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.
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
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.
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.
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.
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.
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