ImTeCHO (Innovative mobile phone technology for community health operations) A joint initiative of SEWA Rural and Department of Heath and Family Welfare

Summary Goal: Reduce maternal and child deaths and malnutrition through mobile phone application for ASHA programme Operational since May, 2013 in Bharuch and Valsad district 6,500 beneficiaries through 110 delivery centres already benefitted, 20,000 m-transactions Improvement in coverage and quality of services Propose implementation in Narmada district in 3 phase implementation starting from Sagbara from Oct-2014

Our vision: India… Where every person has the information they need to keep themselves and their family healthy no matter who they are or where they live 2. Where every health worker has the tools she needs to provide consistent and excellent care 3. Where the health system supports continuity of care through better information, logistics and management Ref: Dr. Marc Mitchell at “mHealth for maternal health” meeting at HSPH

About SEWA Rural Mission Principles Activities: Hospital, Vocational training center, Women empowerment program, Eye care, Community Health and research Community Health so far: PPP for PHC mgmt (1985-99), Safe motherhood and newborn survival project (2003-2011), ImTeCHO (2011- present) Publications

Objectives of ImTeCHO ImTeCHO is a new mobile phone and web application for ASHAs, PHC staff and health officials for Reduction in maternal deaths Reduction in newborn and child deaths Reduction in malnutrition Timely identification and management of sickness among hard to reach and tribal areas of the state. Scope: ALL community based maternal, newborn and child health services to be provided free through ASHA and PHC staff (G2C and G2G)

Support/Value creation for all involved in ASHA program ImTeCHO = I am support Supports ASHAs towards better Morbidity detection and management (HBNC, IMNCI) Scheduling tasks Health education (BCC) Support PHC staff and higher level staff towards better Providing support and motivation to ASHAs(incentives and supply management etc) Supervision and HR management Reporting & HMIS Support/Value creation for all involved in ASHA program

ASHA home visit

Who are the beneficiaries? Pregnant women Newborn babies Children Community level Health workers (ASHAs, nurse, medical officer etc) Block, district and state level health administrators

Problem statement Insufficient support, supervision and motivation to ASHAs (eg. Training, skills, mentoring, incentives, supplies etc)* Inadequate performance of ASHAs Low coverage of proven interventions (eg: HBNC) Unsatisfactory health outcomes *Ref: (1) Columbia University. Improving the performance of Accredited Social Health Activists in India: Working papers series. Mumbai. 2011 (2) National Health Systems Resource Centre (NHSRC) and National Rural Health Mission (NRHM). ASHA: Which way forward...? New Delhi, 2011. (3) ASHA update Jan 2013

ImTeCHO= I am support ImTeCHO Better support, motivation, supervision to ASHAs, FHWs and PHC staff Better performance Increase in coverage of proven interventions Better health MNCH outcomes Ref: www.imtecho.com

Main menu and schedule for ASHA

Automatic diagnosis and treatment

Videos and mamata divas

Motivation of users Announcement of positive case studies “Congratulatory message” for completing tasks Linking incentives Newsletter Monthly performance feedback in mobile

Supervision and support made easy and effective (Medical officer)

ImTeCHO for higher officials

ImTeCHO: Conceptual framework Better support, motivation, supervision to ASHAs and ASHA program Better performance Increase in coverage and quality of MNCH services Improvement in maternal and child mortality and malnutrition Ref: www.imtecho.com

Current implementation Project started in May, 2013 in Bharuch and Valsad district (Population: 90,000) 110 ASHAs and PHC staff are successfully using ImTeCHO 6,500 pregnant women, newborn, children benefitted so far 20,000 m-transactions so far Will cover Narmada district soon Significant improvement in coverage and quality of health services 100% pregnant women and 95% children are enrolled

Few quotations from users and clients A beneficiary mother: “ Now, we receive timely services at our doorsteps”, “I came to know about so many new information due to videos in mobile which will keep me and my child healthy” Medical officer from a PHC: “timely information from field due to ImTeCHO now helps me to supervise my staff from my office” An ASHA: “My prestige have increased in my village because now I use mobile phone”

ImTeCHO is effective N= 50/28 N= 50/28 N= 50/28 N= 95/92 N= 13/8

ASHAs are using ImTeCHO regularly

Quality of HBNC visit in ImTeCHO (n=14)

Technology Application is powered by ArguSoft India Ltd's mAID platform Web application uses PostgreSQL version 8.4 databases used are in the are open-source domain RDBMS Web-application is accessible thru the internet while the Mobile Devices use 2G GPRS network for data synch No major crash/technology glitch so far

Implementation plan Preparation phase Training phase Maintenance phase Mobile connectivity Gather information about all users Purchase of mobiles etc Taking all stakeholders in confidence Training phase Training of ASHAs and PHC staff (7 days) Mentoring (2-3 weeks per PHC) Certification (1-2 weeks) Maintenance phase Ongoing facilitation from SEWA Rural facilitator Regular use of ImTeCHO by all users

Proposal for Narmada district Joint initiative between DHS and SEWA Rural Phase wise implementation (3 phases) starting in October, 2014 with Sagbara Active facilitation from SEWA Rural (training, ongoing technology support etc) Research in collaboration of ICMR/WHO Except 5 PHCs, good GPRS signal in district Expense of phase 1 and 2 will be bourn by SEWA Rural (ICMR/WHO)

Recognition of ImTeCHO “One of the most comprehensive mHealth intervention”: Dr.Marc Mitchell (Harvard schoold of public health) Nominated for two e-governance award Featured in m-governance booklet of GoG

Other considerations Interoperable Feedback/grievance redressal system Activity and financial audit trail Adaptable and scalable Clear roll out plan as PPP model Secure system and confidentiality of medical information

Please visit www.imtecho.com Acknowledgements ASHAs and PHC staff of Jhagadia and Moriyana PHCs along with people of Jhagadia Department of Health and Family Welfare, GoG Argusoft India Ltd Jamsetji Tata Trust Please visit www.imtecho.com