In rural India the rates of diabetes, hypertension and other Non Communicable diseases (NCDs), are increasing, consequently increasing deaths related to these diseases. In India’s rural healthcare system, routine NCD management is mostly provided at the Primary Health Centre (PHC). Despite extensive network of PHCs, the major limitation to providing care in rural communities is the lack of fully trained medical personnel. Moreover, due to the lack of resources, screening is opportunistic (performed only if the person comes to the PHC) resulting in significant number of NCDs going unidentified, Moreover, our experience shows that only 15% of persons identified with NCDs visit the PHCs regularly or have adequate control of the disease. This is due to the lack of (1) lifestyle intervention; (2) sustained access to care; and (3) self-management skills.
To address these limitations, we implemented a public private partnership (PPP) model, the Rural m-Health NCD Prevention Program. Through this Program mass screening for NCDs at home/village level in a population of 50,000 individuals in 24 villages in Kancheepuram District, Tamil Nadu State, India was undertaken. The participants identified with disease were connected to treatment available at the PHCs. The innovations of the program are two-fold: (1) addressing the lack of trained medical personnel by ‘task shifting,’ where in the local community health workers (CHW) are trained and delegated some of the tasks traditionally performed by fully qualified medical personnel; and (2) using of mobile phone technology to standardize and increase access to care. In this m-Health intervention, the mobile technology we have developed (software application with mobile and cloud infrastructure) supports the CHW-led efforts to facilitate sustained link to care at PHCs (appointment reminders), support intervention by CHWs (multimedia content delivery and data collection tools), reinforce self-care behaviors and lifestyle changes (by personalized mobile messages to patients), and help monitor clinical and process measures (online data analysis).
Door-to-door surveys, using the data collection tools in the mobile phones, reveal that, the prevalence of hypertension and diabetes were 21%, and 16%, respectively, with 85% previously undiagnosed, resulting in close to 3000 persons with newly diagnosed diabetes and/or hypertension. In the initial phase, we have implemented the mobile phone-enabled intervention in 500 persons with diabetes and hypertension. Our results over the last 2 years show that CHWs with the help of the mobile phones are able to: (1) collect information efficiently and reliably; (2) provide culturally appropriate educational content that are accessible to low-literacy population; (3) provide lifestyle intervention and self-management skills, which empowers patients to avail treatment at PHCs; and (4) track outcomes and ensure quality of care. Findings from this program suggest that the appropriate use of mobile technology can contribute to the development of a cost-effective, scalable rural PPP model for case finding, linkage to care and treatment compliance for diabetes and other NCDs within existing rural healthcare infrastructure. Integration of this mobile-based intervention model within the existing healthcare system enhances its relevance across other regions India.