Sentiatend - a mobile-based application for pregnant women.

National Level Need to Invest in Maternal and Neo-Natal Health: 

The infant mortality level of any region works as a summary index of the socio-economic development of that region. The recognition of this index has spurred international organizations and national governments to intensify their efforts to reduce the level of infant mortality and promote greater child survival. Each year, of the almost 27 million infants born in the country, 0.88 million dies before they complete one month of their life and a total of one million die before the first birthday.  in 2019, the infant mortality rate (IMR)which refers to the number of infant deaths for every 1,000 live births of India is 28.3 deaths per 1,000 live births. The newborn health challenge faced by India is bigger than that experienced by any other country.

Today, India accounts for the greatest burden of new-born deaths in the world (WHO). Preventable new-born deaths account for 44% of all deaths among children under age of five. Various studies on distribution of neonatal deaths defined as a death during the first 28 days of life reveal that the most vulnerable time in the new-born’s life is during birth and the first week of life. According to UNICEF, nearly a quarter of all maternal deaths worldwide occur in India. Their babies are far more likely to die in the first two years of life than babies whose mothers survive. Less than half of mothers deliver their children in hospitals or other healthy environments. For women in remote, isolated villages, access to – and knowledge about – care can be a matter of survival.

One of the contributing factor in this multifaceted problem is lack of a reliable management information system (MIS) that can alert the community health workers (CHWs) to provide timely services to high risk pregnant women and prepare them for home based new-born care (HBNC).

Lack of Data Driven Decision Making System for Timely Intervention by CHWs: CHWs are trained public health workers who serve as a bridge between communities, health care systems, and state health departments. With specialists being very few in number in the rural sector and a significant load on the available Government facilities access to credible and timely healthcare information with CHWs responsible to provide primary health care at the household level in rural areas becomes one of the most challenging task. 

According to NFHS-5, only 58.1% of mothers had at least 4 antenatal care visits, partly due to the scarcity of qualified health care providers in remote areas. There is an established need for a technology-based clinical decision support system to reduce the gap between health providers and beneficiaries through empowering CHWs with health information. 

In a review report of the health system by the World Bank identified need for improvement in:

• Quality of health system
• Access to the tertiary health system by the poor
• Lack of integrated patient-centred health management and monitoring systems

Our Solution: Invest in Health Information Technology (HIT) to Empower CHWs such as ASHA in Rural India

Empowering CHWs with health information technology (HIT) solutions, such as Sentiatend can improve the quality, safety, effectiveness, and delivery of healthcare services in rural communities. HIT can connect rural patients and providers in remote locations to specialists in urban areas.

Our Selected HIT Tool : Sentiatend

Sentiatend, is a mobile-based application that provides comprehensive mobile solutions to address, identify and solve problems resulting in safe deliveries. “Sentia” is derived from Latin origins and in Roman mythology, “Sentia” is the Goddess of child development. Collectively it represents care for the Mother and Child.

How it Works?

This pivotal mobile application aim to considerably reduce maternal mortality rate (MMR) and infant mortality rate (IMR) and pave way for building predictive models towards safer deliveries and saving lives through  timely identification of high-risk pregnancies prior to, during and post parturition.

• It helps to create a database of the target population and plan health care services for all interventions under AIF's Maternal and Newborn Survival Initiative (MANSI) program. 
• This solution helps the CHWs in the identification of beneficiaries, registration, and tracking of pregnant & lactating women and children under age 5. 
• It has alert features for home-visits care with inbuilt intelligence to send reminders for timely referrals to handle complications. 

Why Sentiatend?

• Co-ordinates all factors in MMR / IMR
• Identification of human resource planning (HRP) during registration or early stages
• Multilingual, non-dependent on education, easy to use
• Easily measurable and highly accountable
• Real time synchronization of data to a secure database server
• Decision support system, highly scalable
• Easy to train and implement in the existing Health fraternity
• Integrated Telemedicine

Delivery Model: Integration of Sentiatend with AIF's MANSI

AIF’s Maternal and New-born Survival Initiative (MANSI) is a community-focused health intervention that addresses India’s significant hurdles in accessing quality and affordable health care for mothers and newborns at the household level. 

At the core of the MANSI, the model is the empowerment of CHWs called the ASHA (Accredited Social Health Activist) worker. ASHAs have been identified under National Rural Health Mission (NRHM) in each village to bridge the gap between the community and the health facility.  These ASHAs will be thoroughly trained in proven, low-cost, low-technology interventions to save mothers and newborns during pregnancy and after birth. 

Through the MANSI intervention, AIF has trained 4,445 ASHA workers in Uttarakhand and Andhra Pradesh to ensure the continuum of care at home from the time the woman conceives till two years after delivery and impart knowledge related to antenatal care, diet, exclusive breastfeeding, adequate complementary feeding, weaning, growth monitoring, vaccinations, and sickness related issues. 

Target Population: 

• Direct Beneficiaries: 
  • Rural pregnant women at high-risk of maternal mortality 
  • New born at high risk of infant and neo-natal mortality.
  • CHW such as ASHA: Technical and clinical capacity building for the use of health information technology like Sentiatend for case management. It improves accountability, ensures systematic workflow, and avoids human errors.
• Indirect Beneficiaries:
  • Community: Men and other family members are also benefitted from knowledge and awareness programs, increased accessibility to health services, and home-based support provided to their child.
  • Village Health, Sanitation, and Nutrition Committee (VHSNC) is also benefitted from the solution in terms of capacity building, decision support and growth monitoring record.
  • Primary Government Health System: The government healthcare system benefits by improving the capacity of its CHWs with the help of this solution.

Target Geography (States): The project will be implemented in two states of India covering a population of 63 million rural population (Census of India, 2011)

Andhra Pradesh(56 Million Rural Population, 67% of total state population): AP is the tenth most populous state in India with 23 districts. According to a world bank report, approximately 70 per cent of the state’s population lives in rural areas and about 17.1 and 5.3 per cent of the population comprises scheduled castes and tribes respectively. 

Uttarakhand (7 Million Rural Population, 70% of total state population): UK is one of the Indian states constrained by several factors, such as difficult hard to reach hilly terrain of Himalayas resulting in infrastructure and manpower shortage and limited access to technology with 13 districts. As per NFHS-5, the neonatal, infant, and under-5 mortality are 32.4, 39.1, and 45.6 respectively. The survey data shows that only 68.8% of mothers had an antenatal check-up in the first trimester, 61.8% had at least 4 antenatal care visits and 46.4% of pregnant women were anaemic. 

MANSI has Public Private Partnership Model for Effective Implementation in Rural India: 

Designed to reduce maternal and child mortality in inaccessible rural and impoverished areas, MANSI utilizes a public-private partnership model to provide the resources and support required to empower local communities to care for their mothers and children, while improving the local health system. MANSI converges the efforts of the state government through strategy consultation and build local expertise for operational efficiencies at the implementation level. 

We are able to infuse innovative ideas in the rural communities through demonstration of our models in the villages. Our state presence at the department of health and family welfare (DoHFW), department of education (DoE) and department of human resource development (DHRD) helps in advocating the learnings from the field into improved state health program implementation plans (PIP). 

MANSI has a Strong Community Outreach Presence in Rural Areas of Need to Inform User Friendly Design of Sentiatend:

MANSI was initially implemented by AIF through donor support, as an intensive pilot (2009–2014) covering a rural population of 83,000 across 167 villages who had limited access to basic health care. The successful rollout of MANSI by AIF over the last 10 years has demonstrated that ASHAs can provide home-based new-born care (HBNC) through a defined number of structured visits.

Presently, AIF has further increased the reach and value addition of MANSI by introducing the HBYC Program (Home-Based Young Child Care) and the Adolescent Health Initiative in Haridwar and Pauri Garhwal districts of Uttarakhand and two Tribal Development Blocks in Vishakhapatnam district of Andhra Pradesh.

Sentiatend-MANSI Extensive Reach in Rural Communities So Far: 

The Solution was implemented nine months ago in Andhra Pradesh where a total number of 55 health workers are using it to and have registered following target group beneficiaries:

• 2,753 pregnant women
• 1,623 lactating mothers
• 1,623 new-born
• 10,298 under-5 children
• 4,376 adolescents 

The solution has also been rolled out in Uttarakhand and is being used by 74 health workers are using it and have registered following target group beneficiaries:

• 24,198 pregnant
• 15,556 newborns
• 22,026 under-5 
• 29,725 adolescents

Strength of Our Team:

• For Advocacy:
  • National Level Advocacy: Mathew Joseph, Country Director
  • State Level Advocacy: Head Advocacy and Government Relations (4)
• For MANSI Design: Dr. Mahesh Srinivas, Public Health Director
• For Sentiatend Design: Aravind Padmanabhan, Founder Sentiacare
• For IT Implementation: Abhishek Srivastava, Chief Technology Officer
• For Finance and Administration: Sunil Seth, Senior Director
• For Monitoring and Evaluation: 
  • Anupam Shukla, Director Learning, Evaluation and Impact
  • State level Monitoring and Evaluation Officers (2)
• For Fundraising
  • India Team: Kavita Srivastava, Director Strategic Partnerships
  • For Fundraising (US Team): Shweta Chooramani, Senior Grant Manager
• For Sentiatend-MANSI State Level Implementation: 
  • State Program Managers (2)
  • Project Officers (2)
• For Sentiatend-MANSI Community Level Implementation: 
  • Project Coordinators (2)
  • Block Coordinators (23)
  • MANSI Mitras (55), equivalent to health workers
  • Health Facilitators (59)
• AIF Full time Staff: 86
• AIF Contractual Staff: 300
• AIF Full time International Volunteers (Banyan Impact Fellowship) : 25

Solve is a global platform and has an excellent pool of experts and professional networks that can help us improve our reach by connecting us to financial and technical experts in the market and choosing the right health information technology product.

• New Public Health Technology Solutions: Connect with like minded technology companies through MIT Solve that offer cost-effective, scalable infrastructure solutions to impact maternal and infant mortality in developing countries like India.
• Strategic Inputs for Scaling: Since use of health information technology is new for AIF, we are looking to access mentorship, coaching and strategic advice from experts in MIT Solve community who have successfully scaled such solutions in rural communities. 
• Funding Support for Scaling and Global Exposure: Looking for active access and participation in MIT Solve conferences/think-tanks/consultation/funding/donors platforms where we can demonstrate/pitch our innovative ideas in public health, improvise upon them and raise funds for scaling Sentiatend across 28 states of India where AIF has presence. 
• Improving Monitoring and Evaluation: We would like to strengthen our existing M&E practice by cross learning from global partners and learn from the emerging trends in the sector. 

Our Choice of Tool:

Sentiatend is a proactive, cost-effective tool to decentralize health care. It helps field workers to detect, respond, identify and alert complications that can arise during pregnancy and childbirth based on the data collected, drastically bringing in a reduction in maternal and infant mortality rates through improved preparedness facilitating and providing expert timely medical care. 

Simply put, Sentiatend reduces the time taken between problem identification and connecting it with the solution. 

It can be a disruptive technology solution if implemented at scale through an existing public health program like MANSI at a population health level in all the states where MMR and IMR is higher than the national average. 

Catalytic Effect Through Timely Intervention:

Right from the time of registration, the mother is brought under real-time knowledge based Sentiatend care. Intelligence driven, color coded, risk recognition system keeps track of the mother’s health status, ready to alert if there is a high risk of complication.

A complete diary of the mother’s activities is noted and any risk is preparedly captured and data transferred for referral. Timely alerts are sent to the PHC/FRU/Tertiary and 108 whichever is faster and possible.

Catalytic Effect for the Mother and Child:

Sentiatend assures the mother and child their safety every minute. The mother can be assured that she is being constantly monitored and in case of any complication that may arise, she will know that timely help is immediate.

Constant development of the child is monitored and a tab is also kept on the immunization schedules. Data is transferred automatically through a central server and is monitored remotely. There is no need of a proper education or advanced technical knowledge to use Sentiatend as it is very simple, user friendly and language independent.

Catalytic Effect for the Medical Personnel:

The ANM or Doctors/Medical Experts can constantly monitor the mother or infant remotely- LIVE. This can enable a protocol based EmOC (Emergency Obstetric Care) at the receiving facility at critical times. In the absence of a specialist at the time of risk, Specialist care can be integrated through A/V for immediate help.

A 2-way communication between auxiliary nurse midwife - ANM’S/Staff nurse and Doctors/Experts assures improved preparedness and timely response. Sentiatend uses cost effective simple technology (2G/3G/SMS) to transfer data and handle emergencies without delays.

Our Innovation: Integration of Sentiatend at Population Health Level

With the help of Sentiatend, MANSI project equips villages with a trained community health worker (Sahiya) to provide home-based care, strengthening individual and family knowledge to promote positive health behaviors while building capacity for whole communities to provide peer-based care through an innovative surveillance system to create an innovative model for community- and home-based care. 

• Through this system, timely referrals and emergency care during pregnancy ensure that mothers get qualified care when they most need it, improving access to and utilization of public and private healthcare services. 
• By promoting social cohesion through mobilizing communities for collective action and increasing healthy deliveries in institutional settings by leveraging a government maternity incentive scheme, AIF is instituting a system for sustainability at all levels for the community and local Health Ministry to uphold over the long term.

Impact Goal for Next 10 Years: To reduce maternal and child mortality in rural, impoverished project areas of AIF in India. 

Impact Goal for Next 5 Years: Increase in pregnant women receiving medical checkups, increase in institutional deliveries and increase in newborns being weighed at Birth. 

Impact Target for Next Year:

• 26,471 pregnant women registered in the Sentiatend app.
• 17,786 new-borns registered in the Sentiatend app.
• 25,761 under-5 registered in the Sentiatend app.
• 41,355 adolescents registered in the Sentiatend app.
• 4,327 high-risk pregnant women identified and followed up at least twice during the ante-natal period using Sentiatend app.
• 4,802 high-risk new-borns identified and followed up at least twice using Sentiatend app.
• 9,242 underweight children (under 5 years) identified and supported in attaining normal weight.
• 34,030 adolescent girls registered and tracked for receiving adolescent reproductive and sexual health education.
• 2,321 adolescent couples using contraception (modern family planning methods) for delaying pregnancy tracked in Sentiatend application.

Outcome Indicators for Next 5 Years:

• Improved Access to Services: Annually, 85% of identified high risk new-born cases visited at least two times by trained CHW in the critical period of 28 days.
• Improved Access to Services: Annually, 85% of identified high-risk pregnant women visited nearest health facility.
• Improved Access to Services: Annually, 85% of identified high-risk pregnant women underwent institutional delivery.

Activities:

• Increase the Supply of Sentiatend Trained ASHA workers in Rural India:  Primarily, build technical capacity of ASHA workers so that they can provide timely and effective HBNC in rural India. 
• Mass Awareness: through education, information and communication (IEC) among target beneficiaries, healthcare providers and community at large. The raised awareness about the dangers of child marriage, risks of teenage pregnancy, female feticide and the benefits of spacing post marriage amongst others will contribute to the improvement of maternal and child health outcomes.
• Advocacy measures will be taken at the state and district level to ensure availability of health care workers under NRHM and capacity building in Sentiatend.

Output:

• Increase in demand for Ante-natal, Post-Natal and Sexual and Reproductive Health (SRH) Services.
• Increase in demand for HIT tools like Sentiatend among Department of Health and Family Welfare (DoHFW) and move away from traditional paper based record keeping system. 

Short Term Outcome:

• Increase in pregnant women receiving medical checkups, increase in institutional deliveries and increase in newborns being weighed at Birth. 
• Increase in number of ASHA workers, ANMs and block medical officers (BMO) using HIT tools like Sentiatend.

Long Term Outcome:

• Reduction in maternal and child mortality in rural, impoverished project areas of AIF in India. 

Sentiatend is a designed and built protocol-driven health care system complementing existing systems of delivery with a feature of complete e-documentation of data. It is a comprehensive care decision support system with features like SMS alerts and reminders, sync to the cloud, real-time monitoring, easy onboarding, and multi-lingual.

Mansi Mitra ( community health worker appointed by AIF) collects data with the help of government appointed ASHA (accredited social health activist) appointed at a village level through door to door household survey of pregnant and lactating women.

Mansi Mitra receives an incentive of $100 per month for providing hand holding support to ASHA and for doing data entry at the primary health care level.

The organization does not discriminate against individuals based on religion, cultural beliefs, race, social status, gender orientation in terms of employment, service delivery, or partnership. We believe that everyone is equal and that is why our core values depict all those characteristics of equality. At AIF, employees must treat each other equally and with respect. The underlying principle is that each one of us in the organization and its businesses are expected to work to create an environment where people are valued as individuals and treated with respect, dignity, fairness, and equality, thus leaving no room for the display of favoritism.

AIF is a private, non-profit, nongovernmental organization. We ensure that every dollar contributed is used as efficiently as possible to maximize impact and catalyze sector-wide changes across India and uplift some of the country’s most impoverished communities. 

Target Customer Segments: 

• Rural Pregnant Women, New Born and Adolescent Girls: Our MANSI services are provided free of cost. No registration fees is charged from at-risk pregnant women and adolescent girls to be a part of the Sentiatend database to receive EmOC.
• Govt. funded Community Health Workers such as ASHA and ANM: The CHWs are provided Sentiatend on their mobile phones/tablets and receive training on how to use Sentiatend from AIF at no cost. 

Investors: 

To meet financial needs for technology installation, AIF raises funds for MANSI project through a diverse group of donors ranging from institutional funding, philanthropies, foundations, corporate social responsibility funds, high-net worth individuals (HNI) and government funding. A program progress and financial utilization report is shared with donors of MANSI to report on impact achieved and financial variance of more than 5%.

Our Technology Partner: 

Sentiatend is our technology partner which provides us license to use their application for a stipulated period of time on fixed cost. 

We plan to integrate some features of the Sentiatend application into Government’s existing Health Management Information System (HMIS), towards greater accountability by using the latest digital technology and real-time information across the nation to enable policymakers to make decisions. Through various advocacy meetings with the Government of India, we will advocate for the importance of the Sentiatend tool in identifying, tracking and following up on high-risk cases and eventually adopting it at the population health level. 

AIF has a successful history of engaging and partnering with the national and state governments in 29 states of India so as to make its programs scalable, replicable and sustainable. This has given us a good understanding of how the government functions and how some of the challenges mentioned above can be addressed. Some of our achievements are:

• An Engagement Coordination and Arrangement (ECA) on Maternal, Adolescent, Child care and Nutrition in Kolhan division in Jharkhand between the National Health Mission, Tata Steel Foundation and American India Foundation under the flagship project MANSI+ (Maternal and Neonatal Survival Initiative+) was signed on Jan 29, 2022 at the office of National Health Mission (NHM), Ranchi. Based on the effective advocacy and MANSI implementation efforts by AIF led to this partnership which resulted in a USD 10 million investment for next 10 years. 

• In Andhra Pradesh we have successfully done advocacy with the Mission Director- National Health Mission (NHM) and the Commissioner- Health and Family Welfare and Commissioner- Integrated Tribal Welfare Department (ITDA) to incorporate the budgets in their respective Annual Program Implementation Plans (APIPs)[1] for the inclusion of Sentiatend application in the NHM plan and to ensure the sustainability of the program.

[1] Annual Program Implementation Plan (PIP) process facilitates the planning, approval and allocation of budgets of various programmes under the National Health Mission (NHM)