Aarogyam ICT for Mother and Child Care
(IAS), MD KESKO
(IAS), District Magistrate, Kanpur Dehat/Ramabai
“My phone informs me now, of when to go for
the vaccination, and I ensure that; I neither have any record nor do I
remember if my elder son received all the vaccinations”
--A lactating mother (beneficiary)
registered a complaint with the phone number (of Aarogyam) I had seen on
a billboard in Baghpat, regarding my grandson’s pending vaccination
and within a few days ASHA visited us and guided us through the
--Beneficiaries mother in Baghpat
“I receive calls on my phone informing me of the list of women and children due for checkups or vaccination in my village and I ensure that they do visit the ANM for the same” --A village head in Baghpat
year, in India, roughly 30 million women experience pregnancy and 27
million have a live birth (MoHFW[i], 2003c). Of these, an estimated
100,000 maternal deaths and one million newborn deaths occur each year.
to UNICEF (2008), about 9.7 million children died before the age of five
years in 2006, globally. Of these, 2.1 million died in India. That means
that every fifth child that dies is Indian, half of them die as newborns
during the first month of life. In addition, millions of more women and
newborns suffer pregnancy and birth-related ill health. Thus,
pregnancy-related mortality and morbidity continues to take a huge toll
on the lives of Indian women and their newborns.
main reasons behind high Infant Mortality Rate (IMR) and Maternal
Mortality Rate (MMR) in India as identified by National Family Health
Survey (NHFS)-II, are as follows:
not attended by trained personnel (inadequate medical staff)
not seeking Antenatal Care(ANC)
Postnatal care (PNC)
of existing services
lacking awareness of the importance of pregnancy care and delivery
of awareness of the location of health services
poor quality of services, including poor treatment by health providers
of decision-making power of
women within the family
pregnancy and their risk of dying
situation is further compounded by:
marginal involvement of community and stakeholders in the health system
leading to one-way supply based approach
use of technology for ensuring healthcare to all and
in monitoring public health service’s delivery mechanism
a strong focus to provide effective healthcare to rural population in
the states which have weak public health indicators or weak
infrastructure, National Rural Health Mission (NRHM) was introduced in
April 2005 in eighteen states of the country. The goals of the mission
include reduced IMR and MMR.
is a Sanskrit word which means "complete freedom from illness”.
Aarogyam is an ICT based responsive system which ensures and involves
active participation of all key stakeholders viz. local administration,
health facilities and doctors, frontline health workers (ASHA
(Accredited Social Health Activists), ANM (Auxiliary Nurse Midwife), and
AWW (Angan Wadi Workers)), village heads and beneficiaries, to ensure
that a pregnant woman is provided with ANC, PNC and complete
immunization throughout the continuum of care.
maintains a village wise database of all the beneficiaries
(pregnant/lactating women, children up to 5 years) of an area, which
gets continually updated with new data generating on the field with the
help of front line health workers. The database thus generated is the
backbone of the software system used by Aarogyam. This system generates
automated alerts in the form of vernacular voice calls/SMS to the
beneficiary thus enabling the beneficiary with vital information at
their door step.
system not only provides beneficiary with the information to be acted
upon but also ensures that the services are delivered to the beneficiary
by generating automated alerts (vernacular voice calls/SMS) for the ANM
and Block level health officials, informing them of due services in
uses a mapped database where each beneficiary is mapped with a village
including the village head (pradhan), related health officials including
frontline workers and health facilities. This multi dimensional mapping
gives Aarogyam the capacity to monitor and take proactive corrective
measures on its own, even in the absence of human interface. e.g. if a
woman is due for TT(Tetanous Toxoid) and she does not receive one,
Aarogyam will not only report this to the beneficiary but also to the
village head and related health workers and subsequently to the health
facility. Competent district authorities can also monitor and evaluate
the performance and pendency at any level of the system, thus
strengthening accountability and transparency. Aarogyam also has an
Interactive Voice response system(IVRS), whereby you can register a
complaint or can enquire about various health related information.
ensures that the government not only empowers its people with
information and knowledge on basic mother and child health care but also
reaches out to them with responsive health care delivery.
the problems and issues identified, the Aarogyam scheme was envisaged as
an ICT based health care delivery system for Pregnancy Tracking and
Digital Health Mapping with the following objectives:
each pregnancy with the help of technology based monitoring system.
complete ANC/PNC care including early registration of pregnancy, 3 ANC
visits, TT, institutional delivery and promotion of Janani Suraksha
100% immunization for pregnant women & children in the age group 0-5
the gap between goals and present-actual values for MDG[ii]
4 and 5 indicators.
healthcare delivery into a two-way demand based interactive eco-system.
community at village level to generate awareness about health services.
maintain the Aarogyam (JBSA) register, which contains village wise
beneficiary details with expected date of delivery and dates of actual
and expected ANC/PNC visits and immunization etc. Initially the complete
data of the Aarogyam register is entered into the Aarogyam database and
then only the incremental data is updated. The incremental data is
captured in three pre-formatted forms using the block and village code.
These forms are for new pregnant women (first time) registration form,
new child (first time) registration form and another form for Updating
existing registered beneficiaries. Each beneficiary is given a unique id
(8 digits) the id consists of Block id (1st two digits) + Village id
(2nd two digits) + beneficiary id (last four digits). Same id is used
for tracking a mother and her child in the system.
works on the four pronged approach of proactive, reactive, Interactive
and educative interventions among the community. It consists of two
tracking and monitoring module (Proactive and Reactive)
1.Proactive- Aarogyam keeps citizens at the centre of the health model and uses an Interactive Voice Response System (IVRS), which automatically generates family specific reminder calls/SMS’s in Hindi encompassing the areas pertaining to the Immunization details for children from 0-5 years informing them about the place and date of vaccination and also the ANC/PNC details of pregnant and lactating mothers based on the due date for TT, IFA tablets etc along with institutional delivery and benefits of Janani Surakhsha yojna (JSY).
In case of pending cases, the reminder calls are sent to the
concerned family and village pradhan for ensuring the service delivery,
ANMs are also sent reminder calls for all uncovered families per
village. This enables Aarogyam to ensure that all beneficiaries receive
the desired services.-
Aarogyam at work (Interactive and Educative)
Redressal and Information dissemination module (Interactive and
–Aarogyam allows beneficiaries to interact with the system through a
dial-in option on a helpline number, one can gather maternal and child
health care information e.g. child vaccinations, antenatal care,
postnatal care, institutional delivery, birth preparedness, and Janani
Suraksha Yojna (JSY) among other topics. A beneficiary can also lodge
specific health related complaints using the dial-in facility.
Aarogyam provides educational support to various health campaigns such
as Directly Observed Treatment Short Course for Tuberculosis (DOTS),
pulse polio campaigns, gender-equality, anti-epidemic (i.e. cholera or
dengue fever) campaigns, Prenatal Diagnostic Tests (PNDT) and the burden
of disease’s in a particular region among others.
In addition to this Aarogyam sends periodic Behavior Change
Communication (BCC) messages to the beneficiaries.
Information retrieval of Health parameters and schemes, Complaint
lodging and redressal; and Community Broadcasting
Aarogyam at work (Interactive and Educative)
was a comprehensive survey of the district with respect to the family health
indicators like age, gender, class, parity, immunization details of
the children, Simultaneously a database of pregnant women with their
expected date of deliveries (EDD) and children in the age group 0-2
yrs was prepared along with the services availed by them till that time,
this was done with interdepartmental coordination especially health
and ICDS department. The survey helped in creating the village wise
database of beneficiaries along with vital health indicators and status.
standard operating procedures (SOP) and
orientation of required institutional mechanisms at district and
block level was done so as to streamline the data capturing,
consolidation and reporting processes. Standardization of required
formats, periodicity of reporting, roles and responsibility of the field
workers and accountability of health officials were fixed, delineated
Building (Trainings) of
ANMs, Data entry operators and other block and district level health
staff was done so as to introduce them to the initiative, its
objectives, use and possible impact.
generated through IEC and BCC activities like films, songs, nukkad
nataks(street plays), pamphlets, hoarding etc. about the project. ANMs
and ASHAs disseminate information regarding the system to the
beneficiaries in the villages.
of web-based monitoring portal which reflects total disposal of
grievances, pending complaints office wise, call alerts status and
SMS’s sent on daily basis etc. This portal is regularly accessed by
key officials including Chief Medical Officer (CMO) and District
monthly meetings are held with key stakeholders to assess the progress.
of audit trails where Aarogyam automatically generates pending lists
with respect to unfulfilled targets for medical officers, ANMs, Pradhans
and beneficiaries; based on this list call alerts and SMSs are sent to
all stakeholders every 10 days till the services are reported as
delivered by the system.
Features and Sustainability
has ensured transparency in service delivery besides helping the general
public, frontline workers and others to have an understanding of all
provisions and entitlements of health services. The health data of each
household/individual is being entered and put on the web for monitoring
by concerned officers. The results give a clear picture on health
service status, efforts made by department and status of compliances.
The approach also ensures the participation of different stakeholders at
different levels such as ICDS, ASHAs, teachers and village pradhans.
model has ensured participation of stakeholders and motivated them to
work and perform together developing a team spirit and thus support the
leadership which conceptualized and implemented the system.
has inbuilt measures of sustainability, once the database is uploaded,
auto dialers and SMS work on their own, without manual intervention.
Aarogyam is IVRS based, easy to access and use. Hindi is used as a
language of communication (calls/SMS) which is understood by all.
has been able to become an integral part of the system, and this has
been ensured by the Expansion of the project by Uttar Pradesh
government, to more districts and divisions along with training and
regular capacity building of staff and front line workers for data
collection, data entry, analysis and monitoring. Data entry operators
have been appointed at block PHC level for collation of data and
uploading the data in central server at district. District level review
committees continue to monitor the progress of Aarogyam with supportive
health behavior in the community is observed, which is supplemented
through mass awareness generation (folk media, Television
advertisements, posters/banners etc.)
has benefitted more than 1.4 lakh families so far (ie.upto Dec-2010) in
the three districts viz Baghpat, JP Nagar and GB Nagar of U.P. Two lakh
more families would be added in four other districts where the scheme
has been initiated. So far more than 175,000 automated calls and SMS’s
have been sent by the system.
Impacts of Aarogyam
responsibility and accountability of service providers:
messages and calls to service providers (ANM, MO I/c etc.) have resulted
in more accountability besides better and timely service delivery to the
of the measurable indicators: There has been a positive trend in the
measurable indicators over the period of time when Aarogyam was put in
use. Indicators like TT Mother, BCG[i],
DPT Booster, measles etc. have shown a significant positive trend.
Achievement in child immunization is also very encouraging and showing
feedback has been an enormous success in the program. Community has
started to understand more about not only the types of health services
available to them but also how to avail them and report any
non-compliance to the health and district administration.
vernacular messages literacy is no more a hindrance for availing health
services and information. Free of cost information delivery and
grievance redressal has empowered communities in demanding services.
on preventive Medicare:
model has helped health department to refocus its strategy on preventive
healthcare whereby on the basis of the health indicators reported and
demand generated along with the complaints lodged in, corrective actions
can be timely taken for achieving better results.
Economically and socially impoverished and illiterate families can also
now not only get information about their health profile and services
required but also demand the services especially regarding ANC/PNC and
immunizations. Aarogyam ensures that the services are delivered to such
sections of society at their doorstep.
Monitoring and Evaluation:
Individual level health indicators’ tracking has enabled the system to
facilitate in monitoring and evaluation of the program implementation
strategies and achievements.
Planning: Better planning of community level health programs especially
ANC/PNC checkups and
drives are possible with the system e.g. ANMs can be now informed of the
number of beneficiaries to expect at the each session, this will not
only result in reduced waste of vaccines but also more accurate head
work load on ANM:
The existing system has different registers for ANM’s. At times having
similar data not only increases data redundancy but more importantly
results in increased work load for the ANM. Similarly regularly filling
and submitting data updates to the system at block office is a time
consuming mechanism, sometimes resulting in extra ANM visits to the
At Present, in Aarogyam data entry is done at the district level and
this data comes in the form of excel sheets. However, challenges are
faced due to data inconsistency and delay’s in data entry along with
inability of block level operator’s to correct/modify data with no
easy access to block reports.
Non availability of advance job-charts or work schedules based on the
Aarogyam data is another issue which needs attention. Such a system for
ANMs/ASHAs can help them plan their community work better.
of mobile numbers:
keep up with a change in the mobile numbers of various stakeholders is
another issue which needs a solution. In the absence of any paper based
reporting/schedules, the system struggles to meet the desired output if
the key stakeholders change their mobiles numbers’ unreported.
and landline coverage among the most vulnerable people and their
involvement in the system continues to remain a challenge.
Despite the challenges, Aarogyam
through information communication and technology can improve the lives
of the poor while capitalizing on the mobile advantage. Aarogyam can
assist India in realizing success in MMR and IMR paralleling its recent
following points that can be considered to make Aarogyam a more