Maitree – Mother and Childcare

In the rapidly evolving landscape of healthcare technology, Maitree stands out as a pioneering mHealth application tailor-made for Accredited Social Health Activists (ASHAs). In this comprehensive blog post, we’ll delve into how Maitree is transforming healthcare delivery in remote areas, empowering ASHAs, and contributing to the reduction of maternal and infant mortality rates.

Introduction to Maitree

Maitree—meaning “friend” in Indian languages—is a ground-breaking interactive tab-based application designed to support ASHAs in their day-to-day activities. It was introduced in September 2015 by the NGO DEEP (Disease Eradication through Education and Prevention), in partnership with local government functionaries.
With India witnessing 27 million births annually and grappling with high maternal and infant mortality rates (MMR and IMR), Maitree has emerged as a technological ally to bridge the gap caused by the shortage of gynecologists and streamline the implementation of government healthcare initiatives.

The Role of ASHAs in India’s Healthcare System

Accredited Social Health Activists (ASHAs) play a crucial role in India’s healthcare system, especially in rural areas where the healthcare infrastructure is limited. They are a part of the National Rural Health Mission (NRHM) and are assigned to bridge the gap between the community and the healthcare system.

Who are ASHAs?

ASHAs are community health workers who are largely from rural backgrounds, with some basic level of education. They are trained to act as health educators and promoters in their communities. Their main role is to ensure that healthcare services are delivered to rural and vulnerable populations, thereby contributing to the overall improvement of health outcomes in the country.

Primary Responsibilities of ASHAs

Community Mobilization: ASHAs encourage communities to utilize the healthcare services available at primary health centers and government hospitals. They play a crucial role in the mobilization of beneficiaries for health services.

Maternal and Child Health: ASHAs focus on routine maternal, newborn, and child health (MNCH) activities. They assist in institutional deliveries and promote immunization programs to reduce infant and maternal mortality rates.

Health Education: They provide vital health education regarding basic hygiene, nutrition, the importance of clean water, sanitation, and the benefits of family planning. ASHAs also conduct home visits for antenatal and postnatal care.

Tracking and Follow-ups: ASHAs are responsible for keeping records of all healthcare-related activities in their designated areas. They help in tracking the health status of various demographics, especially mothers and children.

Counseling: They provide counseling services to families and help them understand the importance of healthcare services, including vaccinations and family planning.
Challenges Faced by ASHAs

Education and Training: Most ASHAs come from a rural background with limited education, which sometimes hinders their ability to perform complex healthcare activities.

Incentive-Based Work: ASHAs work on an incentive-based program. They often have to conduct activities without immediate payment, which can affect motivation and performance.

Data Management: ASHAs face challenges with data management due to delays in information transfer between their reports and the government systems.

Technological Support: The Role of Maitree
To address these challenges and improve the effectiveness of ASHAs, DEEP (Disease Eradication through Education and Prevention) introduced the Maitree app in April 2015

Support for ASHAs: Maitree app helps ASHAs become more effective in government healthcare program delivery by providing an interactive tablet-based platform with videos for conducting various healthcare activities and counseling.

Knowledge Improvement: Studies showed that the knowledge of ASHAs on critical MNCH topics improved after using the Maitree app. Beneficiaries also confirmed receiving consistent and better-quality messages.

Real-time Data Tracking: ASHAs can register beneficiaries and track their activities within the app, allowing supervisors and healthcare officials to receive real-time data, improving monitoring and reporting efficiency.
Features and Functionality of the

Maitree’s APP core functionalities include:

Project Maitree’s application plays a pivotal role in enhancing the capabilities and performance of Accredited Social Health Activists (ASHAs) by offering a range of user-friendly, intuitive features and functionalities. Below, we detail the key components that make Maitree an effective tool for improving healthcare delivery in India

1. Registration of ASHA Details and Connectivity

Maitree allows for the easy registration of ASHA workers, creating a network among them and fostering a sense of community. This feature helps to ensure that ASHAs are not working in isolation but have a support system and a direct line of communication with their supervisors and peers.

2. Registration of Mother and Child

A crucial functionality of Maitree is the registration of mothers and children, which includes entering their names, village details, and unique identification numbers such as Aadhar. This creates a comprehensive database that can be used for tracking health interventions and outcomes.

3. Tracking ASHA’s Activities for Incentive Claims

The app includes a feature for tracking the activities carried out by ASHAs, which is directly linked to their incentive claims. By recording each task, such as antenatal checkups or home visits, Maitree provides a transparent and efficient way for ASHAs to report their work and receive due compensation.

4. Home-Based Newborn Care (HBNC) Video Guides

Maitree offers video guides for HBNC, which are critical in providing standardized healthcare information. These guides help ASHAs deliver consistent and accurate health messaging, leading to better health practices among the beneficiaries.

5. Counselling Videos

The app includes videos designed to aid ASHAs in providing counselling to mothers and families. These videos cover a range of topics, ensuring beneficiaries receive a uniform set of instructions and advice, regardless of the individual ASHA’s education or background.

6. Simple, Intuitive, and Usable Application

Maitree’s simplistic design follows usability principles, enabling ASHAs to quickly learn and engage with the app. The use of pictures, audio, and a focus on ASHA’s activities make the application user-friendly and accessible.

7. Seamless Integration with Government Systems

Maitree is designed to integrate with government applications like MCTS or state-specific systems such as Mahila Sishu. The integration streamlines the data flow, reducing delays in information availability, and ensuring ASHAs’ activities are reported and compensated properly.

8. Developed in Local Language

The app is developed in the local language, Telugu, making it quickly usable and understandable by ASHAs, regardless of their education level. Removing the language barrier accelerates adoption and facilitates immediate feedback from users.

9. Open Source Technology

Maitree is built using open-source technologies like Android, PHP, Apache, and MySQL. The application has undergone extensive user validation over five months, ensuring its reliability and effectiveness in the field.

Key Findings and Statistics:

Since its inception in April 2015, Maitree has seen a marked increase in utilization, with the average monthly usage per ASHA growing from 10 minutes at the start to 90 minutes after five months.
The app’s videos on counselling and HBNC have been used 23,989 times, totaling 568 hours of video viewership, highlighting the demand and reliance on these resources by ASHAs.

Maitree’s features and functionalities have been carefully crafted to improve the knowledge and efficiency of ASHAs, standardize the delivery of health messages, and strengthen the healthcare delivery system in India. With its potential for expansion and integration, Maitree represents a major step forward in empowering healthcare workers and enhancing the health outcomes of mothers and children across the region.

Maitree operates in local languages, starting with Telugu, to maximize usability for ASHAs regardless of their educational background.

The Impact of Maitree on Health Outcomes

The Maitree app has brought about significant improvements in healthcare delivery, particularly with respect to maternal and child health in the Andhra Pradesh region. Through technological support to ASHAs, it has contributed to better health outcomes in several ways.

Improving ASHA’s Efficiency and Knowledge

Efficiency: Maitree has improved the efficiency of ASHAs by offering a simple, intuitive, and effective job aid for a range of activities they are responsible for. With the aid of audio and video materials, ASHAs can deliver consistent healthcare messages and services.

Knowledge: ASHAs who used Maitree showed improvements in their knowledge of critical maternal and child health topics. These improvements were evident when compared to a control group of ASHAs who did not use the app.

Consistency in Health Messaging

Standardized Counselling: The use of video content in Maitree ensures that all beneficiaries receive consistent health messages, regardless of the educational background of individual ASHA workers. This consistency is critical in delivering government health programs effectively.

Expanding the Health Program Scope

The scope of Maitree can be expanded to other diseases or programs like Rashtriya Bal Swasthya Karyakram (RBSK), which has already shown positive results in reducing child mortality through early screening. Expanding Maitree’s features to support screening for conditions like Down’s Syndrome, Cleft Lip & Palate, and Congenital Heart Diseases could potentially enhance these outcomes even further.

Real-time Data Tracking and Integration

Immediate Data Availability: By storing data in the central database and allowing for real-time tracking, Maitree reduces delays in the availability of information to supervisors and healthcare functionaries.

Integration with Government Systems: The potential of Maitree to integrate seamlessly with government applications like MCTS or Mahila Sishu could further improve the speed and accuracy of data management, thereby enhancing healthcare service delivery.

Community Support and Outreach

Community Involvement: Weekly data sharing with local sponsors has enabled community engagement, where assistance is provided for transporting mothers and children to hospitals for check-ups and other activities.

Cost-Effectiveness

Low Relative Cost: The cost-effectiveness of Maitree, particularly in comparison to the benefits it delivers, has been a major factor in its success. The initial hardware investment is offset by the low software and support costs, which is a small price to pay for the benefits experienced by the ASHA workers and beneficiaries.

Integrating Maitree with Government Healthcare Systems

The integration of mobile health technologies like the Maitree app with government healthcare systems is an important step forward in the digitization and optimization of healthcare services. The seamless integration of such tools can lead to improved patient care, better data management, and more informed decision-making by healthcare providers and policymakers.

Challenges in Government Healthcare Systems

Data Silos and Fragmentation: Government healthcare systems often suffer from fragmented data systems that do not communicate well with each other. This can lead to data duplication, inconsistencies, and errors.

Delayed Reporting: Traditional paper-based reporting systems are prone to delays and inaccuracies, affecting the timely delivery of care and the escalation of critical health issues.
Accessibility and Reach: Ensuring that healthcare services reach the most remote and underserved populations is a persistent challenge in many regions.

How Maitree Enhances Integration

Real-time Data Syncing: Maitree facilitates real-time data entry and syncing with central databases. This timely data transfer can support quicker decision-making and more responsive healthcare services.

Standardized Reporting: The app provides a standardized platform for reporting healthcare activities, which reduces the likelihood of errors and ensures consistency in the data captured across different regions and levels of the healthcare system.

Interoperable Systems: Maitree’s design allows for integration with existing government healthcare systems, such as the Mother and Child Tracking System (MCTS) and other regional health service databases.

User-Friendly Interface for Data Entry: The app’s interface is designed to be intuitive for ASHAs, reducing the risk of data entry errors and ensuring that even less tech-savvy users can contribute accurate data.

Decision Support: Maitree can be equipped with decision support systems that assist healthcare workers in identifying high-risk cases and ensuring that they receive timely care.

Steps to Integrate Maitree

Collaboration with Stakeholders: Engagement with government bodies, healthcare providers, and technology partners is crucial for understanding the requirements for integration and ensuring alignment with existing workflows.

Adhering to Standards: Compliance with data security and privacy standards, as well as healthcare interoperability protocols, is necessary to facilitate secure and seamless data exchange.

Pilot Programs: Conducting pilot programs to test the integration in a controlled environment can help identify potential issues and refine the process before scaling up.

Training and Capacity Building: Providing comprehensive training to ASHAs and other healthcare workers on using the app and understanding the benefits of integration is essential for successful implementation.

Feedback Loops: Establishing mechanisms for feedback from users and continuously monitoring the system’s performance will lead to improvements and better user adoption.User

Experience and Accessibility

Maitree’s intuitive user interface, featuring local language support and multimedia, has reduced training times and improved adoption rates among ASHAs.

Maitree’s Cost-Benefit Analysis

The Maitree app’s deployment in the healthcare sector has demonstrated a significant impact on both health outcomes and operational efficiency. To better understand its value, a cost-benefit analysis is crucial. Here are the primary components of Maitree’s cost-benefit analysis drawn from the user’s knowledge base:

Costs of Implementing Maitree

Hardware Expenses: The primary expenditure associated with Maitree is purchasing the tablets (or equivalent hardware) used by ASHAs. Each tablet costs approximately INR 6,000.

Training Expenses: Training for ASHAs is essential for the effective use of Maitree. The training is estimated to cost about INR 2,000 per ASHA annually.

Technical Support and Maintenance: Ongoing support and maintenance of the Maitree app are expected to cost about INR 4,000 per ASHA, encompassing app development and upkeep.

In-person Meetings and Fieldwork: Additional costs involve regular meetings and on-field activities with ASHAs to ensure the program’s smooth operation.

Benefits of Implementing Maitree

Improved Data Management: Maitree enhances the speed at which data is available to government systems, reducing delays and facilitating quicker payment processes to ASHAs.

Enhanced ASHA Efficiency: The app has improved ASHA’s efficiency by providing a user-friendly, simple, and intuitive tool that reduces information delays to functionaries.

Consistent Health Messaging: The application delivers consistent health education messages through its video content, ensuring that all beneficiaries receive the same quality of counseling irrespective of the educational background of the ASHA.

Potential for Expansion: Maitree holds the potential to be utilized in broader health initiatives like the Rashtriya Bal Swasthya Karyakram (RBSK) and other disease tracking programs, which could touch the lives of approximately 1.24 Crore people under RBSK.

Community Engagement: With more than 700 records gathered, local sponsors have used Maitree’s data for community service, facilitating the transport of mothers and children to hospitals for check-ups.

Measurable Outcomes

Usage Statistics: Since April 2015, Maitree’s data shows that counseling and Home-Based Newborn Care (HBNC) videos have been utilized 23,989 times, totaling 568 hours. The average monthly usage per ASHA increased from 10 minutes at the start to 90 minutes at the end of a 5-month window.

Knowledge Improvement: ASHAs who used Maitree showed increased knowledge in critical maternal and child health topics, and beneficiaries confirmed receiving messages in a more consistent and higher quality manner compared to manual methods.

Lessons Learned and Recommendations

Sustained Support: For Maitree’s benefits to be fully leveraged, it needs to be integrated with the health ecosystem and avoid causing confusion by requiring ASHAs to enter data multiple times.

Overcoming Double Data Entry: Since Maitree operates independently of government systems, ASHAs often had to input the same data twice, leading to confusion.

Knowledge and Empowerment Through Maitree
The Maitree app represents a significant leap in community health service delivery, particularly for Accredited Social Health Activists (ASHAs) in the Andhra Pradesh region of India. The app’s impact extends beyond just health outcomes—it empowers ASHAs with knowledge and resources, leading to stronger healthcare systems and communities.
Empowering ASHAs

Enhanced Training: ASHAs using the Maitree app show improved knowledge of critical maternal, newborn, and child health (MNCH) topics. The app’s engaging video content on Home-Based Newborn Care (HBNC) and counseling techniques has facilitated a better understanding of healthcare practices.

Confidence in Delivery: With consistent messages delivered via the app’s videos, ASHAs can provide uniform advice to beneficiaries, which is particularly important given the varying educational backgrounds of ASHA workers.

Usability: Maitree’s interface—simple, intuitive, and in the local language (Telugu)—is specifically designed for community health workers, making it quickly understandable irrespective of their education level.

Technology Adoption: The introduction of Maitree has encouraged ASHAs to embrace technology as a tool for enhancing their work, thus fostering a technology-friendly attitude among community health workers.

Community Impact

Accessibility of Information: By offering guidance in the local language and with an easy-to-use interface, Maitree makes health information accessible to ASHAs and, by extension, the communities they serve.

Local Sponsor Engagement: Data collected weekly through Maitree has been shared with local sponsors, leading to communal support and engagement. Sponsors have used this data to help transport mothers and children to hospitals for check-ups, thus forging a stronger community health system.

Feedback Mechanism: ASHAs have been forthcoming with feedback, demonstrating their readiness to adopt and engage with the app’s features, leading to continuous improvement in functionalities.

Knowledge Dissemination

Consistent Health Messaging: ASHAs deliver government health messages accurately and consistently, ensuring that every beneficiary receives the same quality of information and guidance.

Real-time Information Sharing: The supervisors of ASHAs receive the data entered into Maitree in real-time, allowing for prompt action on different health-related issues and activities.

Technology and Potential

Open Source Platform: Developed using open-source technologies, Maitree has successfully undergone user validations and can potentially be adapted for other health programs like the Rashtriya Bal Swasthya Karyakram (RBSK).

Extension Possibilities: Maitree has the potential to expand beyond its current scope to assist in tracking and managing other significant health programs for diseases like TB or HIV.

Overcoming Challenges

Double Data Entry: One of the challenges highlighted by ASHAs was the double entry of data—once for Maitree and again for claiming their incentives. Seamless integration with government systems could resolve this issue.

Language Variations: While designed in Telugu for Andhra Pradesh, expanding the app’s reach would require adaptations to other regional languages to maintain effectiveness and user experience.

Challenges and Feedback from the Field
While the Maitree app has made strides in enhancing healthcare delivery through technology, its deployment has also encountered challenges. Feedback from ASHAs and other field workers provides valuable insights into the app’s practical impact, its efficiency, and areas for improvement.

Field Challenges

Connectivity Issues: In remote and rural areas, inconsistent internet connectivity can hinder real-time data synchronization and access to video content, a core feature of Maitree.

Device Management: Ensuring that each ASHA has a functional tablet and addressing issues like damage, theft, or technical malfunctions can be logistically challenging and costly.

Training Gaps: Although training sessions are provided, some ASHAs may require additional support to fully utilize all of Maitree’s features due to varying levels of technological literacy.

Data Entry Duplication: ASHAs have reported the inconvenience of entering data twice—once in Maitree and again in government systems for incentive claims—which can be time-consuming and demotivating.

Language and Content Localization: Adapting the app’s content and interface to reflect local dialects and culturally relevant scenarios is essential for effective communication, but it also presents a challenge in terms of resource allocation and scalability.

ASHA and Beneficiary Feedback

User Experience: Positive feedback has highlighted the user-friendly design of the app, which has facilitated easy adoption even among less tech-savvy ASHAs.

Confidence in Service Delivery: ASHAs have expressed increased confidence in their counseling sessions and service delivery due to the standardized and well-structured information provided by Maitree.

Data-Driven Decisions: Real-time data collected by the app has been praised for enabling timely and informed decision-making at various administrative levels.

Improved Engagement: The interactive features of the app, such as multimedia content, have increased the engagement of both ASHAs and beneficiaries, making health education more appealing.

Recommendations from the Field
Enhanced Support: ASHAs suggest ongoing technical and functional support to address issues promptly and maintain the app’s usability in challenging environments.

Integration with Existing Systems: To avoid data duplication and streamline reporting processes, ASHAs recommend integrating Maitree directly with government incentive systems.

Additional Content: Field workers have requested the expansion of content to cover a wider range of health topics and scenarios, tailored to local needs and practices.

Hardware Solutions: Feedback points towards the need for robust tablets with longer battery life and better connectivity options to alleviate hardware-related challenges.

Continuous Training: There is a clear need for continuous, refresher training sessions to keep ASHAs updated on new features and ensure the sustained effectiveness of the app.

The Future of Maitree and mHealth in India
Mobile health (mHealth) applications such as Maitree are at the forefront of transforming India’s healthcare landscape. These technologies not only facilitate improved healthcare delivery but also lay the foundation for a more informed and empowered population. Let’s delve into the prospects of Maitree and the overall mHealth ecosystem in India.

Advancements in mHealth Technologies

Artificial Intelligence and Machine Learning: Future versions of Maitree could incorporate AI algorithms to provide personalized health recommendations and predictive analytics based on user data.

Internet of Things (IoT): Integrating IoT devices could enable real-time monitoring of patients’ vitals, offering a more comprehensive view of health statuses to healthcare providers.

Blockchain: Secure data sharing and management through blockchain can ensure patient privacy while maintaining transparency across the health system.

Maitree’s Roadmap

Government Integration: Aligning the app with national healthcare programs and databases is a key priority to eliminate double data entry and create a more cohesive health information system.

Scaling Up: Expanding the app’s reach to other states and regions, and tailoring it to different languages and health contexts, is essential for national impact.

Enhanced Functionalities: Building upon feedback, Maitree may include additional features such as chatbots for instant queries and support for community health workers.

Sustainability Model: Establishing a sustainable financial and operational model for Maitree is crucial for its long-term viability and expansion.

Expansion of mHealth in India

Collaboration with Telemedicine: As telemedicine initiatives grow, mHealth apps like Maitree can serve as complementary tools, facilitating remote consultations and follow-ups.

Public-Private Partnerships (PPPs): PPPs can leverage private sector innovations and public sector reach to scale mHealth solutions sustainably across India.

Digital Health Policy Framework: The Indian government’s commitment to digital health, exemplified by initiatives like the National Digital Health Mission (NDHM), provides a conducive environment for mHealth applications to thrive.

Community Education and Involvement: Continuous education around mHealth benefits and active community involvement will be key to driving adoption and overcoming resistance to new technologies.

Challenges Ahead

Equitable Access: Ensuring that mHealth technologies are accessible to all segments of the population, including the rural and underprivileged, is critical for equitable healthcare delivery.
Regulatory Hurdles: Navigating the complex regulatory landscape and meeting stringent data privacy and security standards will be an ongoing challenge.
Cultural Sensitivity: Adapting technologies to align with diverse cultural beliefs and practices will be necessary for meaningful engagement and effectiveness.

Maitree exemplifies the transformative power of mHealth applications. Its continued development and integration with healthcare systems hold the promise of better health outcomes and a brighter future for maternal and child health in India.
As Maitree’s journey continues, we invite our readers to reflect on the profound impact that such applications can have on the health of millions and the empowerment of healthcare workers like ASHAs who are at the forefront of this change.