Dear Sunanda,
Thanks so much for your latest message to HIFA. It prompted me to review Vaishnavi's excellent blog:
Digital Health Obsession Has Compromised Care In Anganwadis
https://nivarana.org/article/Digital-Health-Obsession-Has-Compromised-Ca...
This blog reveals the folly of introducing excessive digital burdens on primary health workers without considering their basic needs. We learn of inadequate support, financial manipulation of health workers, breakdown in trust with the community, obligation to use apps that are not fit for purpose, increasing stress, and above all huge amounts of time to collect and input data, making it impossible for the health workers to do the main work - health care and health promotion - for which they are responsible.
We add to this the fact that many of them are being forced to buy and use personal mobile phones when their work phone becomes obsolete but is not replaced.
Below are the first three paragraphs; selected extracts; and a comment from me.
Digital Health Obsession Has Compromised Care In Anganwadis
Anganwadi workers are one of the largest volunteer health workforce in India. There are 14 lakh Anganwadi workers in India, who are the backbone of Mission POSHAN, previously known as the Integrated Child Development Scheme (ICDS). ICDS has been in existence since 1975, and it is one of the largest programs in the world which focuses on early childhood nutrition, care, education, and development. While ICDS only focused on calorie deficiency, this updated program covers aspects like dietary diversity, the promotion of a balanced diet, and behavioral change communication.
Anganwadi workers are the people on the ground who deliver all these services to the beneficiaries. Previously, they used to maintain all the data in the physical registers. But now, they have to compulsorily use a new mobile app called “Poshan Tracker” which is a digital data collection system linked with the Reproductive and Child Health portal of the Ministry of Health and Family Welfare. The government uses the data entered by workers for “real-time monitoring” of their work and the health status of the beneficiaries.
The workers have been using the Poshan Tracker app on mobile phones, either given to them by the government or on their own. As per the author’s experience, the work for Anganwadi workers has increased and become difficult after the introduction of the app. The introduction of technology has brought a change in the nature of the job of workers, from being community care workers to data collection agents for the government.
SELECTED EXTRACTS
We are asked to pay from our own pockets to get a new phone (from the government). So we try to buy a personal phone and work on it on our own. This way we save money. A lot of workers have paid ₹10,000 for a new phone too.”
“This phone is like a jhunjhuna (a toy for children that makes sounds all the time) forcibly given to us. It always keeps ringing, irritating us, and giving us work. We now have a 24-hour job because of this mobile phone. This jhunjhuna takes all our time,” said Worker R from Inderlok, Delhi.
The Anganwadi workers reported that they face hostility from the community when they ask for OTP [one-time password]. This has soured their relationship and is creating distrust between them and the beneficiaries.
The pressure to enter data on time has led workers to ignore their work in Anganwadi. Most workers reported that in Anganwadi centers, they are busy entering attendance and filling their physical registers, and they find no time in conducting activities with children and teaching them, which is their primary role... Their performance is now being analyzed not by how effective they are in the community, but by how effectively they enter the data.
Workers, under pressure to enter data, often enter fake data...
The position of workers at the bottom of the hierarchy, and the volunteer nature of their work, leave them with no power to raise their concerns but to follow orders.
Public health programs in India suffer from this digitalization and dashboard obsession. There has been an influx of an app or dashboard in every health-based scheme in India, be it Nikshay, Ayushman Bharat Health Mission, or Poshan Abhiyaan...
COMMENT (NPW): The above scenario describes a health system that is clearly doing the opposite of what it should be doing. In my view health systems (including digital health interventions) should be designed primarily to empower health workers to deliver the best possible health care and services with available resources. All else is secondary.
The blog also mentions use of personal mobile phones and unfair financial costs for health workers. It would be good to learn more about this, and about CHW programmes i other settings.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org