In September 2019, officers from the Central Health Ministry visited our Program site at ‘Lambkana Primary Health Centre (PHC)’ in Aurangabad, collaborating with Savitribai Phule Mahila Ekatma Samaj Mandal (SAFU), an NGO working with Hedgewar Rugnayala.

The review by Ministry officers was very motivating for our team! They were amazed by the standard practices followed by our health workers (ASHAs) to take care of pregnant women.

We are happy to share some of these practices:

1. The health worker registers a pregnant woman within the first 12 weeks of pregnancy.

2. At the time of registration, she performs her first prenatal check-up.

3. She updates new pregnancy registrations to the ANM (Auxiliary Nurse Midwife) daily.

4. She mandatorily uses gloves during every ANC check-up.

5. She opens the CareMother portable screening kit and begins by checking the mother’s weight on a digital weighing scale. She ensures that the scale is on a flat surface and the mother is standing still and looking straight.

6. Point-of-care random blood-sugar and hemoglobin tests: This involves a finger-tip prick. She uses the standard sterilized lancet for a safe and secure prick, wipes out the initial blood flow, and uses a drop of blood, first for hemoglobin, and then for the blood-sugar test. Both tests give results in 10-12 seconds.

7. Temperature: We have provided a digital thermometer in the kit. After completing the test, the health worker uses a sanitizer-wipe to clean the thermometer. 

8. Blood pressure: She asks the mother to rest on a chair for 5-10 minutes and breathe slowly. She uses a digital BP monitor and ties the cuff on the mother’s left arm.

9. Fetal Heart Rate: The kit includes a fetal doppler device that detects the baby’s heartbeat. She performs this test after the 22nd week of pregnancy. We have trained health workers to detect the baby’s heart position on the mother’s abdomen.

10. Urine test: She asks the mother to provide the urine sample mid-stream and provides a sterilized container for the same. The kit includes a urine strip necessary for measuring protein (for hypertension) and sugar (for diabetes).

11. While performing these tests one by one, health workers put the data into the CareMother app, and counsel mothers on the next steps for any high-risk conditions.

12. As per high-risk status, the application’s decision-support guides the health worker to either conduct more follow-up visits, or refer the mother to the ANM’s care, or to the PHC, or a higher center.

These practices have tremendously improved health workers’ credibility and acceptance of the intervention among families of pregnant women.

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We at CareMother, along with Larsen and Toubro Public Charitable Trust,
routinely provide antenatal care to tribal women in Talasari, who live in huge
disadvantages of cost, time, and distance. We serve pregnant women by our
‘doorstep’ care model, frontline workers, and real-time decisions via a smartphone application.

However, since routine antenatal services are closed down, and ANMs and ASHAs are busy in COVID screening, we brainstormed all possible ways to maintain a constant flow of services to pregnant women in this difficult terrain.

• A critical piece of antenatal care (ANC) is tetanus (TT) vaccination.

When ‘full’ ANC coverage in India is only 32% as quoted in the latest national health survey (NFHS-5), one can imagine the pressure of maintaining coverage in such hard times in a tribal area! So, we started listing the sub-center wise numbers of high-risk pregnant women, with pending vaccination of TT-1 and TT-2, and who were expecting delivery soon (in the following month), so that the newborn does not acquire the deadly disease (tetanus).

• We could obtain this information thanks to our back-end data (Cloud) and prior information entered by health workers in the CareMother application.

Empowered with this list, we contacted our local NGO partner and the Talasari Health department and they coordinated with the under-pressure ANMs and ASHAs to ensure that these vaccinations, at a minimum, are provided to women approaching their delivery dates. We played our part in their truly safe deliveries, and would continue these efforts!

• We believe that COVID-19 need not and should not interrupt routine antenatal services.

More so when pregnant women need good health and nutrition to boost immunity and fight all infections. We know that this is directly linked to a healthy baby, and it is our responsibility as a powerful digital platform to put all possible efforts to continue antenatal care.

Context: Talasari is a tribal municipal council in Palghar district of Maharashtra, touching the Gujarat border, just 140 km from Mumbai. CareMother program, with LTPCT and Zilla Parishad’s Health Department, started with two primary health centers (PHCs) to cover 1500 pregnancies, and in 2019, it has expanded to four PHCs to serve 3000 pregnancies, so far.

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