In 1996, Aparna Hegde was a resident doctor at Sion Hospital, one of Mumbai’s largest public health facilities, when a woman who had just delivered a baby was rushed into emergency care.
“The baby was dead, it’s body stuck inside”, recalls Hegde. The woman too died a few days later.
“She was given a cursory check at her first antenatal visit and not told about potential complications and the need for regular check ups. She developed gestational diabetes in the sixth month.”
Such preventable deaths, Hegde soon realized, were far too common.
“The antenatal OPDs were extremely crowded so there was just enough time for a quick examination,” she says. “We could not offer any counseling. Nothing is worse than to see a woman dying in labour and to realize that you did not give her the information that could have saved her life. Doctors, the government and public health professionals preach that women must come to hospitals for antenatal care, but when they do we fail them.”
These experiences led her to conceive of mMitra - a free mobile voice call service that gives information on preventive care and simple interventions to reduce maternal and infant deaths. The messages are specific to the stage of pregnancy or the baby’s age. They are given in the language of choice and sent weekly or twice a week.
mMitra helps reduce maternal and infant deaths
Launched in late 2014, mMitra services are available at 23 municipal hospitals in Mumbai. Nearly 1.5 lakh women have enrolled so far and Hegde hopes to reach 5 lakh women by 2016.
“We have a health worker in every hospital that enrolls women when they come for the first antenatal visit”, says Hegde, who is a fulltime doctor and heads ARMMAN, an NGO behind several maternal health initiatives. “We also partner with NGOs in slums to reach out to women who register late into the pregnancy and miss out on care during the initial months.”
Apart from high enrolments, there are promising signs of behaviour change in areas where mMitra is available.
“Slums at Nallasopara, outside Mumbai city, used to report very high rates of home births. Now they are down to zero”, says Hegde.
In a country that accounts for 17 per cent of maternal deaths worldwide, information and communication technologies (ICTs) hold out immense possibilities. The existing health infrastructure is clearly inadequate. There are 19 health workers for 10,000 people against the 25 prescribed by the WHO. Rural areas are home to 70 per cent of the population but have 30 per cent doctors and 3 per cent specialist physicians.
“ICTs can transform delivery of health education, help in behavior change communication, training of health workers, and enable an overall health system management”, says Akanksha Malhautra of Dasra, a strategic philanthropy organization that is working on a report on the role ICTs can play in improving reproductive maternal newborn and child health (RMNCH) in India.
A health worker using Mobile Kunji card to guide a mother
The high mobile penetration helps with greater access to rural populations adds Malhautra. It is also cost effective and generates awareness about government and other health financing. Through the report Dasra wants to highlight the potential and challenges in this sector, and to drive funding to organizations that are using ICT solutions in an impactful manner.
Similar to mMitra is Kilkari, a voice messaging service in operation across Bihar. It delivers time-sensitive information to pregnant women, mothers of young children and their families from the last trimester up until the child is a year old.
Kilkari was launched in 2013 under the Ananya program, a joint partnership between Bill and Melinda Gates Foundation and the Bihar government that is working towards improving RMNCH and nutrition outcomes. Over one lakh people in the state have subscribed to Kilkari so far.
Nearly 90 per cent of Bihar’s population is in rural areas with limited access to traditional media, which makes delivery of critical health information difficult, says Usha Kiran Tarigopula of the Bill and Melinda Gates Foundation. In such a scenario community health workers play a critical role in delivering information on ante and post-natal care and interventions like breastfeeding.
“A 2011 benchmark survey revealed that 97 per cent of CHWs have access to a mobile phone so we have developed innovative tools, including mobile health technologies to help train, track and coordinate their efforts”, says Tarigopula.
Setting up an infrastructure that involves six operators including Airtel, BSNL, Idea, TATA, Reliance and Vodafone, who together provide nearly 90 per cent of the coverage, has enabled a wide reach.
Another device is Mobile Kunji, an IVR-based service that comes with a set of printed cards. Every card has a unique short code on it corresponding to a message. Health workers play the message, voiced by a character called Dr. Anita, to the family via their mobile phones, by dialing a number.
However, technology alone can do little and has to be matched by an improvement in health systems.
“ICTs can help remind a mother to get her child vaccinated, but not ensure availability of doctors and vaccines at the health center”, points out Malhautra.
As the Dasra report says, 10 per cent of India’s villages are not reached by any kind of mobile network. Issues like lack of digital infrastructure, mobile and broadband connectivity and digital literacy have to be addressed to enable an ICT revolution in health to kick off in India.
Shai Venkatraman is a Mumbai-journalist and blogger who writes about issues related to public health and gender equality, on her blog, Healthy Living, a part of Business Standard’s platform, Punditry.
She tweets as @shaivenkat