Samote block, quaintly located in the foothills of the District Chamba in Himachal Pradesh, is naturally beautiful. The hilly terrain brings a new way of living, with limited access to many necessities like maternal and child healthcare.

Reena Devi, a 26 year woman got registered for antenatal care at Sukrah sub-centre in her first trimester on 16 July’19. At the time of registration, Reena underwent all routine antenatal examination and diagnostics. She was thoroughly counselled on importance of routine check-up at the scheduled time.

During the first visit only, next visit for checkup was scheduled, which was conducted on 18 September’19 and she was advised to visit at NHPC Hospital Samlei, Block Samote a Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) site to get checked by Medical Officer (MO) during her next routine check-up.

As planned, Reena visited the MO with her reports. During the examination, Reena was screened for Gestational Diabetes Mellitus (GDM). She was further advised for Ultra Sonography (USG) examination to check fetal condition and its development.

During the visit, the MO suggested ‘Conservative Management’ diet and lifestyle modification to control the diabetes. Reena – GDM diagnosed, was at High Risk Pregnancy and her details were entered in High Risk Pregnancy Application (HRP APP or SeWA APP) by ANM (Darshna) and was asked to revisit next month with her USG report for regular follow up.

In next visit, with her USG report Breech presentation (Mal presentation or the incorrect positioning of the fetus) was diagnosed. Darshna through the HRP app, monitored and followed-up Reena’s condition regularly and also informed ASHA of the area to follow up during the ANC period.

At every routine visit, Darshna would update the app with Reena’s current diagnostic details (Blood sugar, Blood pressure, anemia, hemoglobin, etc). It was easy for her to keep record of Reena’s condition using the app. Meanwhile, Darshna worked on the Birth Preparedness Plan in consultation along with Reena and her family, to identify the appropriate facility for her delivery, where a specialist doctor could handle her case.

The app allowed Darshna to send text messages to Reena (PW) and ASHA worker of that area to ensure referral visit with specialist and regular follow ups with ANM along with details of the birth preparedness plan with date, facility center, and medical records.

Speaking to ANM, Darshna, “The HRP app has helped, to keep a record of the high risk pregnant women in our block and timely reach out to them. The app has guidance on additional knowledge of risk conditions and appropriate management (place of referrals etc.). Using this app has improved our confidence and resulted in better maternal and neonatal outcomes which in turns builds trust with the women and the society. However, it has increased accountability for us especially in terms of providing antenatal care to high risk pregnant women. Through this we helped Reena during her antenatal period till the time of delivery. She delivered on 17 February’20 through C-section with Gynecologist in Banikhet, Chamba. We were happy to see a healthy mother and baby.”

Reena shares that “During my pregnancy, I received text messages for referrals, giving details of which facility to visit on which date. Further, I received information on birth preparedness plan as well, which gave me expected due date, who my birth companion would be, which facility to register and along with details of doctor. These regular messages helped in keeping me updated and not miss any routine checkup and having a trouble free pregnancy and outcome.”

About HRP APP (Systematic E Approach for Women at Risk – SEWA)

The HRP app helps in generating evidence for improving quality of antenatal care, using mobile based technology for: Listing of pregnant women identified with high risk conditions, appropriate referral of Pregnant Woman with identified risks for further assessment and management, increased ANC contacts for Pregnant Woman identified with risk condition on account of SMS based reminders and improved programme management of Antenatal care through review process.

The App is essentially for use by frontline workers through android phone or a tablet (ANMoL). It also has a separate office bearer module for managers to review the data and develop reports. The App is also available on web browser; and is available for future integrations with any existing portal. It has an option of offline data entry and has linkages with the RCH portal. As a part of this innovative work, USAID Vriddhi project at first developed tools and registers for line listing and tracking of at-risk pregnancies and followed by digitalizing the whole process. The aim of the HRP application is to improve management of at-risk conditions identified by screening of pregnant women via, strengthening of frontline health workers capacities.