Artificial Intelligence

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

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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 providers may be efficient in disseminating info to giant communities, significantly these which can 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 little one 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 delivery. 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% enhance in infants with tripled delivery weight at finish of 12 months and a 36% enhance in girls understanding 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 stay service calls to girls to clarify the benefit of listening to the messages, it’s infeasible to name all of the low listeners in this system due to restricted help employees — this highlights the significance of successfully prioritizing who receives such service calls.

In “Area Research in Deploying Stressed Multi-Armed Bandits: Aiding Non-Earnings in Enhancing Maternal and Little one Well being”, revealed in AAAI 2022, we describe an ML-based answer 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 commonplace of care group.

We mannequin this useful resource optimization downside utilizing stressed multi-armed bandits (RMABs), which have been properly 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 dangerous 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) downside. Additional, every MDP has an related reward perform (i.e., the reward amassed at a given state and motion) and a transition perform indicating the chance 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 each one arms can change state no matter the motion.

State of a beneficiary might transition from good (excessive engagement) to dangerous (low engagement) with instance passive and energetic transition chances proven within the transition matrix.

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

The chance of transitioning from one state to a different with (energetic chance) or with out (passive chance) receiving a service name are subsequently the underlying mannequin parameters which can 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 kids, and so on., 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 comparable to receiving a service name. To mitigate this, we use clustering methods 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 hear but. Utilizing the mapping, we are able to infer transition chances 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 completely different combos of coaching knowledge (demographic options solely, options plus passive chances, options plus all chances, passive chances solely) to realize probably the most significant clusters, which can be consultant of the underlying knowledge distribution and have a low variance in particular person cluster sizes.

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

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

We evaluated the mannequin in an actual world research consisting of roughly 23,000 beneficiaries who had been divided into three teams: the present commonplace of care (CSOC) group, the “spherical robin” (RR) group, and the RMAB group. The beneficiaries within the CSOC group comply with the unique commonplace of care, the place there are not any NGO initiated service calls. The RR group represents the state of affairs the place the NGO usually conducts service calls utilizing some systematic set order — the thought right here is to have an simply executable coverage that providers sufficient of a cross-section of beneficiaries and may be scaled up or down per week primarily based on out there sources (that is the method utilized by the NGO on this explicit case, however the method might 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 pair of (proper) are considerably completely different. RMAB may be very strategic in selecting just a few clusters with a promising chance 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 Issues
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 alternative at every stage of this system. Knowledge stewardship resides within the fingers of the NGO, and solely the NGO is allowed to share knowledge. The code will quickly be out there publicly. The pipeline solely makes use of anonymized knowledge and no personally identifiable info (PII) is made out there to the fashions. Delicate knowledge, equivalent to caste, faith, and so on., aren’t collected by ARMMAN for mMitra. Subsequently, in pursuit of guaranteeing equity of the mannequin, we labored with public well being and subject consultants to make sure different indicators of socioeconomic standing had been measured and adequately evaluated as proven beneath.

Distribution of highest training obtained (high) 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 stay service name inside every revenue bracket moderately matches the proportion within the general 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.

After thorough testing, the NGO has at present deployed this method for scheduling of service calls on a weekly foundation. We’re hopeful that this can pave the way in which for extra deployments of ML algorithms for social affect 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.

This work is a part of our AI for Social Good efforts and was led by Google Analysis, India. Because of all our collaborators at ARMMAN, Google Analysis India,, 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 offer preventive care info to girls via being pregnant and infancy enabling them to hunt care, in addition to applications to coach and help well being staff for well timed detection and administration of high-risk circumstances. 

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