Role of Information Technology in Policy Implementation of Maternal Health Benefits in India

Fifty thousand women died during childbirth in India in 2013, the highest total in the world; that is, one maternal death every 10 minutes. India and Nigeria account for almost one-third of total global maternal deaths. In pursuit of the Millennium Development Goals, the government of India directed efforts to improve maternal health and was able to reduce maternal mortality rate from 437 per 100,000 live births in 1990 to 140 per 100,000 in 2015, albeit missing the target of 109. Moreover, estimates for maternal morbidity are three to four times that of the mortality rates with even more pronounced regional disparities. Universal access to free public healthcare for maternal health has been a national goal since 2005, but its quality of service and utilization rate of maternal healthcare remains an elusive dream for many of the rural women even after a decade of substantial efforts. In a stark contrast, mobile technology has become more pervasive than the most basic infrastructure across the world. There are over 7 billion mobile phones subscriptions worldwide, but only 4.5 billion people have access to basic sanitation facilities, implying more people have access to mobile phones than toilets in the world, including India. The ubiquity of mobile phones can no longer be ignored. According to the 2011 census of India, 47 percent of the rural households owned mobile phones, and mobile phone network coverage spanned over 99 percent of the rural landscape, but only 31 percent of these rural households had a toilet. This exponential growth in mobile phone ownerships and adaptation has captured the imagination of academic scholars, public administration and the private sector to push for mobile based solutions and services in almost every aspect of public, social and personal life. M-governance has gained prominence too, aimed at improving service delivery, transparency, policy monitoring, public engagement, combatting corruption and poverty, especially in the developing world, leap-frogging poor-resource and low-income constraints. Today there is a mobile app for everything and the solution to any problem is a mobile app, including maternal health. However, amidst this optimism, it is surprising that the potential of mobile phones to improve social policy awareness is yet to be fully exploited. There are initiatives toward health literacy and mobile based cash transfers but few initiatives are geared toward improving awareness of social welfare policies, informing people about eligibility, enrollment and entitlements. Here lies the uniqueness of this research. Motivated to find solutions to actual policy implementation problems in practice, this research lies at the intersection of information communication technology, maternal health benefit policies and public management. In India, low maternal health benefits policy awareness imposes an administrative burden on rural women and leads to uptake of cash and public health service benefits. This research explores if mobile phones can be used as an effective medium to increase maternal health benefit awareness; thereby increasing the claiming of benefits. Using mixed methods of research, insights are drawn from a longitudinal case study in Melghat, a tribal belt of Amravati District in Maharashtra, India; a region that suffers from high maternal morbidity and high infant mortality rate. Forty-two percent of total childbirths take place in the home despite four different maternal benefit policies promoting institutional delivery and safe motherhood. In this dissertation, customized audio messages about maternal healthcare benefit policies were designed and broadcasted to 82 pregnant tribal women and followed up with qualitative interviews to examine any improvements in claiming of the policy benefits in 2013. The research provided an in-depth view of how information was disseminated through mobiles phones, and what factors and trade-offs, beyond information, were actually considered by the households in claiming the policy benefits. This research offers four contributions. First, it provides a deeper understanding of maternal health policies, how incentives work and the impact of conditions attached to these incentives, providing a plausible explanation for why the policies remain only partially effective. Second, in an era of m-governance, it illuminates the potential and limitations of the mobile phones in policy implementation and civic engagement, through a gendered lens. Third, it yields a caution to the technological optimistic use of mobile phones. By evaluating the causal mechanism of whether and how information awareness led to greater claiming of benefits, the findings revealed that information awareness alone was insufficient to improve claims when there were structural and systemic deficiencies in the policy design and management. Fourth, it advances the theory of administrative burden, by using mobile phones to reduce learning costs and by expanding the concepts of compliance costs and psychological costs, and highlights the relative interaction and trade-offs between components of administrative burden in an international context. The research concludes that although mobile phones have the potential to trigger demand for policy benefits and public engagement, and reduce learning cost, they are not the “silver bullet” because they cannot bypass the fundamental challenges of other administrative burdens, policy design deficiencies and bureaucratic processes

The role of m-health in providing antenatal care in rural areas

Background: The maternal mortality rate is high in India and many deaths are due to preventable causes related to pregnancy. Mobile-health is an innovative strategy wherein, mobile phones are used for pregnancy tracking and giving support during the antenatal period. Aims and objectives of the study was to know the role of m-Health in providing antenatal care in rural areas.Methods: This was a prospective, comparative study carried out at Kamineni Hospital, LB Nagar, Hyderabad and the Primary Health Centres (PHC) of Uppal and Narapally, Ranga Reddy district over a period of one year nine months and consisted of 204 registered antenatal cases divided into study and control groups. Both groups received routine antenatal support and the study group, in addition received mobile health support also. Various parameters were compared in both the groups.Results: The study group had more antenatal visits, better correction of anemia, less number of patients who were lost to follow-up, and more number of Caesarean deliveries.Conclusions: Mobile health helps in pregnancy tracking and increasing the antenatal visits. It helps in timely referrals for high-risk pregnancies in remote areas and it has the potential to provide obstetric care and consultations to both low risk and at-risk women in rural areas where specialist care is not always available

Public Service Delivery: Role of Information and Communication Technology in Improving Governance and Development Impact

The focus of this paper is on improving governance through the use of information and communication technology (ICT) in the delivery of services to the poor, i.e., improving efficiency, accountability, and transparency, and reducing bribery. A number of papers recognize the potential benefits but they also point out that it has not been easy to harness this potential. This paper presents an analysis of effective case studies from developing countries where the benefits have reached a large number of poor citizens. It also identifies the critical success factors for wide-scale deployment. The paper includes cases on the use of ICTs in the management of delivery of public services in health, education, and provision of subsidized food. Cases on electronic delivery of government services, such as providing certificates and licenses to rural populations, which in turn provide entitlements to the poor for subsidized food, fertilizer, and health services are also included. ICT-enabled provision of information to enhance rural income is also covered

Connected Women: How Mobile Can Support Women's Economic and Social Empowerment

This report explores how mobile services provided by Vodafone and the Vodafone Foundation are enabling women to seize new opportunities and improve their lives. Accenture Sustainability Services were commissioned to conduct research on the services and to assess their potential social and economic impact if they were widely available across Vodafone's markets by 2020. It showcases the projects and the work of those involved and also poses the question -- what would the benefit to women and to society at large be if projects such as these were taken to scale and achieved an industrialscale of growth? This reflects the Foundation's commitment not solely to the development of pilots but rather the Trustees' ambition to see projects which lead to transformational change. In order to understand this more deeply, the Report looks at the benefits for women and society and providessome financial modelling for how the engagement of commercial players could achieve industrial, sustainable growth in these areas. Accenture has provided the modelling and, given the public benefit and understanding which the report seeks to generate, these are shared openly for all in the mobile industry to understand and share. It is the Trustees' hope that the collaboration with Oxford University and Accenture in the delivery of this Report will stimulate not only the expansion of existing charitable programmes but will also seed other philanthropic, social enterprise or commercial initiatives

Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries.

BACKGROUND:mHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries' perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described. METHODS:A qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose. FINDINGS:The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries' views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS. CONCLUSIONS:mHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members

Improving neonatal health in Nepal: Major challenges to achieving millennium development goal 4

Background: Globally, more than 40% of all under-five child deaths occur during the neonatal period. Neonatal mortality in Nepal is 33 per 1,000 live births, eight times that of developed regions. So there is an urgent need for neonatal care to prevent these deaths, in order to achieve the fourth Millennium Development Goal by 2015. Objective: The objective of this article was to review the major challenges in improving neonatal health in Nepal and to identify possible keys to achieving Millennium Development Goal 4. Methodology: Key literature searches were conducted of electronic databases and relevant web-sites. Furthermore, personal contact with the local population in Nepal and hand searching of key journals was performed. Results: In Nepal, there exist harmful cultural practices during pregnancy and after childbirth. Under utilization of basic maternal and neonatal healthcare, limited health infrastructure with a shortage of trained health care professionals, poverty, illiteracy, women's low status in the society and political instability are major challenges facing neonatal health in Nepal. Conclusions: In order to improve neonatal health in Nepal, it is imperative to focus on biomedical, nursing and social interventions, in addition to family centred care. Health promotion regarding the practices to be adopted during pregnancy and after childbirth, improving health infrastructure and integrating skilled delivery personnel into local health services are important measures. Longer-term solutions could include: improving mother's nutrition and women's position in society, increasing the proportions of girls attending school, as well as involving men in neonatal health matters

The effectiveness of emergency obstetric referral interventions in developing country settings : a systematic review

Peer reviewedPublisher PD

Health Phones: A Potential Game Changer in Health Information Management

Health education has to be one of the most effective ways to reduce morbidity and mortality in developing countries. We need to deliver vital messages and information to people at the lower quarter of the society to use changing behaviour and practices which can save and protect their lives. It is in this context, use of mobile phones in delivering vital health information is of significance. This article reviews few projects which successfully use mobile phones for health information delivery

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation.

INTRODUCTION:Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes. METHODS AND ANALYSIS:This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries. ETHICS AND DISSEMINATION:Ethical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public. TRIAL REGISTRATION NUMBER:ISRCTN83902145