m-DIATM (Mobile Diagnostic Tools Monitoring System)

Pneumonia is considered the leading cause of childhood morbidity and mortality. According to an HMIS report of 2019 – 2020, Pneumonia caused 17% of infant deaths between the ages of 1  - 12 months and 7% of deaths in the age groups of 1 – 5 years in India. Among the 12 diseases treated at OPD at public health facilities in India, pneumonia contributes to 45% of the childhood morbidity. Uttar Pradesh reported 54,637 cases of Pneumonia between the ages of 0 – 5 years for the same period. The proposed solution will be utilized in an ongoing UNITAID funded PATH project “Tools for Integrated Management of Childhood illnesses” . The project is being implemented in the Northern state of Uttar Pradesh, India. Under the project, Pulse oximeters (POX) and Clinical Decision support algorithm (CDSA) devices have been provided to the public health facilities for prompt screening and diagnosis of Acute Respiratory Infections (ARI) cases among. The devices provided at the health facilities for early identification and diagnosis of Acute Respiratory Infections (ARI) has led to prompt management and referral of cases. World Health Organization recommends use of pulse oximetry for identifying hypoxemia, since empirical evidence suggest that early detection of hypoxemia in cases of pneumonia leads to better management of cases and reduced mortality.

For the continued early identification and referral of cases of Acute Respiratory Infections (ARI) and impacting the mortality due to pneumonia, it is essential that all the devices i.e., pulse oximeters and CDSA tablets are functional at all the times. At present there is no system for systematically gathering real time information on the functionality of the devices. In an event a devices become non - functional, the information is shared telephonically, and the time taken to replace the non-functional devices can be few hours to few days which results in many children with hypoxia being missed.

With one district coordinator to monitor 30 health facilities in a district, on an average each facility gets monitored once in 30 days. Monitoring the functionality of pulse oximeter and eCDSA become challenging with limited human resources, and a mobile based solution will be pivotal in ensuring that real time information regarding the critical devices is available round the clock so that in an event of breakdown the replacement devices could be arranged in the shortest possible time.  The mobile based solution will also facilitate the health facility in-charges to report and resolve the problems associated with non-functional devices and reduce the reliance on the monitoring visit by the district coordinator. It is anticipated that based on the results of the pilot phase and user feedback other vital devices available at the health facility can also be added to the mobile based solution during the scale-up phase.

The team proposes to develop a mobile-based application(which can be accessed through smartphones, tablets as well as desktops) for real time information of the pulse oximeters and the CDSA tablets; the functionality of the POX and CDSA tablets, whether they are being used and if they are functional. The application will provide a map view of the location and number of the equipment deployed at pilot facilities. The real time monitoring will also provide information for the nearest facility from which equipment can be loaned/ transported if certain facility’s equipment is non – functional. The application will be handled at district level by the district lead for the project. The users for the application will be the medical officers present at the facility. Every morning, the medical officers will update the information related to the devices on the application. The information collected will be provided as a dashboard to the district lead. As per the information generated, the district programme managers or district coordinators will notify the nearest health facility with the available devices and arrange for the expedited transportation.

The application will be developed with the involvement of the user i.e., the medical officers and service providers at the health facilities. The proposed mobile based application will be easy to use with a user-friendly interface and will require minimum maintenance, and can be operated using any android phone or any tablets

The government of  Uttar Pradesh have  an online “Drugs and Vaccines Distribution Management System”  (https://updvdms.dcservices.in/IMCS/hissso/loginLogin.action) which facilitate in real time monitoring of availability of drugs, vaccines and other consumables at the district level. The proposed mobile based solution created will be fully integrated with the existing system for management of drugs and vaccines.  

The application aims to provide real time information regarding  the functionality of the critical  devices like Pulse oximeters and eCDSA tablets at public health facilities. This solution will be used by medical officers and other paramedical workers involved in identification and management of children less than 5 years presenting with Acute Respiratory infection(ARI). The solution will facilitate availability of functional Pulse oximeters and eCDSA devices at public health facilities which will further facilitate early diagnosis and prompt management of children less than 5 years of age presenting with Acute Respiratory infection. Thus, reducing the mortality on account of Acute Respiratory Infections (ARI).

Upon successful piloting of the mobile based solution, the findings will be shared with the state and district health authorities to advocate for the scale-up and inclusion of other critical devices.

The TIMCI project has been successfully implemented in the target geography since last year. PATH has their own personnel at the facilities and therefore, are well positioned and adept in delivering the solution. 

The challenge provides an opportunity for improving the system of tracking critical diagnostic equipment. Although, we are submitting the concept as the current research opportunity does not have provision for testing the use - case for m - DIATM. This concept can be quickly scaled up to 170,000 public health facilities across the country for monitoring the functionality of critical equipment like Pulse oximeters and eCDSA tablets. We hope that this platform will help us network with agencies/ donors interested in addressing this gap.

The challenge will provide a platform to test the concept. This hypothesis testing will pave the way for further research and solutions on the processes involved in provision of primary health care with a focus on the effects of the downtime of critical diagnostic devices. The solution has a human centric approach with the critical involvement of the users during the development phase. This approach will help in making an application that addresses the concerns of the users and is user friendly.

The target over the next year would be to successfully test and evaluate the usability of the application developed. The evaluation will provide the empirical data as to whether the application has a potential to be scaled up or not.

The team intends to utilize an open-source digital platform like DHIS 2 for the development of this application.

The primary data will be collected at the district level and utilized by
the district lead for obtaining information of the functionality of the
devices. The health care providers present at the facilities will be able to
view the presence of devices at other facilities to quickly replenish/ loan
critical devices in cases of shortage/ non – functionality. The data on the
functionality of the devices will be fed by the health care providers.

The team would include equal number of women as compared to men. The team is being led by an accomplished female public health expert.

The solution once developed and successfully tested would be available freely to anyone who would like to use it. The application will be open sourced.

The solution’s target user is envisioned as government. The government requires such open sourced, free available application to track the functionality of many essential devices present at the public health facilities. The team plans to provide the software to the government when requested for and the government can provide the essential finance for the backend support for the data base and for troubleshooting user issues. 

The team has developed a similar application for the use of government for early identification and quick response when a new case for Lymphatic Filariasis is reported in the state.

The application has been successfully pilot tested and is being implemented in 75 districts of the state with full support financially and administratively by the government of the state of Uttar Pradesh.