Title: e-Health Initiative for Villages in Rajasthan.

 Background: India is a strong country with billion plus people, increasing population in India over-burdens the health care structure in the country.

 While, those living in cities and big towns have access to high end health services, the millions of people living in rural India, particularly in the remote parts of the country face problems of  inadequate facilities and poor access to healthcare.

  So as to provide better health care access to the priceless human resources, which in turn can make India healthier too, we want to use e health initiatives.

  The health care industry has generated huge amounts of data, driven by record keeping, compliance and regulatory requirements and patient care .

  Now, the e-health initiative has transformed the health care system to become much more efficient, less expensive and achieve better quality.

  As India too is making strides in the field of e Health. We have developed  an App  namely Health Smart app , made with the concept of iconic data entry or data entry with a few clicks .

This innovative technology is a way to improve the performance of health care systems by linking various systems.

  Rationale: The present initiative to create health smart villages shall create an impact on:

             neonatal and child health including vaccinations,

             maternal health,

             infectious disease and

             non-communicable disease.

  Mobile technology based surveillance of healthcare workers shall lead to better delivery of preventive care

  Constant population surveillance shall lead to early diagnosis of epidemics.

  Equal focus on childhood and adult mortality shall reap healthcare and economic dividends.

  Real-time feedback can lead to rapid policy initiatives and improve practice.

  Academic enrichment

Objectives of the study

     1. To focus on health issues from womb to tomb of every individual.

     2. To create technology empowered primary health care workers.

3. To use conventional technologies as well as e-health initiatives in disease surveillance and management.

4. To use e - health in disease screening, and timely intervention.

5. To strengthen health care delivery system and referral system.

 Methodology:

Is a prospective cohort study

 will track changing lifestyles, risk factors and chronic disease using periodic standardized data collection in rural area. This study is being conducted in three phases:

A Vanguard phase

Recruitment phase

Follow-up phase

       i ) A Vanguard phase 

    During which all aspects of the protocol were further refined and tailored , development of  android application for tablet, development of training module for ASHA,  final training and standardization of methods was done .

ii) Recruitment phase: (3months)

During which all individuals of  the village  were recruited and underwent detailed baseline assessments. During this phase, the initial cross-sectional analysis using baseline data was done.

iii) Follow-up phase:(8 month)

Consists of follow-up of all subjects every monthly, for up to 1 year, to document any changes in the health profile of all the participants.

Sampling Frame

1)    Selection criteria: 

          such villages are choosen which had difficult approach or the health services were inadequate.

 2) Location and names  -

               (i)  Lakhesra  -  30 km from RUHSCMS,  Jaipur    under Luniyawas      PHC on Jaipur  Agra road.

     (ii)  Kapurwala - 25 kms  from RUHSCMS, Jaipur under Dadiya PHC on Diggi Malpura road.

Health Smart App

  An android based application (Health Smart App) developed to be used on tablets.

  The health worker (ASHA) provided with tablets which are GPS, skype  and 3G enabled .

  It consists of pop up videos for increasing awareness and knowledge of various health related issues of the general population.

   To go for real time data collection with visualisation and real time processing of information at central loaction. (RUHS College of medical sciences, Jaipur) .

Methods

  Training of ASHA

  We  trained the ASHA’s on different aspects

  First of all we trained her to use the tablet.

  In the subsequent process we  made her friendly with Health Smart Android App

  She was made acquainted with different forms of the Performa, entries to be made on the tablet itself.

  She was trained to take different anthropometric measurements, BP & measure blood glucose level by glucometer and hb estimations through training modules & real time demonstrations.

  We trained these ASHA’s already working in rural area with the e health initiatives which will remove the complete file work and help her to take decision, perform large scale screening for non communicable diseases, update them with alerts like list of people for vaccination , list of antenatal and post natal mothers so as to create health smart  villages.

Overview of Data Collection

•      Standardized, interviewer-based questionnaires are being used to collect detailed information at the community, family and individual level through clicks on the tablet .

•      Physical measures include anthropometry, blood pressure using automated equipment.

•      The data would be transferred directly to the central computer & report on various aspects will be generated automatically on daily basis through the server, So as to capture any deviation from normal in the health status of the community & family.

   Follow up...

  Regular check-up of those who are at high risk (Hypertension, Diabetes Mellitus, Anaemia) in form of  B.P. monitoring, blood sugar estimation and haemoglobin estimation.

 For those found hypertensive and pre hypertensive  monthly B.P. monitoring will be done.

  For diabetics and prediabetics monthly blood sugar estimation will be done and

   Anaemics will be given 3 month of IFA tablets and there haemoglobin estimation will be done after 1 month of completion of the IFA course to see the effect .

  ASHA /CHW will refer those patients to FRU’s. We will also organise specialist visits once a month to the village itself, so as to provide treatment there itself.

  Tracking of these newly diagnosed cases for regular treatment and follow up by ASHA/ CHW.

  Reporting of any new event in the household in form of morbidity, mortality and birth will be done on daily basis.

  Supervision and monitoring of ASHA / CHW by the coordinating team will be done weekly.

         We are training and retraining the ashas to use these e health initiatives  so as to empower them in providing better services at the grass root level  to the people and also be able to screen the population for various NCD’s and provide timely referral so that we can control the occurrence of these diseases.