Aarogyam - OneWorld South Asia...Baghpat and J.P. Nagar districts of the state in 2008. Under...

[email protected]

April 2012

Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public GrievancesMinistry of Personnel, Public Grievances and Pensions, Government of Indiahttp://indiagovernance.gov.in/

Researched and Documented by

OneWorld Foundation India

AarogyamDigital Health Mapping and Service Delivery

TRANSPARENCY AND

Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public Grievances

Ministry of Personnel, Public Grievances and Pensions

Government of India

Table of Contents EXECUTIVE SUMMARY ................................

METHODOLOGY ................................

BACKGROUND ................................

OBJECTIVE ................................................................

PROGRAMME DESIGN ................................

KEY STAKEHOLDERS ................................

WORK FLOW ................................

MOTHER AND CHILD TRACKING FACILITY

PROVISION OF ADEQUATE

CAPACITY BUILDING AND

MONITORING AND EVALUATION

TECHNOLOGY UTILISED

FUNDING ................................

IMPACT ................................................................

IMPROVING ACCOUNTABIL

EMPOWERING THE COMMUN

BETTERING THE MATERNA

PROVIDING A REPLICABLE MODEL FOR IMPROVIN

CHALLENGES IN IMPLEMENTATION

CONCLUSION ................................

REFERENCES ................................

APPENDIX A – INTERVIEW QUESTIONNAIRE

RANSPARENCY AND ACCOUNTABILITY

Governance Knowledge Centre Promoted by Department of Administrative Reforms and Public Grievances

Grievances and Pensions

Researched and documented by


Aarogyam:

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TRACKING FACILITY ................................................................

ROVISION OF ADEQUATE HEALTHCARE FACILITIES ................................................................

APACITY BUILDING AND COMMUNITY AWARENESS GENERATION ................................

VALUATION ................................................................

GY UTILISED ................................................................................................

................................................................................................................................

................................................................................................

MPROVING ACCOUNTABILITY AND RESPONSIBILITY OF HEALTH SERVICE

MPOWERING THE COMMUNITY ................................................................................................

ETTERING THE MATERNAL AND CHILD HEALTH SCENARIO IN U.P ................................

E MODEL FOR IMPROVING DELIVERY OF HEALTH

MPLEMENTATION ................................................................................................

................................................................................................................................

................................................................................................................................

UESTIONNAIRE ................................................................

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TY OF HEALTH SERVICE PROVIDERS ............... 9

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G DELIVERY OF HEALTH SERVICES ................ 11

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TRANSPARENCY AND



Government of India

EXECUTIVE SUMMARYThe Infant Mortality Rate and Maternal Mortality rate in Uttar Pradesh (U.P) is amongst the

highest in the country.1 The lack of access to adequate facilities combines with the unawareness

of the rural population in the state to make the maternal and infant health situation abysmal.

Aarogyam, an ICT based health related service delivery provision system, seeks to corre

problem of high incidences of maternal and infant deaths in U.P by tracking women's

pregnancies and maintaining a record of child immunisation over time. It was initiated in

Baghpat and J.P. Nagar districts of the state in 2008.

Under Aarogyam, a village wise database of all the beneficiaries (pregnant/lactating women,

children up to 5 years) of an area is maintained, which gets continually updated. Based on this

database, the Aarogyam software sends automated alerts in the form of vernacular voic

calls/SMS to the beneficiaries informing and reminding them about their pending antenatal and

postnatal care and immunisation appointments. These alerts are also sent to local level health

officials informing them about due services in the area.

Aarogyam also has an in-dial facility where beneficiaries can call up to inquire about any

maternal and infant related health issues and also file their grievances. These grievances are

registered under the Management Information System (MIS) of Aarogyam that prov

basis for concerned health professionals to take related corrective measures.

In this manner, Aarogyam is ensuring that the government reaches out to people with pro

active and responsive health care delivery.

districts of the state, making health professionals accountable along with empowering the

community with adequate reproductive and infant health related information. Given its

remarkable performance, Aarogyam has received several awards and rec

NASSCOM Social Innovation Honors 2010 and the M

METHODOLOGY The Governance Knowledge Centre (GKC) documents best practices in governance in India in

support of further replication. For this purpose, select initiatives that are significantly

1Maternal and Child Mortality Rates and Total Fertility Rates. Registrar General of India. Sample

Registration Survey (SRS). July. 2011. Web. April 29. 2011. <

http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf






Aarogyam:

UMMARY The Infant Mortality Rate and Maternal Mortality rate in Uttar Pradesh (U.P) is amongst the

The lack of access to adequate facilities combines with the unawareness


Aarogyam, an ICT based health related service delivery provision system, seeks to corre



Baghpat and J.P. Nagar districts of the state in 2008.

village wise database of all the beneficiaries (pregnant/lactating women,


database, the Aarogyam software sends automated alerts in the form of vernacular voic



officials informing them about due services in the area.

dial facility where beneficiaries can call up to inquire about any


registered under the Management Information System (MIS) of Aarogyam that prov


In this manner, Aarogyam is ensuring that the government reaches out to people with pro

active and responsive health care delivery. Aarogyam has today been expanded to



remarkable performance, Aarogyam has received several awards and rec

NASSCOM Social Innovation Honors 2010 and the M-Billionth Award 2010.

The Governance Knowledge Centre (GKC) documents best practices in governance in India in


Maternal and Child Mortality Rates and Total Fertility Rates. Registrar General of India. Sample


p://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf>

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The Infant Mortality Rate and Maternal Mortality rate in Uttar Pradesh (U.P) is amongst the

The lack of access to adequate facilities combines with the unawareness


Aarogyam, an ICT based health related service delivery provision system, seeks to correct this



village wise database of all the beneficiaries (pregnant/lactating women,


database, the Aarogyam software sends automated alerts in the form of vernacular voice



dial facility where beneficiaries can call up to inquire about any


registered under the Management Information System (MIS) of Aarogyam that provides the


In this manner, Aarogyam is ensuring that the government reaches out to people with pro-

Aarogyam has today been expanded to about eight



remarkable performance, Aarogyam has received several awards and recognitions like the

Billionth Award 2010.

The Governance Knowledge Centre (GKC) documents best practices in governance in India in



>

TRANSPARENCY AND



Government of India

contributing towards the betterment of public service delivery are identifi

research team. The team conducted extensive secondary research using credible web sources to

establish the suitability of Aarogyam

in Uttar Pradesh - as a best practice. This research r

successfully harnessing information and communication technology tools to create a pregnancy

tracking database for facilitating the timely delivery of crucial maternal and infant related

health services.

Having recognised Aarogyam as a best practice, the key stakeholders in the initiative were

identified and interviewed to gain a deeper insight into the operation and impact of the

initiative. This document has been created by compiling the information collected thro

secondary research as well as the insights gathered through an interview with the Managing

Director of Kanpur State Electricity Company Limited (KESCO) who, along with the District

Magistrate of Kanpur-Dehat, was responsible for initiating and implemen

Baghpat and J.P.Nagar.

Efforts have been made to provide objective information in the document. However, since only

the implementers of the project were interviewed, there is a possibility of percolation of

information bias.

BACKGROUND Providing accessible and qualitative healthcare to an increasingly vast population remains a

humongous task for service providers in India. Among the foremost healthcare challenges that

the country faces is the high rate of maternal and infant mortality. As p

Registration System (SRS)2, India’s Infant Mortality Rate (IMR)

2010) while its Maternal Mortality Rate (MMR)

As identified by the National Family Health Survey (NH

reasons behind such high incidences of infant and maternal deaths in India are the lack of

awareness among women about the importance of antenatal care (ANC) and postnatal care

(PNC), inadequate infrastructural as well a

2 THE SAMPLE REGISTRATION SYSTEM (SRS)

ESTIMATES OF BIRTH RATE, DEATH RATE AND OTHER

NATIONAL LEVELS. <

HTTP://CENSUSINDIA.GOV.IN/VITAL_STATISTICS3 Number of infant deaths per 1000 live births4 NUMBER OF MATERNAL DEATHS PER 1,00,000






Aarogyam:

contributing towards the betterment of public service delivery are identifi


establish the suitability of Aarogyam - a pregnancy tracking and digital health mapping system

as a best practice. This research reflected the manner in which Aarogyam is



ognised Aarogyam as a best practice, the key stakeholders in the initiative were


initiative. This document has been created by compiling the information collected thro



Dehat, was responsible for initiating and implemen



viding accessible and qualitative healthcare to an increasingly vast population remains a


the country faces is the high rate of maternal and infant mortality. As p

, India’s Infant Mortality Rate (IMR)3 is 47 per 1000 live births (in

2010) while its Maternal Mortality Rate (MMR)4 is 212 per 100,000 live births (2007

As identified by the National Family Health Survey (NHFS)-2 of the year 1998



(PNC), inadequate infrastructural as well as medical facilities and assistance during delivery,

(SRS) IS A LARGE-SCALE DEMOGRAPHIC SURVEY FOR PROVIDING R

DEATH RATE AND OTHER FERTILITY & MORTALITY INDICATORS AT THE NATIONA

TATISTICS/SRS_BULLETINS/SRS%20BULLETIN_%20DECEMBER

live births

1,00,000 LIVE BIRTHS

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contributing towards the betterment of public service delivery are identified by the GKC


a pregnancy tracking and digital health mapping system

eflected the manner in which Aarogyam is



ognised Aarogyam as a best practice, the key stakeholders in the initiative were


initiative. This document has been created by compiling the information collected through



Dehat, was responsible for initiating and implementing Aarogyam in



viding accessible and qualitative healthcare to an increasingly vast population remains a


the country faces is the high rate of maternal and infant mortality. As per the Sample

is 47 per 1000 live births (in

is 212 per 100,000 live births (2007-2009).

2 of the year 1998-99, the main



s medical facilities and assistance during delivery,

RVEY FOR PROVIDING RELIABLE ANNUAL

ATORS AT THE NATIONAL AND SUB-

ECEMBER%202011%20.PDF/>

TRANSPARENCY AND



Government of India

incomplete immunisation and improper treatment of birth related problems among infants,

and provision of service by under

combine with under utilisation of technology and marginal involvement of communities and

other stakeholders in the health system to result in a unidirectional, unresponsive supply based

health service delivery approach.

Hoping to address these shortcomings, the Government of India

Reproductive and Child Healthcare (RCH) Programme in 1997

maternal and child health in the country. In April 2005, this RCH programme was integrated

within the National Rural Health Mission (NRHM) to take for

motherhood and child survival. Under NRHM, the

that seeks to address problems of maternal mortality and infant mortality by providing cash

incentives to women who choose institutional deliv

that both the mother and child are provided with adequate care (ANC and PNC) and medical

facilities (medicines and immunisation) that they would otherwise be deprived of in case of

home based deliveries with the assistance of a mid

However, in spite of such national level schemes, states all across India have failed to follow a

streamlined approach to reach the targeted population. The absence of a proper tracking

process results in many women and childre

care schemes. In instances where the target population is being adequately reached out to, there

is a lack of follow up mechanisms because of the failure to maintain an appropriate database.

Recognising these shortcomings, most Indian states have been devising new processes and

mechanisms to meet their commitments under the NRHM. An interesting development of late

has been the use of information and communication technology (ICT) tools for improving the

delivery of health related services.

One such initiative that is successfully leveraging the use of technology for efficient healthcare

delivery in the country is Aarogyam in Uttar Pradesh (U.P). The IMR and MMR in U.P are

amongst the highest in the country.

unawareness of the rural population in the state to make the maternal and infant health

situation abysmal. Developed in 2008, Aarogyam seeks to address this by effectively leveraging

ICT for delivering timely health services.

5 Maternal and Child Mortality Rates and Total Fertility Rates. Registrar General of India. Sample








Aarogyam:


and provision of service by under-capacitated health professionals. These factors further

ation of technology and marginal involvement of communities and


health service delivery approach.

Hoping to address these shortcomings, the Government of India

Reproductive and Child Healthcare (RCH) Programme in 1997-98 with the goal of improving


within the National Rural Health Mission (NRHM) to take forward the goals of safe

motherhood and child survival. Under NRHM, the Janani Suraksha Yojana


incentives to women who choose institutional delivery. With institutional delivery, it is hoped



he assistance of a mid-wife.



process results in many women and children being left out from the coverage of such health



se shortcomings, most Indian states have been devising new processes and



very of health related services.



amongst the highest in the country.5 The lack of adequate facilities combines with the



mely health services.



http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf>

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capacitated health professionals. These factors further

ation of technology and marginal involvement of communities and


Hoping to address these shortcomings, the Government of India (GOI) launched a

98 with the goal of improving


ward the goals of safe

Janani Suraksha Yojana is a crucial scheme


ery. With institutional delivery, it is hoped





n being left out from the coverage of such health



se shortcomings, most Indian states have been devising new processes and





The lack of adequate facilities combines with the





>

TRANSPARENCY AND



Government of India

‘Aarogyam’ is a Sanskrit word that means ’complete freedom from illness’. An ICT based

responsive system, Aarogyam, ensures active participation of all key stakeholders viz. local

administration, doctors, frontline health workers

ANM (Auxiliary Nurse Midwife), and AWW (Anganwadi Workers)

beneficiaries, to ensure that a pregnant woman is provided with ANC, PNC and that children

are given complete immunisation.

Aarogyam maintains a village wise database of all the beneficiaries (pregnant/lactating women,

children up to 5 years) of an area, which gets continually updated. Based on this database, the

Aarogyam software sends automated alerts in the form of vernacular voice ca

beneficiaries informing them about their pending appointments. These alerts are also sent to

local level health officials informing them about medical services due in the area. In this

manner, Aarogyam ensures that the government reaches out

care delivery services. Initiated in two districts of U.P

today been expanded to about eight districts of the state.

OBJECTIVE Aarogyam is an ICT based health care delivery system for pregnancy tracking and digital

health mapping. It has the following objectives:

• Tracking each pregnancy in the target areas with the help of a technology based

monitoring system

• Ensuring complete ante and

institutional deliveries

• Providing 100 percent immunisation for pregnant women and children in the age group

0-5 years

• Developing a two-way demand based interactive health care delivery eco






Aarogyam:



administration, doctors, frontline health workers - ASHA (Accredited Social Health Activists),

ANM (Auxiliary Nurse Midwife), and AWW (Anganwadi Workers)


are given complete immunisation.

aintains a village wise database of all the beneficiaries (pregnant/lactating women,


Aarogyam software sends automated alerts in the form of vernacular voice ca



manner, Aarogyam ensures that the government reaches out to people with responsive health

Initiated in two districts of U.P - Baghpat and J.P Nagar

today been expanded to about eight districts of the state.

is an ICT based health care delivery system for pregnancy tracking and digital

health mapping. It has the following objectives:

Tracking each pregnancy in the target areas with the help of a technology based

Ensuring complete ante and post natal care for pregnant women and promoting

institutional deliveries

Providing 100 percent immunisation for pregnant women and children in the age group

way demand based interactive health care delivery eco

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ASHA (Accredited Social Health Activists),

ANM (Auxiliary Nurse Midwife), and AWW (Anganwadi Workers) -village heads and


aintains a village wise database of all the beneficiaries (pregnant/lactating women,


Aarogyam software sends automated alerts in the form of vernacular voice calls/SMS to the



to people with responsive health

Baghpat and J.P Nagar - Aarogyam has

is an ICT based health care delivery system for pregnancy tracking and digital

Tracking each pregnancy in the target areas with the help of a technology based

post natal care for pregnant women and promoting

Providing 100 percent immunisation for pregnant women and children in the age group

way demand based interactive health care delivery eco-system

TRANSPARENCY AND



Government of India

PROGRAMME DESIGN

KEY STAKEHOLDERS

• Rural health workers like

Nurse Midwife), and AWW (Anganwadi Workers):

aggregation and updation of data related to

that related health services are delivered in a timely manner.

• Data operators at the Block and District level:

health workers is entered correctly in the Aarogyam software.

• Complete Healthcare Centres (CHCs) and Primary Healthcare Centres (PHCs) at the

Block Level: Rural health workers associated with CHCs and PHCs leverage their facilities

to deliver healthcare to mothers and infants. CHCs and PHCs also act as centres for data

aggregation.

• Village Pradhans: Aarogyam keeps the

infant health related services, who then use the information to ensure timely delivery of

services.

• Beneficiaries: These include pregnant and lactating women an

of age.

• Private software companies

software.

• National Informatics Centre (NIC)

WORK FLOW

Aarogyam has two crucial components a) mother and child tracking facility b) provision of

adequate healthcare facilities to mothers and children below five years of age.

MOTHER AND CHILD TRAC

The beginning point for health delivery services under Aarogyam

maternal and child health related information within the target area. For this purpose, a

comprehensive baseline health survey of households in the targeted districts was conducted.

Data was collected on the basis of gender, religion

aspects like immunisation details of infants and pregnancy related information with expected

date of deliveries along with the services availed by a pregnant women till that time.

time of the survey, each beneficiary was given an 8 digits unique ID that consists of block id

(first two digits) + village id (second two digits) + beneficiary id (last four digits). This unique

ID is used for tracking the health of a mother and her child in the system.






Aarogyam:

ESIGN

Rural health workers like ASHA (Accredited Social Health Activists), ANM (Auxiliary

Nurse Midwife), and AWW (Anganwadi Workers): They play a crucial role in

aggregation and updation of data related to pregnant women and infant

that related health services are delivered in a timely manner.

Data operators at the Block and District level: They ensure that the data collected by rural

health workers is entered correctly in the Aarogyam software.

Healthcare Centres (CHCs) and Primary Healthcare Centres (PHCs) at the

Rural health workers associated with CHCs and PHCs leverage their facilities


Aarogyam keeps the Pradhans informed about the status of maternal and


include pregnant and lactating women and children below five years

Private software companies: They have been responsible for development

National Informatics Centre (NIC): It supervises the overall functioning of the software.

l components a) mother and child tracking facility b) provision of


OTHER AND CHILD TRACKING FACILITY

The beginning point for health delivery services under Aarogyam was the collection of



Data was collected on the basis of gender, religion, caste and 13 health indicators that included


date of deliveries along with the services availed by a pregnant women till that time.

ch beneficiary was given an 8 digits unique ID that consists of block id


ID is used for tracking the health of a mother and her child in the system.

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ASHA (Accredited Social Health Activists), ANM (Auxiliary

They play a crucial role in collection,

and infants, and in ensuring

They ensure that the data collected by rural

Healthcare Centres (CHCs) and Primary Healthcare Centres (PHCs) at the

Rural health workers associated with CHCs and PHCs leverage their facilities


informed about the status of maternal and


d children below five years

They have been responsible for development of the Aarogyam

supervises the overall functioning of the software.

l components a) mother and child tracking facility b) provision of


was the collection of



, caste and 13 health indicators that included


date of deliveries along with the services availed by a pregnant women till that time. At the

ch beneficiary was given an 8 digits unique ID that consists of block id


TRANSPARENCY AND



Government of India

The ANMs were responsible for conducting the baseline health survey according to a

prescribed format that helped in creating a village wise database of beneficiaries along with

vital health indicators, pregnancy status and contact details. This database is house

office of the Chief Medical Officer (CMO) at the district level. At the village level, ANMs

maintain the Aarogyam register, which contains village wise beneficiary details with the

expected date of delivery and dates of actual and expected ANC/PNC

etc.

Once the process of creating this initial database was completed, a systematic data upgrading

process was designed. Every month the data collection formats are filled by ANMs, unique IDs

given to new beneficiaries and completed forms are submitted to the block PHC/CHC where

the data entry operator consolidates village wise data in pre

Once the Excel sheets are prepared, the data entry operator at the CMO office enters block

data into the Aarogyam software as per the excel sheets. This data is presented in the

Management Information System (MIS), that is, the web

Aarogyam, and can be accessed by key health professionals.

PROVISION OF ADEQUATE

Out-dialling facility

Once the data of a family has been entered at the CMO database, every family’s reproductive

and child health status is monitored regularly and alerts are sent through cell phone text

messages and phone calls. Aarogyam u

automatically generates family specific reminder calls and SMSs in Hindi. It disseminates

updates regarding immunisation for children from 0

vaccination delivery and also the ANC/PNC details of pregnant and

the due dates for health service provision. Village

reminders about families currently not covered under maternal and child health service

delivery facilities in order to ensure benefits of t

families within the target areas.

In-dialling facility

Aarogyam also allows beneficiaries to interact with the system. By calling on a toll

number, beneficiaries can gather maternal and child health c

vaccinations, antenatal care, postnatal care, institutional delivery and birth preparedness. This

information has been pre-fed into the system and is provided to the beneficiary free of cost as

per requirement.






Aarogyam:

Ms were responsible for conducting the baseline health survey according to a


vital health indicators, pregnancy status and contact details. This database is house

Chief Medical Officer (CMO) at the district level. At the village level, ANMs


expected date of delivery and dates of actual and expected ANC/PNC visits and immunisation


Every month the data collection formats are filled by ANMs, unique IDs


the data entry operator consolidates village wise data in pre-formatted Microsoft Excel sheets.

nce the Excel sheets are prepared, the data entry operator at the CMO office enters block


Management Information System (MIS), that is, the web-based monitoring por

Aarogyam, and can be accessed by key health professionals.

ROVISION OF ADEQUATE HEALTHCARE FACILITIES



messages and phone calls. Aarogyam uses an Interactive Voice Response Sys


updates regarding immunisation for children from 0-5 years, the venue and date for

vaccination delivery and also the ANC/PNC details of pregnant and lactating mothers based on

the due dates for health service provision. Village Pradhans and the ANMs are also sent


delivery facilities in order to ensure benefits of the system are equally distributed among

families within the target areas.

Aarogyam also allows beneficiaries to interact with the system. By calling on a toll

number, beneficiaries can gather maternal and child health care information related to child


fed into the system and is provided to the beneficiary free of cost as

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Ms were responsible for conducting the baseline health survey according to a


vital health indicators, pregnancy status and contact details. This database is housed at the

Chief Medical Officer (CMO) at the district level. At the village level, ANMs


visits and immunisation


Every month the data collection formats are filled by ANMs, unique IDs


formatted Microsoft Excel sheets.

nce the Excel sheets are prepared, the data entry operator at the CMO office enters block-wise


based monitoring portal designed for



ses an Interactive Voice Response System (IVRS), which


5 years, the venue and date for

lactating mothers based on

and the ANMs are also sent


he system are equally distributed among

Aarogyam also allows beneficiaries to interact with the system. By calling on a toll-free helpline

are information related to child


fed into the system and is provided to the beneficiary free of cost as

TRANSPARENCY AND



Government of India

Beneficiaries can also lodge specific health related complaints using the dial

complaints are registered on the Aarogyam MIS and then attended to by in

officials.

CAPACITY BUILDING AND

Standard operating procedures (SOP)

district and block level was done so as to streamline the data capturing, consolidation and

reporting processes. Standardisation of required formats, periodicity of reporting, role

responsibility of the field workers and accountability of health officials were also fixed.

The district administration held several rounds of training workshops for village

ASHA workers and ANMs for disseminating information regarding Aar

beneficiaries.

Community awareness was generated through films, songs,

distribution of pamphlets, display hoardings and such like to disseminate information about

the project.

MONITORING AND EVALUATION

In order to monitor the proper functioning of Aarogyam system, regular

held with key stakeholders to assess the progress. Aarogyam also automatically generates

pending lists with respect to unfulfilled targets for medical officers, ANM

beneficiaries. Based on this list, call alerts and SMSs are sent to all stakeholders every 10 days

till the services are reported as delivered by the system.

The Aarogyam MIS reflects real time data on total number of grievances disposed,

pending in various offices, status of call alerts and SMSs sent on daily basis etc. This

information is regularly accessed by key officials including the CMO and District Magistrate

(DM) who then ensure that any visible gaps in health service d

Technology utilised

The Aarogyam software has the following components:

- Management Information System (MIS) where health related data is uploaded and which

facilitates web based monitoring.

- Interactive Voice Recording system

reminder alerts and responding to help line queries and grievances.

Aarogyam utilises the existing hardware at the PHC, CHC and CMO office. The computers at

these offices are employed for use of the Aarogyam






Aarogyam:

es can also lodge specific health related complaints using the dial

complaints are registered on the Aarogyam MIS and then attended to by in

APACITY BUILDING AND COMMUNITY AWARENESS GENERATION

procedures (SOP) were established and orientation of required officials at


reporting processes. Standardisation of required formats, periodicity of reporting, role


The district administration held several rounds of training workshops for village

ASHA workers and ANMs for disseminating information regarding Aarogyam to target

was generated through films, songs, nukkad nataks


VALUATION

In order to monitor the proper functioning of Aarogyam system, regular


pending lists with respect to unfulfilled targets for medical officers, ANM


till the services are reported as delivered by the system.

reflects real time data on total number of grievances disposed,



(DM) who then ensure that any visible gaps in health service delivery are attended to.

The Aarogyam software has the following components:

Management Information System (MIS) where health related data is uploaded and which

facilitates web based monitoring.

Interactive Voice Recording system (IVRS) and SMS service for sending automatic

reminder alerts and responding to help line queries and grievances.


these offices are employed for use of the Aarogyam software.

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es can also lodge specific health related complaints using the dial-in facility. These

complaints are registered on the Aarogyam MIS and then attended to by in-charge health

GENERATION

orientation of required officials at


reporting processes. Standardisation of required formats, periodicity of reporting, roles and


The district administration held several rounds of training workshops for village pradhans,

ogyam to target

(street plays),


In order to monitor the proper functioning of Aarogyam system, regular monthly meetings are


pending lists with respect to unfulfilled targets for medical officers, ANMs, pradhans and


reflects real time data on total number of grievances disposed, complaints



elivery are attended to.

Management Information System (MIS) where health related data is uploaded and which

(IVRS) and SMS service for sending automatic


TRANSPARENCY AND



Government of India

FUNDING

The funds for Aarogyam have been secured under the Janani Suraksha Yojana

NRHM. Beneficiaries are not charged a user fee under the programme. The major costs

incurred were in the process of developing the software which round out to an approximate

amount of four lakh rupees. The running and maintenance costs of t

as it utilizes existing human and infrastructural resources.

IMPACT

IMPROVING ACCOUNTABILITY AND RESPONSIBILI

Under Aarogyam, health related data of each individual in every household is captured and

aggregated on a common web platform for monitoring by concerned officers. This monitoring

provides a clear picture on status of health services , action taken by various departmen

involved and the rate of compliance by target population. Aarogyam has also streamlined

processes for service providers by making available for them a comprehensive database that

MATERNAL AND CHILD

RELATED DATA COLLECT

AGGREGATION OF DATA A

AUTOMATED REMINDER ALERTS

SENT TO BENEFICIARIES AND HEALTH

SERVICE PROVIDERS ABOUT PENDING

APPOINTMENTS THROUGH IVRS

TECHNOLOGY.

DATA SUBMISSION AND ENTRY INTO THE

FIGURE 1: DIAGRAM SHOWING THE W

SOURCE: ONEWORLD






Aarogyam:

The funds for Aarogyam have been secured under the Janani Suraksha Yojana



amount of four lakh rupees. The running and maintenance costs of the programme are minimal

as it utilizes existing human and infrastructural resources.

ITY AND RESPONSIBILITY OF HEALTH SERVICE

, health related data of each individual in every household is captured and


provides a clear picture on status of health services , action taken by various departmen



ATERNAL AND CHILD HEALTH

RELATED DATA COLLECTION AT THE

.

GGREGATION OF DATA AT THE BLOCK LEVEL.

WEB-BASED PORTAL FOR

MONITORING OF HEALTH

RELATED SERVICE DELI

BE USED BY SERVICE

PROVIDERS.

HELPLINE FOR BENEFICIARIES

TO ADDRESS QUERIES AND

REDRESS GRIEVANCES.

NTRY INTO THE AAROGYAM SOFTWARE AT THE DISTRICT LEVEL

IAGRAM SHOWING THE WORK FLOW OF AAROGYAM

ORLD FOUNDATION INDIA

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The funds for Aarogyam have been secured under the Janani Suraksha Yojana scheme of the



he programme are minimal

TY OF HEALTH SERVICE PROVIDERS

, health related data of each individual in every household is captured and


provides a clear picture on status of health services , action taken by various departments



BASED PORTAL FOR

MONITORING OF HEALTH

RELATED SERVICE DELIVERY TO

BE USED BY SERVICE

.

TRANSPARENCY AND



Government of India

helps them prioritise their work commitments as well as address gap areas.

and calls to service providers have resulted in more accountability and also ensured better and

timely service delivery to the community.

The Aarogyam system has facilitated integration and effective participation of stakeholders at

various levels such as ANMs, AWWs ASHAs, teachers and village

health services and provides basis for rewards and incentives to well performing employees.

EMPOWERING THE COMMUN

Under Aarogyam, the economically and socially impoveri

information about medical services they are entitled to as per their health profile, demand

services related to ANC, PNC and immunisations that was earlier denied to them and was the

privilege of a select few. With A

various types of health services available to them and are also able to report any non

compliance to the health and district administration. This sort of community feedback is

providing valuable insight to the service providers regarding areas that need improvement.

BETTERING THE MATERNA

With Aarogyam, there has been an improvement in the measurable health indicators in the

state. Immunisation coverage particularly that

trend over time. The coverage of Polio, BCG, Measles and Tetanus coverage has gone up from

an average of 60 per cent in February 2008 to 91 per cent in February 2010.

institutional deliveries in the targeted districts has also risen.

The Aarogyam database has resulted in better planning of community level health programmes

especially with regard to ANC, PNC checkups and immunisation drives. Health officials are

now adequately informed about expected number of beneficiaries and can plan their activities

and use of resources accordingly. This helps in avoiding wastage of medical and human

resources. The model has also helped the Health Department to refocus its strategy on

preventive healthcare whereby on the basis of the health indicators reported and demand






Aarogyam:

helps them prioritise their work commitments as well as address gap areas.


timely service delivery to the community.


us levels such as ANMs, AWWs ASHAs, teachers and village pradhans


MPOWERING THE COMMUNITY

conomically and socially impoverished and illiterate families can avail



privilege of a select few. With Aarogyam, the beneficiaries have been able to understand the

various types of health services available to them and are also able to report any non


nsight to the service providers regarding areas that need improvement.

ETTERING THE MATERNAL AND CHILD HEALTH SCENARIO IN U.P


coverage particularly that of children has shown a significant positive

The coverage of Polio, BCG, Measles and Tetanus coverage has gone up from

an average of 60 per cent in February 2008 to 91 per cent in February 2010.

nal deliveries in the targeted districts has also risen.



ormed about expected number of beneficiaries and can plan their activities


The model has also helped the Health Department to refocus its strategy on

e healthcare whereby on the basis of the health indicators reported and demand

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helps them prioritise their work commitments as well as address gap areas. Instant messages



pradhans in the delivery of


shed and illiterate families can avail



have been able to understand the

various types of health services available to them and are also able to report any non-


nsight to the service providers regarding areas that need improvement.

U.P


has shown a significant positive

The coverage of Polio, BCG, Measles and Tetanus coverage has gone up from

an average of 60 per cent in February 2008 to 91 per cent in February 2010.6 The number of



ormed about expected number of beneficiaries and can plan their activities


The model has also helped the Health Department to refocus its strategy on

e healthcare whereby on the basis of the health indicators reported and demand

TRANSPARENCY AND



Government of India

generated, along with the complaints lodged in long term, precautionary measures can be

timely planned and implemented.

Aarogyam has benefited more than 1.4 lakh families up to

of operation in U.P., namely Baghpat, JP Nagar and GB Nagar. With its expansion to five other

districts, it is expected to benefit about 2 lakh people more. As of July, 2011 more than 175,000

automated calls and SMSs have been sent by the system.

PROVIDING A REPLICABLE MODEL FOR IMPROVIN

Since its development in 2008, Aarogyam has improved not just the RCH delivery processes in

U.P but also impacted RCH processes across the country.

Given its remarkable performance, Aarogyam has received several awards and recognitions

like the NASSCOM Social Innovation Honors 2010 and the M

made it amongst the finalist in the run up for prestigious awards like the St

and Manthan Award.

The Aarogyam model went on to become an inspiration behind the implementation of the

Mother and Child Tracking Programme (MCTP) under the NRHM by providing a

model to other Indian states for

CHALLENGES IN IMPLEMENTATION Restricted administrative capacity

The regular filing and submitting of data updates to the system at the block office is a time

consuming mechanism and has added additional work lo

rectified by dividing the work responsibilities between ASHAs, AWWs and ANMs.

Lack of a culture of transparency in government operations

It was a very challenging task to motivate health professionals and village

Aarogyam because it meant increased work load for them as well as tight monitoring of their

functioning. However, with time the efficiency and usefulness of the system was successfully

advocated to them and their cooperation secured.

Low motivation among community members

Getting the community on board was another significant challenge. Often the alerts sent out

from Aarogyam were mistaken as promotional calls. Gradually, with time, the community has






Aarogyam:


timely planned and implemented.

Aarogyam has benefited more than 1.4 lakh families up to December 2010 in the three districts



ave been sent by the system.

E MODEL FOR IMPROVING DELIVERY OF HEALTH


impacted RCH processes across the country.


like the NASSCOM Social Innovation Honors 2010 and the M-Billionth Award 2010. It has also

made it amongst the finalist in the run up for prestigious awards like the St


Mother and Child Tracking Programme (MCTP) under the NRHM by providing a

model to other Indian states for monitoring the delivery of maternal and child health services.

MPLEMENTATION Restricted administrative capacity


consuming mechanism and has added additional work load on the ANMs. This could be


Lack of a culture of transparency in government operations

It was a very challenging task to motivate health professionals and village



advocated to them and their cooperation secured.

ion among community members



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December 2010 in the three districts



G DELIVERY OF HEALTH SERVICES



Billionth Award 2010. It has also

made it amongst the finalist in the run up for prestigious awards like the Stockholm Challenge


Mother and Child Tracking Programme (MCTP) under the NRHM by providing a workable

very of maternal and child health services.


ad on the ANMs. This could be


It was a very challenging task to motivate health professionals and village pradhans to support





TRANSPARENCY AND



Government of India

been made aware about Aarogyam and the benefit

community has become more forthcoming.

Technological challenges

Aarogyam relies on telephonic communication to alert beneficiaries and government officials of

health services due as well as to enable users to enqui

services available. Therefore, in case of change in mobile numbers of stakeholders, the entire

database needs updation in order to continue functioning effectively. In many instances,

Aarogyam struggles to meet the des

beneficiaries) change their mobiles numbers unreported. Along with this, constant data

upgrading remains a tedious task and for this purpose ANMs have to be given adequate

incentives so that they perform

CONCLUSION While the Aarogyam team has already sent a proposal to the Government of Uttar Pradesh for

replicating the programme in the entire state, teams from various state and central

governments have met with them to learn from and adapt their model. The success of

Aarogyam lies in its ability to develop a responsive healthcare model. Its sustainability now

rests on the institutional will to leverage its potential in reforming rural healthcare scenario an

utilising the data it provides for scanning other health indicators and promoting various health

related campaigns. At the same time, it has to be ensured that Aarogyam continues to capture

the health needs of beneficiaries over time adequately and is ab

service providers.

Research was carried out by OneWorld Foundation India (OWFI), Governance Knowledge Centre (GKC) team.

Documentation was created by Research Associate,

For further information, please contact

REFERENCES

‘Aarogyam kendras: Technology11. 2010. Web. April 24. 2012. <

technologybased-healthcare-delivery






Aarogyam:

been made aware about Aarogyam and the benefits it provides them with As a result, the

community has become more forthcoming.


health services due as well as to enable users to enquire about various diseases and medical



Aarogyam struggles to meet the desired output if the key stakeholders (officials and



incentives so that they perform this task with commitment.

While the Aarogyam team has already sent a proposal to the Government of Uttar Pradesh for


with them to learn from and adapt their model. The success of


rests on the institutional will to leverage its potential in reforming rural healthcare scenario an



the health needs of beneficiaries over time adequately and is able to communicate this to

Research was carried out by OneWorld Foundation India (OWFI), Governance Knowledge Centre (GKC) team.

Documentation was created by Research Associate, Sapna Kedia

For further information, please contact Rajiv Tikoo, Director, OWFI, at [email protected]

Aarogyam kendras: Technology-based healthcare delivery system’. The Indian Express

11. 2010. Web. April 24. 2012.

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s it provides them with As a result, the


re about various diseases and medical



ired output if the key stakeholders (officials and



While the Aarogyam team has already sent a proposal to the Government of Uttar Pradesh for


with them to learn from and adapt their model. The success of


rests on the institutional will to leverage its potential in reforming rural healthcare scenario and



le to communicate this to

Research was carried out by OneWorld Foundation India (OWFI), Governance Knowledge Centre (GKC) team. Sapna Kedia

[email protected]

The Indian Express. April

http://www.indianexpress.com/news/aarogyam-kendras-

TRANSPARENCY AND



Government of India

‘Aarogyam ICT for mother and child care’. Information technology in developing countries.

July. 2011. Web. May 1. 2012 <

Maternal and Child Mortality Rates and Total Fertility Rates. Registrar General of India.

Sample Registration Survey (SRS). July. 2011. Web. April 29. 2011. <


Registrar General of India. Sample Registration Survey (SRS). SRS Bulletin. December. 2011.

Web. April 29. 2012






Aarogyam:

Aarogyam ICT for mother and child care’. Information technology in developing countries.

July. 2011. Web. May 1. 2012 < http://www.iimahd.ernet.in/egov/ifip/jul2011/ritu





Web. April 29. 2012

http://censusindia.gov.in/Vital_Statistics/SRS_Bulletins/SRS%20Bulletin_%20December%20201

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Aarogyam ICT for mother and child care’. Information technology in developing countries.

http://www.iimahd.ernet.in/egov/ifip/jul2011/ritu-mayur.htm/>



http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf>


Web. April 29. 2012

http://censusindia.gov.in/Vital_Statistics/SRS_Bulletins/SRS%20Bulletin_%20December%20201

TRANSPARENCY AND



Government of India

APPENDIX A – INTERVIEW BACKGROUND

1. Prior to the introduction of the ICT based initiative Aarogyam in 2008, what were the

problems in delivering the required heath care facilities (ANC, PNC and immunization) to

pregnant women and new born children in Baghpat and J.P. Nagar districts? How we

these problems being addressed?

2. Why was there a need to develop an ICT based maternal and child healthcare delivery

system? How do you think is this ICT system going to be an improvement over existing

mechanisms to provide and monitor health service d

3. Aarogyam seeks to address the problems of high Maternal Mortality Rate (MMR) and

Infant Mortality Rate (IMR) in the target districts. Was it introduced to further the

reproductive and child healthcare goals of NRHM? What are the spec

child health issues that Aarogyam seeks to address and how does it plan to do so?

PROGRAM DESIGN

STAKEHOLDERS

4. The key stakeholders in the project are National Informatics Centre (NIC),

Society-Baghpat and J.P. Nagar, P

ASHAs. What are their roles and responsibilities?

5. Are there any other stakeholders? If yes, please explain their roles and responsibilities.

PROCESS FLOW

6. As per our research, Aarogyam began with surveys

related health information in the districts and mapping their current health status.

a) Who was responsible for conducting these surveys? What was the unit of analysis for

these surveys?

b) Which health parameters do these surve

c) Who is responsible for aggregating the survey data? Where is it done?

d) How often are the surveys conducted?

7. On the basis of the data collected, health alerts are sent to beneficiaries and health service

providers about pending pregnancy a

calls. Who is responsible for sending these alerts? What is the format of these alerts? Are

they in the local language?

8. Beneficiaries can call a helpline for assistance with regard to their pregnancy and

immunization needs and for grievance redressal.






Aarogyam:

NTERVIEW QUESTIONNAIRE

Prior to the introduction of the ICT based initiative Aarogyam in 2008, what were the


pregnant women and new born children in Baghpat and J.P. Nagar districts? How we

these problems being addressed?

Why was there a need to develop an ICT based maternal and child healthcare delivery

How do you think is this ICT system going to be an improvement over existing

mechanisms to provide and monitor health service delivery in the region?

Aarogyam seeks to address the problems of high Maternal Mortality Rate (MMR) and


reproductive and child healthcare goals of NRHM? What are the spec


The key stakeholders in the project are National Informatics Centre (NIC),

Baghpat and J.P. Nagar, PHCs, CHCs and rural health workers like ANMs and

. What are their roles and responsibilities?

Are there any other stakeholders? If yes, please explain their roles and responsibilities.

As per our research, Aarogyam began with surveys for collecting maternal and child


Who was responsible for conducting these surveys? What was the unit of analysis for

Which health parameters do these surveys aim to measure?

Who is responsible for aggregating the survey data? Where is it done?

How often are the surveys conducted?

On the basis of the data collected, health alerts are sent to beneficiaries and health service

providers about pending pregnancy and immunization issues through SMS and phone


they in the local language?

Beneficiaries can call a helpline for assistance with regard to their pregnancy and

ation needs and for grievance redressal.

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Prior to the introduction of the ICT based initiative Aarogyam in 2008, what were the


pregnant women and new born children in Baghpat and J.P. Nagar districts? How were

Why was there a need to develop an ICT based maternal and child healthcare delivery

How do you think is this ICT system going to be an improvement over existing

elivery in the region?

Aarogyam seeks to address the problems of high Maternal Mortality Rate (MMR) and


reproductive and child healthcare goals of NRHM? What are the specific maternal and


The key stakeholders in the project are National Informatics Centre (NIC), District health

HCs, CHCs and rural health workers like ANMs and

Are there any other stakeholders? If yes, please explain their roles and responsibilities.

for collecting maternal and child


Who was responsible for conducting these surveys? What was the unit of analysis for

Who is responsible for aggregating the survey data? Where is it done?

On the basis of the data collected, health alerts are sent to beneficiaries and health service

nd immunization issues through SMS and phone


Beneficiaries can call a helpline for assistance with regard to their pregnancy and

TRANSPARENCY AND



Government of India

a) How are these helplines managed? Were staff members specifically recruited for this

purpose?

b) Who responds to the grievances? Is a record of the grievances maintained?

c) What are the charges that accrue to callers for this service?

AWARENESS GENERATION AND

9. How was awareness generated among beneficiaries about Aarogyam and the purpose it

serves? How did beneficiaries respond to this new ICT based system

10. How was the support of service providers sought? Was there any resistance on their part?

If yes, how was it overcome?

11. Were service providers given any training for using and maintaining Aarogyam? Is yes,

please provide details of the

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