Nupur Bahl, Programme Head, Reliance Foundation and Pompy Sridhar, Director-India, MSD (Merck) for Mothers, recommends empowering healthcare providers with tech-enabled tools to take timely decisions helping improve health outcomes
Maternal and child health are two of the most critical indicators of the healthcare status of any country. In India, the turn of the millennium saw some significant efforts to improve both these areas, but those efforts have not had the desired impact. According to UNICEF, globally, about 800 women die every day of preventable causes related to pregnancy and childbirth, and 20 per cent of these women are from India. India still accounts for 26 per cent of all neonatal deaths and 17 per cent of maternal deaths in the world. 1
The Government of India had introduced the Janani Suraksha Yojana in 2005 with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme, which integrates cash assistance with delivery and post-delivery care, has contributed to a phenomenal rise in institutional deliveries.2 However, there was no significant reduction in India’s maternal and child mortality rates. This was because healthcare infrastructure in many districts; high patient to provider ratios; inadequate or irregular measures to strengthen the capacity of healthcare workers; inadequate supplies and equipment at healthcare facilities and so on.
As a step towards addressing this situation, the Union Health Ministry, in 2017, announced the launch of LaQshya — a programme aimed at improving the quality of care for pregnant women in labour rooms, maternity operation theatres, obstetrics intensive care units and high dependency units. It was a step in the right direction. But there’s yet another significant and unfortunate cause of maternal deaths that needs attention —the problem of delays improving maternal and neonatal outcomes through improved healthcare facilities should continue to be one of the top priorities for the government.
Delay: A major area of concern
There could be instances when a woman in labour is unable to reach a health facility in time owing to traffic conditions or the unavailability of a vehicle or ambulance. There could also be delay during the transfer from a lower health facility to a higher one. It is critical that, treatment and care be initiated immediately and be continued uninterrupted throughout the duration of treatment and stay at a healthcare facility. Delays at this stage are hard to excuse and yet they do occur for many reasons such as uncertainty in making decisions or managing complications; lack of emergency preparedness; lack of equipment or medical supplies; lack of adequately trained staff; and weak referral systems between healthcare facilities. Many of India’s public health system facilities are short-staffed. This puts a lot of pressure on the existing set of nurses, physicians, doctors and other personnel and contributes to delay. This, together with certain other factors, accounts for a sizeable percentage of maternal deaths that occur at health facilities. Much of this can, however, be addressed with the right technological interventions.
Equipping understaffed and overburdenedhealthcare providers with decision-support tools is critical
Digitisation enables medical facilities to save electronic health records or patient health records on portable wireless devices such as tablets and set up long-distance e-consultations with doctors. Digital interventions can significantly improve the recording of vitals like Foetal Heart Rate — a critical part of high-quality care to ensure good neonatal outcomes. They can also enable on-demand support from a network of mobile-connected medical facilities or referral hospitals through a remote call centre. By using data from digitised checklists and case sheets populated by individual healthcare service providers, the remote support centre can assist medical facilities in making informed decisions. Digital processes can notify a hospital of incoming referrals and save precious time in the process. Technology can also help healthcare providers with relevant alerts and tips and make procedures easier.
Digitisation is, however, only a tool. Its effectiveness depends greatly on the people using it. The quality and the outcomes of healthcare can only be improved when technologies and processes are used by well-trained and efficient professionals. Capacity strengthening of India’s public healthcare providers is thus of critical importance. Digital technology has a role to play even here, in the form of ‘gamified’ learning programmes and on-demand content support.
Ingraining technology in the government’s health programmes will improve outcomes
Using technology to drive capacity-building and high-quality service delivery will have a measurable impact on maternal and newborn mortality. For too long, the health discourse in India has been focussed on improving access to care, without enough emphasis on provision of high-quality, timely and respectful care. Over the years, there have been many pilot projects in different regions, aimed at improving certain aspects of India’s public health system, but what we really need are technology-based solutions that can be implemented on a nationwide scale for maximum impact.
Governments of Rajasthan and Madhya Pradesh are working with philanthropic and private sector organisations and public health experts like ASMAN (Alliance for Saving Mothers and Newborn) on solutions that have potential to be upscaled. There are many examples of how technology can introduce and improve evidence-based best practices to reduce maternal and neonatal deaths at public health facilities. Going forward, such solutions can be made even more effective by incorporating technologies like virtual reality and artificial intelligence.
A modernised, technology-enabled public health system will not only improve outcomes, but also enable better governance, transparency and accountability. And that’s something the country truly needs.
1 http://unicef.in/Whatwedo /1/Maternal-Health
2 https://www.livemint.com/ Opinion/PwRuPTCR8imbCM1mKbEJLK/The-limited-success-of-Janani-Suraksha-Yojana.html