Leveraging ICT ln Achieving MDGs-Success Stories from the Ground Level

By Gp Capt (Dr) Sanjeev Sood Hospital Administrator, Air Force Hospital Chandigarh-160003 Email-doc_ssood@yahoo.com M-09799996732

Key words-Information and communication technology, MDGs, Healthcare Introduction The Millennium Development Goals place health at the heart of human development and economic growth by tackling ill-health and poverty. Three of the 08 goals are directly health related and all other goals have important indirect effects on health. Goal: 4 aims to reduce child mortality; Goal: 5 aims to improve maternal health and Goal: 6 endeavors to combat HIV/AIDs, malaria and other infectious diseases by the year 2015 .These issues allude to global public health problems and need major commitment and resources from healthcare systems and Governments. India is a signatory to the Millennium Summit held in Sep 2000 at New York, amongst 188 other nations, and committed to achieving MDGs by 2015. Further, the target 18 of MDGs, states that in cooperation with the private sector, make available the benefits of new technologies, especially information and communications. Technology is a big enabler and differentiator that has revolutionized the delivery of quality and affordable healthcare. It improves the overall accessibility, operational efficiency, speeds up workflows, curtails TAT; improves clinical outcome and costs in a healthcare organization. Applications using mobile telephone and telemedicine can greatly enhance the accessibility and penetration of healthcare services and overcome barriers in delivery of equitable healthcare, thus speeding up achievement of MDGs Also, all computer transaction creates an audit trail that increase accountability. In addition, having more consistent data to analyze promotes best practices that make the healthcare systems more efficient and patients safer and healthier. Finally, the ICT solutions help the healthcare systems to comply with government regulations. Well conceived and appropriately designed ICT solutions can be as effective a tool in Public Health domain as in a tertiary care hospital setting in achieving pre stated objectives. This paper discusses how certain ICT initiatives at national and local level can help achieve MDGs through better and efficient management of healthcare resources, information and improved accessibility and universalization of healthcare services.
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Integrated Disease Surveillance Project Integrated Disease Surveillance Project (IDSP), launched by MOHFW in 2004, is a decentralized; State based Surveillance Program in the country, intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner. It uses Information technology for collection, collation, compilation, analysis and dissemination of data .This facilitates achievement of MDG Goal: 6 in effective monitoring and combating of major infectious diseases. When combined with Early Warning & Response System-remote satellite Imagery ,GIS and
metrological data , outbreaks of infectious and vector borne diseases such as Cholera , SARS can be timely predicted and quickly analyzed using GIS tools.

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Health Statistics Information Portal National Rural Health Mission (NRHM) -flagship program under MoHFW, GoI,has launched its 'Health Statistics Information Portal' in the year 2009- a web-based health management information system- a one-stop-site that will facilitate quick and efficient flow of information starting from the Facility-level, up to the District, State and finally the Centre. On top of all this, the system will provide an array of intelligent tools for advanced data analytics, robust data warehousing, reporting, monitoring, evaluation and overall program management. NRHM clearly addresses the MDGs and through this portal and endeavors to focus on maternal and child health and combating infectious diseases. e-Mamta Programme in Gujrat

In spite of the great advancements made in the medical field and the Indian Government's efforts in this regard, the maternal mortality rate continues to be high (450 deaths per 1, 00,000 live births with wide regional disparities) in our country. Even higher than BRIC and neighbouring SAARC countries with comparable healthcare resources, the figures are way behind India's Millennium Development Goals which call for a reduction to 109 by 2015, according to UNICEF. Anaemia, haemorrhage, sepsis and toxaemia of pregnancy are the most common causes of nearly 70,000 deaths per year reported in India, which are preventable with better healthcare management. To address the problem, Gujrat State Government has developed a comprehensive IT application for improving mother and child tracking system from pregnancy till complete life cycle for better public health services delivery .The programme covers the entire rural, urban slum population. The application is appropriately called e-Mamta. The application generates unique health ID for every mother and child to ensure complete continuum of antenatal care services delivery to reduce IMR/MMR. The application can use mobile based technology for data entry at source and also sort and group data to identify beneficiaries for special public health problems like anemia, malnutrition and disease control. The application is feature rich and can provide SMS alerts to beneficiaries and service providers for better service delivery, improved coverage and follow up. It can also track drop outs and reinduct them to healthcare services. It also manages details of various incentives paid to all cadres of health workers, individual records for the benefits of JSY, BSY and CY schemes besides online health record/immunization card. It can be easily integrated with the HMIS and generate reports and registers through aggregation of services. It ensures better interdepartmental coordination - ICDS, education department and RSBY. The data can be searched on basis of eight nine basic parameters- name, health Id, ration card number, BPL
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number, mobile number, UID, family Id. It also contains database of service providers in the public/ private sector and all ASHAs with their mobile nos. The eMamta programme has resulted in comprehensive delivery of maternal and child health services, universal coverage of immunization, reduction in anemia , malnutrition and reduced IMR, MMR and TFR .e Mamata is indeed a great ICT initiative towards achievement of MDGs.

Pregnancy Tracking System,Dugarpur On a smaller scale ,in the neighboring district of Dungarpur, Rajasthan, another IT driven solution has changed the prospects of maternal health .Pregnancy Tracking System is a software created by IL and FS, a firm based in Delhi. With a live database at the district level, information is sent by ANMs at the Sub Centers through mobile text messaging as ASHAs report to them regarding pregnant women in their areas. Their name, expected date of delivery, previous pregnancies, and so on are recorded in this live data base. This data is given to the blocks and then to districts and monitored at DCs office. This facilitates to track women during ante natal care and when approaching due date ,advice them for institutional delivery. The programme can also track children after birth for immunization and married couples for family planning counseselling, and so on. The programme has been operational in a tribal area of Dungarpur, Rajasthan, where the rate of institutional deliveries has gone up by 70% in last two years, significantly higher than the majority of the country despite lack of resources and infrastructure. The IMR in Dungarpur is now down to 49 (state :65 ) per 1000 live births and MMR to 281 (state:388) per 1000,000 live births.

IT Application to Monitor Growth of Pre-term Infants

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Doctors at St. Johns Medical College Hospital and Research Institute, Bangaluru, have developed an IT solution for monitoring weight and growth of preterm infants in NICU. This is a screening tool where electronic data is captured that is easy to manage and analyze. Firstly, maternal and infant information is captured, followed by daily recording of body weight, weekly measurement of recumbent length, head circumference and mid upper arm circumference and co morbid conditions (ICD 10) in a pre-term infant by any number of devices that support this application. The application has features to display the standard reference curves; plots the weight measurements against the reference curve background and display the same in tabular form (see figures). Pilot data generated at a 35 bedded level III NICU of the St Johns Hospital shows that the Indian preterm infants fall on/ below the 3rd percentile of the standard reference curves for the western population. Data gathered from the reports can be exported to Excel and further analyzed.

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This application serves as a bed-side decision support tool, provides real-time analysis, multi-point accessibility and can be used to create a registry that truly represents the Indian population. Such an application can really go a long way in reducing IMR- and important MDG.

Save the Baby Girl The recent census report has shown that Indias sex ratio has not shown much improvement remains a matter of concern. This unique and innovative IT led solution in form of a dedicated web-portal, named as www.savethebabygirl.com endeavors to correct the adverse sex ratio and provides solutions to otherwise a recalcitrant cultural issue of gender inequality in developing Asian countries. The project was first launched on 15 Aug 2009, in Kolhapur and adjoining districts of Western Maharashtra. A private firm Magnum Opus, in association with District Administration initiated this project of Save The Baby Girl, to prevent the female fetus from illegal sex determination and termination. The project is two phase application, online submission of records as per PCPNDT Act 2003 and Silent Observer (SIOB), an advanced, secured and intelligent device embedded to the ultrasound machine that records the video images of the ultrasound. Silent Observer is a device that is attached externally through cables and that captures the video images of the each sonography conducted and stores in the local hard drive of the SIOB. Within a month and half of its launch, all 240 sonography centers were logging to STBG on daily basis and submitting the relevant information of sonography tests of all pregnant women conducted by them. The information is then collected on centralized web server and application is designed to generate various reports and statistics to identify the key indicators such as total number of patients registered by centre, area specific (rural, urban, tahesil etc.), number of MTPs, deliveries, (normal, abnormal etc), and birth results such as live, EUD etc., to monitor the performance of each centre. The entire data is processed and displayed using online dashboard to have a summary status of the entire district on a single screen, categorized as rural, urban, progressive and monthly statistics. The individual login for various levels of district
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administration is planned so that concerned authority will view the reports of the area defined to him/her on personalized dashboard. The intelligent reading and careful analysis of the generated information (district, tahsil. Taluka and sonography centers clinic wise), and reports by the district and tahsil level administrator pinpoint/indicate the culprit centers of sex determination tests and results in inspection of such sonography centers by the appropriate authorities and punitive actions are initiated. The figures of male and female born in private maternity homes with sonography machines, for Oct to Dec 2009 indicate improvement in sex ratio in favour of girls.The interaction with medical fraternity, especially with the respected doctors, known for their integrity and ethics revealed that the success in improvising sex ratio is due to continuous online monitoring of all center on daily and weekly basis and feedback given to the doctors/radiologist of sonography centers even for minor lapses.

Since every centre is filling online record of each patient online as per PCPNDT prescribed format, there is no need of any additional record keeping system. The F form or monthly reports can be generated through the STBG online. This indirectly saves tremendous amount of time of District Administration to check each and every form manually. It is very difficult to identify pregnant female with one or two previous girls and with age of above 35 from the monthly manual records of 10,000. But because of this solution, district administration does not only identify the detailed report of all pregnant female of above 35 age and of having one or two previous girls, but also locate them, define them as per the area and respected authorities to provide the healthcare support and counseling not to go for sex selection abortions. The second initiative in the form of SIOB is path breaking and acts as an effective deterrent against the doctors indulging in unlawful practice of sex-determination tests, resulting in arresting the declining sex-ratio and finally normal or equal to world average. Further it has potential of replication all over India and thus in next 10 years time the imbalance in the sexratio of India will be removed all together if implemented properly. The district administration of Kolhapur, Maharashtra has shown a way worth emulating across the nation for the serious social problem of female feticide.

Conclusion
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The technology, in particular ICT, has a great potential to create positive effects in life of people and transform delivery of quality health care services to one and all. Along with health education and other initiatives, it can prove to be a big enabler and facilitator in alleviating poverty and reducing disease morbidity and mortality. The above success stories amply illustrate the potential of ICT driven solutions in tackling ill health and better and efficient management of healthcare resources, information and improved accessibility and universalization of healthcare services. India seriously needs to embrace and adopt appropriately designed technological solutions at a much wider scale as part of its concerted and overall strategy towards achievement of MDGs. The author, Gp Capt (Dr) Sanjeev Sood is a Hospital Administrator and NABH empanelled Assessor. Hes a prolific writer on healthcare matters. Email :doc_ssood@yahoo.com

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