New Delhi: “Kilkari Calls – the program that provides critical preventive care information during pregnancy and infancy, guided me on how to care for my wife and child. Together, we learned about the importance of immunisation, breastfeeding practices and good nutrition,” says 25-year-old Daisy Kumari’s husband Mukesh Kumar from Bihar, who listened to the weekly services from Kilkari Calls along with his wife when they were expecting. 42-year-old, Sushma Pranesh Aryamane from Mumbai, Maharashtra says, “After 3 miscarriages, I got pregnant again at 41 and safely delivered a baby, thanks to mMitra programme.”
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Mobile For Maternal Healthcare Programmes
Kilkari and mMitra are free mobile voice call service that send the expecting mothers preventive care information weekly/bi-weekly. Kilkari calls cover the critical time period where the most maternal and child deaths occur, from the second trimester of pregnancy until the child is one year old (72 weeks). mMitra calls provide information, starting from pregnancy till the child is a year-old. In India these programmes are a part of the largest mobile-based maternal messaging program in the world, implemented in partnership with the Ministry of Health and Family Welfare by ARMMAN’s (Advancing Reduction In Mortality And Morbidity Of Mothers, Children And Neonates), India-based non-profit organisation that leverages mobile for Health.
Mobile Academy is another initiative that provides Reproductive Maternal Neonatal and Child health training course to refresh Accredited Social Health Activist (ASHA) workers’ knowledge of life-saving preventative health behaviours. The idea is to improve the quality of ASHA workers’ engagement with new and expecting mothers and their families. Mobile Academy has also been implemented in partnership with Ministry of Health and Family Welfare (MoHFW).
Mobile Healthcare In India – Slowly Becoming A Game Changer
Daisy and Sushma are not the only beneficiaries of such programmes. There are many who are reaping the benefits of mobile penetration across the country. Today, the mobile healthcare is slowly becoming a game changer in the country. According to the Telecom Regulatory Authority of India (TRAI) from 2021, there are more than 1.17 billion wireless subscribers in the country, and more households have mobile phones than toilets in India.
Mobile healthcare in India making sure healthcare reaches the last mile
The same has been highlighted in one of the recently published report – “The Promise and Progress of Maternal Nutrition In India” by Sight and Life, a Swiss-based foundation and humanitarian nutrition think tank working to innovate in nutrition towards eradicating all forms of malnutrition. The report has been published as a part of India’s POSHAN Maah celebrations where the month of September is marked as National Nutrition Month.
Talking about the benefits of mobile healthcare in India, Dr Aparna Hegde, from ARMMAN, Mumbai, says,
Mobile health solutions in India have emerged as a viable route to reach every last woman directly in her home and train health workers.
Sharing examples of the scope of mobile healthcare she further said,
In an overpopulated, geographically and culturally diverse country like India, where almost 60% of women are anaemic, it is imperative that pregnant women and new mothers should be aware of best maternal nutrition practices. And mobile health solutions have emerged as a viable route to reach every last woman directly in her home and train health workers. Health interventions such as mMITRA have a significant emphasis on self-care and behaviour change in the country. During our computer-assisted telephonic survey covering randomly selected subscribers who were in the last phase of pregnancy, it was found that 26% of respondents increased their intake of vegetables and fruits while 25% started eating smaller meals several times a day after listening to mMitra calls.
‘The Promise and Progress of Maternal Nutrition In India’ report also mentions the positives of the tele-communication programme in Uttar Pradesh where Hello Didi, a phone-based counselling and information service in six districts of Uttar Pradesh was conceptualised in 2021 to accelerate the rehabilitation of Severe Acute Malnourished (SAM) children at home and increase demand for, and utilisation of, maternal health services. The project was implemented from September to December 2021 and engaged with 843 pregnant women who were either in the first or second trimester of pregnancy. A total of 3,075 tele-counseling sessions were completed with pregnant women and over a period of four months (four counselling calls), the project was able to improve ANC (Antenatal Care) and maternal nutrition knowledge and practices.
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Way Forward For Mobile Healthcare Programmes
The report highlights robust mobile network and states that India has a mega digital presence, with 1.17 billion wireless phone subscribers, 560 million internet subscribers, 354 million smartphone devices, and 294 million users engaged in social media. Underlining the road ahead for India, the report concludes,
As mobile penetration, mobile literacy and internet access via mobile phones increase, the financial viability and effectiveness of mHealth programs will significantly improve. However, while technology is a great enabler, it can also potentially reinforce the same inequities that it seeks to address. It is imperative to look more closely at integrating empowerment and equity into digital programs in a tangible manner while designing and testing tools that can be used to measure progress.
Talking about the digital divide and the important role of ASHA workers, Kalyani Prasher, Editor of the Sight and Life report signed off the discussion by adding,
With 500 million active WhatsApp users and 1 billion active mobile connections in India, using mobile services is an effective solution for expanding coverage of nutrition interventions. However, we need to look at a mix of offline and online services. The role of frontline workers doing house calls in remote regions can’t be undermined and will fill in the digital access gap that remains a reality in India.
The report also highlighted the two major challenges for mobile healthcare in India, it said that for these programmes to be 100 per cent effective, India first needs to fix the inequalities and added,
Access to mobile/network is currently unequal based on gender, geography and economic status. There is a gap of 23% between female and male phone ownership, which means women do not have equal access to mobile telephony. Secondly, digital literacy is relatively poor in rural regions and economically weaker sections of society. SMS is an alternate digital communication method, but it lacks the emotional connection of a voice call and has limited reach as 34.5% of Indian women are illiterate, according to Literacy Rate of India – Population Census 2011.
Rural India accounts for nearly 69 per cent of the total population according to Census of India 2011, but has about only 26% of total hospital beds and 33% of the total healthcare professionals, as per a study published in National Library of Medicine. Due to the unequal distribution of healthcare resources, the rural public health system in India remains inadequate. To bridge the gap, government of India with all these programmes is trying to promote Mobile Healthcare more and more and provide basic primary care services to the population living in remote and underserved areas close to their homes.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF)status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.
