The key here is that solutions be developed bottom-up, working closely with the community they are designed for
Technology has become ubiquitous today, and public health is no exception. Some key areas include monitoring health interventions, sharing and analysing data, disseminating information, and managing diagnostics. However, new technology products often come across as divorced from field realities. This is because there is a dichotomy. Grassroots NGOs best understand needs, but rarely understand technology. Nifty technology developers often have preconceived notions and have never been to the field. The key here is that solutions be developed bottom-up, working closely with the community they are designed for. Let us look at a few cases to understand this better.
Vaccine cold chain management is a precarious system. Maintaining the correct temperature from a vaccine’s manufacture till the point of administration is crucial. Wastages and stock-outs are common. The health ministry, working with United Nations Development Programme, indigenously developed the Electronic Vaccine Intelligence Network (eVIN) using its extensive grassroots experience. Rolled out in more than 370 districts, eVIN provides real-time information on vaccine stocks, flows and storage temperatures through a simple smartphone application. The simplicity of the product ensures that cold-chain handlers of all age groups and technical capabilities readily take to it. The temperature loggers are low-cost, requiring no electricity or internet connectivity. This is a good example of a clear understanding of last-mile issues and user requirements leading to a technology solution that is highly relevant.
Rural public health facilities in India are often understaffed and ill-equipped to conduct essential health diagnostics. Faster diagnostic solutions, which are easily handled by front-line health workers, are vitally needed. Few technology products have hit this sweet spot, because field realities have not been well understood. Can the product work in remote locations with minimal infrastructure? Is it robust enough to work in very hot or humid conditions? Is it too heavy to carry for a government field worker, who must travel by bus? Many such real-world questions must be asked from the outset. Solutions then need iterative testing and feedback in consultation with users and recipients.
In these columns, I’ve emphasized that data sharing among rural health workers is the key to effective health delivery. I mentioned how various technology applications cater to only stand-alone needs of different front-line workers. While serving as excellent personal digital assistants for individual workers, they miss out on the fundamental need to share data. Rajsangam is a mobile app developed in Rajasthan that links the three vital front-line government health workers in real time. The product was born from needs identified at the grassroots. An evolution that began with rationalising voluminous registers of health workers, led to bringing them on to a common manual platform using village maps. Insights from these resulted in a product that not only digitizes their daily tasks, but also links them together in real time. It enables better supervision as data is fed real time up the chain of command. Extensive pilot testing and constant refining with hundreds of health workers ensured that the product truly improves front-line effectiveness.
Technology is vital in monitoring health programmes. Dashboards with up-to-date information on programme activities and beneficiary outcomes can help organizations and government make crucial course corrections. This need has not yet been fully realized, and many programmes still rely on paper trails that are fed into computerized information systems. Not only are there time lags, but information that reaches the top is often incorrect and incomplete. Mobile technology solutions such as the Open Data Kit (ODK), which began as a Google.org-sponsored project, are open-source tools that allow easy data collection, aggregation, analysis and generation of reports. These tools are grassroots-friendly in that they enable electronic forms and surveys to be filled without the need for constant internet connectivity. Features such as data validation and geotagging (adding geographical location to data) improve the quality of data. Numerous organizations across India, Africa and other developing nations are applying these tools for large-scale, data-driven decision-making. In Rajasthan, government health supervisors are using ODK to monitor activities such as the monthly village health and nutrition day. I wish to see more health programmes follow suit.
Public health technologies are all about improving processes to increase effectiveness of service delivery and ensure scalable health programmes. These considerations are often missed since the donors are far away from the field. It’s high time we all hit the ground.
Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok.
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