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.

Improving Health Information Access in the World’s Largest Maternal Mobile Health Program via Bandit Algorithms

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.

Robust Planning over Restless Groups: Engagement Interventions for a Large-Scale Maternal Telehealth Program

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.

Scalable Decision-Focused Learning in Restless Multi-Armed Bandits with Application to Maternal and Child Health

Increasing Impact of Mobile Health Programs: SAHELI for Maternal and Child Care

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.

Field Study in Deploying Restless Multi-Armed Bandits: Assisting Non-Profits in Improving Maternal and Child Health

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Posters & Demos III

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Shresth Verma

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SHORT BIO

Presentations

Improving Health Information Access in the World’s Largest Maternal Mobile Health Program via Bandit Algorithms

Robust Planning over Restless Groups: Engagement Interventions for a Large-Scale Maternal Telehealth Program

Scalable Decision-Focused Learning in Restless Multi-Armed Bandits with Application to Maternal and Child Health

Increasing Impact of Mobile Health Programs: SAHELI for Maternal and Child Care

Field Study in Deploying Restless Multi-Armed Bandits: Assisting Non-Profits in Improving Maternal and Child Health

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