Gates-sponsored mobile health effort launches in India

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On January 15, the Government of India launched a nationwide mobile health program designed to train community health workers and to directly reach millions of women within three years. The program is powered by MOTECH, a mobile health technology developed by Grameen Foundation, with support from the Bill & Melinda Gates Foundation.

“Until now, mHealth applications have been relatively small and siloed,” says John Tippett, global director of mobile health at Grameen Foundation. “By allowing systems to work together and serve huge numbers of people, MOTECH opens a new era for tackling global health problems at scale through mobile technology.”

Grameen Foundation is a global nonprofit that combines mobile technology and strategic partnerships to bring life-saving and life-changing information and services to millions of the world’s rural poor. It constantly innovates to provide financial services, agricultural knowledge tools, market opportunities and health information to even the most remote communities.

India’s Ministry of Health and Family Welfare announced the national roll out of two MOTECH-powered programs developed by BBC Media Action, Mobile Academy, and Kilkari, both aimed at addressing health challenges that result in high infant and maternal mortality rates.

Kilkari directly calls pregnant women and mothers, delivering health information targeted to their stage of pregnancy or their infant’s age. Mobile Academy uses Interactive Voice Response messages on mobile phones to train front-line health workers in maternal and infant care. The health workers, known as ASHAs (Accredited Social Health Activists), are selected by the village they serve, and are central to India’s strategy to improve maternal and child health.

“The Government of India has launched Digital India program in order to transform the entire ecosystem of public services through the use of Information Technology,” says Shri Jagat Prakash Nadda, the Honorable Union Minister of Health and Family Welfare. “We need to transform healthcare by empowering people to become active healthcare citizens with choice but most powerfully with information and to take more responsibility over their own health and life choices… . I am confident that these services will bring us a step closer to the people who need our services the most.”

As of the launch announcement, national scale-up was already underway. Kilkari — the Hindi word for “a baby’s gurgle,”— is live in six states, and Mobile Academy is live in four. According to statistics from the Ministry of Health and Family Welfare, these include some states with India’s highest infant and maternal mortality rates. Rural areas in Madhya Pradesh register 57 infant deaths per 1,000 live births, well above the national average of 40/1,000. Uttar Pradesh and Uttarkhand have the country’s second highest maternal mortality rates — 285 maternal deaths for every 100,000 live births.

According to Grameen leaders, the proliferation of mobile phones in low- and middle-income countries has created unprecedented opportunities to extend health services to underserved populations, helping to educate and inform patients, and helping community-based health workers diagnose, treat, and monitor a broad range of conditions. But until now, most mHealth programs have had limited reach and narrow applications, and have been unable to interface with bigger national information and health systems.

The application of MOTECH to improving the health of mothers and babies across India required partnerships and collaborations with a range of institutions. The Government of India’s Ministry of Health and Family Welfare; state health ministries; the Bill & Melinda Gates Foundation; BBC Media Action, the BBC’s independently funded international development charity; and Grameen Foundation all played crucial roles.

“The national launch of mHealth services is a great step towards leveraging India’s increasing mobile penetration to make healthcare services accessible to everyone across India,” says Shri Rahul Mullick, lead ICT and mHealth, Bill & Melinda Gates Foundation. “We at the foundation believe technology can offer compelling solutions in solving public health challenges and are committed to supporting the government in its ambitious agenda of prioritizing equitable access to public health services.”

With funding from the Bill & Melinda Gates Foundation, Grameen Foundation created MOTECH as an open-source platform that works across key areas for health services: behavior change, managing patient data, improving worker performance, strengthening last-mile supply chain, and improving patient adherence. Because it is compatible with any mobile technology, MOTECH’s impact can continue to grow along with the adoption of android devices or other smart phones in rural areas.

“To start with, we needed a technology powerful enough to interact with government data bases and reach women across India’s population of 1.29 billion people,” says Chandni Ohri, CEO of Grameen Foundation India. “At the same time, we needed to be able to do smart things on really basic feature phones, which is what people in rural areas now own and use.”

MOTECH does both, and is designed to reach anyone, regardless of how remote their location or sophisticated their mobile technology. It registers patients in the system; manages their data; schedules messages; tracks ASHA training; and connects with national health systems, including the national Mother & Child Tracking System (MCTS) a pan-Indian health database. This allows women in the database to be automatically enrolled in Kilkari.

MOTECH programs are also being used to facilitate an Ebola vaccine trial in Sierra Leone; and to serve HIV/AIDS patients, tuberculosis patients, and community health workers in more than 15 countries including Ghana, India, Tanzania, Uganda, and Zambia.  medadnews