Gandhinagar: Veenaben Solanki, mother of a one-and-half year-old boy, recalls the first text message she received from the state government when she was pregnant. The message, in Gujarati, suggested that she reach a nearby public health clinic for various antenatal care services. She took up the suggestion and the state followed through, having an accredited social health worker accompany her during the delivery to ensure safe childbirth.
Since then Solanki, a resident of Unava village near the state capital Gandhinagar, has been regularly receiving messages on her phone. The latest came about a week ago, reminding her it was time to get her son vaccinated for measles.
The auto-generated texts are part of a state project that matches advanced technology with old-fashioned governance to deliver healthcare to mothers and children.
With a few million mobile connections and a few thousand health workers, the state has brought down avoidable child and maternity-linked deaths.
After a pilot test, the National Rural Health Mission (NRHM) and the Gujarat government implemented e-Mamta—a mother and child tracking system—in May 2010.
“Although there was abundance of information in health sector there was no ‘client’ focused model which would track services. Through e-Mamta the idea was to bring in a paradigm shift in data collection wherein we could see through the data, making it easy to find, communicate or use the information effectively and link it to individual beneficiaries,” says Anju Sharma, who conceived the initiative as the then director of the State Rural Health Mission. She was recently transferred as commissioner, women and child development department.
Using this mobile phone-based technology, the state managed to save four babies out of every 1,000 births, bringing down the infant mortality rate from 48 in every 1,000 births to 44 by 2011.
The aim is to bring down the infant mortality rate to 30 in every 1,000 births by 2015, says Sharma.
Funding support for the Gujarat initiative was sought under NRHM and the programme was developed through the National Informatics Centre (NIC), Gujarat. To execute the initiative, health workers conducted a family health survey in rural and urban areas wherein individual records of around 920,000 families comprising 45 million beneficiaries, covering almost 80% of the population of Gujarat, were entered in the information system. The data was then validated by comparing with below poverty line, voters’ and ration card lists. A unique family healthcare ID was then provided to capture migration details. After that, all pregnant women and children up to the age of six were registered and provided a unique mother and child ID.
The application is being implemented in all 26 districts of Gujarat and eight corporations, comprising 1,090 primary health centres, 7,274 sub-centres, 283 community health centres and 26 district hospitals. Presently, the application stores family health records of over 9.5 million families. E-Mamta has registered 2.17 million pregnant women and a little less than 1.3 million children up to age six.
The Union ministry of health and family welfare, recognizing e-Mamta as the best mother and child tracking system, has started replicating it in other states and Union territories with the support of the Gujarat government.
The application was a finalist for the South Asia Manthan Awards 2010 and has been presented at various national and international conferences.
There are close to 30,000 social health workers trained by NRHM, Gujarat. They go door-to-door to collect information on pregnant women and infants and send it to NRHM, which collates the data into a centralized repository. This data is then used to alert the rural social health workers— via text messages—to make sure they reach out to the pregnant women and mothers regarding immunization dates or medicines to be taken.
The whole family health register is online and can be viewed by authorized users.
A simple search enables instant retrieval of historical data and service records and allows the development of reports, such as height-weight charts and growth and immunization charts. This, in turn, is easily accessed and analysed by medical, block and district officers.
“With numbers being replaced by names, monthly work plans have been introduced for the first time as delivery schedules and left-out lists,” said Nancy Gupta, project officer, e-Mamta, NRHM Gujarat.
The system has also helped cut down the time needed to compile reports from various offices. This work, which used to take about three weeks earlier, can now be done instantly as the process is computerized across the state.
E-Mamta is developed for quick communication in times of disasters and medical emergencies. As many as 16,000 text messages were delivered to all nurses and doctors of Gujarat within minutes of infant deaths reported due to measles vaccines at a hospital in Kutch in March 2011.
One of the bottlenecks for the project is the issue of language and font. While not everyone is able to read, some mobile phones do not support all language fonts. “The ASHA (social health) workers are always updated and they are there to communicate with the people. Besides, the receiver (of the message) can also seek help from family members or villagers,” said Gupta. To get rid of this problem, e-Mamta will soon introduce a voice-based message service, she added.
Another hurdle at times is seamless connectivity as the system works on the Internet. Also, it’s been tougher to implement e-Mamta in the cities as people are difficult to reach out to when compared with the rural populace where health workers have already made some progress, Gupta said.
Of the total cases handled by GVK Emergency Medical and Research Institute (EMRI), which runs ambulance services in the state, one-third are related to maternal issues, says Sharma, adding that in an effort to reduce high-risk pregnancy, EMRI tracks pregnant women in rural areas and reaches out to those in need.
There is a lot of scope in the modular design to expand the application into a multi-service delivery network for the entire health system, including nutrition and disease control, stock management and payment modules.
“The database has details of family health register. So if a government official wants to know how many people are suffering from tuberculosis in a given village, he can avail it with a click. We are aiming to integrate e-Mamta with Integrated Child Development Services data,” said Sharma.
Mint has a strategic partnership with Digital Empowerment Foundation, which hosts the mBillionth Awards.
Picture: Driving change: A beneficiary shows an e-Mamta message on her mobile phone. Photo by Siddharaj/Mint.