An Auxiliary Nurse Midwife (ANM) is often the first point of contact between a health centre and a mother or expectant mother in India. She takes care of activities as basic as registration of pregnant women to more advanced interventions like routine immunization, identifying medical complications and providing referrals. An ANM has a lot of responsibilities and this simple, mobile-based intervention, Suyojana, enables her to effectively carry out her duties.
Rohini, from Chamrajnagar, Karnataka, is an Auxiliary Nurse Midwife (ANM), working in rural areas of the state. Despite the fact that she is proactive and interested in her work, Rohini often finds herself struggling to remain on top of all the information required to serve her patients effectively. From tracking crucial health parameters to scheduling important visits for critical cases, Rohini finds herself swamped with details that she is unable to handle in an organized manner.
Recently, however, Rohini began using Suyojana, a mobile-based application that improves the decision-making processes in maternal and child care activities undertaken by ANMs.
“The Suyojana application guides me from one step to another, within examinations and investigations, and does not let me skip a single step. This has made my work way more organized and systematic. The application has also made it very easy to identify high-risk cases and refer the patients on time to better facilities. The tool helps me take the right decisions at the right time,” says Rohini.
Rohini is just one among several ANMs who have benefitted from the simple technology, Suyojana, launched by Swasti, a health resource centre established to provide health services to socially backward communities, in collaboration with D-Tree International and Karuna Trust.
“Swasti has been working in this field for 11 years now and work on improving different aspects of public health. Since ANMs do such important work at the grassroots level, we thought it was necessary to make decision-making easier for them through this mobile intervention,” says Shama Karkal, Director, Swasti.
As par-medical professionals who are closest to the rural communities, ANMs play a crucial role. They are required to use their knowledge in order to take requisite actions on time.
Though ANMs undergo training, many times they are unaware of the basic practices they should follow. Shama recalls that ANMs met during the pilot did not carry blood pressure or weighing machines during home visits. “Everyone assumes that they know what they are doing. Even ANMs are not aware of what they could do better and there is no system to monitor the quality of the care they provide.
Without the application, ANMs can skip many of the examinations and other critical components of an ante-natal or post-natal visit.
This results in incomplete and in-accurate health monitoring of pregnant women and children.
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This is where Suyojana plays a crucial role. This mobile-based clinical-decision support system (DSS) provides ANMs with consistent guidance with antenatal care (ANC), postnatal care (PNC), and neonatal care.
The mobile app takes ANMs through all the procedures and guidelines to identify the person’s conditions and provides options for decision making. The app uses the national guidelines maternal and neonatal care to guide the ANM. The app also allowsANMs to track patients they have visited, their expected clinic visit dates, their medication, etc. This also helps ANMs to identify those women who are due for their next appointment, both in-clinic visits and home visits.
“The app has various forms which ANMs complete during different visits. The forms in the application include registration, antenatal history (for ANC clients), pregnancy outcome (for PNC clients), danger signs, physical examination, investigation tests, intervention, and counselling. Basic care and monitoring of the child is also included — from foetal heart rate to neonatal danger signs, pre-referral treatments and home-based new-born care counselling. Required fields in the app must be completed in order to complete the visit and record it. This way, every aspect of the care provided is tracked,” says Shama.
With the app the ANMs do not need to maintain multiple registers. The app generates the standard reports which can be further customized.
Another interesting aspect of the app is that it also runs offline and synchronizes with the server using general packet radio service (GPRS) for back up, reporting and analysis.
Thanks to the easily available data, a supervisor can track the details from the server and can identify maternal health trends in a particular area. This way ANMs can also take expert advice from remote locations and can decide the next step they need to take on time.
“This application will help us in quickly referring a complicated case to higher public health facilities and will replace the cumbersome procedure of checking registers and day books. All we would be required to do is click on the app to get all the details. This would be a great relief for us and reduce our workload,” says Saraswathi, yet another ANM from Karnataka.
The interesting initiative, which was launched as a pilot project in March 2014 in Chamarajanagar district, involved 31 ANMs in four districts of Karnataka, including Chamarajanagar, Ramanagara, Bijapur, and Chikkaballapur.
To make the app more user-friendly, all the information is available in Kannada. The ANMs are first given formal training before they actually start using this app. Once the training is complete, ANMs using this app and sync the data collected by them on a regular basis. There is also a full-time supervisor who assists the ANMs in case of difficulties.
“We launched it on mobile phones since they are easier to use and are more handy. Currently, we install the app on the mobile phones of ANMs and it is not available for the general public to use,” says Shama.
Though the simple mobile app looks like a feasible solution to address difficulties of ANMs and the quality of care provided by them, the team is still struggling to have it accepted with the government.
The pilot was funded by D-Tree International, has a small team of four members, who are looking forward to expanding the initiative to cover many more districts and ANMs.
To know more about the initiative, check out their website.