Integrated use of Digital Connectivity and Data to improve Child Health
Integrated use of Digital Connectivity and Data to improve Child Health
Background
The National Family Health Survey-4 (NFHS) highlighted malnutrition as a major concern globally in healthcare. The treatment of all these cases is a huge challenge in the already overcrowded hospitals/clinics. The condition is further exacerbated given that malnutrition is rampant in areas where there is low physician density. It is therefore important to recognise the link between availability of healthcare providers in these regions and higher incidence of malnutrition and mortality. Telemedicine, such as through Karma Healthcare e-clinics, has immense potential to resolve chronic and longstanding health problems by connecting patients and doctors from far-flung regions to address issues of scarcity of healthcare providers and infrastructure.
About the Study
The study aimed to assess the impact of Karma Healthcare e-clinics by analysing the progress achieved by Karma Healthcare in enhancing knowledge of childhood illnesses among caregivers/mothers; evaluating the impact of the innovation on improving malnutrition related health outcomes among children aged 6-59 months; and identifying key successes, good practices and gaps/constraints that need to be addressed.
Methodology
We collected the baseline and endline data from Karma’s Health Management Information System (HMIS) using purposive sampling. The baseline sample included children between the age 6-59 months who visited the Karma E Clinic only once since the opening of the first clinic in April 2018 until 31 January 2019. The mothers of these subjects were assessed for their knowledge of childhood illnesses in a face-to-face interview, using the detailed closed-ended questionnaires provided to the data collectors.
Another list of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) subjects was selected from the Karma Health database in a similar way, with the exception that all the SAM/MAM patients were selected irrespective of their number of visits to the clinic. Further, a questionnaire was administered to the mothers of these subjects.
A similar sample of SAM/NAM children in the age group 6-59 months, not receiving any services from the Karma Healthcare e-clinics were selected in the field and the same questionnaire (administered to Karma Health patients) was introduced to these mothers and the anthropometric measurements of the children were done.
In the case of the Endline, a list of subjects was prepared using the Karma Healthcare database (HMIS- Karma Healthcare) as per the inclusion/exclusion criteria. The Endline sample included children between the age 6-59 months who visited the Karma E Clinic more than once (i.e. either repeat or follow-up) since the opening of the first clinic in April 2018 until 30 August 2019. The same detailed questionnaire of Baseline was administered to mothers of the selected children.
A non-participative observation study was conducted to evaluate the project with respect to the screening process of under-5 children for malnutrition, knowledge and awareness about childhood illnesses, outreach activities, the accessibility and availability of services at the e-clinics, adequacy of equipment, Information, Education and Communication (IEC) services, etc with the goal of analysing the quality of services at 5 running Karma Healthcare Clinics.
Outcome
The study provided key insights for improving the utilization and quality of services offered through e-clinics. Community engagement can be improved through well-defined outreach strategies, but regular training of healthcare staff can be beneficial too. Local resources such as existing public health workers can augment the implementation and monitoring of such programmes. Besides, creating awareness of child health conditions, such as malnutrition, among the parents/caregivers and an active approach to case-finding can ensure children are healthier. Lastly, considering the impact of e-clinics on reduction of malnutrition, telemedicine interventions like these can be widely shared, replicated and adapted in other areas.