Ushering mHealth revolution in public health

Atanu Garai

Of late, health industry is going mobile. Consumers in urban India are already using mobile devices and apps to measure blood pressure, glucose, and even to report their health data to doctors. Use of Internet to get tips from an expert is a common practice among the urban youth. Private providers have also started using mobile devices to advise patients. However, for public health programmes, the scene is quite different. Programmes like National Rural Health Mission (NRHM) are having a hard time trying to catch up with the mobile health or ‘mHealth’ revolution.

Despite the growth in mobile telephony, a sizeable section among the poor and women living in rural India is yet to gain access to mobile phones. Lack of direct access to mobile phones among hundreds of thousands of women means that providers cannot communicate to the primary beneficiaries under the NRHM programme.

Health workers, even with secondary education, use their mobile phones to record the services they deliver to the beneficiaries. For hundreds of thousands of health workers across India, mobile phones can simplify reporting delivery of care. It can reduce the cost to the exchequer in the longer run, with additional gains on timeliness, and accuracy in data reporting.

For more than a year now, some 582 accredited social health activists (ASHAs), community health workers under NRHM in Saharsa district of Bihar, have been reporting on the maternal, child health and nutritional services they are deliver using a mobile application called CCS . In this project, CARE, an NGO working for social issues, has imparted training to ASHAs and their supervisors in using CCS application.

When ASHAs delay, or even default healthcare to the beneficiaries, their supervisors will be able to quickly identify them. Through mobile reporting, the supervising ANM in village health centres or medical officers in health centres in blocks quickly find those delays. In Dhamtari district of Jharkhand, Virtuous Solutions, an IT company based in Delhi, implemented a mobile reporting system for mother and child tracking system (MCTS). The mobile MCTS project generates alerts for supervisors when ANMs delay in attending beneficiaries in their catchment area.

Like the providers, patients often tend to forget taking medicines as prescribed by their doctors. Till now, families used to prompt the patients to take their dosage on time. When providers record patient data in an electronic health record system, the system can generate an SMS or a call to remind the patients on their dosages.

BBC Media Action, the development arm of the broadcasting agency BBC, sends such prompts in the form of calls to the pregnant women across eight districts in Bihar. Known as Mobile Kilkari, women subscribers get one call every week according to their maternity stages during the entire period of subscription. Available as 7, 12, and 16 months subscription packs, the call automatically deducts Re 1 from the talk time. In the last few months, more than 7000 women opted to get Mobile Kilkari calls.

These calls prompt the women to take their iron supplements on time, or visit the village health centre for antenatal check-up. Some calls also tell them the nutritional values in the regular foods. More importantly, each weekly call takes into account the current stage of maternity. When India is grappling with the challenge of poor maternal and child health, these messages help in empowering our women, children, and families.

There can be little doubt that the use of mobile phones can help providers and beneficiaries improve delivery and adoption of healthy practices. But there are several bottlenecks in implementing these solutions at scale. Soon after the launch of NRHM in 2005, it recruited ASHAs without even prudent screening. Mobile users familiar with English numbers and alphabets can enter data using their phones with minimal training and practice. However, ASHAs with low literacy can find it difficult to type data in their phones.

For health workers, it can be fairly easy to tick a check box to record delivery of service. However, even advanced mobile users can find it difficult registering a beneficiary, along with her demographic details, using small phone keypads. More importantly, there is little possibility to know whether health workers are enumerating all the eligible beneficiaries in the system. This problem could have largely been overcome with the electronic National Population Register. It could provide the state health departments with demographic data by the communities. Health departments could crosscheck the data reported by providers with Aadhar service, the flagship national identification scheme promoted by the Central Government. However, both Aadhar and NPR are yet to be made available on a large scale. In the absence of beneficiary data, state governments should engage community health workers, government machinery, and private resources for enrolling beneficiary data.

India provides cash benefits to pregnant women for delivering babies in health facilities. Pregnant women find it difficult to go to the nearest bank branches to withdraw these amounts, which are often disbursed in two to three instalments. IPE Global, a development consulting firm based in Delhi, is supporting the Panchayati Raj Department to disburse wages to workers under Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) through engagement of mobile operators and their network of mobile retailers. In this method, the MGNREGA workers will use their mobile phones to authorise withdrawal of wages credited in their bank accounts. Then the mobile retailers who are selling phone recharge coupons in and around villages shall provide the workers with cash. Pregnant women can also withdraw cash in and around their communities in this way.

Once the data about the patients is available electronically, doctors and trained staffs can screen them to detect risk profiles. In Sky Health Centres, now operational in several districts of Bihar and Uttar Pradesh by the World Health Partners, doctors screen the patient profiles sitting in remote locations before prescribing over the Internet. Electronic screen has the potential to save valuable time for experts and doctors in rural areas.

There is little doubt that mobile communication can empower the public health system in India in a big way. However, there appears to be little awareness and ownership of promoting mHealth across the political and bureaucratic hierarchies. Most mHealth projects fail to get necessary resources and support from public and private quarters on time. Both central and state health department should designate nodal persons to expedite the approval and engagement processes for such project implementation.