India Day 2. ASHAs, camels and mobile phones

On our second full day in India with Save the Children we travelled to Roopangarh village in Kishangarh district, Rajastan. Here we were to meet with ASHAs to see a tremendously successful yet simple health project in action. ASHAs are Accredited Social Health Activists who are a form of Community Health Volunteer. They are excellent grass roots change agents as each is from their community, chosen by their community and works for her community.  ASHAs are the first port of call for any health related demands of deprived sections of the population where there is one ASHA per 1000 persons. Damanjeet, the Save the Children India (SCI) staff explained to us how historically the ASHAs encountered constraints in their daily work which included poor counselling skills, a lack of visual aids or tools for their health promotion work, and poor resources for calculating and handing in their monthly reports and statistics. This is where Save the Children stepped in. In 2010 Save the Children designed a project which would help to tackle the constraints the ASHAs faced and help reduce the high infant and maternal mortality rates in the area. The solution was mobile phones. Incredible!

We began by meeting a selection of the local ASHAs of Roopangarh at the government offices. All were extremely enthusiastic about telling us how they use their new technology to spread vital health messages to the local families they serve. All the 70 ASHAs of Kishangarh block were given training to use the mobile application, and at the end had been given basic Nokia handsets to use. It seems the features of these applications included counselling guidance from pregnancy to safe newborn care, audio prompts, pictorials and registration through to data collection. Each ASHA was proudly clutching her precious mobile phone as they explained to us all how they go from household to household gathering data on each family, showing the women the pictorials and holding the phone out for all to hear the educational messages in the local language. It was fascinating to hear but I have to admit I was sceptical about how sustainable such a project was in such a resource poor setting. I was later reassured to hear that it costs the ASHAs less than USD$1 per month for mobile recharges. Also, the whole system had clearly given the ASHAs confidence in their work; the phones’ application meant that no vital health messages were left out, they no longer had to carry around their cumbersome health registers and it improved their credibility as health volunteers as advice is consistent and up to date. I was fascinated, and luckily we were all to see for ourselves how these worked.

Ralka and the ASHAs introducing us to the mobile phone technology in Roopangarh village, Rajastan.

Ralka and the ASHAs introducing us to the mobile phone technology in Roopangarh village, Rajastan.

We each went off with an ASHA to see the mobile phone project in action. Raj our video/photographer, Megan from the Save the Children UK and myself went with Ralka the ASHA to the community she serves. She took us to see a family where a young mother was expecting her second baby, she must have been around 32 weeks pregnant. We all sat around together as Ralka conducted her routine visit for us to see how she used her phone. I was gobsmacked. Ralka inputted the girl’s data and the phone knew where she lived, how many weeks pregnant she was and what her obstetric history was. The phone then displayed the relevant pictures and prompts for Ralka to give advice based entirely on this girl and her stage of pregnancy. For example there were pictorials and voice messages given about the importance of institutional birth, why she should start breastfeeding very soon after the birth and even how to position the baby during feeds. During the pre-birth section of the session there were even pictorials of antepartum haemorrhage, eclampsia, premature labour and other obstetric emergencies and prompts for discussions on what the women should do if any of these occurred before he got to hospital. I really was speechless – this simple device in the poorest of settings was delivering consistent but more importantly up to date advice based on UNICEF guidelines. I myself had recently attended a Baby Friendly Initiative breastfeeding update study session prior to heading to India with Save the Children, and the messages given by Ralka and her trusty phone were spot on in relevance and accuracy. We struggle to achieve this in the UK with many breastfeeding mums saying they switch to bottle feeding due to inconsistent & inaccurate advice. Shame on us. Also I couldn’t help but think about how women in the UK carry round one set of paper pregnancy records which we can’t even access at our hospitals and which could not be retrieved if lost or destroyed, yet here each woman’s pregnancy data and demographics were inputted electronically and sent to a central server for officials and ASHAs to access. For 1USD per month. Remarkable and inspirational. It’s no wonder Ralka and her fellow ASHAs were inseparable from their phones – not for Facebook or twitter but for interventions that are improving health and saving lives. What a learning curve for us all.

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This low cost technology requires only a one off cost for the purchase and training of the staff. So far 95% of all ASHAs trained to use this mobile technology remain active and serve more around 938 mothers and 960 children.  We heard how the pilot project proved so successful in it’s ability to reach the vulnerable in their communities and initiating positive behaviour change that the Government of India are looking to roll this out in other areas.  Well done Save the Children, and I have no doubt that Ralka and her colleagues will continue to use this initiative to improve the lives of women and children in India, as they have already seen vaccination rates and numbers of women giving birth in hospitals increase.

From the village we were fortunate to see Roopangarh Fort affording us excellent views across the district, including the cutest camel and her baby.

Mum and baby camel near Roopangarh Fort, Rajastan, India

Mum and baby camel near Roopangarh Fort, Rajastan, India

View of Kishangarh district from Roopangarh Fort

View of Kishangarh district from Roopangarh Fort

For more info on Save the Children India see: http://www.savethechildren.in/

For more info on the Power of the First Hour – Breastfeeding see:http://www.savethechildren.org.uk/breastfeeding-more-info

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