Mobile application A modal Initiative to ensure quality family

planning services in Doiwala block, Dehradun, Uttarakhand

Rural Development Institute, Himalayan Institute Hospital Trust

Dehradun, Uttarakhand

Dr RAJEEV BIJALWAN RDI-HIHT

Rural development Institute

The mission of the Trust is to develop integrated and cost- effective approaches to health care and development that address the local population, and which can serve as a model for the country as a whole, and for the underserved populationworldwide.

A combined approach in which traditional systems of health care complement modern medicine and advanced technology, is the prime focus of clinical care, medical education, and research at HIHT.

MISSION

Founder - Dr. Swami Rama

Out reach Initiatives in Health and Development

Health :• Reproductive and Child Health (RCH)• Adolescent health• School health• Primary health careWater and sanitation • Management of natural sources• Drinking water and sanitation services• Development irrigation canal Education ScholarshipLivelihood contract farming on aromatic plants

Presentation has……………

Objectives Principle guide line for application

Geographical Interventional area

Type of information and entry processes

Systematic approach Development of key and its digitalization

Comparative status of Quality indicators

Flow of new information system

Existing Information system Processes of implementation

Loopholes of existing Information system

Key benefits

Concept of Innovation Way forward

Objectives To establishment client based

information management system

To develop cost effective and people friendly application

To ensure that we can use any networks as well as basic handset of

mobile

To ensue using simple operational process so that any one can use it at

community level

To ensure data migration, analysis and storage facility

To ensure the automatic feed back system

Working Area of Doiwala Block, Dehradun, Uttarakhand, India

Uttarkashi

Tehri Garhwal

HaridwarGarhwal

Chamoli

Bageshwar

Pithoragarh

Almora

Nainital Champawat

Doiwala

block

1 CHC& 5 PHC

32,ANM

centers

165 ASHAs

181 village

s

193346

population

21894 household

32873 eligibl

e coupl

e

Systematic approach

Comparative status of Quality indicators fact sheet

Indicators India Uttarakhand DoiwalaOverall discontinuation rate (1 year)

25.1% 28% 31.1 %

Temporary methods (1 year)

44% 37% 42 %

Pill(1 year) 45% 45% 33%Condom (1 year) 49% 34% 51%Offered basket of choice or informed choice

37 10.3%

Received pre checkups

* * 75.8%

Information about side effect

29 7.9%

Received follow up * * 44.6%

Existing information flow

CHC PHC

Area Coordin

ator

ANM Centers ASHA Eligible

Couple

Weakness of existing information system

1. Information is coming from various sources at various levels.

2. Maximum possibility of duplication or repetition

3. Do not provide actual status at community level

4. Do not provide any information about non users

5. No integration between service information with social determents

6. Large amount of paper use and no use of information in feed back

Mobile Application for QFPS MIS

Concept of innovative Mobile application

• Concept of application is based on client• Ensure effective use of information in

program feedback, researches and studies• Develop a cost effective and early response

system• Ensure program progress at all level• Use information system for staff appraisal• Ensure simple technology

• Develop client based information system Under the client based information system we always get the information from the client

• This system help us to understand the reach of the program at community level and assessment of performance of providers

• It always works as a external monitoring system which is not under the control of providers

Principal guideline for application

• No network restriction • Ensure use of basic set of mobile• Development of Simplification or digitalization of

information• Create reminder system and full scope for extension• Create free SMS system for health education and

information • Develop effective tools on the basis research for

staff training and orientation

Basic Entry Information• Name/ S. N.• Age• No of children M/F• Family status – Nuclear/ joint• Social status- APL/BPL• Education/ wife and husband• Occupation / wife and husband• Village/ code• Name of ASHAs/ mobile number• Name of ANMs/ ANM centers /mobile number• Medical officers / PHCs/ mobile number

Description of key S N Contraceptive s

(UC)

Women condition(WC)

Services(S)

Health providers (HP)

Place of health provider (PHP)

Users status (US)

1 NSV Newly married Counseling ASHA Village Non-user

2 Tubecotomy Pregnant Basket choice AWW AWW centre Switch over

3 Condom Post delivery Pre-checkup ANM ANM centre New user

4 OCP Abortion Follow up Govt. Doctor PHC/CHC Drop out

5 Cu-T Infertility Complication Pvt. Doctor Pvt. Hospital

6 E-pill Others Medical store

7 Injection

8 Female condom

9 SDM

10 LAM

11 Others

SMS keyUpdate entry RN,VC,MC,FC,UC,CW,S,HP,PSP,US*Comment

RN150,VC0010,MC2,FC1,UC2,CW3,S4,HP1,PSP3,US1*Comment

New entry VC,CN,A,MC,FC,UC,CW,S,HP,PSP,US*Comment

VC0010,CNANITA,A29,MC2,FC1,UC2,CW3,S4,HP1,PSP3,US1*Comment

• CHC wise Report

• PHC wise Report

• ANM wise Report

• Village wise Report

• ASHA wise Report

• Client status

• Users wise of Contraceptive

• Condition Of Woman

• Providers and service centre

• Total users, non users, switch off and switch over

• Demand calculation at all level

• Total umber receive pre check ups, counseling, basket of choice and follow-up services

Client based information collection Mechanism

NE- RN, VC, CN, A, MC, FC, UC, CW, S, HP, PSP, US *Comment

UE- RN, VC, MC, FC, UC, CW, S, HP, PSP, US *Comment

The flow of Information Management

ASHA (ASHA will collect individual information at household level)

Central Information Registration System at Rural Development Institute-HIHT

House hold level

ASHA level

ANM level

PHC level

CHC level

The information will be send on a prescribed format by the mobile phone through a SMS to the Central Information Registration System Center

Central Information Registration System (Software)

Community Level (Eligible couple)

Central Information Registration System will also send the reports of eligible couples to the all the centers every month by e-mail or postal services

The Central Information Registration System will evolve various reports automatically

Feedback and Monitoring System (Recheck process and reminder SMS

Application Suite Architecture

Web Server

DB Serve

r Mail Server

Application

Admin Application Interface

SMPP

SMSC

MMSC

GSM Modem Stack

Family Planning at Village Level Report from …………………. To …………………

A Model Inititative to Ensure Quality Family Planning Services in Uttarakhand

Doiwala Block, Dehradun

CHC Name ANM Centre Name Village Name

Name of the ANM ASHA Name

PHC Name CHC Incharge

Reg. No. Eligible Couple Name Entry M/Y Age

No. of living children

Use of Contraceptive Condition of woman Services Result

M F

Permanent Temporary Natural

Newly married

Post delivery

Abortion InfertilityCounseli

ng

Basket of

choice

Information- side

effect

Pre-checkup

Follow up

Satisfied with

services

Non-users

Switch over

New user

Drop outTubecot

omyVasecto

myCondom OCP IUD E-pill Injection

F_condom

Safe period

Exclusive breast feeding

Withdrawal

method

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

                                                             

Flow of existing information

CHC PHC

Area Coordin

ator

ANM Centers ASHA Eligible

Couple

Process of Implementation

• Conducted a research study on various aspects on mobile phone such as use of SMS and other facilities

• Development of software• Pre testing• Re – design• Demonstration• Development of training materials and its delivery

process• Implementation of application

Key features of mobile application

• Independent of the Specific Mobile Handset• Independent of the Telecom Operator• Keywords Simplicity: • Master Databases Management: • Integrated Auto Push, Pull, E-mail (or Voice if required• Validation of Input Information• Predictive Analysis Scalable Approach• Automated Quality Analytics Feedback System• Interactive Voice Response System (IVRS) Integration

Key benefits• Highly Scalable Multi User Solutions over Wired/Wireless/GSM/CDMA

Networks• Immediate Information Transfer • Highly Targeted and Accountable Medium • Time Efficiency (Reduces Time Lag)• Economical (Cost Effective)• High Retention Value• Reduction of Manpower / Man Hours• Accuracy of Information Flow• Automated and Acknowledged Information Transfer to Multiple Points• Bulk Communication on touch button• Handy & Automated Accurate Information

Impact on program

• Easily get any information at all levels• Use tracking system to see specific cases at

any levels• Develop accurate demand for contraceptives

and ensure actual need based distribution mechanism at each stage

• Provide effective clinic services for specific area

Impact of program

Description Baseline

(Sep 2008)Year Oct 08- Sep 09

Year Oct 09-Mar 10

Total Eligible Couple 848 (sample size) 28005 30282

Tubecotomy 18.8 33 32.4

Vasectomy 2.0 0.5 0.9

IUD 1.7 2.5 2.2

Condom 21.7 31.2 27.9

OCP 7.2 13.7 8.6

Injection 0.1 0.1 0.4

E-Pill * 0 0.1

CPR 51.5 67 72.5

Way forward…….

• Planning for scaling up and extension of software

• Documentation of learning's and sharing it at state as well as national levels

• Use of information to improve the supply system

• Wider role of mobile technology in health sector

Ensure multiple use of mobile in health program for multiple

purpose