Addressing comprehensive primary healthcare in Gujarat through mHealth intervention: Early implementation experience with TeCHO+ programme

Saha, Somen; Kotwani, Priya; Pandya, Apurvakumar; Patel, Chintan; Shah, Komal; Saxena, Deepak; Puwar, Tapasvi; Desai, Shrey; Patel, Dashrath M; A, Sethuraman; Ravi, Jayanti S.

doi:10.4103/jfmpc.jfmpc_835_19

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…Based on our findings, there seems to be a demand for training in depression care that will be further explored in the forthcoming trial. With digital technologies becoming an increasingly important tool in health systems in many low-resource settings in India, as reflected by efforts to finance the adoption of smartphones among frontline health workers to support care delivery [ 29 ], future research can expand on the findings reported here to determine how technology can support the scale up of mental health care. Importantly, it will be necessary to determine how to effectively leverage digital technology to enable supervision and quality assurance for the sustained delivery of high quality psychological treatment for depression, as this will be critical to support task-sharing mental health services in low-resource settings towards addressing the care gap [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, mobile internet penetration continues to increase rapidly in many low-resource countries, with close to 450 million people in 2020 in India having internet access from their phones [ 27 ]. While many frontline health workers do not have access to or own smartphones, this is changing in several parts of India as government health systems are now providing smartphones to health workers to support them in their work [ 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

Muke

Tugnawat

Joshi

et al. 2020

IJERPH

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Introduction: Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods: Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results: Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content—issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions: This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

Muke

Tugnawat

Joshi

et al. 2020

IJERPH

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“…On the beneficiary side, the data collection and storage methods varied depending on the state with increasing fragmentation of data storage and frequent difficulty with collating data due to network and central server failures. After a national needs assessment, our prototype work was focused on Gujarat to help connect beneficiary health data from TECHO+, their health data app,7 to supply chain side data. Invested technological partners were key to assuring that the possible solutions generated through this process are able to be implemented in the future.…”

Section: Needs Assessment Of Indian Immunisation Data Storagementioning

confidence: 99%

Blockchain technology for immunisation data storage in India: opportunities for population health innovation

Banerjee¹,

Banerjee

Bhagi

et al. 2021

BMJ Innov

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“…21 The Health ID, linked to Aadhaar or mobile number, can be created by individuals themselves and provides the basis of integrating all their digital health records allowing seamless, consented sharing of health data between providers, laboratories and pharmacies. The health IT systems we have helped develop, Affordable Medicines and Reliable Implants for Treatment (AMRIT), 27 Technology Enabled Community Health Operations (TeCHO+) 28 and the national NCD (Digital LifeCare) 29 system have their own unique identifiers which are being linked to NDHM Health IDs.…”

Section: Introductionmentioning

confidence: 99%

“…34 TeCHO+ serves over 60 million people across multiple health verticals in the primary care settings and enables longitudinal tracking of patient information using a unique ID between village health facilities, PHCs and across secondary healthcare facilities. 28 Lateral integration across these systems will be enabled by the adoption of the common Health ID and health registries offered by NDHM. Figure 1 describes the platform approach to establish a continuum of care.…”

Section: Introductionmentioning

confidence: 99%

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

Nadhamuni¹,

John

Kulkarni³

et al. 2021

BMJ Glob Health

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In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.

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Addressing comprehensive primary healthcare in Gujarat through mHealth intervention: Early implementation experience with TeCHO+ programme

Cited by 9 publications

References 14 publications

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

Blockchain technology for immunisation data storage in India: opportunities for population health innovation

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

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