The Right Blend of Technology | Improving health outcomes for underserved women and children through optimal mix of “tech” with “touch”

Swati saxena & Kruti dalal | ARMMAN

The only thing that can be even remotely considered as a silver lining in this pandemic is the stark and unrelenting spotlight shone on persistent gaps in healthcare in India. While those within the health system valiantly fought to provide the best care possible within limited resources, the fact remains that the system itself is grossly inequitable, especially for underserved pregnant women and children.

Inequitable health care system

Even today, 3 women die every hour because of pregnancy-related complications. Only one of five pregnant women get complete antenatal coverage while 18% infants have low birth weight, leading to complications that prevent them from realising their full potential. Adding to this is the acute shortage of medical staff. India has 37.6 health workers for every 10,000 people, against WHO’s minimum recommendation of 44.5.

The sheer size and scale of India’s problems requires an equally bold response, one that can serve its huge population and remain resource-light. Technology, thus, promises a powerful solution

Ramesh Padmanabhan, ARMMAN’s CEO

Promise of Tech-enabled Solutions

25-year old Anita stays at a Mumbai slum. During her fourth month of pregnancy, when she went for a checkup at the nearby hospital, she was enrolled in ARMMAN’s mMitra program. She started receiving bi-weekly pre-recorded mMitra calls on her phone, in her mother tongue. mMitra calls guided her on important vaccination milestones, provided nutrition-related information, and made her aware of danger signs and symptoms. Mobile technology allows this potentially life-saving and critical information to reach each woman, something not feasible at an overcrowded hospital. 2.5 million women like Anita have been enrolled in mMitra, making it one of only five such scaled mHealth programs across the world.

Rapid Response of Tech-Solutions during COVID

When COVID-19 struck, as a pregnant woman living in a slum, Anita was especially vulnerable. Thus, when she started getting additional mMitra calls with COVID-19 specific information, she paid close attention and followed the advice regarding sanitization and social distancing. This helped her as she couldn’t access a hospital for regular care as it was converted to a COVID hospital and there was limited public transportation to go to another centre. Technology enabled ARMMAN to reach 300,000 women and 800,000 health workers within a few days.

“Touch” Integration Critical in Tech-Solution

Technology by itself is inadequate and requires a strongly interlinked “touch” model to be effective. In her ninth month of pregnancy, Anita started experiencing acidity and frequent headaches.She reached out to Shital, ARMMAN’s hospital supervisor, for advice, who connected her to a doctor at its free Virtual clinic. The doctor diagnosed it to be a consequence of high blood pressure- a high-risk condition that requires monitoring. Anita’s blood pressure was immediately checked and brought under control with timely intervention. While mMitra calls were critical, access to a doctor and the hospital supervisor’s support was just as crucial during this daunting time.

Importance of Contextualised Tech-Solutions

With technology, it’s also tempting to deploy a cookie cutter approach, which has challenges in a country as diverse as India. “An mMitra, working well in an urban slum with good network connectivity, may falter in tele-dark tribal areas like Palghar that is just 4-hours drive from Mumbai. Here, a stable network is limited to certain public spaces in the larger villages, with smaller hamlets often falling off the connectivity grid. Telephonic coverage is almost certainly not available in the kitchens at the back of the houses or in the cowsheds where women generally spend most of their day,” mentions Mr. Padmanabhan. Thus, pregnant women and children are supported with door-step healthcare through ARMMAN’s Arogya Sakhi project. Frontline health workers from the community are trained to provide home-based preventive care. They counsel women on topics like nutrition and vaccinations, perform diagnostic tests, screen for high-risk factors and ensure early referral. They are aided by a tablet with an application-based decision support algorithm which acts as a database and flags off any high-risk conditions, thereby alerting the health worker of any possible complications during pregnancy and infancy. The technology is designed to function in a low-bandwidth setting and mobile hotspots created for limited access to data.

Danger of Technology Exacerbating Inequities

Although technology is a great enabler for transformation, it can also act as a barrier by deepening divides and exacerbating existing inequities. For example, digital-first solutions will not work where people lack access to even a basic mobile phone, or with a large migrant population that frequently changes its number. Here, it is imperative to adopt an equity lens while designing tech-enabled solutions to ensure that technology does not end up excluding the most vulnerable and marginalised i.e. the very group of people the intervention aims to uplift. It is also crucial to understand the interventions of other civil society organizations in the area, and explore possible avenues of collaboration to achieve the most effective outcomes.

The “tech plus touch” model can go a long way in addressing systemic gaps, but implementing truly impactful and equitable health initiatives requires multi-stakeholder input, innovative approaches and a design that keeps the mother and child at the centre of all solutions.

ARMMAN is one of the 10 organisations that has been covered as a case study in the report titled ‘Buffering Now’, published by the 10to19 Dasra Adolescents Collaborative. This report spotlights organisations that have had a head start when it comes to leveraging digital technologies in a pre-Covid world, and thus sharing learnings and recommendations for organisations that want to adopt to digital tools and technologies amid the pandemic to serve their communities.

Photo Credits: ARMMAN

Reference Example for easy understanding

Table 1

The policy gap(s) addressed by the program

The exclusion of young people in the decision-making process for policy issues surrounding adolescents

Community need(s) addressed by the program

Greater awareness and understanding of adolescent issues regarding their education, sexual and reproductive health, and early marriage

Opportunity for innovation addressed by the program

The opportunity to bring and work together with critical stakeholders on a single platform

Table 2

Day-to-day program activities

Stakeholder management, vendor management

Periodic program activities

Monitoring, Reporting, Training of Personnel

One-off program activities

Government advocacy, designing campaigns

Tools/frameworks/systems & processes/ways of working from the program

Systems Change Framework

Table 3

Program practices

Is the practice impactful? If yes, list down why?

Is the practice sustainable? If yes, list down why?   

Is the practice scalable? If yes, list down why?  

Is the practice innovative and/or unique? If yes, list down why?  

Youth-led social audits and presenting youth-centric priorities directly to decision makers

Yes, as it allows young people to directly engage with decision makers and contribute to the decision-making process

Yes, as it equips young people with leadership skills. It is also cost effective due to the long-term gains it offers upon initial investment

Yes, as such training modules can be replicated across multiple initiatives by other practitioners & organizations. In addition, trained young people can also train other young people

Yes, as it follows an approach which centers its design and delivery around young people, in an end-to-end manner

+

+

+

+

+

Table 4

Promising Practice

Youth-led social audits and presenting youth-centric priorities directly to decision makers to: (i) create a platform for youth to exercise their agency (ii) effectively engage decision makers

Source

  • Verbal evidence from community
  • Verbal feedback from on-ground team members
  • Project report & surveys

Details

Community feedback of adolescents feeling confident, understood, and acknowledge

On-ground team feedback on creation of government champions for the project’s objectives

Project report and surveys observe greater youth involvement and efficacy in engaging directly with decision maker

Table 5

RECOMMENDATIONS

Promising Practice

Youth-led social audits and presenting youth-centric priorities directly to decision makers to: (i) create a platform for youth to exercise their agency (ii) effectively engage decision makers

The demographic it addresses

Adolescents from the age of 10 to 19 years

The gap/ need/ opportunity it addresses

The exclusion of adolescents and young people in the decision-making process for policy issues regarding adolescents and young people

Govt stakeholders

Holding consultations with critical stakeholders and young people from the inception of a program

Funders

Taking inputs from all stakeholders and young people before initiating a new project to ensure a deeper visibility and understanding of their demographic and its needs

Other Practitioners

Engaging young people in decision-making processes to adopt a more collaborative approach between stakeholders and young people

Community Stakeholders

Undertaking youth-led social audits and engagement with decision makers to engage directly with young people, understand their needs & concerns and influence change at the community level

5

Objective Review

Outcome

Promising Practices and recommendations ratified by at least one member/ partner organization/ community/ MEL partners outside of ‘the team’

5

Objective Review

Objective

To validate the final promising practice and recommendation(s) by at least one person/ partner organization/ community/ MEL partners outside of the team.

4

Document

Outcome

2-3 promising practices documenting:

 

  • What gap/need is addressed
  • How it is addressed and the change that is created
  • The potential for replicating along with recommendations for implementing

4

Document

Objective

To document the promising practices in a detailed manner

3

Develop into a recommendation

Outcome

Well-articulated recommendation(s) addressing:

 

  • Demographic to cater to
  • Gaps/needs/opportunities addressed by the practice
  • The change brought in by implementing such a practice

3

DEVELOP INTO A RECOMMENDATION

Objective

To construct a recommendation in a brief, specific and clear-cut format which would assist other initiatives in implementing the same

2

CALIBRATE & SUBSTANTIATE

Outcome

Obtaining qualitative and/or quantitative data to assess the promise of the shortlisted practices according to the five guiding factors

Arriving at first list of promising practices

2

CALIBRATE & SUBSTANTIATE

Objective

To substantiate the shortlisted practices by collating gathered data in the form of:

 

  • Feedback from the community
  • Verbal accounts of the ground team
  • Documentation reports
  • Other valuable data

1

List & Shortlist

Outcome

Identifying:

  • Policy gaps
  • Community needs
  • Opportunities for innovation and other aspects that the program is addressing.

    Creating a list of program practices that are working on-ground in bridging gaps/needs/opportunities.

1

List & Shortlist

Objective

To identify gaps/needs/opportunities and to shortlist program practices that are impactful, sustainable, scalable, innovative and/or unique.