Through effective implementation of health related services, Gujarat is writing a new chapter in healthcare. Anju Sharma, Mission Director (NRHM), Gujarat, in this freewheeling interview with Dhirendra Pratap Singh, shares her perspectives on various healthcare issues in Gujarat

What is your assessment of the health sector in Gujarat today?

Gujarat has been an enthusiastic in bringing quality healthcare to its people. The state has programmes such as Chiranjeevi & Balsakha Yojana (PPP), 108 EmergencyTransport and e-Mamta Mother & Child tracking (IT application). We have district quality accreditation boards- Quality Assurance Group (QAG), Quality Improvement Programme (QIP), NABH. Gujarat is also the first state with accredited PHCs in tribal areas . The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna, a unique PPP initiative that serves BPL and tribal mothers. There is an evident reduction in number of maternal deaths. We have saved approximately 893 mothers.

The Bal Sakha scheme has private pediatricians or trust hospitals providing free of cost expert care to newborns for up to one month. The emergency ambulance 108, initiated in the year 2007, answers 99 percent calls and so far has attended more than 15, 51,718 emergencies.

How effective do you think the state government has been in improving healthcare?

With the goal of improving the Human Development Index, the Government of Gujarat has celebrated the last year as its Golden year. The Millennium Development Goals 4 and 5 of reducing maternal and child mortality are the Swarnim Gujarat goals. There is massive effort being made to reduce infant mortality and immunize children against measles. The reduction in maternal mortality can be achieved through institutionalisation of deliveries. The focus of the Health and Family Welfare Department is to bring down the infant mortality and maternal mortality rates as envisioned by the National Rural Health Mission (NRHM).

How do you propose to bring down the MMR, IMR and Total Fertility Rate (TFR) in Gujarat? What is the role of ICT in improving healthcare scenario in Gujarat?

Innovation in healthcare delivery is important because there are challenges related to delivery, affordability and quality of services. e-Mamta, mother and child tracking web based application, is uniquely designed management tool, which aims at registering individual pregnant mothers, as well as children in the age group of 0-6. The idea is to ensure complete service delivery of antenatal care (ANC), child birth, post natal care (PNC), immunisation, nutrition and adolescent services. It also provides a management tool to the service providers at the grassroots level to determine the potential recipients of the services along with their details, through comprehensive work plans. Finally, the services are aggregated to generate reports that are reliable and valid. The approach is therefore to plan, deliver and monitor, in a proactive rather than reactive way.

In Integrated Disease Surveillance Project (IDSP), we are using ICT for disease surveillance and forecasting epidemics. Gujarat is front runner in implementation of IDSP. State has successfully developed web based weekly surveillance system capable of forecasting an epidemic. Analysis of weekly surveillance data on regular basis, and providing feedback to reporting units has lead to containment of diseases ultimately reducing mortality and morbidity. In eMamta, we are tracking each mother and children through ICT.

Reaching out is main challenge in deploying new technology in health sector. We have to reach out to the grassroots level to cater to the ultimate beneficiary at their door step. Another, big issue is data quality. If the data quality is not there, then you are not able to achieve the results that reflect reality.

Anju Sharma
Mission Director – National Rural Health Mission, Gujarat

What kind of reengineering is needed for the effective implementation of ICT in healthcare? Please elaborate challenges in deploying new technology in health sector?

Like any other sector, we require data integration in health sector. We need to integrate the data where we can get one point information. Reaching out is main challenge in deploying new technology in health sector. We have to reach out to the grassroots level to cater to the ultimate beneficiary at their door step. Another, big issue is data quality. If the data quality is not there, then you are not able to achieve the results that reflect reality. Third is data convergence, bringing the entire data under one umbrella is also a challenge.

What steps should be taken to ensure healthcare for all?

As for as IT roadmap is concerned, we have to see it in terms of various levels of service delivery. The issues and challenges at primary, secondary and tertiary care level are different. There is a need to handle these challenges effectively in coming period to mitigate and to deliver adequate health response. At primary level, the issues are in terms of public health delivery and basic maternal and child health (MCH) services. At secondary and tertiary level, of the issues relate to maintaining patient information for better patient management

How much do you think mHealth will contribute to healthcare in the coming years? What is the current status for mHealth in Gujarat?

There are unlimited opportunities for using mobile phones in implementing mHealth in hospitals, insurance and pharma companies. With increasing urban and rural tele-density, we in India, should certainly be poised, to incorporate mHealth into the very fabric of our healthcare delivery system. The opportunity for mHealth has been stimulated by a number of factors, which include technological innovation relating to systems integration, improvements in wireless networks, mobile handset innovations, and the continued growth of mobile phone subscribers. In eMamta we are using sms alerts. Socially optimal demand level in healthcare can be reached through mHealth. In health sector, a lot of patient councilling is required and mobile technology is very helpful in that. The adoption of mHealth globally has initially been based around healthcare information and alerting using SMS as a medium, this is a proven model in India, however with the emergence of smart phones this traditional model is going through some rapid change.

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