India Interior

The sky’s the limit, for ASMAN

Preeti Mehra | Updated on June 12, 2020 Published on June 12, 2020

Healthcare linked by technology

How this Alliance saves mothers and newborns by timely use of technology

Mona (name changed), a sanitary worker in Delhi, lost her daughter six weeks ago, due to delivery complications. Luckily, the baby is alive and well. With a lockdown in place and several hospitals reserved only for Covid-19 patients, the pregnant young woman lost time moving from one hospital to another for admission. As the hospital where she finally gained entrance was unfamiliar with her case, when serious complications arose during delivery, she could not be saved.

Contrast this with the case of 21-year-old Sarita (name changed) from Madhya Pradesh’s Shivgarh village, around 20 km from Ratlam, the nearest town. Sarita’s first port of call when she experienced labour pain was the primary health centre (PHC) in her village. When nurse Lata examined her, she observed pre-term labour with breech presentation.

The complexity of the case did not overwhelm Lata. She quickly entered the details on the ASMAN tab she had been trained to use. A clinical alert was issued by the ASMAN interface and following its advice, she administered a dexamethasone injection to Sarita. While plotting the e-partograph, the nurse realised that the baby was in foetal distress. She quickly alerted the doctor and prepared for referral, after obtaining informed consent from Sarita’s family. The mother-to-be was sent to a higher facility, the District Hospital in Ratlam, which was informed through the ASMAN application and an ambulance was arranged.

When Sarita reached the hospital, it was easy for medical officer Dr Preeti Sakya to familiarise herself with her medical history and current status through the referral slip on the tab. This was technology bridging the information gap to help health officials make timely decisions while eliminating all unnecessary delays to save a life.

Sarita’s case is among those documented in detail by the Alliance for Saving Mothers and Newborns (ASMAN) programme, which is undertaking a pilot in eight districts, four in Madhya Pradesh and four in Rajasthan in collaboration with the State governments. The fact is that if the same ASMAN app had been available for Mona’s daughter in Delhi, there is a possibility that she too may have been saved.

“As of now, we have the ASMAN application in 81 district and PHC facilities in the two States. There are three reasons why a delay takes place in child deliveries in India. The first delay happens in the family itself as many are not aware of institutional deliveries. The second delay occurs in transportation and the third delay is in the timely care both mother and child need at this crucial juncture. Through the programme we have been able to build the capacity of all medical personnel and standardise the process — from admission to delivery to discharge,” explains Dr Pratibha Gaikwad, Public Health Consultant at Tata Trusts, and Programme Manager for Tata Trusts under the ASMAN Alliance.

The Alliance, which started in 2015 to improve the survival of mothers and newborns by providing better quality of care during childbirth and the first 48 hours after delivery, has five development sector partners. Apart from Tata Trusts, there is the Bill & Melinda Gates Foundation, MSD for Mothers, Reliance Foundation and the United States Agency for International Development. The idea was to use innovation in technology to help India reach the 2030 Sustainable Development Goals 3.1 and 3.2, which are reducing maternal mortality and ending all preventable deaths under five years of age, respectively.

“Most maternal and neonatal deaths occur within 48 hours of childbirth and up to 80 per cent of the deaths can be prevented. The ASMAN tablet-based application allows real time data entry and recording of vitals. It gives an alert to the medical officer if a case is in the high-risk category. As staff nurses handle most delivery cases across the country, if they are warned they can immediately refer the case to a specialist, helping save mothers and newborns,” says Gaikwad.

Apart from aiding case management, the application gives specialist doctor support 24X7 through remote support centres that offer real-time assistance to health providers. “ASMAN has integrated a gamification module as well on the platform to improve the capacity of healthcare providers. The module has interactive games based on simulated intrapartum and immediate postpartum complication management scenarios that aids healthcare providers in critical thinking and the practice of evidence-based case management for safe childbirth,” says Gaikwad, while emphasising that above all the application is a time saver. “Currently nurses have to fill 16 registers, with ASMAN we can do away with manual registers.”

Monitoring outcomes from ASMAN is still in progress and both the States are asking for it to be extended to other districts. Assessment till now has revealed that incidence of fresh stillbirths at intervention facilities fell from April-June 2019 to January-March 2020: the stillbirth rate declined from 7.3 per cent to 6.5 per cent in Madhya Pradesh and 6.2 to 4.7 per cent in Rajasthan. Across the programme facilities, neonatal mortality rate declined from 2.3 per cent to 1.4 per cent in Madhya Pradesh and was maintained at 2.9 per cent to 3.0 per cent in Rajasthan between April-June 2019 and January-March 2020.

Other States are also showing interest in the ASMAN model, and if all goes well with the outcomes, in the years to come, mothers like Mona will be spared the trauma of losing their daughter during childbirth.

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Published on June 12, 2020

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