Pune: The World Health Organization (WHO) defines surveillance as the systematic process of collection, transmission, analysis and feedback of public health data for decision-making. When this definition is married to mobile technology, it makes a real difference in the field of healthcare services delivery, a difference often between life and death.
Take malaria. It occurs across the country with a mortality rate between 2001-09 having remained almost unchanged at just over 1,000 million, according to the National Vector Borne Diseases Control Programme (NVBDCP) of the central government.
Among the challenges that healthcare agencies face is the remote and inaccessible habitat of large numbers of people, where delivery of any programme is a challenge. Malaria is a public health problem with 95% of the population living in areas that are malaria-endemic. This takes a huge chunk of public health spending along with high levels of hospital admissions. The prevailing system of a paper-based surveillance system has the big disadvantage of taking three-four weeks to find and treat a positive case, the first step in treatment.
This was an area crying for the deployment of modern methods and technologies. The Centre for the Development of Advanced Computing (C-DAC) came up with the MoSQuIT, or Mobile based Surveillance Quest using Information Technology. The reason for choosing malaria was that the UN’s Millenium Development Goals and the NVBDCP have identified it as a thrust area.
Explaining the objectives of the solution, Medha Dhurandhar, associate director and head of the department at C-DAC, said, “MoSQuIT helps keep a watch over the status of malaria in a group or a community. The solution also helps identify potential outbreak of the disease and provides an early warning to the state health system for its control, allowing for the redeployment of the accredited social health activist (ASHA) network in case of such an outbreak. The solution also helps the state health agencies track the performance of the ASHA staff and they, in turn, find this easier to work with than the earlier paper-based system.”
A team of 12 researchers, including medical doctors, at C-DAC, developed the software for this mobile-based application over an 18-month period, studying the existing paper-based system and adapting this accordingly. For instance, the form that the ASHA worker has to fill in is called M-1, the same as in the earlier system.
Using a mobile-based application has meant that work gets done quicker: from the stage of the ASHA worker reporting the findings, sending these off (along with a slide of the blood sample) to the laboratory at the Primary Healthcare Centre (PHC). After the analysis is done, the findings get sent back to the ASHA worker who can then start treatment, if needed.
Tabulating the time saved, researchers at C-DAC noted that data collection still takes five minutes but data transfer is now instantaneous instead of taking 21 days, diagnosis takes a day against the earlier week-long process, data verification by the medical officer per 100 records takes an hour instead of a day, the surveillance report and epidemiological indices report generation takes an hour against a month taken earlier and data availability and granularity for analysis can be done on a monthly, quarterly or annual basis instead of annually earlier. This does not take into account the logistics issues which also get addressed in the mobile-based application: medicine and other stocks with the ASHA worker can now be replenished quickly. This is a huge morale booster for the ASHA worker.
C-DAC has taken some basic precautionary steps; the first being that the mobile phone is locked and the ASHA worker is able to use it only for the purpose for which it has been given.
The service is currently offered in English, because the paper-based model was in English. Dhurandhar said C-DAC already has the capability to offer translation into several Indian languages. However, more important than language transliteration is the capability to offer better service, so they could add graphical user interface (GUI) once ASHA workers get used to the mobile phone-based application, covering more diseases and rolling it out in more areas.
The deployment in the Tengakhat PHC of Dibrugarh district of Assam, covering some 50,000 people in 50 villages, is part of the government’s North-East focus, where topography hampers development. Given the poor connectivity in the region, an ASHA worker can send data by mobile phone service by general packet radio service (GPRS) if connectivity is good, short message service (SMS) if the connectivity is poor or manually.
The Navi Mumbai Municipal Corp. (NMMC) had run a six-month pilot scheme for mothers using a mobile phone-based service, and the NMMC family welfare officer, Vidya Kshirsagar noted that it helped timely record keeping and updation. “The project had huge benefits for the beneficiaries of the scheme: they got reminders and the records were kept up to date by the healthcare delivery personnel. There often used to be a delay in record keeping: with the mobile phone-based service, these were maintained up to date.”
Maintaining updated records is regarded as a major benefit of any scheme that has real-time delivery, an aid in decision-making.
The decision to base service delivery on mobiles rather than on computers was due to the ubiquity of the phone and the fear of computers that many have, Dhurandhar explained. “For the future, healthcare services delivery will have to be mobile phone-based because there is acceptance of the phone at every level of our society.”
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