In a country of over 1.3 billion people, health issues that affect even a small percentage of the population can become major humanitarian concerns. Such is the case in India, where health problems have ranged from a lack of qualified medical staff, to employee absenteeism, to an insufficiency of resources and supplies.

Women and very small children are disproportionately affected by these deficiencies. Low birth weight among newborns, growth stunting in children under six years old, and anaemia among women aged 15–49 are some of the persistent – and avoidable – health problems that desperately need addressing.

Now, India’s Ministry of Women and Child Development is leveraging mobile health technology to try to turn the situation around. Its POSHAN Abhiyaan program, with funding and resource investment from the World Bank, directly targets low birth weight, stunting and anaemia by equipping its 1.4 million community health workers with technology to improve registration to health programs and the deployment of the right care to the most vulnerable groups.

While  health tech is crucial to delivering better care to women and children, it creates its own set of challenges that the Ministry now have to tackle: how can it consistently manage and update its software, and how can it stay on top of the huge amount of data that it is collecting?

A new system

The first step in overhauling the healthcare system in four states in India was dealing with the issue of access: how could health workers reach the most vulnerable and marginalised women and children?

This is where the technology came in. An innovative Common Application software called ICDS-CAS uses a mobile app and a web dashboard to allow the health workers – called Anganwadi workers – to register all the families in their catchment area.

Once all families have been registered, the Anganwadi workers can work to identify all pregnant and lactating women, as well as children ages 0-6, who represent where the gaps in adequate care have been.

While it may seem simple, universal registration was nearly impossible before the mobile and web app. Now, all pregnant and lactating women, as well as children, are automatically registered to receive further services, creating a neat list for health workers to use in their visits.

"The very nature of these improvements also creates fresh challenges."

The technology also auto-generates priority home visits based on the demographic data collected at registration. The World Bank’s Mohini Kak explains how this works in practice: “If a child is 6 months old, the tool will encourage the worker to visit the household to advise them on initiating complementary feeding. This ensures counselling and home visits by Anganwadi workers are done [in a] timely [fashion] and are focused on critical messages relevant for that time period.”

In addition to improving health workers’ ability to offer relevant and specific services to those who need it most, the ICDS-CAS technology addresses the issue of quality control among the health workers themselves. With the technology, the Anganwadi workers’ performance is more easily and objectively assessed.

The data collected also allows managers to set incentives set for the health workers: for example, they may get a financial bonus for ensuring monthly growth monitoring of at least 60% of children under 2 years of age, and completing at least 60% of their mandated home visits.

The challenges

While this technology has brought new efficiencies to a desperately outdated system, the very nature of its improvements also creates fresh challenges.

Mohini Kak says that the Ministry responsible for the project is still trying to work out how to create a reliable system for managing and updating the software that so many people now depend on.

On top of that, the system now generates huge volumes of data that will be generated from the 1.4 million Anganwadi workers. This is a hugely important development, but creating a mechanism to use the data for better decision making is a daunting new IT project in and of itself. The Ministry aims to tackle it by eventually building a devoted IT cell, but this will take a large amount of time and investment to get off the ground.

Nevertheless, POSHAN Abhiyaan is already among the largest ever distributions of mobile technology for public health benefits in the world. The next steps of data use and better IT management – difficult though they are – will allow the technology’s effect to reach its full potential. — Megan Dent

(Picture credit: Eddy Milfort/Flickr)

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