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Business News/ Politics / Policy/  A digital drive against maternal mortality
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A digital drive against maternal mortality

An Android app is being used to collect data and supervise and monitor health institutions in Assam

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The United Nations children’s fund (Unicef) is supporting Assam in rolling out a reproductive, maternal, newborn, child and adolescent health (RMNCH+A) strategy in six high priority districts and in strengthening the cold chain system across the state under a Vaccine Alliance health system strengthening project.

Regular monitoring and supervision of health institutions at 805 delivery points and 792 cold chain points is a key intervention under the programmes.

Unicef has received funding from Vaccine Alliance for health system strengthening in India for a period of three years from 2014 to 2017. The agency is using digital technology, an Android-based mobile application, to aid in its complex task.

“The reason we went to Assam is that it has the highest maternal mortality rates. So any interventions in Assam would result in a significant increase in the access of healthcare services. If the health system gets strengthened, then a lot of women who are not having access to healthcare services will benefit. Similarly, Bihar has the ignominy of having a very high mortality rate for children. This app will help our cold chain infrastructure, the human resource to be more effective so that more children can have access to vaccination," said Kamal Lochan Sahoo, team leader, Unicef Assam.

The functional overlap in the majority of the health institutions provided a unique opportunity to integrate RMNCH+A supervisory visits. Three member teams consisting of faculty members and postgraduate students from medical colleges were allocated to each district for the supportive supervision (SS). To capture the data in real time, Android versions of the checklists were developed using open-source technology.

“There is a lot of gap between generation of information at the grassroots level and feeding it up through the decision-making chain to the policymakers. The current systems are paper- based that take a lot of time to correlate. There are some issues with data quality. So, we try to work around this and create some pitch in some innovation based on the mobile platform,"said Sahoo.

The service providers in the public health institutions are aware that a supervisor will be visiting them and collecting information in real time related to service delivery, which automatically stimulates them to perform better and provide improved services. Over the long term, this will lead to reduced infant and maternal morbidity and mortality and improve access to quality health services, including immunization. The supervisors push the filled forms to the server which is followed by data analysis and presentation on a dashboard in the form of figures, graphs and maps, helping policymakers and programme managers take evidence-based corrective measures. A rapid scale-up of real-time supportive supervision across all 27 districts of Assam within a record four months, covering 469 health facilities out of 805 (58.2%) and 448 cold chain points out of 792 (56.5%), could be achieved using this technology. Medical involvement ensures sustainability.

The technology used can be segmented into three major areas: data collection, collation and dissemination. An Android-based mobile application was used for data collection. A mobile application, SDRC Collect, is based on the widely adopted Open Data Kit (ODK) platform.

This Android app communicated with a centrally hosted data aggregation system called ODK Aggregate, which is a web application. The data is then collated into a DevInfo database, and feeds the dissemination systems. The database and the web apps are hosted on industry-standard hardware infrastructure located in a secure environment at a facility in Bhubaneswar, Odisha.

The facility has fast Internet services and is well prepared for emergencies with multiple backbones. The application is serviced by a third-party vendor, SDRC Pvt. Ltd (www.sdrc.co.in), which is responsible for the upkeep and maintenance of the site. The technology infrastructure is managed on a turnkey basis by SDRC.

“Entire platform is generic, it is open-source, it can be scaled across a particular state or cover multiple states. For example, from Assam we have also covered Bihar. This technology is relevant not only in the health domain, but also in education and livelihood. So, it provides a lot of opportunity in terms of making the data accessible and making our policy more decision-based and evidence-based," said Sahoo. “We already have programmes in Malaysia; there is something happening in Eritrea. So, there is a lot of international collaboration happening. The focus right now would be to encourage more actors, development practitioners to make use of this platform."

This is the first time globally Android phones have been used to conduct an EVM (effective vaccine management) assessment, which is complicated and time consuming. This is also the first time that real time supportive supervision using Android phones is being implemented at such a massive scale covering the entire state of Assam.

This application allows data collection across multiple platforms—mobile, desktop and tablets—in real time, without additional programming requirements. It is free of cost, royalty-free, doesn’t require licensing as it is developed in open source. Globally, EVM assessment is done using paper-based data collection followed by analysis on an Excel-based tool.

The app won a prize in the health category in the 2015 mBillionth Awards.

The minimum system requirements for this mobile app are an Android smartphone, external SD card on the device and WiFi/GPRS for data transmission.

Mint has a strategic partnership with Digital Empowerment Foundation that hosts the mBillionth and Manthan Awards.

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Published: 16 Sep 2015, 12:32 AM IST
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