The problems faced in the healthcare delivery in rural India are no secret. However, what is often missed is the depth India's primary healthcare systems, an integral part of which are the Community Health Workers (CHWs).
Community Health Workers like ASHAs, ANMs and Anganwadi workers are the backbone of rural healthcare delivery, servicing the last-mile healthcare needs of almost 70% of the Indian population. News headlines, numerous studies and multiple CHWs we have spoken to echo the same distress, overwork. They've just got too much to do.
The problem doesn't just lie in the ratio or even the coverage - it lies in the absence of workflow management systems. In any village, the conventional model CHWs follow as part of their responsibilities is door-to-door surveys and checkups of households which, as the CHWs told us in interviews, is incredibly inefficient because of the random, haphazard pattern of coverage with no tech to optimize the process.
Sakhi is a simple solution with a two pronged approach - using Integrated Voice Recording Services for the end customers, and an app for the CHWs and healthcare providers, decision/policy makers.
How it works?
For a Community Health Worker
There will be a toll free public helpline number for emergency cases. Just calling that number would get you immediate attention from a CHW. The CHW receives an immediate notification on the app, calls back and gets the patient to the hospital if needed.
Every evening, a prerecorded phone call using IVRS would be made to all families, asking a simple question - if everyone in your family is okay, ignore this message. If not, press 1 (next).
On pressing 1, the IVRS would say: if you need a general consultation/hospital visit, press 1 (and schedule a CHW home visit), if you have a health query, press 2 (and schedule a CHW phone call).
The following morning, the CHW logs in and then receives real-time data about what segments of the population require urgent care, non-urgent care or simple counselling. (She/He also gets this same data in the form of vulnerable demographic segments allowing her to also focus on different health verticals, and hence integrate and coordinate with her other CHW counterparts).
This deceptively simple tech solution also does something exceedingly powerful - it stratifies the population, giving the CHW real-time data about who requires care and who doesn't - data which, as of today, has no other means of being collected.
For a Government Official
- The officials can view daily/weekly/monthly cases of category emergency/general for selected demographic region.
- For each kind data field above, the official can also view age/gender-based classification.
- Because we also capture the timestamps when the issue was created(through the IVRS) and when the issue was resolved(when CHW marks it as completed in the app) we are able to calculate average response times and the number of cases that go unaddressed per day. This can help decision makers to appropriately distribute number of workers in the regions.
- When the workers mark issues as completed they also mention the category of the issue. This helpsto identify patterns in the population and address incoming social health problems beforehand.
Why should this be implemented?
All 4 stakeholders benefit - patients, providers and CHWs, and Government policy makers in Public Health Domain. From epidemiology and symptomatic tracking, to targeted high risk interventions and monitoring the efficiency of national health programmes, this real-time monitoring can provide unprecedented improvements to policy making.
All this data is also accessible to district and state authorities.
We did our competitor analysis, and as of today it's just us working in workflow management for CHWs in India.
We've done the math. We'll try to raise capital from govt grants under NHM and IDSP, the Gates foundation and 'Adopt a CHW' CSR programs.
And that is how we intend to use inexpensive, highly scalable low tech solutions to transform CHWs workers' lives, and being a confidant, a guide, a Sakhi (Sakhi: friend/helper in Hindi).