Before they were handed mobile phones, Accredited Social Health Activists, popularly known as ‘ASHAs’ in Gujarat, used to visit homes of pregnant women and mothers of newly-born During these visits, they would inquire about the health of the mother and the child, but would not always delve deeper. This has changed with technology.

Now, ASHAs digitally track pregnant women and infants’ health and schedule home visits, which enables decision support through a digital checklist that help analyse health complications and notify stock levels of drugs, vaccines and other consumables.

According to data released by the Indian Council of Medical Research (ICMR), a scientific study related to the mobile app ImTeCHO — now being used almost across the State — has shown substantial improvement in health of women and children. The app also helps primary health care centre (PHC) staff and doctors monitor data that ASHA feeds, track high-risk cases, register births and deaths, calculate and pay incentives to ASHAs online, and broadcast training content to ASHAs for enabling learning on the job.

“Armed with Android phones loaded with ImTeCHO, over 10,000 ASHAs are in the process of moving towards paperless functioning in the State. While earlier the ASHAs had to fill a 94-column register, which involved cumbersome paperwork, it is all a click of a button now,” said Gaurav Dahiya, MD, National Health Mission, Gujarat.

While ImTeCHO was rolled out in the State only in 2017, the conceptualisation of the app began back in 2013, and involved multiple surveys that were carried out with the support of the State government and ICMR.

Increase in coverage

In 45 villages with a population of 45,000 — and after training 45 ASHAs — results in the intervention arm were better as compared to the control arm where no intervention was conducted. The coverage of home-based newborn care was 56 per cent as compared to 10 per cent in ASHAs which had no technology support. Similarly, exclusive breast feeding (44 per cent vs 23 per cent) and reporting of neonatal complications (78 per cent vs 27 per cent) improved in the intervention area compared to the control area, results shared by ICMR.

Another larger study of 22 PHCs in hard-to-reach areas of Narmada and Bharuch districts indicated that the use of cellphone technology can improve coverage and quality of mother and child services. The study involved 561 ASHAs, and a population of 4,76,943. After 12 months of implementing the project, 6,493 mothers were surveyed. It showed that 11 PHCs in the intervention arm where ASHAs used the app had recorded 32.4 per cent home visits within the first week of birth compared to 22.9 per cent of the control arm.

Cost-efficient solution

“One of the features of ImTeCHO is that it throws up daily schedules for the population to be covered once ASHAs log in. Up to 88 per cent of ASHAs logged in every day. In contrast, only 24 per cent medical officers logged in on their dashboards, which is used to view alerts or process ASHA fees. We expected that the uptake would at least be 50 per cent among officers, but it was low,” explained Shrey Desai, co-principal investigator of the study and a doctor at non-profit Sewa Rural.

Close to ₹42 lakh was invested in conducting the study over the past year. The study estimated prevention of 11 infant deaths per 1,000 live births, of the total 3,014 live births reported in the study area. “ImTeCHO is a cost-effective intervention from a programme perspective, at an incremental cost of ₹4,817 per life saved and ₹3,29,208 per death averted,” said Dhiren Modi, another co-principal investigator of the study.

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