Volume 13, No. 1, June 2003
India
Health Care Project: An application of IT in rural health care at grass root
level
C.L. Roy Sastry
CMC Limited, India
roy@cmcltd.com
The basic health care delivery system in India is implemented through the Primary Health Centers (PHC). Each PHC has a group of female health assistants called ANM (Auxiliary Nurse Midwife) associated to cover a population of 5000 by each of them. These ANMs are in direct contact with rural people in delivering health care. The basic health needs of the rural villages typically are safe water, hygiene, and protection from communicable diseases, healthcare for mother and child, among others. The social divide of rich and poor makes the ANM even more significant in providing the needy with health care at minimal cost. In providing these services the ANMs are made to maintain a number of records in registers.
Keeping this as the key information, CMC Limited (a leading IT solutions company of India) designed a project using state-of-the-art technology mobile devices (Personal Digital Assistant - PDA) which were handed to the ANMs for capturing data at the doorsteps of the rural people. The Name-based follow up with linkage of 'Multipurpose Household Survey' helps to ensure capture of the citizen data and strengthen service delivery system by ANMs.
The financial support to the project was extended by infoDev, a funding agency of the World Bank. The Department of Health & Family Welfare of the Government of Andhra Pradesh State in India, showing keen interest in improving the health care system, piloted this project in Nalgonda district. CMC Limited provided the solution for recording and better monitoring by the ANMs while providing the services, through the use of PDAs.
The implementation approach is to train the existing ANMs in using the PDAs, which can capture the data with ease. The use of PDA will also guide the ANM in proper health care procedures and train other paramedical staff in use of computers, update professional knowledge and expose them to new methods of treatment.
Nalgonda District situated in the Telangana region of Andhra Pradesh State, is just 100 kilometers away from the state capital Hyderabad. The district covers a vast area of 14,240 square kilometers and according to 2001 census has population of around 32,38,449. More than 80% of the population is rural. There are 59 Revenue Mandals (sub-districts)_ and 67 Primary Health Centres (PHCs) in the district covering the entire population for basic health services provided by the department of Health & Family Welfare.
The total number of 459 ANMs based in 67 PHCs cover the entire district.
The system covers the health care delivery at two levels. At the first level in the Sub Centers the data is captured by ANMs in PDAs thus completely eliminating the maintenance of multiple paper registers. The system helps the ANM in tracking the history of on-hand cases and taking preventive measures such as treating a high-risk pregnant woman or timely vaccination to children etc. At the second level in Primary Health Centers (PHCs) the desktop computers are used to collect the data from all the Subcentre PDAs covered under the PHC area. The PHC computer processes data about the health status of the population under PHC coverage. From the data, the system will generate reminders for immunization, ante and post-natal care for pregnant women, family planning and various scheduled programs. The schedules generated will help the ANM to know which house holds she needs to visit that month. She will also know at a glance which households have persons at risk and need attention. She can also know the latest instructions from the district head quarters transferred into her system during the regular course of data exchange with the immediate server. These instructions can pertain to a particular type of ailment or a new method of treatment either on demand or at a time when it is needed
The data from these two levels is electronically transferred upwards in the department hierarchy for strategic planning and decision-making at the administrative level to plan in line with the health policy of the country.
The regional servers at district headquarters receive data from all the PHCs covered under the district. After compilation of the data, the reports up to district level can be glanced by DMHO (District Medical and Health Officer) from these computers. The data from here is transferred to State level through dial up connectivity.
DATA FLOWS FROM SUB CENTER HIGHER LEVELS AS SHOWN ABOVE
At state level the Central Server at commissioner’s office receives data from all districts in the state. The data here is compiled and the reports from village level to state level can be viewed on these computers. Also this integrated data can be extended to inter-departmental usage by the government.
The percentage of time saved by the ANM, improved accuracy of collected data in the family encounters and number of timely responses to emergency problems and accuracy of reports at all the levels in the health care system will be the indicators for improved health. When usage builds up the Basic Health indicators, Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) will show improvement. The average weight of new born children, percentage reduction of ANM time in data capture and reporting percentage increase in the population coverage, total number of family planning operations done on the eligible couples, etc will also form the indicators to the effectiveness of the solution.
For the common man in rural villages, the use of PDA by the ANM helps his family members prevent health disasters. This is possible because the ANM, who is giving service to his family members in treating a high-risk pregnant woman or immunization to a child, has all the history of the cases stored in her PDA. The ANM can access anytime the history data in PDA and take necessary steps for providing appropriate treatment in time. This pre-preparedness of ANM helps the common man not only protect his family members from preventable fatalities, but also heavy financial losses through spending on treatment, irrecoverable health disasters, and loss of life. When applied to large-scale population, the above health-care system can lead to poverty elimination at the village level as the common man’s expenditure on medical treatment comes down drastically.
In the other districts where the computerization is not in place in the health sector, the statistics is number based. The main benefit to the Government through the PDA aided project is that the system is name based and can track the complete record of every citizen level at any time. This helps the Government in strategic planning such as maintaining optimal stock of medicines, infrastructure facilities and so on.
Lessons learned during the implementation of the project have been deliberated at a workshop where delegates from the Ministry of Health of the Government of India, health administrators, academicians, doctors, ANMs, and para-medical professionals participated. Key lessons are listed below:
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Building up of reliable citizen’s database in rural villages helps the common man to get multiple services from a single point of source that the Government wants to facilitate.
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Monitoring at all levels and usage of the systems and reports is vital as it is key to optimal resource planning in terms of inventory maintenance of drugs and infrastructure facilities.
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Before taking IT to the rural villages, the key factors like telecommunications, power supply, connectivity to villages are essential.
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Schedules and automatic report generation has resulted in considerable timesaving for the ANMs, which could be utilized for providing better service.
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Use of IT in facilitation of name based service at individual level is a paradigm shift from the way health services were provided earlier.
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Use of common citizen database can facilitate other Government Departments as well.
The innovative use of information technology by ANMs in delivering the rural health care services with a PDA has been successful. The cost of these devices will become affordable by the Governments as the volumes of demand increases reflecting in decreased prices. Computerization helped the department in evaluating and improving the health parameter indices like MMR, IMR and monitor the couple production rate, birth rate etc.
Awareness of the benefits of IT at all levels, increases professional knowledge and new methods of treatment to improve the health care and in-turn enhance the quality of health of rural population.
Project Activities of India Health Care
CMC Engineer supporting ANM on the field
ANM giving Immunization Service