Non-communicable diseases (NCDs) are the leading cause of adult mortality and morbidity worldwide. The World Health Organization (WHO) estimates that NCDs are collectively responsible for almost 70% of all deaths across the world. A WHO report from 2015 says that 1 in 4 Indians have a risk of dying from an NCD before they reach the age of 70; now the number must be higher. The Government of India’s National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) focuses on the promotion of a healthy lifestyle and early diagnosis and management to tackle the high incidence of NCDs in the country. The launch of the Government of India NCD accredited social health activist (ASHA) app is another step in this direction.
Karnataka is one of the many Indian states that bears the high burden of NCDs. To tackle the challenge, it implemented population-based screening (PBS) in 10 sub centres and three primary healthcare centres in each district, under the NPCDCS. However, enrollment numbers for PBS continued to fall and the state also ranked low on the national dashboard. The Department of Health and Family Welfare Services, Government of Karnataka, gradually increased PBS across all sub health centres and health and wellness centres in all districts to improve enrolment and screening. Lack of tablets and high workload of auxiliary nursing midwives (ANMs) continued to bring in low PBS enrollment and performance figures.
The Tata Trusts stepped in to provide techno-managerial support to strengthen the programme implementation and service delivery, especially to leverage information technology in the form of a comprehensive CPHC application to support the NCD programme in Karnataka. This is ensured through field monitoring, capacity building and mentoring support to the service delivery functionaries at different levels, and alongside enabling the use of a digital platform to ensure delivery of the NCD programme.
Dr Aman Singh, Programme Lead, Tata Trusts, mentions that, “In the review meetings with district teams, the Tata Trusts highlighted the benefits of implementing the use of the ASHA app among ASHAs across Karnataka. If enrolment could be done by ASHAs though the mobile phone-based app, the workload of ANMs would be reduced, which in turn could help them focus on screening and improving enrollment figures. The teams, thus, decided to go ahead with encouraging the use of the ASHA app.”
When the programme was rolled out in Karnataka in January 2020, the Tata Trusts and the district health teams planned to implement use of the ASHA app in six districts. Initially, smartphones for using the app were not procured and distributed by the health department, which was a hurdle in the immediate implementation of the programme. However, the teams identified ASHAs who had their own smartphones and were ready to install the CPHC NCD app on their mobiles. The ASHAs were also selected on the basis of their knowledge about the survey and awareness about the family folder and community-based assessment checklist, which needs to be filled in by ASHAs.
Mrs Prabitha, an ASHA from Mangalore taluka, Dakshina Kannada, Karnataka, narrates her experience, “After the teams created user IDs for the app, they trained us on the use of it, so that we had good practice before we actually started entering the records. Moreover, the app is easy to use and we don’t need to carry multiple paper copies while going to the field. We can do our work easily with our mobile.”
By January 30, 2020, due to the initiative of the Trusts, 310 ASHAs had started using the ASHA app. This practice was followed up by initiating training for ASHA facilitators, with the support of the district team, who would in turn train other ASHAs across districts on an online platform. The facilitators, with support from the taluka team, trained many more.
Dr Aman Singh highlights that, “The numbers went up dramatically in a short period of time ... the effort resulted in more than 21,500 trained ASHAs in the field until April 1, 2021. Most of them using the app on their own mobiles. Of the total enrolments of 20,346,616 across the state, those done through the ASHA app totals 9,400,705. The state's ranking on the national dashboard shot up to the 2nd place by March 2021, from the 8th place in October 2020.”
The ASHA app has simplified processes. As Ms Dakshayini, an ASHA from Panduvapura taluka, Mandya, Karnataka, says, “Before we started using the ASHA app all our documentation was messed up. But the app is systematic and the required documents are available easily. There is no need to go through the pages and pages of survey books.”
As use increases across the state, the ASHAs will contribute significantly towards realising Digital India’s mission of ensuring government services are made available to citizens electronically and efficiently.