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  • Volume 377 1719 (2011)
  • May 21, 2011

E-MAMTA: Mother and Child Online Tracking System

Background


Social indicators like maternal mortality ratio (MMR) and infant mortality rate (IMR) are important metrics by which the growth of a country can be benchmarked. For India, the MMR and IMR are 250 per 100,000 live births and 52 per 1000 live births respectively. These figures remain high compared to developed countries where the rates for MMR and IMR is 8 per 100,000 live births and 7 per 1000 live births respectively (1,2). The majority of the deaths can be attributed to common conditions related to maternal morbities such as anemia, hemorrhage, obstructed labour, sepsis and hypertensive disorders of pregnancy (3). These causes are more striking given how preventable they are through provision of basic perinatal health interventions. Understanding this situation, the Government of India has launched the “E-Mamta: Online Mother and Child Tracking System” to reduce the current maternal and infant mortality rates.


The Government of India opted to name its nascent programme to curb maternal and infant mortality Mamta, the Sanskrit word for “maternal affection”. This pilot project termed “E- Mamta: Mother and Child online tracking system” aims to ameliorate current services related to maternal and infant illnesses. The programme will use an online tracking system to monitor the health of pregnant females and infants with instantaneous capabilities to document adverse health events. Stricter monitoring of outcomes aforementioned will enable health authorities to initiate preventive action rapidly and avoid unnecessary maternal and infant mortality.


Gujarat is one of the most industrialized states of India with one of the highest per capita income, but simultaneously has one of the highest rates of MMR at 172/100,000 live births (4). The Government of Gujarat has launched several initiatives to tackle this problem including the ‘Chiranjeevi Yojna’ involving a partnership between the public and the private sector and movement towards safe motherhood and healthy children (5). Gujarat is one of the first states which will be implementing the above mentioned ‘E-Mamta scheme’ to improve the quality of existing healthcare being delivered at present. This new innovative health initiative by harnessing the power of information technology, aims in reducing the maternal mortality below 100 per 100,000 live births and, ultimately, achieve the Millennium Development goals (6). Specifically, the program endeavours to create a tracking system of pregnant women for tracking ante- and post-natal care as well as for children’s immunization and nutrition.

E-MAMTA: The Overview


The state government has provided a computer with internet connectivity to each of its Primary Health Centres (PHC)*. The software for online tracking of mother and child has been developed by the National Informatics Centre (NIC) in consultation with the Ministry of Health and State of Gujarat’s Family Welfare Division.  The PHC is a referral unit for six sub centres consisting of 4 to 6 beds with a medical officer in charge and about 14 subordinate paramedical staff (7). The local health workers (ASHA)* will gather information regarding the residents in their designated area and identify the target population of pregnant females and infants. This information is then conveyed to the local PHC enabling the data to be entered and stored in the online tracking system. These pregnant women are then tracked and followed for the outcomes mentioned below.  Once a week, usually Wednesdays dubbed as “Mamta Divas,” pregnant females and mothers with infants come to the health centre for their weekly health check up. The information obtained and services provided during this day are as listed in Table 1.

Table 1

Beneficiary Information Obtained/Service Rendered
A.)Children
  • Vaccination Status
  • Monitoring of Growth
  • Vitamin A and Calcium Supplementation
  • Provide requisite nutritional supplementation
B.)Pregnant Females
  • Antenatal Registration of Pregnancy
  • Measurement of weight, blood pressure and haemoglobin
  • Tetanus Toxoid Vaccination
  • Supplementation of Iron/Folic Acid/Calcium
  • Education and Counselling regarding childbirth and importance of institutional deliveries
  • Identification of high risk pregnancies and referral to tertiary centres for management
C.) Lactating Mothers
  • Counselling regarding importance of breast feeding and methods of contraception and family planning

After this information is entered in the database, the software will assess whether each of the beneficiary registered in the system has been provided the requisite service. If this service is not delivered, the system immediately indicates this and a health worker is informed to correct the shortcoming. This would permit the achievement of the benefits listed below in Table 2.

Implications and Potential Benefits


This programme is novel in its approach to reduce MMR/IMR as it uses technology and broadband connectivity to organize for detailed organization and rapid dissemination of healthcare information. It has tremendous potential to revolutionize the healthcare of pregnant women and children residing in impoverished settings in a relatively cost-effective manner (Table 2).

Table 2

Potential Implications/Benefits

  • Identifies and increases the number of deliveries occurring under the guidance of appropriately trained individuals, both in institutions and the community.

  • Stringent monitoring of pregnancy outcomes assists in preventing adverse outcomes such as female foeticide.

  • Alerts appropriate health authorities to be activated to care for pregnant females optimizing the delivery of the foetus.

  • Distribution of vaccines based off the database to PHCs serving the most unvaccinated population to take advantage of economies of scale.

  • Instantaneous deployment of personnel based upon unmet needs leads to a more effective use of existing workforce and rapid correction of any service shortcoming as indicated by the computer generated report.

  • Information can be readily accessed through any remote location and transferred rapidly.

  • Improved data analysis to create improved Block/District health action plans based on accurate denominators.

Admittedly, the program does have challenges to overcome. First, establishing a technical infrastructure needed to employ the necessary tools in remote areas requires significant cost and time. Second, incidents of computer viruses leading to delayed input of information have been encountered. Third, the training of local health workers in the use this new technology and enabling to adopt a newer technical approach has been challenging.


Conclusion


Despite these initial challenges, E-MAMTA through information technology can improve the lives of the poor that would assist India in realizing success in MMR and IMR paralleling its recent economic growth.

Abbreviations


PHC: Primary Health Centre

ASHA: Accredited Health Activist

BHO: Block Health Officer

References

  1. UNICEF India Statistics. March 2, 2010. Nov 23, 2010. Retrieved from <http://www.unicef.org/infobycountry/india_statistics.html>
  2. UNICEF USA Statistics. March 2, 2010. Nov 23, 2010. Available from <http://www.unicef.org/infobycountry/usa_statistics.html>
  3. Registrar General of India in collaboration with Centre for Global Health Research, University of Toronto. Maternal Mortality In India: 1997-2003 Trends, Causes and Risk. Nov 24, 2010. Available from <http://www.health.mp.gov.in/Maternal_Mortality_in_India_1997-2003.pdf>
  4. Health Review Gujarat 2007-2008. Nov 24, 2010. Available from <http://www.gujhealth.gov.in/basicstatastics/pdf/Health%20review%2007-08.pdf>
  5. Amarjit Singh, Dileep Mavalankar, Ajesh Desai, SR Patel, Pankaj Shah: Human Resources for Comprehensive EmOC: An Innovative partnership with the Private sector to provide delivery care to the Poor. Nov 24, 2010. Available from <http://www.gujhealth.gov.in/ Chiranjeevi%20Yojana/pdf/Chiranjeevi%20Yojana-A%20Journey%20to%20safe%20motherhood.pdf>
  6. UN Millennium Development Goals. Nov 24, 2010. Available from <http://www.un.org/millenniumgoals/maternal.shtml>
  7. Origin and Evolution of Primary Health Care in India. Nov 24, 2010. <http://www.whoindia.org/LinkFiles/Health_Systems_Development_Primary_Health_Care_Origin_and_Evolution_.pdf>

Purav Mody
Final Year, Govt Medical College,  Surat, India

E-MAMTA: Mother and Child Online Tracking System

Background

Social indicators like maternal mortality ratio (MMR) and infant mortality rate (IMR) are important metrics by which the growth of a country can be benchmarked. For India, the MMR and IMR are 250 per 100,000 live births and 52 per 1000 live births respectively. These figures remain high compared to developed countries where the rates for MMR and IMR is 8 per 100,000 live births and 7 per 1000 live births respectively (1,2). The majority of the deaths can be attributed to common conditions related to maternal morbities such as anemia, hemorrhage, obstructed labour, sepsis and hypertensive disorders of pregnancy (3). These causes are more striking given how preventable they are through provision of basic perinatal health interventions. Understanding this situation, the Government of India has launched the “E-Mamta: Online Mother and Child Tracking System” to reduce the current maternal and infant mortality rates.

The Government of India opted to name its nascent programme to curb maternal and infant mortality Mamta, the Sanskrit word for “maternal affection”. This pilot project termed “E- Mamta: Mother and Child online tracking system” aims to ameliorate current services related to maternal and infant illnesses. The programme will use an online tracking system to monitor the health of pregnant females and infants with instantaneous capabilities to document adverse health events. Stricter monitoring of outcomes aforementioned will enable health authorities to initiate preventive action rapidly and avoid unnecessary maternal and infant mortality.

Gujarat is one of the most industrialized states of India with one of the highest per capita income, but simultaneously has one of the highest rates of MMR at 172/100,000 live births (4). The Government of Gujarat has launched several initiatives to tackle this problem including the ‘Chiranjeevi Yojna’ involving a partnership between the public and the private sector and movement towards safe motherhood and healthy children (5). Gujarat is one of the first states which will be implementing the above mentioned ‘E-Mamta scheme’ to improve the quality of existing healthcare being delivered at present. This new innovative health initiative by harnessing the power of information technology, aims in reducing the maternal mortality below 100 per 100,000 live births and, ultimately, achieve the Millennium Development goals (6). Specifically, the program endeavours to create a tracking system of pregnant women for tracking ante- and post-natal care as well as for children’s immunization and nutrition.

E-MAMTA: The Overview

The state government has provided a computer with internet connectivity to each of its Primary Health Centres (PHC)*. The software for online tracking of mother and child has been developed by the National Informatics Centre (NIC) in consultation with the Ministry of Health and State of Gujarat’s Family Welfare Division. The PHC is a referral unit for six sub centres consisting of 4 to 6 beds with a medical officer in charge and about 14 subordinate paramedical staff (7). The local health workers (ASHA)* will gather information regarding the residents in their designated area and identify the target population of pregnant females and infants. This information is then conveyed to the local PHC enabling the data to be entered and stored in the online tracking system. These pregnant women are then tracked and followed for the outcomes mentioned below.  Once a week, usually Wednesdays dubbed as “Mamta Divas,” pregnant females and mothers with infants come to the health centre for their weekly health check up. The information obtained and services provided during this day are as listed in Table 1.

Table 1

Beneficiary

Information Obtained/Service Rendered

A.)Children

Ø Vaccination Status

Ø Monitoring of Growth

Ø Vitamin A and Calcium Supplementation

Ø Provide requisite nutritional supplementation

B.)Pregnant Females

Ø Antenatal Registration of Pregnancy

Ø Measurement of weight, blood pressure and haemoglobin

Ø Tetanus Toxoid Vaccination

Ø Supplementation of Iron/Folic Acid/Calcium

Ø Education and Counselling regarding childbirth and importance of institutional deliveries

Ø Identification of high risk pregnancies and referral to tertiary centres for management

C.) Lactating Mothers

Ø Counselling regarding importance of breast feeding and methods of contraception and family planning

After this information is entered in the database, the software will assess whether each of the beneficiary registered in the system has been provided the requisite service. If this service is not delivered, the system immediately indicates this and a health worker is informed to correct the shortcoming. This would permit the achievement of the benefits listed below in Table 2.

Implications and Potential Benefits

This programme is novel in its approach to reduce MMR/IMR as it uses technology and broadband connectivity to organize for detailed organization and rapid dissemination of healthcare information. It has tremendous potential to revolutionize the healthcare of pregnant women and children residing in impoverished settings in a relatively cost-effective manner (Table 2).

Table 2

Potential Implications/Benefits

Ø Identifies and increases the number of deliveries occurring under the guidance of appropriately trained individuals, both in institutions and the community.

Ø Stringent monitoring of pregnancy outcomes assists in preventing adverse outcomes such as female foeticide.

Ø Alerts appropriate health authorities to be activated to care for pregnant females optimizing the delivery of the foetus.

Ø Distribution of vaccines based off the database to PHCs serving the most unvaccinated population to take advantage of economies of scale.

Ø Instantaneous deployment of personnel based upon unmet needs leads to a more effective use of existing workforce and rapid correction of any service shortcoming as indicated by the computer generated report.

Ø Information can be readily accessed through any remote location and transferred rapidly.

Ø Improved data analysis to create improved Block/District health action plans based on accurate denominators.

Admittedly, the program does have challenges to overcome. First, establishing a technical infrastructure needed to employ the necessary tools in remote areas requires significant cost and time. Second, incidents of computer viruses leading to delayed input of information have been encountered. Third, the training of local health workers in the use this new technology and enabling to adopt a newer technical approach has been challenging.

Conclusion

Despite these initial challenges, E-MAMTA through information technology can improve the lives of the poor that would assist India in realizing success in MMR and IMR paralleling its recent economic growth.

Abbreviations

PHC: Primary Health Centre

ASHA: Accredited Health Activist

BHO: Block Health Officer

References

1. UNICEF India Statistics. March 2, 2010. Nov 23, 2010. Retrieved from <http://www.unicef.org/infobycountry/india_statistics.html>

2. UNICEF USA Statistics. March 2, 2010. Nov 23, 2010. Available from

<http://www.unicef.org/infobycountry/usa_statistics.html>

3. Registrar General of India in collaboration with Centre for Global Health Research, University of Toronto. Maternal Mortality In India: 1997-2003 Trends, Causes and Risk. Nov 24, 2010. Available from <http://www.health.mp.gov.in/Maternal_Mortality_in_India_1997-2003.pdf>

4. Health Review Gujarat 2007-2008. Nov 24, 2010. Available from <http://www.gujhealth.gov.in/basicstatastics/pdf/Health%20review%2007-08.pdf>

5. Amarjit Singh, Dileep Mavalankar, Ajesh Desai, SR Patel, Pankaj Shah: Human Resources for Comprehensive EmOC: An Innovative partnership with the

Private sector to provide delivery care to the Poor. Nov 24, 2010. Available from

<http://www.gujhealth.gov.in/ Chiranjeevi%20Yojana/pdf/Chiranjeevi%20Yojana-A%20Journey%20to%20safe%20motherhood.pdf>

6. UN Millennium Development Goals. Nov 24, 2010. Available from

<http://www.un.org/millenniumgoals/maternal.shtml>

7. Origin and Evolution of Primary Health Care in India. Nov 24, 2010.

<http://www.whoindia.org/LinkFiles/Health_Systems_Development_Primary_Health_Care_Origin_and_Evolution_.pdf>

Authors

1.) Name: Purav Mody

University: Govt Medical College, Surat, India

Year: Final Year

Email: puravmody@gmail.com (Corresponding author)

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