Digital Health

Sangoshthi

In developing countries, particularly rural areas, there is a high rate of home deliveries and a lack of skilled care during the initial weeks after childbirth, leading to a significant number of neonatal deaths. The World Health Organization (WHO) recommends the use of Community Health Workers (CHWs) to provide home-based care in these countries. CHWs are local individuals who are selected and trained to improve basic healthcare access and educate the community. In India, under the Home Based Post Natal Care (HBPNC) program, Accredited Social Health Activists (ASHAs) are mandated to make regular home visits to new mothers and promote globally approved newborn care practices. These home visits have been proven effective in improving the health of newborns. However, studies have shown that ASHAs require regular refresher training and innovative strategies to enhance their skills. Technology-enabled health education is seen as a viable solution to train ASHAs and the community, but there are challenges in rural areas such as financial limitations, low literacy rates, poor infrastructure, and weak internet connectivity. To address these constraints, a low-cost training and learning platform called "Sangoshthi" in collaboration with Indraprastha Institute of Information Technology (IIIT) was proposed for CHWs in low-resource settings. Sangoshthi was built on the existing work of Sehat ki Vani, which has been revamped and renamed as Citizen Radio for better stability in low-bandwidth internet contexts. Sangoshthi programme was organised in 2 phases---- Sangoshthi 1.0 and Sangoshthi 2.0.

The main objectives of Sangoshthi 1.0 were to check the Feasibility, Efficacy and usability of the programme. Sangoshthi 2.0 was conducted to train 500 ASHAS on Home Based Postnatal care (HBPNC), to find out the gain in knowledge of ASHAs after training and to identify the strongest and weakest points of the training.

For Sangoshthi 1.0, SWACH identified ten topics on HBPNC which were aligned with the National Rural Health Mission (NHRM) training course material which focused on important elements of day to day care which are often missed in ASHA training. In total, 40 ASHAs were selected from two districts of Haryana for knowledge testing on these topics, with 20 ASHAs serving as a control group. All selected ASHAs were at least 10th grade pass and between the ages of 26 to 50 years. Out of the 40 ASHAs, 11 owned smart-phones and 29 had low-end feature phones. Two female SWACH employees were chosen as hosts, while the head of SWACH (an expert pediatrician with 45 years of experience) acted as the expert for the training sessions. The selected ASHAs were randomly allocated into two groups--- the treatment group and the control group. The treatment group received a training intervention consisting of 12 shows on the 10 chosen topics, which were delivered over a period of 22 days. The shows were hosted three times a week, within a fixed time slot from 2 pm to 3:30 pm. This timing was chosen based on the preferences of the majority of the ASHAs. All shows were hosted from the SWACH office, with the expert and two hosts physically present together. Additionally, a dummy listener from the SWACH staff was recruited to indicate any voice-related problems during the live shows.

Read More

Development and pilot test of a mHealth Interactive Education and Social Support Intervention for Improving postnatal care

Postnatal health care includes education and clinical care necessary for ensuring maternal and infant health: neonatal care practices (breastfeeding, newborn hygiene, etc.), prevention activities (immunization, recognition of infant danger signs, etc.), and assessment of maternal physical recovery from childbirth, postpartum mental health, and postnatal contraception adoption.

Postnatal care improves maternal physical and mental health, and wellbeing. Extending group-based pregnancy care or women’s group models that have proven successful in improving maternal and neonatal outcomes in South Asia and elsewhere to the postnatal period could show health improvements. However, barriers exist to successfully implement postpartum group care, including logistical challenges of traveling to the facility or group meeting with a young baby and limited mobility in South Asia, including postnatal seclusion. Applying an mHealth approach to postnatal care may help new mothers overcome such challenges, and high mobile phone penetration in Haryana state, India, supports the feasibility of testing a group mHealth intervention in this population. Most mHealth interventions for maternal and child health (MCH) in low and middle-income countries, including India, have focused on unidirectional and non-interactive approaches, primarily text messaging. However, ample evidence suggests that provider-led, interactive educational programming and social support are key for improving health behaviors and outcomes. It was proposed to develop a mobile interactive education and support group intervention, Maa Shishu Swasthya Sahayak Samooh (MeSSSSage), to improve the health and well-being of Indian women and infants in the postnatal period using a provider-moderated group approach with aims to reduce postnatal care barriers arising from distance, economic burden, cultural practices, and fatigue, and provide social support in this time to help reduce women’s postpartum isolation.

Read More

Strengthening of Home-Based Essential New-born and Maternal Health Care by ASHAs in Haryana Using Mobile Phone Technology

Background:

Since the inception of NRHM (2005), a lot of progress has been made in the field of maternal, new-born and child health in Haryana. Despite many efforts, there has been slower than expected decline in new-born mortality rate in the state. The training of all levels of health care providers including ASHAs has not lead to a change in key practices and behaviours that determine favourable outcomes. Reporting of vital events continues to be unsatisfactory and the current reporting system does not lend itself to timely action, if there are problems. SWACH had an experience of working in villages of Bilaspur using mobile phone technology in the form of phone calls and messages in SMS which were extensively used to collect information on vital events, capacity development of ASHAs, follow up of new-borns and solving problems of the families and ASHAs. As a result, reporting of births, deaths, still birth and abortion improved. This was shared with Mission Director, NRHM, Haryana and his team in the state and the district and expressed their willingness to implement it in a backward block Chhachhrauli in district Yamunanagar on a pilot basis.

Objectives:-

  • To register all the pregnancies and outcomes of pregnancy
  • To follow-up the new-born through home visits by ASHAs as per the guidelines of HBPNC.
  • To establish a system of networking to strengthen on-going capacity development of ASHAs for home based new born and maternal health care
  • To establish an electronic communication system for empowerment of families and facilitate early and appropriate corrective actions.
  • To facilitate timely and appropriate referrals.
  • To determine the status of mother and the baby after 28 days and 42 days.
Read More