Originally published on Medium
Authors: Madison Lawson, Satish Srivastava, Vandana Mishra
What is mobile health (mHealth) to you? Is it something you associate with your regular doctor visits? Or something you picture as the future of health systems? For Uttar Pradesh, India, mHealth is becoming the norm, and the mHealth intervention supporting community health worker programming has received the green signal to scale up to five districts covering a population of nearly 18 million, recognizing the value of this evidence based intervention.
National Health Mission (NHM) in Uttar Pradesh employs ASHAs, or Accredited Social Health Activists, as community health workers to bridge the gap between rural households and the health system for effective health services in remote rural locations. With the objective to reduce preventable maternal and infant deaths, the network of ASHA volunteers extends support to households through enhancing knowledge on proper health practices for improved maternal and child health, through family contacts, counselling, and resolving concerns on acceptance of services. In initial stages of ASHA programming there were many apprehensions due to low literacy levels of ASHAs themselves and poor management structure with inadequate role clarity. However, the initiative's potential continued to stand out as time progressed. With proper supervision and tools for compliance set in place, the community health worker's effectiveness increases, delivering improved outcomes.
To provide support to enhance performance of ASHAs, National Health Mission (UP-NHM) introduced ASHA Facilitators, namely, ASHA Sanginis. Under the CRS ReMiND (Catholic Relief Services Reducing maternal and newborn deaths) project, UP-NHM and CRS equipped ASHAs and their facilitators with Android Devices to create a supportive environment for structured household counseling and tracking uptake of health services. The ASHAs mobile phone device supports a checklist for client assessment, including identification of pregnancy or postpartum complications to provide accurate referral services, and plays audio messages for counselling on proper and up-to-date prenatal or antenatal care techniques. For the Sanginis, the mobile software provides appropriate guidance and mechanisms to assess ASHA performance for decision-making and providing necessary support. Introducing the ASHA facilitators app led to ease of operation through this distinct mobile phone-based application. With the help of app developer Dimagi Inc, and local organizations Vatsalya and Sarathi Development Foundation, the mobile-application supported managing results for ASHA performance:
40% increase in proportion of ASHA Sanginis who guide ASHAs, in tasks they could not complete the previous month
46% increase in proportion of ASHA Sanginis who discuss with ASHAs their coverage of marginalized community members
56% decrease in proportion of ASHAs reporting families who are resistant to their messages and support
How can a mobile app make such a difference?
There are over one billion mobile phone subscribers in India. Utilizing such penetrative digital technology was not only innovative, but convenient. mHealth is no longer associated with advanced and tech-savvy areas, but has proven to be useful and effective even for the most remote villages.
Not only does the mobile application eliminates inconsistencies often found in paperwork, but more importantly, it allows for real time data to be analyzed for data-informed decision making. With the connectivity provided by a mobile device, data is collected in real time, uploaded to online dashboards, and visualized by stakeholders and government officials. Such live updates promote transparency and provide necessary statistics for enhanced healthcare programming at the district and state level.
Subsequently, ASHA performance data is used for providing feedback and guidance to enhance program quality. The mobile app allows for remote monitoring of ASHAs and targeted follow ups. In analyzing ASHA performance data, Sanginis are able to provide better advice and guidance, inclusive of accurate reporting of maternal and infant deaths, high risk pregnancies, and tracking of ASHA drug kits. With strengthened capability and increased accountability, ASHAs and Sanginis are motivated to perform and better equipped to enhance healthcare services to the local communities.
The success of this mHealth intervention resulted in vital acknowledgement from the state and national government. The Sangini intervention has been awarded as one of the 'good, replicable practices and innovations in public health care systems in India'. In light of this National Health Mission, Uttar Pradesh has received an approval to upscale this intervention in five more high priority districts of the state. CRS has signed a memorandum of understanding with NHM to provide technical support in scaling the Sangini program. The scale up will encompass 523 ASHA Sanginis, providing supportive supervision to 10,385 ASHAs and covering a population of 17.7 million people. Scaling up reveals the importance of this collaboration between effective mobile based ICT mechanisms, district and state governments, and NGOs to provide enhanced quality health services to remote communities in need.