Student Dissertation

Agency : Auxiliary nurse midewives; Mobile health application; MCHN Day; Khushi Baby; Swasthya sandesh seva.

Objective : The study included the following objectives: (1) to study the process of MCHN Day. (2) To understand key stakeholders involved in conducting MCHN day. (3) To study the challenges faced by ANMs in conducting MCHN day, especially maintaining records and preparing report. (4) To find out feasibility of an alternative m-health solution that is already being worked out for MCH in parts of Rajasthan

Background : Auxiliary Nurse Midwives are the most peripheral point of contact to the deliver healthcare in India. They provide the majority of rural primary maternal and child healthcare services. Each ANMs visits four to five different villages every month to conduct maternal and child nutrition (MCHN) day where she provides basic preventive and curative services and also maintains separate register for data entry for every villages, fill different formats of monthly reports and do various other documentation work. Keeping in view the use of technological advancement by many development partners, it is important to look for alternate solutions to overcome the challenges and its feasibility of use. Pilot studies suggest that Mobile health technologies have made significant contribution in reducing the burden of recording and reporting for frontline health workers. However, very few mobile health applications have explored the space of user centric approach where the feasibility of the mobile prototype needs to be tested and co-created by the user.

Methodology : The study was conducted in three blocks (Badgaon, Girwa, Rishabdev) of Udaipur district of 6 Rajasthan. A total of thirty ANMs (13 from Badgaon, 15 from Girwa and 2 from Rishabhdev) were interviewed using a semi structured questionnaire. A total of seven Maternal and child nutrition day of Badgaon block were observed to study the workflow and process. Besides primary data collection, a review was done for the variables in the ANMs registers and Khushi Baby (ongoing m-health project in the district) mobile based information system. Based on the current variables used by ANMs a mobile app was created to test the usability in general.

Findings : Seven key stakeholders namely AVD, ANMs, ASHA, AWW, LHV, Block manager and beneficiaries were identified to be directly involved during the MCHN Days. Five key challenge areas were identified (i) Patient identification and registration, (ii) at immunization site, (iii) resource mobilization. (iv) Communication (v) Training and education. Due list was found to be the major source of information for patient identification. Ninety percent of the total thirty ANMs interviewed said that the do multiple entries using the RCH register. Fifty two percent of them said that the data documentation time over exceeds the time taken to deliver services to the patient. Although Seventy five percent of the ANM ranked the LHV first to receive immediate feedback for decision making but the frequency of meeting was found to be only 2 times a month. To overcome these challenges an alternate solution i.e. an m-health app prototype was built and tested among 10 users for feasibility. The application variables for antenatal care and child care were reduced from 117 to 88. The overall time taken to successfully complete different steps in the prototype was greater for the >35 age group ANMs. The overall experience of the application was satisfactory.

Recommendations : The alternate solution will help in minimizing double data entry and time taken per child/ANC will subsequently decrease. The findings may further be researched to know the intricate details of the workflow of the ANMs and the challenges that they face in conducting MCHN days to consider it for scaling up.