Madhya Pradesh has 21% tribal population facing challenges in access to quality health care. Naina is one of them. She is residing in one of the remote villages in hilly terrain, approximately 18 kms from block headquarter in Southern Madhya Pradesh. Across state migration is another major issue in this area due to inefficient opportunities of employment while making it difficult to guarantee quality antenatal care through regular visits.

Hence, the practice of village level ANC sessions is practice for taking care near to the woman. Under iWIN, care navigators are deputed at block level to navigate these pregnant women through the ecosystem to ensure regular follow ups.

In one of these sessions conducted on 1st December, 2022, Naina was found to have a severe anemia with hemoglobin of 6.1 g/dl and she was 8 months pregnant. Since, this can be a precipitating factor for obstetric hemorrhage, health team consisting ANM, CHO and care navigator motivated pregnant woman to go to the higher center for blood transfusion. Potential complications were explained to her husband too to ensure immediate referral.

She was then given blood transfusion on the next day at block level community health center (CHC). The same team revisited the village on 22nd December, 2022 for follow up and she was found to have a hemoglobin of 8.1 g/dl. 2 days later, she started having labor pains and was taken to the CHC by ambulance where she delivered a baby weighing 2.6 kg.

The health team’s commitment to provide continuum of care and our care navigator’s ability to navigate pregnant women through the ecosystem has helped many such Naina in Madhya Pradesh. The efficient tracking mechanism not only ensures early identification but also modifies health seeking behavior of high-risk pregnant women.

Anmol (ANM online) MP is a digital platform to register and track eligible couples, pregnant women and children across continuum of care. The ANMs and CHO enter the data at community level while data entry operators do it at facility.

Anmol MP has 3 major components, community ANC, facility ANC and facility level delivery module. However, inability of these modules to interact with each other was the biggest hurdle in continuum of care.

The application records approximately 15 lacs pregnant women registration per year entered by around 12000 ANMs. In an attempt to transform such massive data into action, ANMOL RCH portal dashboard is prepared based on line list across continuum of care as an administrative decision-making tool.

To universalize maternal health review mechanism at state & district level, a role-based dashboard has been prepared. The Key performance indicators (Process as outcome) are linked with the dashboard & dashboard has the facility to highlight poor performing districts, blocks & SHCs across different indicators.

The dashboard is launched by the Mission Director, NHM in presence of President & CEO, Jhpiego and all the 51 districts along with state maternal health division have successfully adopted the dashboard. The state has been instrumental in focusing on the facility ANC, improvement in registration, 4 ANC visits, diagnostic services, HRP identification rates and delivery outcome update. Operational indicators such as CHO, MO & gynecologists visits during ANC has shown marginal improvement. Dashboards have highlighted some reporting issues in portal which helped introduce logics & validation in the existing software.

This low cost, less resource intensive but high impact modality has every potential to scale up across different states for maternal health monitoring.

In initial months of I-WIN implementation, during series of field visits and interactions with HCPs, we used to observe youth from the same village in and around ANC service delivery points, immunization points, offering their help and assistance to needy clients as and when required on a voluntary basis.

Most of them qualified, smartphone enabled, bike riders but unfortunately unemployed. In order to utilize these locally available village experts, I-WIN team decided to onboard and formalize their support in a more structured manner. We onboarded them as Care Navigators in our initial focused implementation geography and utilized their presence for field-level support to ANMs.

Support was mainly towards improvement of ANC session organization, resources availability, use of digital applications for recording and effective referrals in case required. Simple, feasible checklist and tools were developed and care navigators are provided with training and support to ensure standardized nature of non-technical assistance that they provide to ANMs.

In identified 6 focused intervention blocks, we have 32 Care Navigators as on date such that each one is supporting 25-30 ANMs in a structured manner. They have already supported navigation of more than 1000 pregnant women across care pathways. In the words of Block program manager of Segaon, Khargoan ,“With help of care navigators we are able to identify the issues with ANMOL and referral, now we are able to follow up these issues on time!”

Kaushal, a third-time pregnant woman from Betul, Madhya Pradesh, faced a perilous journey during her pregnancy. Struggling with moderate anemia and a history of postpartum psychosis, her condition deteriorated rapidly as her delivery date neared. Despite the tireless efforts of healthcare workers Anuradha and ANM Pramila Dhurve, her relatives initially refused urgent medical intervention.

ANM Pramila's persistence eventually convinced Kaushal to seek help, but challenges persisted. Despite reaching the district hospital, the scarcity of blood donors left her in despair. Yet, the unwavering dedication of ANM ensured Kaushal's brother was contacted, bringing hope. With the coordinated efforts, Kaushal received vital blood transfusions, securing her and her baby's health.

Ms. Wahedunisha found solace in CHC Gogawa during her delivery. Amidst the premature birth, her newborn struggled to cry, signaling distress. Swift action by Rinku Meena, a Dakshata iWIN Champion, proved pivotal. Recognizing the urgency, Rinku promptly referred them to the District Hospital. Dakshata's training equipped her with vital knowledge, ensuring timely intervention aligned with the Government of India’s Dakshata guidelines. Rinku's expertise and compassion, mother and baby received the necessary care. This story exemplifies the profound impact of dedicated healthcare professionals, ensuring every birth is met with compassion and expertise, safeguarding the precious gift of life.

In the rural health clinic, ANMs once faced daily challenges, the daunting task of data entry. After long days in the field, they would trudge home burdened with stacks of paperwork and reentering the data of the patients due to the technical errors faced in the center, their tired hands meticulously recording each detail. But now, the ANMOL device makes their life easy, their evenings are transformed.

ANMOL isn't just a piece of technology; it's a cutting-edge technology solution for these dedicated healthcare workers. With its design and intuitive interface, ANMOL has revolutionized the way ANMs collect and input vital health data. No longer confined to the drudgery of post-shift paperwork, they can now enter information swiftly and seamlessly right at the point of care. With ANMOL and IoT devices, the healthcare experience becomes not just a transaction, but a human connection rooted in trust and compassion.

For ANMs like Sunita and Priya (imaginary names), every day presents new challenges and opportunities to make a difference. Recently, they embarked on a journey of refresher training in the essential care of vulnerable newborns, particularly those born below 2.5 kilograms. This training, facilitated by IWIN team, proved to be a pivotal moment in their careers.

As they delved into the intricacies of newborn care, Sunita and Priya found themselves equipped with knowledge and skills that would empower them to better serve their community. They understood the critical importance of identifying vulnerable newborns early on and providing them with the care they need to thrive.

Armed with refreshed knowledge and newfound confidence, Sunita and Priya eagerly set out into the villages, ready to impart their learnings to the community. They knew that education was the key to empowering parents and caregivers to provide the best possible care for their newborns.

One of the crucial aspects they emphasized was Kangaroo care, a simple yet effective method of holding a newborn against the mother’s bare chest. Sunita and Priya passionately explained how this practice helps regulate the baby's body temperature, promotes bonding, and supports overall development.

In Betul district, Madhya Pradesh, Jhpiego's workshops ignite a spark of empowerment within Jan Mangal Sanstha (CBO) to work with ASHA workers and communities. These unsung heroes, dedicated to their community's well-being, now find themselves armed with knowledge and skills. Through ANC workshops and precise clinical terminologies, they bridge the gap between healthcare systems and local women, nurturing trust and understanding. Documenting their efforts, they weave a tapestry of care, bringing quality healthcare closer to home. With each engagement, they don't just deliver services; they plant seeds of hope and resilience, transforming communities one step at a time.