of being pregnant and infancy enabling them to hunt care, in addition to applications to coach and assist well being staff for well timed detection and administration of high-risk situations. 

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