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mSakhi: Digitizing Health Care at the Grass Roots


This app is revolutionizing health care for moms and babies in Jhansi, India.


The science fiction author William Gibson famously quipped, "The future is here, it’s just not evenly distributed."

"There is arguably no greater manifestation of our uneven world than that of health care,” says the noted technology writer Richard Hartley. “In the wealthiest countries, thousands of people in their 60s and 70s are kept alive with cardiac pacemakers that are remotely monitored over the Internet, and adjusted by algorithms with no human intervention. In poorer states, three-quarters of a million children under five are dying each year because of shit in their water,” he adds.  

Inequity in health care distribution holds true for India as well—in comparison to South Asian and sub-Saharan African countries and also among its states. As per Credit Suisse First Boston's latest wealth-data book, the inequality in India has sharpened, with the top 1% possessing 58.4% of the national wealth in the country.

This is one innovation that deserves our attention.

Demonetization—the central conversational topic since November 8—also suffers from inequality.

Apart from shrinking our conversational topics, it has also sized down our idea of digitization. E-wallets, digital payments, and mobile phone banking have become the only forms of digitization we are talking about. In this din, many innovations targeting the poor and public service delivery have completely missed the media’s attention.

The government of Uttar Pradesh's mobile phone-based job aid and registration app, mSakhi, is one such.

Wide-ranging benefits

Health care indicators in Uttar Pradesh, home to over 200 million people, are abysmal.

In a study by the Rajiv Gandhi Institute of Contemporary Studies, the number of public health centers (PHCs)—the front line of the government’s health care system—decreased by 8% over 15 years until 2015, with the state’s population increasing by more than 25% in the same period.

Uttar Pradesh has India’s second-highest maternal mortality rate—285 maternal deaths for every 100,000 live births. The state also performs poorly in child mortality indicators with 64 deaths in children below five years of age per 1,000 live births, as per pan-India Rural Health Statistics 2015.

Health care innovation in Uttar Pradesh, thus, deserves attention.

The state’s government, in collaboration with the nonprofit IntraHealth International and the tech major Qualcomm, has been running a mobile application-based program called mSakhi in Jhansi since 2013. The program enables community health workers, who are at the forefront of India's National Health Mission, to help women and their families recognize maternal and neonatal danger signs and promptly seek care.

These community health workers comprise accredited social health activists (ASHAs) in the lowest rung of the health care vertical, anganwadi workers (AWWs) at the bottom of the nutrition-cum-child development vertical, and auxiliary nurse midwives (ANMs) at the front line of the professional health care workforce.

However, a majority of ASHAs and AWWs are village women with low literacy skills and they face operational challenges in conducting routine maternal, newborn, and child health activities and in keeping their skills updated. They lack access to health care information, refresher training, meaningful supervision, and user-friendly job aids, which compromise their ability to contribute to improved maternal and newborn health outcomes.

mSakhi (where stands for "mobile" and Sakhi means "a friend") is an interactive regional language (available in Hindi currently) audio/video-guided mobile application that supports health workers in conducting routine activities across the continuum of mother-and-child care. The application’s content is based on the guidelines and formats laid out in the National Health Mission and the Integrated Child Development Scheme.

The app brings comfort and efficiency to health workers' jobs.

Health workers register pregnant women and newborns by entering basic information into the mSakhi app during home visits. Upon registration, mSakhi generates a home-visit schedule for each beneficiary and provides a set of audio/video guided instructions for counseling, assessment, and referral specific to each mother and child, in each visit.

Auxiliary nurse midwives, the de facto supervisors, can track ASHAs and beneficiaries in real time as data is stored on mSakhi’s central database. A similar approach has worked for the Anganwadi workers and their respective supervisors, the Child Development Programme Officers at the block level.

The app is compatible with any Android smartphone and can be downloaded for free.

Amod Kumar, the original architect of the program, currently posted at the Chief Minister’s office, states that unburdening the Anganwadi workers, ASHAs, and ANMs from the kilograms and kilograms of registers and flip charts (which restrict their mobility) to do their core job of tracking mothers and children and counseling them was the primary aim. Bringing comfort and efficiency to their jobs was the thought behind this app.

The app also simplifies public administration, eliminating the need for data-entry operators. mSakhi manages to convert the data into a digital format right from the point of entry, to be used, analyzed, accessed, and processed across the health system by all relevant staff members.

This was the systems approach needed in a country where various departments think in silos, rarely collaborate, and duplicate efforts.

Qualcomm's partnership in this initiative stems from that systems-approach worldview, points out Anirban Mukerjee, manager at Qualcomm Wireless OutReach, which is working on the intersection of development, mobile phones, and internet access.

Hence investment in tools that give them ongoing on-the-job training, reduces their burden of carrying registers, and reduces the task of compilation by compiling and processing data automatically, seems a worthwhile effort. mSakhi is one such.

The app also improves the social status of women health workers.

Though Meenakshi Jain, country director for IntraHealth in India, has a word of caution: apps can only increase efficiency, but staffing inadequacy, human resources challenges, and systems’ inefficiencies still need to be tackled to comprehensively counter the morbidity and mortality challenge.

The app has the added benefit of improving the social status of women health workers, since they were some of the first ones to get smartphones in their villages and blocks.

Unlike the standard criticism of online courses and digital applications that doesn’t recognize deprivation or class and dehumanize every interaction, this is one app that actually enhances humanized interaction by guiding the service providers (ASHAs and AWWS, in this case) to have structured interpersonal conversations with the mother and her family members to counsel and care for them better.

This is one innovation that deserves our attention. Not just for clinical and public health reasons, but for social, anthropological reasons. And the fact that this app puts health workers front and center, who are the backbone of effective health systems, is as good a reason as any to demand our attention.

This post originally appeared on Down to Earth.