Technology enabled transformation of human potential for saving lives in most deprived settings with enhancedskills, scale and speed
In this era of ever expanding technological advancement in India, an overwhelming number of mother and children still face the challenges of survivale specially amongst tribal communities. Anaemia, low birth weight, malnutrition,diarrhoea, pneumonia, add on to this quest of survival further impeding opportunities to thrive in life Therefore, investments to ensure optimum health services delivery to each citizen through suitable initiatives are needed by the government to gain holistic development including the remotest belt.
JanSwasthaya means public health. Any nation without healthy citizen,especially women and children, can not grow to its full potential. Over they ears, many interventions have been tested and found very useful for not only saving the lives of women and children, but also to make them grow to their fullest potential. The state and national governments have developed policies to provide these evidence based interventions even in the remotest area of the country, including Rajasthan.
However, these services are mainly delivered by a government hired woman staff known as the Auxiliary Nurse Midwives (ANM) in the rural area. Delivering these interventions by an ANM is a difficult easy task in the complex ecosystem, cultural and traditional social fabric of the rural Rajasthan. There still remain multiple obstacles related to:-
- Poor Inter personal counselling skills and sub optimal use of job aids which are often bulky and difficult to carry during home and community visits.
- Poor skills of ANM despite multiple trainings.
- Decision regarding the health of the women and children is either taken by the family or by societal elders who are rigid in their beliefs, fail to spot the importance of the required care. The delay makes the situation worse causing even death.
- The ANM does manual updation of records which is a tedious process.
- Most of the preventive and promotive healthcare interventions depend on the communication between the family members and the ANM which often gets neglected due to weak skills of ANMs.
- Despite huge investment in setting up of monitoring mechanisms, it remains weak due to low quality and incomplete data.
ईJanSwasthya is an android-based application developed for National Health Mission Rajasthan, by an innovation hub set up at State Institute of Health and Family Welfare (SIHFW)with the technical support of UNICEF Rajasthan which has transformed the functioning as well as thoughts of the ANMs from number to quality.
This was initiated with 15 ASHAs in one of the most deprived district Barmer and then advocated with the partners and district administration of various districts. In district Dungarpur‘ Save the Children’ is implementing through their resources where 60ANM and 60 ASHA are using this application. In Pali, it started with 8 ANMs and now 120 ANMs are working.In Jhalawar district it was started at one PHC with 8 ANMs. The Chief Minister of Rajasthan witnessed the application being used by ANMs on at Jhalawar district and announced for the pilot in seven districts of Rajasthan in her budget speech.
ई JanSwasthya Application
This is an android based application and includes the key interventions delivered by ANMs and ASHAs in the rural areas.
1.Improved Interactive Client Centric Communication to facilitate actions at the community and Family Level:
It will facilitate decision at community and family level on the basis of information collected in analysis and preparing the automated key message to be communicated to the pregnant women, mothers of the young children and their family members. It also helps in better communication of messages which are auto-generated depending on the situation, providing a client centric communication and also use of Videos for communicating messages as a powerful tool.
2.Enable ANM and Frontline functionaries to deliver life saving services with quality and improve Effectiveness
The application covers key components of care during pregnancy, care after birth for mother and newborn, care of young children with monitoring and tracking of their growth. It helps in timely identification of deviation from normal progress during pregnancy and after child birth.. It also helps in tracking the growth of every child leading to timely identification of undernourished children.
3. Empower ANMs and Front line functionaries in generating evidence based work plan and list of due beneficiaries:
It generates the work plan and due-list for ANMs so that no woman and child are left. Most often ANMs forget to provide services to the eligible couple using family planning methods. This application automatically reminds both the user and ANMs regarding services to be provided for family planning to the eligible couples also tracking their preference towards contraceptive and its use. It keeps record of all eligible couples requiring any type of contraceptives.
4. Every Child Counts
Denominator based tracking of every women and child in ANM or ASHAs area will help in counting and reaching to the most deprived and also track the left outs.
5. Transparent Performance-based monitoring
Transparent performance based monitoring can contribute in keeping the staff motivated and also identifying under performers. An automated star rating / grading system based on the denominator and achievements will be calculated,which can be seen both by the worker and supervisors.
6. Simplified Reporting mechanism
Form 6: Most of the time ANMs face difficulty in preparing form 6 report because the records collect the information on area basis,while reports need to be service based for that particular sub-centre unit. E Janswasthya addresses this by a form 6 which can be filled during MCHN Day (VHND) and auto compilation would generate a form 6, which can be submitted for digitisation at the PHC level.
7. Reminder to beneficiaries and service providers
To improve coverage and continuous utilisation of key Maternal New born and Child Health interventions an automated SMS will be generated at the time of registration as well as two days prior to next due date.
The initial results from the field confirm the robustness of the application as well as ease of use by lesser educated front line functionaries who are successfully tracking 1500 pregnant women, 650 children and 32000 eligible couples. In phase one given the preliminary results,the Government of Rajasthan has prioritized the distribution of tablets to 1500 ANMs aimed at reaching 20000 pregnant women and 100000 children below 5 years. E Janswasthya is being considered for replication in other states by Govt of India. The Government of Chhattisgarh also showed interest inusing this approach.
Successful implementation of ईJanswasthya by India would be apioneering step towards delivering health services in remotest are asusing technology aboard Digital India Platform.