As health systems struggle to cope with the pandemic, the advantages of scale, agility and cost-effectiveness offered by technology-enabled interventions have gathered prominence. Covid-19 has created two main crises in addition to the health crisis—the diversion of resources from other critical services, and the dire need for real-time and effective training of healthcare workers. We take a look at two examples of using technology for impact—ARMMAN and ECHO India, both non-profit organisations:
ARMMAN’s “Tech plus Touch Approach” to improve maternal and child health In India, a woman dies in childbirth every twenty minutes and two children under the age of five die each minute; making underprivileged pregnant women and children a highly vulnerable population. With Covid-19 being the focus in all hospitals, accessing regular care during pregnancy and infancy has become more challenging as out-patient departments are either closed or not working at full capacity. Reaching the facilities is also difficult because of the limited public transport.
When Covid-19 struck, ARMMAN quickly adapted their existing technology platform to launch interventions targeting specific gaps in the system. A pan-India free Virtual OPD (V-OPD) was set up with support from 50+ volunteer doctors. Pregnant women and mothers were given a platform to call a toll-free number to reach obstetricians and pediatricians from Monday to Saturday. The V-OPD could receive 100 average daily inbound calls with a capacity to handle 250.
ARMMAN used its existing mMitra program to send critical Covid-19 information to 300,000 pregnant women and mothers of infants in Mumbai's slums via their mobile phones along with providing linkages with health facilities and services through a call center. Further, in partnership with the Ministry of Health and Family Welfare, 800,000 health workers were sent updated COVID-19 information on their phones.
ARMMAN’s 'tech plus touch' approach leverages the existing frontline health worker network of the government and partner NGOs and combines it with the ubiquity of the mobile phone, to achieve cost-effective scale while remaining rooted through on-ground interventions. They are currently implementing the largest maternal messaging service in the world (Kilkari) and two of only five scaled maternal messaging programs globally (mMitra and Kilkari).
ARMMAN follows the model of scaling through partnerships. It has a government partnership for the implementation of Kilkari and also Mobile Academy, an IVRS-based training program for frontline health workers. Through its collaboration with the government, 40 on-ground NGOs and 97 health facilities, ARMMAN’s programs have reached over 20 million women and trained 173,000 health workers across 16 states, with plans to scale pan-India by 2025.
The ECHO Model of 'All Teach, All Learn'
Today, with the availability of very basic equipment and knowledge, interactive healthcare education sessions are being run in the remotest areas of the country. Covid-19 has exacerbated the need for real-time virtual training of healthcare workers (HCWs). ECHO—Extension for Community Healthcare Outcomes—India (affiliated with Project ECHO) is solving for this need by bringing practitioners and patients together virtually, thereby reducing isolation of rural practice, eliminating distance barriers and reducing costs.
The ECHO Model uses multipoint videoconferencing technology to simultaneously connect several HCWs utilising a ‘hub-and-spoke’ model. Medical practitioners in various parts of the country (spokes) present real-life cases at the sessions, which are then addressed by a group of experts at a large healthcare educational/institution (hub) to provide solutions. Sharing best practices for problem solving creates an active learning loop which combined with frequent and regular mentoring and iterative guided practices, creates a community of like-minded professionals who enable and learn from each other.
This unique ‘telementoring’ approach focuses on upskilling healthcare professionals wherever they are and therefore ensures expertise is not limited to urban hubs or large hospitals. This eliminates the need for patients to travel in order to receive timely and quality healthcare, which is even more critical in this age of physical distancing. Hence, this model solves those challenges that traditional telemedicine doesn’t. Through this model, 3,18,828+ HCW were trained via 1,222+ sessions in this time of Covid-19.
An example of this systemic change was seen in the state of Punjab with the issue of Hepatitis C (HCV). PGIMER historically treated about 1,500 HCV cases a year. The ECHO model was used to train doctors in the treatment of HCV at 23 districts hospitals and 3 medical colleges. Since 2016, over 91,000 (~60x more) Hepatitis C patients have been cured in Punjab.
Along with partners like PGIMER, NIMHANS, NITRD, SGPGI, KGMU and 39 others, 61 ECHO programs are run across their focus areas which include TB, mental health, hepatitis, cancer prevention and treatment, and others. ECHO India’s success has led to partnerships with the Indian government and six state governments for capacity building in the healthcare sector. Through these and more partnerships, ECHO India’s mission is to impact 400 million lives by 2025.
The impact of the two diverse approaches of ARMMAN (from the demand side and supply side) and ECHO India (from the supply side) lays the groundwork for continued focus on tele-connectivity and data accessibility in order to further enable a strong ecosystem for digital interventions. The Covid-19 crisis should be used to catalyse more resources towards technology-led solutions for equitable healthcare.
Aparna Hegde is a renowned Urogynecologist and founder and managing trustee of ARMMAN and Kumud Mohan Rai is the founder-chairman of ECHO Trust (India) and is the director of vascular surgery at the Max Superspeciality Hospital, Saket New Delhi