Healthcare consultant and entrepreneur Dr. Aakash Ganju examines the state of maternal and child health in India, and the potential for mhealth solutions to improve care.
Over 25 million Indian mothers and young children (under the age of 5) have died in the last two decades due to pregnancy or childbirth related causes. That’s nearly as much as the number of people that have died of the AIDS epidemic. About 20% of global maternal deaths and deaths of children under the age of 5 are in India. With 27 million new births annually (more than the population of Australia), these staggering numbers reflect the challenge, the urgency and the opportunity to provide better care for mothers and children in India.
Several reasons point to the still lagging statistics for maternal and child health in India. Key is India’s abysmally low government expenditure on health (around 1% of GDP). Other reasons include the widely dispersed landscape, poor infrastructure in India’s over 600,000 villages, poor sanitation and social norms (in some parts) favoring early marriage and childbirth as well as a preference for the male child. The burgeoning masses that choke health resources in the city slums add to the challenge of serving health to the urban poor in India.
Despite the constraints, India has made considerable progress over the last 2 decades. Only one out of every 550 women are likely to die of pregnancy related complications today compared with one out of 166 women in 1990. In 1990, one out of 12 infants was likely to die in the year after being born. Today, only one out of 25 dies in the year after being born.
Despite the progress in the last two decades, the number of women and children we lose remains unacceptably high. Other emerging economies like China and Indonesia have shown that neither the size of the country nor the economy need be deterrents to improving the state of maternal and child health. Bringing care to the level of developed countries will require an over 10-fold improvement. Based on improvements over the last two decades, that could take anywhere from 50-80 years. Clearly, incremental improvements won’t do and more radical approaches are needed.
It is against this crisis that India’s mobile revolution offers hope. Over the last decade, Indian consumers have bought mobile phones in the masses. Between 1995 and 2002, India had 6 million mobile subscriptions. In the next 10 years, India’s mobile subscriptions grew to over 800 million. Mobile phones are now ubiquitous, even in rural communities. Their penetration has increased faster and deeper than any other service. More Indians today have access to a mobile phone than a toilet!
Source: Annual Report 2012-13; Telecom Regulatory Authority of India
This presents a huge opportunity to reach the masses dispersed in far-flung towns and villages. A number of mhealth services are exploring how mobiles can be used to generate demand for consumption of health services, empower healthcare workers with training and tools to better monitor the health of pregnant women, new mothers and their children. Challenges abound though.
Despite the mobile revolution, most people in India consume voice not data. Pushing services using voice is more expensive and requires adaptation of content to meet the needs of different levels of literacy, comprehension and languages spoken within India. This makes the scale-up of potential programs more expensive.
Despite the dozens of small-scale deployments, there is a dearth of large scale mHealth programs. There remain questions about the impact and the cost-effectiveness of these solutions. A reasonable challenge would be: Is it more impactful to deploy an additional dozen health workers with known outcomes (even if modest) than to deploy an mHealth program that reaches thousands but with yet unknown impact?
These questions are increasingly driving mHealth interventions to focus on the end consumer, which will drive scale and impact. The solutions need to be less about the technology and more about integrating with the mobile consumption patterns. Inevitably, over the next decade, the challenges, questions and concerns will drive several iterations of current solutions. The innovation cycle will thankfully be short and will yield better and more impactful solutions. I am convinced mobile-based health interventions will be a critical component to improving the health of our mothers and children at a rate faster than we have seen in the past.
Dr. Ganju (@aakashganju) is a healthcare consultant and entrepreneur, focused on increasing transparency, access and convenience to health providers and consumers. He is the CEO of Mirai Health and lives in Mumbai, India. Follow Dr. Ganju’s company on Twitter @MiraiHealth1.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the authors.