# Decisions and Deployment: The Five-Year SAHELI Project (2020-2025) on Restless Multi-Armed Bandits for Improving Maternal and Child Health

arXiv: https://arxiv.org/abs/2604.07384 · HTML: https://mlsanity.com/paper/2604.07384/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 39 references that are in the map.
- First posted on arXiv 8 Apr 2026.

## Builds on (most cited first, 10 of 10)

- [Melding the Data-Decisions Pipeline: Decision-Focused Learning for Combinatorial Optimization](https://mlsanity.com/paper/1809.05504/) (2018)
- [Personalized HeartSteps: A Reinforcement Learning Algorithm for Optimizing Physical Activity](https://mlsanity.com/paper/1909.03539/) (2019)
- [Field Study in Deploying Restless Multi-Armed Bandits: Assisting Non-Profits in Improving Maternal and Child Health](https://mlsanity.com/paper/2109.08075/) (2021)
- [A Decision-Language Model (DLM) for Dynamic Restless Multi-Armed Bandit Tasks in Public Health](https://mlsanity.com/paper/2402.14807/) (2024)
- [Learning to Prescribe Interventions for Tuberculosis Patients Using Digital Adherence Data](https://mlsanity.com/paper/1902.01506/) (2019)
- [Scalable Decision-Focused Learning in Restless Multi-Armed Bandits with Application to Maternal and Child Health](https://mlsanity.com/paper/2202.00916/) (2022)
- [Towards a Pretrained Model for Restless Bandits via Multi-arm Generalization](https://mlsanity.com/paper/2310.14526/) (2023)
- [Optimizing Vital Sign Monitoring in Resource-Constrained Maternal Care: An RL-Based Restless Bandit Approach](https://mlsanity.com/paper/2410.08377/) (2024)
- [Beyond Listenership: AI-Predicted Interventions Drive Improvements in Maternal Health Behaviours](https://mlsanity.com/paper/2507.20755/) (2025)
- [Decision-Focused Evaluation: Analyzing Performance of Deployed Restless Multi-Arm Bandits](https://mlsanity.com/paper/2301.07835/) (2023)

## Abstract (arXiv)

Maternal and child health is a critical concern around the world. In many global health programs disseminating preventive care and health information, limited healthcare worker resources prevent continuous, personalised engagement with vulnerable beneficiaries. In such scenarios, it becomes crucial to optimally schedule limited live-service resources to maximise long-term engagement. To address this fundamental challenge, the multi-year SAHELI project (2020-2025), in collaboration with partner NGO ARMMAN, leverages AI to allocate scarce resources in a maternal and child health program in India. The SAHELI system solves this sequential resource allocation problem using a Restless Multi-Armed Bandit (RMAB) framework. A key methodological innovation is the transition from a traditional Two-Stage "predict-then-optimize" approach to Decision-Focused Learning (DFL), which directly aligns the framework's learning method with the ultimate goal of maximizing beneficiary engagement. Empirical evaluation through large-scale randomized controlled trials demonstrates that the DFL policy reduced cumulative engagement drops by 31% relative to the current standard of care, significantly outperforming the Two-Stage model. Crucially, the studies also confirmed that this increased program engagement translates directly into statistically significant improvements in real-world health behaviors, notably the continued consumption of vital iron and calcium supplements by new mothers. Ultimately, the SAHELI project provides a scalable blueprint for applying sequential decision-making AI to optimize resource allocation in health programs.