Presenter: Aparna Ananthakrishnan, Centre for Technology and Policy, IIT-Madras
Background: Several initiatives in South India, with minimal systematic documentation, explore the use of mobile phones to strengthen the maternal-newborn healthcare system (mHealth), the indicators of which fare better than national averages leading most to believe in its adequacy within the health system. However, deteriorating District Level Health Data (DLHS 2014) and the foray of health technologies into the conventional health system led us to analyze the role of mHealth in this sector, its various stakeholders, nature and scale of operational challenges and policy measures for their scalability in a low-resource setting.
Methodology: Four pilot mHealth initiatives that functioned over a 1-2 year period were chosen from three southern states (Tamil Nadu, Kerala and Karnataka). A semi-structured questionnaire combined with on-site visits, personal interviews and focus group discussions with program innovators, App developers, users and physicians, provided insights on the design, history, user profiles, financial specifications and challenges to implementation of this technology.
Results: The emerging mHealth framework largely comprises experimental attempts, encouraging ‘Pilotitis’. With significant diversity in the delivery of programmes, most initiatives involve basic electronic record keeping. A few have attempted to merge these records with the larger central health database, linking it to vaccine reminders and ANC visits. Anxiety to use new technology, heavy work schedules, low skill levels and low perceived usefulness emerge as factors for slow technology uptake. Structural inadequacies complicate real-time data transfer. Stakeholders lack consensus on methods of implementation and implications of this technology.
Conclusions: Although high mobile phone penetration rates have heightened the expectations of mHealth in transforming maternal newborn healthcare delivery in India, high handset costs, poor awareness, unstable electric and mobile connectivity and health worker empowerment strongly determine this technology use. Global issues of privacy and medical liability are pressing concerns and require serious consideration for any attempts at scale-up.