| 4. In which ways is the initiative creative and innovative?
e-Mamta is based on Principle of Name based tracking which ensures each family, pregnant woman and children are provided a unique identity number for tracking of essential RCH services.
• Concept of work plans (generated village-wise each month) has been introduced for the first ever time where beneficiary wise detailed schedule of due service is prepared for each grass root level worker. Following workplans are prepared: Work Plans for New registration, Ante Natal Care Delivery, Post Natal Care, Newborn care, Child services, Adolescents, Anemia, Family Planning services, Malnutrition, Institutional Delivery, Family planning services etc. Due to these beneficiary tracking has become more effective including tracking of migrant population.
• Use of SMS Technology for Tracking beneficiaries: Customized vernacular language SMS and voice call jingles are sent as per predefined schedule to beneficiary and service providers from e-Mamta according to their due dates of services, which is a IEC based new paradigm in healthcare sector. SMS technology bridges communication gap between beneficiaries & service providers caused due to migration and disperse scattered population
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
e-Mamta is introduced in Gujarat by the collaborated efforts of the Health and Family Welfare Department of Government of Gujarat with technical support of National Informatics Centre (NIC) Gujarat team. The Government of India has appreciated the initiative of e-Mamta and announced Nation wide replication of the software as a step towards overall improvement in the public health of the entire country.
e-Mamta database caters to more than 95% of entire Gujarat population focused on targeted segments of 14,52000 Pregnant women, 13,21000 Deliveries and 13,21000 Newborns across the state to provide effective and timely service delivery care.
Beneficiary Coverage in e-Mamta
• Families entered: 1.40 crores
• Members entered: 6.18 Crores (More than 95% of Gujarat’s Population)
Service Registered in Year 2015-16
• No. of PW reg. during the year (No. /% against Est.): 13, 25,224 (91.29%)
• No. of Early ANC out of reg. PW (No. /% against reg.PW): 6, 83,000 (51.54%)
• No. of Identification of High Risk PW: 1,49,328 (20 % )
• Identification of Eligible Couples: 69,93,433
• No. of Institutional Delivery (No./% against total delivery): 11, 73,103 (98.5%)
• Total Children reg. (0-1 year) (No. / % against Est.): 12, 28,889 (93.03%)
• BCG given: 11, 58,687(98.4%)
• DPT-3/Penta-3: 11, 23, 723(95.4%)
• Measles Dose: 10, 93,998(92.9%)
• Fully immunized children: 10, 89,848(92.6%)
• 0-5 years age group children screened across the state by FHW during Kuposhan Mukt Gujarat Mahaabhiyan to identify SAM child: 43,14,134
| 6. How was the strategy implemented and what resources were mobilized?
• The e-Mamta system has passed on various critical benefits to the citizens of Gujarat. Through its ‘Complete Lifecycle Approach’, the system records the data from birth to death of an individual and addresses the gaps in ensuring comprehensive Maternal and child health services in rural as well as urban areas. It incorporates the concept of work plans at grass root level for clear understanding of targeted beneficiaries. The provision of Unique IDs (UID) to individuals has resolved the issues like migration / transfer in service delivery and duplication of registration of mothers. The system records every individual as one single unit, ruling out the possibilities of excluding even one person.
• Rural health challenges such as high dropout rates, high left out rates, quality of services, inability to track beneficiary pregnant women and children leading to high MMR & IMR are targeted through e-Mamta. e-Mamta is accessed through user id and password for government department employees.
• 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 & Family Welfare 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 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/children are then tracked through Work plans 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 below:
• Pregnant Females:
o Antenatal Registration of Pregnancy
o Measurement of weight, blood pressure and hemoglobin
o Tetanus Toxoid Vaccination
o Supplementation of Iron/Folic Acid/Calcium
o Education and Counseling regarding childbirth and importance of institutional deliveries
o Identification of high risk pregnancies and referral to tertiary centers for management
o Vaccination Status
o Monitoring of Growth
o Vitamin A and Calcium Supplementation
o Provide requisite nutritional supplementation
• Lactating Females: Counselling regarding importance of breast feeding and methods of contraception and family planning
The software will assess the gap for requisite service of individual beneficiary. If this service is not delivered, system immediately indicates this and a health worker is informed to correct the shortcoming.
The year wise growth of eMamta is as enlisted below:
• Jan 2010: e-Mamta Conceptualization and data entry modules developed
• May 2010: e-Mamta Project launched all over Gujarat
• July 2010: Presentation in review meeting of NRHM at Bhopal and announced for National Roll out by GOI
• August 2010: Training to state Nodal officers & State data entry Managers in four batches of all the states of India at Delhi & Gandhinagar.
• December 2013: Presentation in Strengthening Civil Registration & Vital Statistics Systems Through Innovative Approaches In The Health Sector, Technical Meeting, Geneva, December 17-18 2013 Organised By The WHO In Collaboration With Canada, Unicef, USAID And The World Bank
• Jan 2013 to Present status: Various modules of New programmes launched by GOI as per RMNCH+A guidelines has been in continuous development process to develop data entry screen, Workplans and Report modules
• Aug-Sept 2016: Baseline data developed for identified Eligible couples
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
State Health officials
• Conceptualization and Implementation across the state, facilitated National Roll out Upgradation of various modules in alignment to Newer National guidelines
• Develop database modules as per State’s priorities and campaigns launched
• Impart training to District officials
• Resolve technical queries of Districts incoordination with NIC team
• Conduct the reviews of District’s performance and identify the Gaps
• Coordinate with MCTS team based at Government of India for updation of e-Mamta data in central server.
• Technical support of other UN agency such as UNICEF for upgradation of Nutrition module in e-Mamta.
State National Informatics Centre Officials
• Technical development of Web based software application
• Training to Government of India’s NIC team for national roll out of the software
District Level Officials
• Overall implementation of program across District
• Solve issues: HR, Technical and Other as per guidance of the state
• Training and guidance to Taluka and PHC
• Timely feedback to state for improvement, Data monitoring & review, cross verification/Validation
Block Level Health Officers
• Ensure avaibility of network connection, hardware, operator for data entry
• Ensure correct facility mapping in e-Mamta
• Performance review PHC wise
• Ensure updated information/Cross Verification
• Family Health Survey: Ensure completeness and verification every year
• Registration: Ensure completeness for ANC and Child services
• Coordination between staff for data entry and workplan content
• Validation/Verification: e-Mamta Vs HMIS
• Migration: Updated information of services data entry
• Performance review: Subcentrewise
• Ensure updated information
• Cross verification of sample
Data Entry operators
• Timely completion of correct data entry from Workplans
• Generate Workplans and provide to Female Health Workers
Female Health Worker (FHW)
• Family Health Survey Updation/Verification every year
• Work plan receive in timely manner and submit duly filled
• Record: e-Mamta generated unique ID to be noted in RCH register and Mamta Card
• Provide e-Mamta generated ID to beneficiaries
• Counselling to keep Mamta Card and ID when attended facilities
| 8. What were the most successful outputs and why was the initiative effective?
1. Identifies high risk pregnant females for timely service delivery and increases the number of deliveries occurring under the guidance of appropriately trained individuals, both in institutions and the community along with stringent monitoring of pregnancy outcomes assists in preventing adverse conditions along with distribution of vaccines based off the database to PHCs serving the most unvaccinated population to take advantage of economies of scale
2. Eligible couples for family planning services improves access and provision of basket of family planning services
3. Detailed Nutrition module provides opportunity for real time identification and management of Severe Acute malnutrition children and appropriate treatment facilitation
4. 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.
5. Improved data analysis to create improved Block/District health action plans based on accurate denominators in addition to Information which can be readily accessed through any remote location and transferred rapidly.
| 9. What were the main obstacles encountered and how were they overcome?
• Need of orientation/Training to implement e-Mamta application:
Orientation/Training was arranged at all level: District/other state Official’s training conducted at State office, Taluka level health officers along with PHC/UHC Medical officer’s training conducted at District office, Health facility based Data entry operators and field level health worker’s orientation was conducted at PHCs/UHCs.
Gujarati and English language Guidelines developed and uploaded online
• Vacancy of Human Resource and unavailable Logistics:Ensured the HR at all level through regular recruitment and monitored/reviewed the supply of logistics
• Data (Collection, Data entry):
Workplan generation: Work plan is conceptualized to process the available online registered data to generate & provide denominators that determine the entire gamut of beneficiaries and provides the detailed service schedule to be targeted – name wise.
This further facilitates concentration on individual beneficiaries and determining the left outs of service delivery during a certain period of time.
Work plans are generated village wise assumed on Mondays at PHC/UHC level and handed to ANMs so that beneficiaries are tracked in advance by ASHAs prior to Mamta session planned on Wednesdays.
Direct data entry from workplan is facilitated for ease of DEOs to understand the indicators and search beneficiaries.
• Poor data entry Issue:
Regular review at all level : State/District/Taluka/Health facility
• Verification/Validation of data Issue:
Family Health Survey verification conducted annual basis
• Duplication of Data Issue:
Report for duplicate data, entry generated and verified.
SEARCH module is developed to track any registered beneficiary on basis of parameters such as Aadhar UID, Ration card no, BPL no, DOB, Name, Village location, Health id.
Helpdesk callcentre to answer queries related to health id search in online database
• Technical issues:
Helpdesk at State level to solve queries in coordination with NIC team under support of Demography & Evaluation team
• Communication Issue:
Regular feedback from field through email and improvement