Written by Abhiram Mehandale
Being a dental surgeon and a public health professional I have always seen the health system in two ways, one which is curative and the other which works on clinical aspects with an emphasis on diagnosis and treatment. The objective of this aspect is to reduce disease prevalence. The curative method puts more emphasis on prevention of disease by identifying and controlling the risk factors, with an objective of reducing the disease incidence. Both of them should ultimately reduce the disease burden and improve the health status of the society. For this, we need to have a perfect balance between both these mechanisms. If curative healthcare services are important at the individual level, for a patient who is suffering from an ailment, the public health interventions also play an important role at the community level to prevent such cases of disease in the future. There are many ways to implement such preventive public health interventions; health education, behaviour change communication and screening of communities are some of them.
If we look at the mother and child health situation in cities like Mumbai, the city has a good number of municipal hospitals, maternity homes, private tertiary care hospitals, yet many women in slums of Mumbai deliver at home. This clearly shows that availability of health services is merely one factor, but health is multidimensional and various other factors such as accessibility, acceptability, affordability also affect the healthcare services utilization and ultimately the health status. The most efficient way to change this scenario is to educate these women in slums about the importance of taking care of their health and their babies during pregnancy and after delivery. Looking at the spread of slums in Mumbai and the density of population in these slums, it is not possible for any governmental authority, non-governmental organization or community based organization to conduct awareness activities and health education sessions everywhere.
Looking at the penetration of mobile phones in India and especially in cities like Mumbai, mMitra mobile voice messaging service is the most efficient way to educate the women on mother and child health. This service fulfils the dual purpose of health education and behaviour change communication and in addition, use of mobile connections is the best possible way to reach a large number of such women in a short period of time and is also not very resource intensive at the same time. Though this service is information based and does not provide any direct health service to the pregnant women and lactating mothers, it has a potential to influence the current healthcare infrastructure in the city dedicated to mother and child health. If in long term, these voice calls could bring about behavioural change, more and more women will access the health facilities during pregnancy and for the delivery. This will have a positive effect on efficiency of current mother and child healthcare facilities. If all of these aspects work in tandem, it will not be difficult to achieve an ultimate objective of reducing maternal, infant and child mortality as set in the Millennium Development Goals.