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Private Sector Project for 
Women’s Health
Evaluation Report 
PDA Pilot Program 
Submitted to:
Dr. Basma Khraisat
Contracting Officer’s Technical Representative (COTR)
USAID/Jordan
Submitted by:
Reed Ramlow
Chief of Party
Private Sector Project for Women’s Health
Abt Associates Inc.
Prepared By: 
Dr. Nadia Al-Alawi
January 2011
Private Sector Project for Women’s Health-Jordan
PSP Task number 802
Contract number: GPO-I-802-04-00007-00
The information contained in this document is considered 
CONFIDENTIAL and is intended for the recipient and their 
authorized representatives only. Any unauthorized distribution is 
strictly prohibited without the prior written consent of submitter.
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A. Executive Summary 
One of the major activities of the Private Sector Project for Women’s Health (PSP) is to 
implement a home-based outreach program with hard to reach population groups. Home 
outreach visits focus on women’s health, including information sharing on modern methods 
of contraception, breast and cervical health, and other topics which address women’s health 
needs, as well as increasing use of family planning (FP) services, increasing self-breast exam, 
and providing referrals to FP and breast cancer health services. 
As of September 2010, PSP, through its partners, had visited an estimated 1,283,527 women 
through Community Health Workers (CHWs). Because CHWs visit such a large number of 
homes, PSP piloted use of Personal Data Assistance devices (PDAs) as a tool for data 
collection by CHWs. The pilot program had two objectives: to reduce the amount of time 
required by CHWs for data entry during home visits; and to minimize errors in both data 
collection and data entry. To reach a decision on the feasibility of expanding PDA use with 
the home outreach program, PSP conducted an evaluation of the PDA pilot program, 
comparing qualitative information, quantitative data, and costs of use of the PDA compared 
to that of paper client forms. 
The assessment found that paper client forms are a better data collection method than PDAs 
based on the following key findings: 
 Paper client visit forms are easier and faster for CHW to use than PDAs. Paper client 
forms allow CHW to see all visits and information at once, making it easy for CHW 
to follow trends and make notes, corrections, or additions to client information. 
 CHW have better interpersonal communication skills when using paper client forms 
than when using PDAs. When using the paper client forms, CHW are better able, 
when compared to those using PDAs, to make eye contact, see facial expressions, 
establish relations, and maximize the human contact necessary to influence behavior 
change. 
 When CHW used PDAs to collect client information, CHW visited fewer women and 
had fewer women switching to modern FP methods than when they used paper client 
forms to collect client information. 
The home outreach program should revert to using paper client forms for collecting 
information from clients during all home visits. 
B. Introduction 
The Private Sector Project for Women’s Health (PSP), funded by the United States Agency 
for International Development (USAID) 2005 - 2012, has a mandate to improve the health of 
Jordanian women and families. The project uses an integrated approach to increase demand 
for modern contraception and related women’s health services, increase availability of quality 
private sector health care services, increase early detection of breast cancer, and address 
domestic violence against women. 
One of the project’s major activities is to implement a home outreach program with hard to 
reach population groups. Home outreach visits focus on women’s health, including 
information sharing on modern methods of contraception, breast and cervical health, and 
other topics which address women’s health needs, as well as increasing use of family 
planning (FP) services, increasing self-breast exam, and making referrals to FP and breast 
cancer health services. 
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To conduct its home outreach program, PSP, through its NGO partners Circassian Charity 
Association (CCA) and General Union of Voluntary Associations (GUVS), recruited and 
trained over 140 community health workers (CHW) to visit door-to-door and to counsel 
women in their homes. CHW conduct home visits, at least twice, with all women of 
reproductive age (aged 15 to 60 years old) residing in geographical areas with low 
contraceptive prevalence rates, high unmet need for FP, and recognized poverty pockets or 
camps. CHW further visit a minimum of 32% of the above-visited women for third and 
fourth visits to address health problems, follow up with new adopters of modern FP methods, 
or address unmet need for FP. A further 11% are visited up to eight times to further address 
health problems, follow up with additional new adopters of modern FP methods, or to further 
address unmet need for FP. 
As of September 2010, PSP, through its partners, had visited an estimated 1,283,527 women. 
Because CHW visit such a large number of homes, PSP piloted use of Personal Data 
Assistance devices (PDAs) as a tool for data collection by CHWs. The pilot program had the 
following objectives: 
1. To reduce the amount of time required by CHWs for data entry during home visits 
2. To minimize errors in both data collection and data entry 
PSP collaborated with a local information technology firm, REALSOFT, to establish a PDA 
data collection system and to modify the existing home outreach program database to handle 
direct data entry from the PDAs. CCA selected six existing CHWs, two each in Amman, 
Irbid, and Zarqa, to participate in the pilot PDA program (to use PDAs rather than paper 
client forms as a tool for data collection and counseling). REALSOFT trained participating 
CHW and data entry personnel in use of PDAs. After theoretical and field training, CHW 
started using the PDAs, in urban and rural areas of Amman, Zarqa and Irbid, on April 11, 
2010 and continued through December 2010. 
To reach a decision on the feasibility of continuing and expanding PDA use with the home 
outreach program, PSP conducted an evaluation of the PDA pilot program. The evaluation 
compared qualitative and quantitative data, as well as financial costs, of the PDA with those 
of paper client forms. This report presents the evaluation findings. 
C. Methodology 
PSP hired a consultant, Nadia Al-Alawi, to conduct the qualitative, quantitative, and cost 
evaluation of the PDA pilot program. The consultant reviewed relevant PSP project 
documents, including the paper client forms (see Annex 1) and collected data for the 
evaluation between December 1 and December 19, 2010. 
To understand the CHW home outreach program, the consultant interviewed the PSP 
Outreach Program Manager, Ansam Bizzari. She also shadowed a senior CHW, Kamela 
Labdoosh, conducting home visits using PDAs.
Following collection of background information, the consultant developed focus group 
discussion guides for qualitative data collection (see Annex 2). The consultant conducted the 
interviews and focus group discussions, partially translated by the PSP Outreach Program 
Manager, with the following CCA staff involved with the PDA pilot program: 
 Dr. Sahar Izzat, CCA Community Outreach Field Manager, who has 11 years of 
experience overseeing community outreach work that uses paper client forms and 
eight months of experience overseeing community outreach work that uses the PDA 
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 Kamleh Labdoosh, CCA CHW in Amman, who has 10 years of experience as a 
CHW using paper client forms and eight months of experience using the PDA. 
 Maysoon Abu Shayra, CCA CHW in Amman, who has three years of experience as a 
CHW using paper client forms and eight months of experience using the PDA. 
 Samar Al Barooni, CCA Data Entry Supervisor in Amman, who has 8 years of 
experience entering data into the home outreach program database using paper client 
forms and eight months of experience using the PDA.
To obtain quantitative data collected by CHWs during home visits the consultant accessed 
and analyzed data from the CCA home outreach program database. She compared home visit 
data from participating CHW before the pilot PDA program with data from participating 
CHW during the pilot PDA program. Information compared included total number of home 
visits for each time period and total number of women newly accepting modern FP methods 
for each time period. 
D. Findings 
1. Technology 
Participating CHW liked learning and using the new technology of the PDAs. They also liked 
the ease with which they could carry them. In comparison to paper client forms, which were 
cumbersome and could be heavy to carry during home visits, the PDAs were small, light, and 
easier to carry around. Likewise, management reported that storage of thousands of paper 
client forms, on which individual home visit information is recorded, was significantly more 
cumbersome with paper client forms than with the PDA and electronic record keeping. 
While CHW enjoyed using new technology to assist their work, there were drawbacks to 
using PDAs. Participating CHW were nervous of losing the PDA or its stylus. ‘It would be 
expensive to replace if I lost it,’ said one CHW, noting that she had bought a new coat with 
deep pockets especially to hold her PDA, and that she walked with her hands in her pocket to 
ensure she did not lose the small device. Focus group discussion participants also complained 
that the PDA screen was too small and could not be easily read. CHW reported that if the 
PDA malfunctioned for any reason, they would not be able to capture data for the remainder 
of that day (unless they carried paper cards with them at all times).
Interestingly, CHW also reported that while most visited women were excited by and 
interested in the new technology, others, particularly husbands of visited women, were 
nervous and suspicious of the devices. Participating CHW reported that some men ‘thought
the PDA devices could be used to spy on them’, ‘since mobile phones can make visual and 
auditory recordings, the PDA could be used to do the same’, and wondered ‘where is the 
information going?’ In response to these fears, if a husband was present during a home visit, 
CHW would postpone using the PDA until he left the room. 
2. Device Programming 
While all respondents noted there were numerous programming challenges with the PDAs, 
they felt the PDA was effective in preventing missed or incorrect entries for many client 
questions. Management reported that CHW could not answer some questions until the 
previous one had been answered, preventing CHW from skipping questions. Likewise, for 
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many questions, answers were predefined as variables, preventing CHW from entering 
invalid answers.
Examples of programming challenges or issues presented by respondents included the 
following:
 The records of visited women on the PDA do not have prioritized screens. CHW 
report scrolling through multiple screens of client and visit information to find 
information they need. The name and FP intention, for example, are the most 
important pieces of information for CHW to know prior to visiting a woman, yet these 
are not on the first screen of a client viewed upon opening a client file.
 The PDA does not include the addresses of the visited women. CHW reported 
carrying their own hand written address books or maps to women’s homes for each 
trip.
 The PDA client summaries are insufficient to meet the needs of CHW. The PDAs
include all the information about each visit to each client, but the summary 
information for each client is inadequate to meet CHW needs. CHW reported that for 
any visit other than a first time visit, they needed significant time to prepare a 
summary of each client prior to home visits. CHW were obliged to carry the 
summary, in addition to their address books (see above), comments (see below), and 
the PDA itself.
 There is no “comments” section on the PDA for additional notes on home visits. 
CHW reported that important information needs to be captured in note form during 
visits. CHW make notes for example, on the paper client forms of the extended family 
situation of a visited woman or the need to make a return visit when a client was not 
home on a particular visit. These types of notes are not possible when CHW used 
PDAs to record data collected during home visits.
 It is time consuming to make changes to data already entered. CHW report it is hard 
and very time consuming to change or amend original entries. Respondents stated that 
the only way to correct a data entry error (they entered the date of the last menstrual 
period, for example, incorrectly and wished to change it), was to click the “back” 
button. In some cases, the CHW had to go back several screens to return to the screen 
containing the error. 
 Small data entry errors can result in whole sets of questions being skipped. If a CHW 
for example, did not know a woman was pregnant until part way through their visit
(and data entry), the CHW would either have to restart the whole set of data collection 
questions or go back many screens to correct the error (and follow the subsequent 
correct line of questions).
 Some data entry screens allow CHW to leave blanks or respond with incorrect 
answers.
 Making changes to the data entry program was not possible. Respondents stated, for 
example, they needed a count of the number of visits conducted, but that they could 
not add this to the data entry program.
 It is difficult to select clients from the PDA device to visit on any given day. The 
Community Outreach Field Manager reports that not all selection criteria for choosing 
clients for follow-up visits are in the current program, therefore a lot of time and 
paperwork is required to choose which clients to visit at any given point in time.
 CHW could not enter information from more than one woman at a time. CHW report 
visiting women, for example, when several other clients are also present. With paper 
client forms, CHW can fill in several forms at one time.
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 Technical assistance was not readily available during the pilot program. The 
Community Outreach Field Manager stated that REALSOFT management was 
extremely quick to respond to any queries, but the technical team was not as 
committed or responsive.
3. Data Entry 
Once the data is collected and recorded in the PDA devices by the CHW, data entry from the 
PDA into the home outreach program database is very easy and fast. The Data Entry 
Supervisor reported synchronization between the PDA and the database computer to be very 
efficient, taking only minutes. Data entry with the paper client forms is time consuming and 
provides another point of potential human error. See Figure 1 below for a comparison of the 
amount of time required to enter data from 110 home visits to married women of 
reproductive age from one CHW (an average of one week of home visits) with data collected 
with either PDAs or paper client forms. 
Figure 1: Minutes required to enter data from 110 home visits into home outreach database 
4. Quality Control 
Identification and correction of errors is much faster when data is collected using paper client 
forms than when it is collected using PDAs. The Data Entry Supervisor reports that data 
auditors are able to audit more random samples of client visit records from the home outreach 
program database when data is collected using paper client forms than when data is collected 
using PDAs. See Figure 2 for a comparison of the number of visit records audited per day 
using data collected from PDAs with data collected from paper client forms. 
10
20
150
75
0
20
40
60
80
100
120
140
160
First visits Follow up visits
PDA
Paper Client Forms
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Figure 2: Number of records audited per day 
CHW using paper client forms can easily locate and correct errors prior to or while entering 
information into the home outreach program database. For paper cards, data auditors 
carefully review and make notations of errors on all incoming paper client forms (one two￾sided card per client visit) prior to data entry. CHW revise or correct cards as needed, directly 
on the original paper client forms. Corrected data is then entered into the computer. 
For PDAs, following synchronization of the PDAs with the home outreach database to enter 
client data (see above), data auditors print all entered information (about 12 pages of) for 
each client who converted to a modern contraceptive method (about 14% of all visited 
clients). As with the paper client forms, data auditors carefully review and make notations of 
errors on client information on these printed papers. CHW then revise or correct data as 
needed, in the PDA. This takes a considerable amount of time: One two-sided paper client 
visit form requires 23 individual screens on the PDA; To make a correction on screen 22 of a 
specific client data set, the CHW must first navigate or scroll through 21 PDA screens; 
Following correction, data entry personnel resynchronize corrected PDAs with the home 
outreach database; The PDA is not available for use by CHW, during this time, resulting in 
further loss of productivity. 
5. Use of Resources 
After establishment of the PDA system, based on time spent by staff, use of the PDA to 
capture client information during home outreach visits is less expensive than use of paper 
client forms. The PDA reduces by approximately one third the amount of time required by 
staff to capture and correct information from client visits. The following table gives an 
indication of the differences in time spent accurately capturing client information during 
home outreach visits when using paper client forms and when using PDAs. 
Table 1: Comparison of relative time spent when using paper client forms with time spent 
when using PDAs to accurately capture client information from home outreach visits 
Activity PDA Paper Client Forms
Time to visit client 100 82
14 28 28
300
350
250
0
50
100
150
200
250
300
350
400
First Visits Second Visits Other Follow-up
Visits
PDA
Paper Client Forms
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Activity PDA Paper Client Forms
Time to enter data from first visit data 100 1500
Time to enter data from other visits 100 375
Time to audit first visit client records 100 5
Time to audit second visit client records 100 8
Time to audit follow up visit client records 100 11
Total relative time 600 1981
6. Home Visit Outputs 
CHW are able to visit more clients per day when using the paper client forms than when 
using the PDA devices to collect client information. See Figure 3 for a comparison of the 
average number of clients visited per day by CHW when using PDAs to collect client 
information and the number visited by the same CHW when using paper client forms to 
collect client information (based on information provided by the Community Outreach Field 
Manager). 
Figure 3: Average number of clients visited per day 
7. Home Visit Outcomes 
Because CHWs using PDA visited only new clients during the pilot PDA program (whereas 
they would normally visit a range of new and old clients for a mix of first, second, and follow 
up visits), a direct comparison of home visit outcomes between CHWs using paper client 
forms and those using PDAs is not possible. Respondents anecdotally report however, that 
there were fewer visited women switching to modern methods of FP when CHWs used PDAs 
to record home visit data. 
All respondents report the PDA is a barrier or hindrance to building client rapport. Because of 
the need to “fiddle with” the PDA, CHWs are less able to establish eye contact with clients, 
have less time overall to counsel clients, and are less able to have meaningful two-way 
interpersonal communication. 
18
22
0
5
10
15
20
25
PDA Paper Client Forms
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8. Respondent Recommendations 
All participants of the individual interviews and focus group discussions unanimously 
recommend using paper client forms (rather than PDA) for collecting and recording client 
visit information for home outreach program. 
For home outreach programs wishing to use computer technology to support implementation, 
respondents had the following suggestions and recommendations: 
 Use technology to share messages and information (e.g. videos/DVDs). Implementers 
can overcome major barriers to modern FP messages by showing short video clips to 
women in their homes. This would be effective and provide consistency with FP 
messages between CHWs. 
 Should outreach programs use PDAs to collect information, the CHW should have 
strong data entry skills or be very familiar with computers. 
 Should outreach programs use PDAs to collect information, program the PDAs to 
have tabs for each screens. This would allow fast and easy scrolling through client 
files. It would alleviate some of the programming challenges faced during data entry 
and error correction. 
 Use PDAs for first visits only or for activities involving only single client visits. 
Respondents agreed that many of the programming and quality issues faced were 
caused by the difficulties in accessing previously established files (i.e. client files 
from previous visits). 
 Should outreach programs use PDA devices to collect information, allow CHWs 
significantly more time with clients (plan for only seven to eight home visits per day). 
E. Conclusions and Recommendations 
Despite saving time (and money) during the data entry process, paper client forms are a better 
data collection method than PDAs with this home outreach program aimed at influencing 
women’s FP practices. 
This recommendation is based on the following key finding: 
 Paper client visit forms are easier and faster for CHWs to use during home visits than 
PDAs. Paper client forms allow CHWs to see all visits and information at once, 
making it easy for CHWs to know their clients, follow health trends, and make notes, 
corrections, or additions to client information. 
 CHWs have better interpersonal communication skills when using paper client forms 
than when using PDAs. When using the paper client forms, CHWs are better able, 
when compared to those using PDAs, to make eye contact, see facial expressions, 
establish relations, and maximize the human contact necessary to influence behavior 
change. 
 When CHWs used PDAs to collect client information, CHWs visit fewer women and 
are anecdotally reported to have had fewer clients switching to modern FP methods 
than when they used paper client forms to collect client information. 
The home outreach program should use available technology to present educational videos to 
clients at home in the presence of experienced CHWs. CHWs can show specific videos on 
contraceptive methods to specific clients as needed and appropriate, and answer any 
questions arising from the presented information. This will increase the effectiveness of the 
home outreach program in changing attitudes and behaviors towards modern FP methods. 
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While it is not recommended for this program, should PDAs be used for data collection for 
other home outreach programs, REALSOFT needs to greatly improve the programming to 
address the many issues arising during the pilot program. In addition, CHWs would need 
more extensive training on use of the device, a more efficient quality control system is 
needed, and the program should use devices with big screens. 
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Annex 1 
Paper Client Visit Forms 
Microsoft Office 
Excel 97-2003 Worksheet
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Annex 2 
Focus Group Discussion Guides 
Community Health Workers 
1. Names, position, and assigned work location of respondents 
2. How long had you been using the paper logs? 
3. How long have you been using the PDA? 
4. What do you like about the PDA? 
5. What do you dislike? 
6. What do you like about the paper logs? 
7. What do you dislike? 
8. How did the training needs compare between the two? 
9. Can you visit more women per day with PDA or paper logs? 
10. How does ease of use compare? 
11. How does quality of the information collected/making errors compare? 
12. Which do you prefer to use: PDA or paper logs? If a new CHW was starting and they 
could choose, which would you recommend to them? Why? 
13. What suggestions do you have for the PDA? 
Data Entry Personnel 
1. Name, position, and assigned work location of respondents 
2. How long have you been doing data entry with paper logs? 
3. How long have you been doing data entry with the PDAs? 
4. What do you like about data entry with paper logs? 
5. Dislike? 
6. What do you like about data entry with the PDA? 
7. Dislike? 
8. How does the time required for data entry compare between the two? 
9. How do the error rates/sizes and correction compare between the two? 
10. How do equipment needs compare between the two? 
11. How do the data entry/error audit training needs compare between the two? 
12. Which do you prefer to use? If a new data entry person was starting, and they could 
choose, which would you recommend to them? 
13. What suggestions do you have for the PDA? 
Management 
1. Name, position, and assigned work location of the respondents 
2. How long have you been overseeing outreach work with paper logs? 
3. How long have you been overseeing outreach work with the PDA? 
4. What do you like about paper logs? 
5. Dislike? 
6. What do you like about the PDA? 
7. Dislike? 
8. How do equipment costs compare between the two? 
9. How do training costs compare between the two? 
10. How do staff costs compare between the two? 
11. How do overall costs compare between the two? 
12. How does time for use compare between the two? 
13. Which do you prefer? 
14. What suggestions do you have for the PDA?