Asara: Maternal Telehealthcare for Tribal Women
Asara(c) reduces maternal mortality through telemedicine technology, capacity building, dedicated health workers and community buy-in.
About You
About You
About Your Organization
Organization Name
Health Management and Research Institute
Organization Website
Organization Country
India, AP, Hyderabad
Country where this project is creating social impact
India, AP, Araku Valley
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
1‐5 years
Has the organization received awards or honors? Please tell us about them
• 2011 eWorld Forum, Jury Choice Award for “Best ICT Initiative in Improving Maternal Health”
• 2011 The World Education Summit, Jury Choice Award for “Best Public-Private Initiative in Vocational and Skills Training”
• 2011 NASSCOM and KPMG, Healthcare IT Awards, “Best Technology Solution for Healthcare Inclusion”
• 2010 EdelGive, Social Innovation Honors, “Health and Well Being”
• 2010 NASSCOM, Social Innovation Honors, “ICT-led Innovation by Non-profit Organizations”
• 2009 eIndia, eHealth Award, “Civil Society/Development Agency Initiative of the Year”
2009 Manthan South Asia Award, “Best eContent for Health Services
References - Please provide two references with a two-sentence biography, email address, and phone number for each
Mr. P.K. Hota
E-mail: puruhota@yahoo.co.in
Mobile: +91 9818 567830
Mr. P.K. Hota is the former Secretary of Health and Family Welfare for the Government of India.
Sashikumar Maranganty
E-mail: sashi@yugantar.org.in
Mobile: +91 9848 533023
Sashikumar Maranganty is CEO of Yugantar, an NGO based in Hyderabad that works in the area of social equity. Mr. Maranganty is also a Member of HMRI’s General Body.
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Innovation
Select the stage that best applies to your solution
Growth (your pilot is up and running, and starting to expand)
How long have you been in operation?
Operating for 1‐5 years
The Need: What problem are you trying to solve?
Asara(c) works to address issues of accessibility, availability and affordability of maternal healthcare among remote tribal women in the hilly areas of Araku Valley, Andhra Pradesh. At 400 and 150, respectively, the maternal mortality ratio and infant mortality rate of this area is significantly higher than Andhra Pradesh and India. Much of this is due to lack of infrastructure, education, poverty and cultural beliefs. By integrating with the community, leveraging rural health workers and delivering healthcare to the doorsteps of the people, HMRI's Asara(c) program works to reduce maternal and infant mortality.
The Solution: What is your solution? Be specific!
HMRI’s Asara(c) project envisions a future in which tribal women have access to high quality and affordable maternal healthcare, the ability to make informed decisions about their health, and do not die due to preventable or manageable causes. To achieve this goal, Asara(c) deploys a comprehensive solution to health that provides women with culturally grounded and medically validated health information through IEC activities, first level care through the training of traditional birth attendants, and virtual access to specialist physicians through videoconferencing. HMRI achieves this cost-efficient, high impact solution by leveraging cutting-edge information and communications technologies and superior operations management.
The Model: Walk us through a specific example of how your solution makes a difference; include your primary activities
HMRI initiated Asara© not only in response to the region’s alarming maternal mortality ratio (MMR), but also to address maternal mortality’s root causes. These include a lack of education (Araku Valley’s female literacy rate is 22.70%, compared with 59.74% for the state), geographic and financial access to healthcare (Araku Valley faces poor road connectivity and families earn roughly $23/month), and skilled health workers.
The goal of Asara© is to reduce the region’s MMR. HMRI does this through conducting the following activities free of cost and through the use of innovative technology::
• Capacity Building. HMRI trains community health workers (CHWs) on maternal health and traditional birth attendants (TBAs) on safe delivery methods. HMRI also provides TBAs with delivery kits.
• IEC Activities. Trained CHWs train local communities on maternal health and facilitate behavioral change.
• Village Health Outreach. Trained ANMs travel to each habitation once per month to monitor pregnancies, conduct screenings, and refer patients to the telemedicine center.
• Telemedicine. HMRI’s vehicle transports pregnant women from a pickup point to the telemedicine center where they undergo a physical examination and lab tests, consult with an OB/GYN located in Hyderabad via videoconferencing, and receive medication/supplements if necessary.
Asara(c) uses Dox-in-Box(R), HMRI's unique point-of-care technology to capture patient vitals in the field, bridging gaps in distance and time and eliminating unnecessary trip to the telehealth center.
The Marketplace: Who are your peers and competitors? Identify others also working to address the needs you are and what differentiates you from them. What challenges could these players pose to your success or growth?
Two organizations conducting similar work in India are SEARCH (Society for Action, Education, and Research in Community Health) and ARTH (Action, Research, and Training for Health).
Asara’s© approach is more comprehensive facing no challenges from other parties. ARTH does not solve the geographic barriers and specialty deliveries for high-risk pregnancies. SEARCH does not offer three antenatal checkups like Asara© does. Nor does it provide village-level screening services with the use of technology to ensure that women travel to the telemedicine center or hospital only if medically necessary. Asara© combines the village-level healthcare that SEARCH and ART strive for with the specialty services of urban OB/GYNs and the technological innovation of Dox-in-Box®.
This Entry is about (Issues)
Social Impact
Founding Story: We want to hear about your "Aha!" moment. Share the story of where and when the founder(s) saw this solution's potential to change the world.
Dr. Mastan Rao Govada founded Asara©. He has over 40 years of experience in medicine and public health and served as Director of Health, Andhra Pradesh.
Dr. Mastan Rao grew up as a member of a marginalized community. Throughout his youth he saw society’s inequality and disparity. Although he felt he was unable to effect change when he was young, Dr. Mastan Rao decided to commit himself to social service and became a doctor. He recalls, “Walking through [tribal] areas you can feel the smell of it [disparity].”
Once the issue of maternal mortality began to garner attention, Dr. Mastan Rao saw an opportunity to transform society through programmatic innovation. He pioneered HMRI’s Asara© program to solve the health inequalities he witnessed his entire life.
Please describe the goal of your initiative; outline what you are trying to achieve
HMRI primarily aims to decrease maternal and infant mortality through preventative healthcare, early identification of high risk cases, education on hygiene and nutrition for mothers and infants and inculcating behavioral changes among the tribal population of India.
What has been the impact of your solution to date?
The primary metric for Asara’s© success is the number of maternal and infant deaths. Pregnancy outcome is another key factor. Among Asara’s© 900 deliveries, there have been 816 live births, 11 stillbirths, 27 abortions, and 30 neonatal deaths. Two maternal deaths have been recorded, compared to 7 expected maternal deaths per the region’s MMR. Additionally, there has been an increase in institutional deliveries by 50%.
Another important factor is registrations. 2,155 beneficiaries have registered. The number of registrations during the first and second trimesters has risen from 11-30% and 36-48%. This demonstrates the less measurable yet equally important factor of changing perceptions of maternal health among tribal people.
What is your projected impact over the next five years?
HMRI plans two key evolutions over the next five years. The first is that HMRI will reduce the maternal mortality ratio among tribal populations under its service areas by 50%. The second is that HMRI will add seven new telehealth centers throughout Paderu Division, Andhra Pradesh, to reach the target tribal population, roughly 5,600,000 and later to the other parts of India. The services would be rendered beyond maternal and infant care to include illnesses that debilitate tribal communities. These illnesses will include, but are not limited to, malaria, vector-borne diseases, anaemia, goiter, arthritis, and malnutrition, etc.
Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact
HMRI aims to change the behavior of pregnant women so that they actively seek healthcare.
Identify three major tasks you will have to complete to reach your six-month milestone
Task 1
Train health workers to identify neonatal risks and motivate parents to bring their infants to the hospital if necessary.
Task 2
Form committees to oversee risky cases on a weekly basis to ensure they do not degenerate into morbidity/mortality.
Task 3
Ensure key village influencers become aware of pregnancy/neonatal risks and become part of the change process.
Now think bigger! Identify your 12-month impact milestone
Ensure that no deliveries will occur without the presence of a doctor or trained traditional birth attendant.
Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1
Train and conduct refresher trainings for all traditional birth attendants (TBAs) in the project area.
Task 2
Establish early risk identification and management program so that pregnant women and TBAs can take necessary precautions.
Task 3
Establish a referral system so that pregnant women can go to gov't hospitals with Asara(c) records and undergo care immediately.
Sustainability
Tell us about your partnerships
HMRI partners with MacArthur Foundation, Centre for Policy Research, Avantor Performance Materials, and Zolt Info Solutions for Asara© . Centre for Policy Research conducts independent, third party monitoring and evaluation. Avantor Performance Materials supplies laboratory equipment and SEDY – 12 and ER – 2007. HMRI purchases Chem master – Semi Automated Biochemistry Analyser and Noble III which are integrated with HMRI’s telemedicine software. HMRI works closely with Zolt Info Solutions to develop HMRI’s patient service software and Dox-in-Box®.
Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?
HMRI plans to initially expand Asara© through the addition of seven maternal telehealth centers throughout Paderu Division, Andhra Pradesh, serving a tribal population of 600,000. Later we plan to scale up the project to the entire tribal population of Andhra Pradesh, which comprises five districts of the state. Once these centers are established HMRI plans to expand to tribal areas throughout India.
What type of operating environment and internal organizational factors make your innovation successful?
HMRI possess a strong operational team with visionary leaders directing the project towards its goals. However, its our on-the-ground relationships that make Asara© so successful. Our dedicated field staff have cultivated community buy-in which is evident from increasing registrations. Our managerial team maintains close connection with the staff and on-the-ground program workings to provide a constant atmosphere of support. The managerial team also looks out for the big picture, looking for ways to improve and expand the program.
Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list
HMRI anticipates collaborating with organizations that would aid in delivering high quality, low cost, technology-enabled healthcare to rural populations.
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