NNOS, which has been involved in preventive care and treatment of NCDs for the past five years, started by exploring various methodologies/models available for this purpose, including detailed study of a project on diabetes and hypertension care run by Kidney Help Trust in the project area for the last fifteen years, and the World Bank funded NCD Project run by the State Government’s Tamil Nadu Health Systems Project. After holding discussions with key stakeholders, including the beneficiaries in the target area many times, NNOS finally initiated the Project with doorstep screening to assess the prevalence of NCDs in the target population. It also studied various plausible technologies for preventive care suited to the ground realities, and decided on the use of modern, easily accessible, mobile-based technology in the Program.
One promising strategy of our Program to address the lack of trained medical personnel in rural areas involves ‘task shifting,’ where front-line, non-physician CHW are delegated some of the tasks traditionally performed by fully qualified medical personal. However, our initial experience showed the inability of the CHWs to provide standardized interventions and collect quality data. Therefore, we introduced mobile technology as a valuable support tool to health services provided by CHWs to (1) facilitate process improvements leading to quality data collection and intervention, (2) ensure compliance to standards and guidelines, (3) provide education and training support. In addition, based on our experience with the target population, we decided to capitalizes on the universal availability of simple/basic mobile phones among the participants and build on experiences elsewhere that have shown that SMS-based intervention is an effective and acceptable method to deliver lifestyle interventions and care coordination.