Written by Team Kilkari & Mobile Academy
The last six months at ARMMAN have been extremely challenging, but also gratifying. The period marked the beginning of ARMMAN’s partnership with the Ministry of Health & Family Welfare to implement two of the largest mHealth initiatives in the world – Kilkari and Mobile Academy. Kilkari is a mobile health education service, like mMitra, while Mobile Academy is an IVR-based reproductive, maternal, neonatal and child health refresher training course for frontline health workers.
The two complementary programs are potential game changers in addressing lack of knowledge leading to deaths and complications during childbirth that are otherwise preventable. The number of Kilkari subscribers has crossed 11 million while over 0.26 million ASHAs* (frontline health workers) have started the Mobile Academy course. As we look at further expanding our programs across India, we visualize a world in which every woman will be better informed and will proactively adopt improved behaviors such as taking supplementary iron during pregnancy, early initiation of breastfeeding, family planning, oral rehydration therapy, etc. – practices that are known to be associated with reduced maternal and infant mortality. The informed woman will also proactively anticipate problems, decipher danger signs, seek timely care and demand that her health needs are met. The knowledge gained by the women will be supported by the enhanced knowledge base of the ASHA workers and their improved ability to counsel and provide care. This will lead to a reduction of maternal mortality and morbidity, which will benefit society overall.
The next two and a half years are going to be a terrific learning process and we certainly have some plans as we get settled in to implement Kilkari and Mobile Academy till 2021. Our vision for the programs include:
1) mMitra as Innovation Lab
mMitra, ARMMAN’s free voice messaging service for pregnant women and new mothers, is currently available in 4 languages and has reached women in 9 states of India. mMitra will upgrade to an innovation lab while proven measures will be scaled through Kilkari and Mobile Academy.
- Personalized and interactive content for high-risk groups (Whatsapp feasibility study)
- Two-way communication using call center services
- Standardized outcome measures (Attentiveness and Engagement Indices) to benchmark mHealth interventions.
The first two mMitra innovations will make the women feel supported and offer validation for their concerns, allowing them to choose the information dissemination system that best suits their needs.
2) Improvement in Data Quality
Kilkari extracts the phone number and other relevant data such as the Last Menstrual Period (LMP) date and child’s date of birth directly from a government database – ‘Mother-and-Child-Tracking System’/Reproductive and Child Health portal (MCTS/RCH). Kilkari has an embedded continuous feedback loop for data rectification that leads to improvement of data quality. This live database of all pregnant women and children in the country can become the backbone for all maternal and child health services of the government and other NGOs. It can link and co-ordinate the services of various institutions.
It will also help ensure that a non-represented and marginalized woman enters into the formal system. This will facilitate her access to many maternity welfare benefits including subsidized credit and conditional cash transfers and her entry into the government’s database has the potential to spur a cascading improvement in her welfare ecosystem overall.
3) Pan-India expansion
Kilkari and Mobile Academy are the largest mHealth initiatives of their kind in the world. While they are currently available in five languages and being implemented in 13 states across India, the goal is to expand them throughout the country over the next three-five years.
* Including ASHAs who had started Mobile Academy as part of BBC Media Action’s pilot project in Bihar
Background/ Editor’s Note:
Kilkari delivers free, weekly, time-appropriate audio messages about pregnancy, child birth and child care via Interactive Voice Response (IVR). Messaging begins in the second trimester of pregnancy and continues until the child is one year old. The program was started by BBC Media Action in the year 2013 in Bihar in an attempt to improve the connection between families and service providers through technology. At that time, the maternal mortality rate in Bihar (219) was much higher than the national average of 178. There was an urgent need to increase uptake of antenatal care services, attended delivery, newborn care and post-natal care practices. Kilkari aimed to persuade families to adopt healthy behaviours more effectively by equipping them with information and improving risk perceptions.
In the initial years, all Kilkari subscribers were charged a nominal fee. Later on, the Ministry of Health and Family Welfare adopted this program and Kilkari was launched in 2016 in 6 states.
Kilkari complements Mobile Academy (a free reproductive, maternal, neonatal, and child health audio training course for frontline community health workers in India) by reinforcing the messages communicated by health workers, who are interacting directly with new and expecting mothers and their families, to encourage healthier behaviour.
ARMMAN signed a Memorandum of Agreement with the Ministry of Health and Family Welfare in January 2019, taking over the implementation of Kilkari and Mobile Academy from BBC Media Action. We will be implementing the programs till 2021, with scope for extension.