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Sunday 29 April 2012

mHealth- Innovation for Maternal & Child Health in India


Dear Friends, It is been a while since I wrote my last post. Life hasn't been easy after we claimed the title of "the only niche mHealth consulting company" in India. But we are doing fairly good by going just well.

This post of mine is centred towards Disease surveillance and missing links in India. Very recently when I joined the UN's Best Practices and Innovations Working Group for Maternal and child health, I went deep dive to understand the problems in this sector. The revelations were quite alarming...
  • Infant mortality remains as high as 63 deaths per 1,000 live births. Most infant deaths occur in the first month of life, with up to 47 per cent in the first week
  • Diarrhoea remains the second major cause of death among children, after respiratory-tract infections. Unhygienic practices and unsafe drinking water are some of its main causes.
  • India has an estimated 220,000 children infected by HIV. It is estimated that 55,000 to 60,000 children are born every year to mothers who are HIV-positive.
  • With an estimated 12.6 million children engaged in hazardous occupations, India has the largest number of child labourers under the age of 14 in the world.
  • Children in India continue to lose their lives to vaccine-preventable diseases such as measles, which remains the biggest killer. Tetanus in newborns also remains a problem.
  • Anaemia affects 74 per cent of children under the age of three, more than 90 per cent of adolescent girls and 50 per cent of women. 


Anaemia led post partum haemorrhage and death are common in India. A mild anemic condition may have no obvious symptoms. Individuals with moderate anemia may complain of headaches, fatigue, and lethargy. Severe anemia can cause shortness of breath, dizziness, chest pain, or palpitations. In a rural setup however, this goes easily un-noticed. Spoke to a few doctors locally and realised that Asha workers can do it for them BUT ARE NOT EQUIPPED...

Tests: Iron levels are typically only taken during the first prenatal visit and sometimes after 28 weeks gestation. Therefore, it is important for a pregnant woman to notify her healthcare provider if she notices any associated symptoms. Although one may not be anaemic in the early stages of pregnancy, as the pregnancy progresses the foetus draws on the woman's resources and anaemia can develop.

These facilities are either un-utilised or are not available- mHealth solution- Myshkin and his team have developed a portable, mobile phone sized device to diagnose and monitor anaemia non-invasively i.e. without needles. The technology works on an optical principle and gives out results instantly. Once detected, Anaemia can be easily cured with iron supplements.



Diarrhea-  I interviewed a few women from a village and asked what do they do when they realise that their kid has got diarrhea:
1. Increase Fluids
2. Decrease Fluids
63% of them said reduce fluids...Many of you will say, How sad! they don't even know. The answer is think for a second???

The water in this area is so polluted that the more the kid consumes water, the more ill he gets. These families know about Oral Rehydration Solutions, juices, how to prepare it at home and all of it. Is the supply of ORS packets sufficient? In India healthcare still starts from clean drinking water, better roads and proper sanitation facilities.

Innovations for Poverty Action (IPA) has developed a chlorine delivery mechanism that is very cost-effective and highly popular with end users—the chlorine dispenser. IPA has demonstrated that chlorine dispensers achieve usage rates of nearly 70%, while dramatically reducing the cost of household chlorination by cutting packaging and transportation costs. Chlorination has been proven to reduce the incidence of child diarrhea by 20-40%.

Baby blankets- IN FOR MATION BLANKET FOR NEWBORNS A blanket that keeps newborns warm or cool depending on the weather to provide immediate and lasting protection for the infant as it develops. As important, the blanket is imprinted with a very basic bible of information for mothers to reference as their little one continues to grow. The Blanket features a code for scanning, so health workers can reference a database to quickly register the child, and keep tabs on it as it develops.

mHealth- For tracking of these supplies, wireless technologies can be utilised. Uniphore is a healthcare startup and one of few technology companies that is working to impact rural India through a for-profit model. The startup designs and delivers mobile solutions for businesses using Multilingual Speech Recognition and Voice Biometrics in customized IVR and GRPS applications — so that businesses can enable customers to get information and do transactions from remote places and in their local languages (regardless of literacy level, language capability, connectivity or location.)

Pneumonia- India records the highest number of child pneumonia deaths globally, but is among the only four of the 15 countries with the highest child pneumonia death toll that is yet to introduce the newest generation of pneumoccal vaccines.

A Pneumonia progress report, 2011, released by the International Access Vaccine Centre (IVAC) and John Hopkins Bloomberg School of Public Health on Wednesday shows that India recorded 3.71 lakh child pneumonia deaths in 2008, but till 2010 had "not introduced" the HIB vaccine against pneumonia.

mHealth- Plug -in Technology For Mobile Phones Diagnoses Pneumonia- Researchers at the University of Melbourne in Australia are adapting cell phones to help health workers quickly diagnose pneumonia. The team has developed a low-cost oximeter, a device that measures the oxygen content in red blood cells by tracking the absorption of red and infrared light waves as they pass through a patient’s fingertip. This can be plugged into a smartphone with special diagnostic software to analyze readings obtained from the sensor and determine a patient’s health. The next step is expanding the prototype to work with simpler cell phones.
 In the last decade or so, except for GDP growth, in most development indicators, India has significantly lagged behind the rest of the world – particularly in health care.India's share in global deaths, maternal and prenatal disorders, communicable disease, infant mortality and morbidity, and nutritional deficiencies, to name a few, is staggering.

I would recommend reading Abby Tabor's Blog on 

Born Too Soon: WHO says simple measures would save most premature babies


The paper titled ‘Health care and equity in India' in Lancet, by Balarajan et al. – 2011, gives a detailed account of the key challenges that the country faces with respect to health care provision, equity financing, and financial risk protection. It highlights how inequalities in socio-economic status, geography, and gender are intertwined with poor health metrics in India, using the three National Family Health Survey (NFHS) data.


Sunday 1 April 2012

mHealth India Plans 2012


Mobile Health is going to be a 3000 crore market in India by 2017. (Source PwC). M-health (use of mobile phones) and E-health are all set to make an entry into India's primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. Healthcare industry is expected to show a strong growth of 23% per annum to become a US$ 77 billion industry by 2012. One of the largest sector in terms of revenue and employment has grown at 9.3% per annum between 2000-2009 with a current size at par with fastest growing developing country like China, Brazil and Mexico.Driven by various catalysts such as increasing population, rising income levels, changing demographics and illness profile with a shift from chronic to life style diseases, healthcare industry is expected to move to levels of US$ 77 billion in next 3 years. (Source: ASSOCHAM).

Empowering rural India is of utmost importance and the government needs to do so by provisioning for broadband penetration and financial inclusion. Access to quality health care is another key to achieving rural empowerment. The budget for this segment was raised marginally last year and it would be good to have an allocation for rural health care programs with provisions for technology that would help modernize this sector to expand its reach through remote healthcare solutions and telemedicine.

Furthermore, the government announced a big budget campaign 'Swabhimaan' in the budget last year to promote banking and provide services to about 20,000 villages. In order to meet this goal, the budget this year too would need to make provisions accordingly. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. Disease surveillance will be put on a GIS platform.

Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children andwomen, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.

Economies of Indian states can grow 1.08 per cent faster with every 10 per cent increase in Internet and broadband connections, says a study released by Indian Council for Research on International Economic Relations (ICRIER). Consequently, for every 10 per cent increase in Internet and broadband penetration, India could potentially add USD 17 billion to the Gross Domestic Product (GDP). Also as per a report by HealthCursor, the tele-density in urban areas in India is almost 100 percent while in the rural areas, it is 37 percent. The pervasiveness of mhealth and ehealth (Commnity based broadband now available) platforms will be harnessed in the MDG and National Health plans in India.
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