Automated voice calls with health information are a proven method for disseminating maternal and child health information among beneficiaries and are deployed in several programs around the world. However, these programs often suffer from beneficiary dropoffs and poor engagement. In previous work, through real-world trials, we showed that an AI model, specifically a restless bandit model, could identify beneficiaries who would benefit most from live service call interventions, preventing dropoffs and boosting engagement. However, one key question has remained open so far: does such improved listenership via AI-targeted interventions translate into beneficiaries’ improved knowledge and health behaviors? We present a first study that shows not only listenership improvements due to AI interventions, but also simultaneously links these improvements to health behavior changes. Specifically, we demonstrate that AI-scheduled interventions, which enhance listenership, lead to statistically significant improvements in beneficiaries’ health behaviors such as taking iron or calcium supplements in the postnatal period, as well as understanding of critical health topics during pregnancy and infancy. This underscores the potential of AI to drive meaningful improvements in maternal and child health.

Harnessing the wide-spread availability of cell phones, many nonprofits have launched mobile health (mHealth) programs to deliver information via voice or text to beneficiaries in underserved communities, with maternal and infant health being a key area of such mHealth programs. Unfortunately, dwindling listenership is a major challenge, requiring targeted interventions using limited resources. This paper focuses on Kilkari, the world's largest mHealth program for maternal and child care -- with over 3 million active subscribers at a time -- launched by India's Ministry of Health and Family Welfare (MoHFW) and run by the non-profit ARMMAN. We present a system called CHAHAK that aims to reduce automated dropouts as well as boost engagement with the program through the strategic allocation of interventions to beneficiaries. Past work in a similar domain has focused on a much smaller scale mHealth program and used markovian restless multiarmed bandits to optimize a single limited intervention resource. However this paper demonstrates the challenges in adopting a markovian approach in Kilkari; therefore CHAHAK instead relies on non-markovian time-series restless bandits, and optimizes a layered set of multiple interventions to improve listenership. We use real Kilkari data from the Odisha state in India to show CHAHAK's effectiveness in harnessing multiple interventions to boost listenership, benefiting marginalized communities. When deployed CHAHAK will assist the largest maternal mHealth program to date.

In 2020, maternal mortality in India was estimated to be as high as 130 deaths per 100K live births, nearly twice the UN's target. To improve health outcomes, the non-profit ARMMAN sends automated voice messages to expecting and new mothers across India. However, 38% of mothers stop listening to these calls, missing critical preventative care information. To improve engagement, ARMMAN employs health workers to intervene by making service calls, but workers can only call a fraction of the 100K enrolled mothers. Partnering with ARMMAN, we model the problem of allocating limited interventions across mothers as a restless multi-armed bandit (RMAB), where the realities of large scale and model uncertainty present key new technical challenges. We address these with GROUPS, a double oracle–based algorithm for robust planning in RMABs with scalable grouped arms. Robustness over grouped arms requires several methodological advances. First, to adversarially select stochastic group dynamics, we develop a new method to optimize Whittle indices over transition probability intervals. Second, to learn group-level RMAB policy best responses to these adversarial environments, we introduce a weighted index heuristic. Third, we prove a key theoretical result that planning over grouped arms achieves the same minimax regret--optimal strategy as planning over individual arms, under a technical condition. Finally, using real-world data from ARMMAN, we show that GROUPS produces robust policies that reduce minimax regret by up to 50%, halving the number of preventable missed voice messages to connect more mothers with life-saving maternal health information.

Underserved communities face critical health challenges due to lack of access to timely and reliable information. Nongovernmental organizations are leveraging the widespread use of cellphones to combat these healthcare challenges and spread preventative awareness. The health workers at these organizations reach out individually to beneficiaries; however such programs still suffer from declining engagement. We have deployed SAHELI, a system to efficiently utilize the limited availability of health workers for improving maternal and child health in India. SAHELI uses the Restless Multiarmed Bandit (RMAB) framework to identify beneficiaries for outreach. It is the first deployed application for RMABs in public health, and is already in continuous use by our partner NGO, ARMMAN. We have already reached ~100K beneficiaries with SAHELI, and are on track to serve 1 million beneficiaries by the end of 2023. This scale and impact has been achieved through multiple innovations in the RMAB model and its development, in preparation of real world data, and in deployment practices; and through careful consideration of responsible AI practices. Specifically, in this paper, we describe our approach to learn from past data to improve the performance of SAHELI’s RMAB model, the real-world challenges faced during deployment and adoption of SAHELI, and the end-to-end pipeline.

This paper studies restless multi-armed bandit (RMAB) problems with unknown arm transition dynamics but with known correlated arm features. The goal is to learn a model to predict transition dynamics given features, where the Whittle index policy solves the RMAB problems using predicted transitions. However, prior works often learn the model by maximizing the predictive accuracy instead of final RMAB solution quality, causing a mismatch between training and evaluation objectives. To address this shortcoming, we propose a novel approach for decision-focused learning in RMAB that directly trains the predictive model to maximize the Whittle index solution quality. We present three key contributions: (i) we establish differentiability of the Whittle index policy to support decision-focused learning; (ii) we significantly improve the scalability of decision-focused learning approaches in sequential problems, specifically RMAB problems; (iii) we apply our algorithm to a previously collected dataset of maternal and child health to demonstrate its performance. Indeed, our algorithm is the first for decision-focused learning in RMAB that scales to real-world problem sizes.

The widespread availability of cell phones has enabled non-profits to deliver critical health information to their beneficiaries in a timely manner. This paper describes our work to assist non-profits that employ automated messaging programs to deliver timely preventive care information to beneficiaries (new and expecting mothers) during pregnancy and after delivery. Unfortunately, a key challenge in such information delivery programs is that a significant fraction of beneficiaries drop out of the program. Yet, non-profits often have limited health-worker resources (time) to place crucial service calls for live interaction with beneficiaries to prevent such engagement drops. To assist non-profits in optimizing this limited resource, we developed a Restless Multi-Armed Bandits (RMABs) system. One key technical contribution in this system is a novel clustering method of offline historical data to infer unknown RMAB parameters. Our second major contribution is evaluation of our RMAB system in collaboration with an NGO, via a real-world service quality improvement study. The study compared strategies for optimizing service calls to 23003 participants over a period of 7 weeks to reduce engagement drops. We show that the RMAB group provides statistically significant improvement over other comparison groups, reducing ~30% engagement drops. To the best of our knowledge, this is the first study demonstrating the utility of RMABs in real world public health settings. We are transitioning our RMAB system to the NGO for real-world use.

For years, researchers have explored the use of mobile phone reminders to improve adherence to medication. However, few studies have measured the direct medical benefit of those reminders, especially for low-literate populations in the developing world. This paper describes the use of automated voice calls to promote adherence to iron supplements among pregnant women in urban India. Unlike prior studies, we assess impact via a direct measurement of hemoglobin (Hb) levels in the blood. We enrolled 130 pregnant women from a low-income area of Mumbai, India and randomly assigned them to control and treatment groups. Both groups received a counseling session and a free supply of medication. The treatment group also received short audio messages, three times per week for a period of three months, encouraging them to take iron supplements. Results suggest that automated calls positively impacted Hb levels. However, because we could only recover 79 women for follow-up, and the effect size was small, our results lack statistical power (average change in Hb = 0.43 g/dL, 95% CI = -0.13 0.98 g/dL, p=0.13). We conclude that automated calls deserve further consideration for reducing maternal anemia, and we share our lessons learned for the benefit of future interventions.