4. Bringing affordable and accessible maternal healthcare to the poorest districts of India

Shantanu Pathank
CareNX Innovations, India
Anjana Donakonda
CareNX Innovations, India

Women in the poorest districts lack access to maternal healthcare

Improving maternal and child healthcare is a difficult challenge, particularly for countries like India which, despite substantial efforts, accounts for more than 19% of maternal deaths worldwide. Many programmes within the maternal and child healthcare system of India have shortcomings due to the unavailability of smart, automated tools. And although 69% of women in the richest districts received institutional deliveries in 2010, this figure was just 45% in the poorest districts.

Maternal deaths affect marginalised groups disproportionately. However, up to 60% of maternal deaths can be prevented through regular preventive antenatal check-ups. Studies also prove that preventive care enhances the overall well-being of the child. Socio-economic and cultural factors, and gaps in service delivery, leave the majority of India’s mothers unable to access quality antenatal services. This irregularity directly correlates to maternal, neonatal, and infant health outcomes.

Equipping community health workers with digital tools enables them to carry out diagnostic tests and connect women to doctors in hospitals

Community health workers, who are predominately the only affordable and accessible healthcare providers for marginalised communities, often lack the proper tools to actively engage with mothers and provide them with adequate healthcare services. CareMother,1 developed by CareNX Innovations, is a complete solution for pregnancy care that addresses this problem. The package has been designed with the specific purpose of providing quality antenatal and postnatal services to marginalised populations, so as to reduce disparities in terms of affordability and accessibility.

CareMother is a portable kit equipped with point of care devices for screening and diagnostic tests with the same quality as those found in mainstream hospitals. It is administered by community health workers, and the test results are stored and tracked in a mobile application that transmits real-time data to the doctors in health centres and hospitals via a cloud and a mobile application. CareMother can be used by non-government organisations (NGOs), governments, and hospitals.

CareMother is currently being implemented in ten different states through more than 15 strategic partners, including four different government bodies. The solution has already shown striking results, with a direct, positive impact on maternal and neonatal health. As CareMother is a robust solution that can be implemented in a variety of settings, it is one of the most efficient intervention, monitoring, and referral tools for tracking the health status of pregnant women and ensuring them a safe and positive pregnancy experience.

The CareMother solution has enabled about 30 000 pregnant women to experience positive pregnancy, and it has empowered more than 500 health workers by enhancing their digital literacy. It has achieved a 33% increase in antenatal care coverage with 100% of women receiving a first antenatal visit coverage, 38.7% escaping anaemia prior to term, 96% having live births, and 89% experiencing an improved birth weight of their baby.

Adapting sophisticated technology to needs on the ground and implementation through strong partnerships are key to success

A key driver of success is upgrading technology to reflect realities on the ground, to comply with WHO/Government of India’s guidelines, and so that it can be executed through implementing partners. As a complete end-to-end solution - using software built with an iHRP (identification of high-risk pregnancy) algorithm, and a decision-support tool - the application is unique in helping to detect high-risk pregnancies at an early stage.

Other drivers of success include capacity-building modules for health workers, a public-private partnership whereby funds are leveraged through a corporate social responsibility initiative, and infrastructure support provided by the Government of India. A pre-defined exit strategy ensures sustainability of the project in the long term, and the project is regularly monitored to ensure quality.

Despite all these efforts, there are still some gaps in terms of health workers’ digital literacy and in integrating the technology into existing monitoring mechanisms set by the government. Also, the lack of availability of gynaecologists in remote areas poses a challenge for some high-risk pregnant women.

What next?

CareNX anticipates providing care for approximately 300 000 pregnant mothers and their babies over the next two years by actively collaborating with respective state governments in India as well as governments in lower middle-income countries and NGOs. The technology will be upgraded further and will be readily integrated into existing government systems. Additionally, CareNX will develop capacity building modules and a strategy to monitor and report the performance of community health workers regularly in terms of quality outreach.

Moreover, CareNX seeks to rigorously increase its scale of operations by partnering with governments at state level in order to minimise the number of women who are left behind. To achieve this, CareNX will establish project management support teams to provide handholding support on technology. CareNX will also submit to a third-party evaluation in order to identify strengths, gaps and along with recommendations on how these can be filled.

Building regional partnerships and establishing a service model among partner champions and government will lead to successful engagement, proper use of technology, and quality healthcare delivery. CareNX plans to build upon initial evidence from 100 village projects in the Nagaland state of North Eastern India, and direct implementation at Palghar district from a tribal block in Maharashtra with a public–private partnership to create a broader-scale sustainable and quality healthcare initiative.

Figure 4.1. CareMother solution
picture

Source: CareNX Innovations.

Note

← 1. For more information: https://www.caremother.in/.

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