Project ASMAN: Supporting Maternal and Newborn Health Programs through Data Collection

Sumer Drall, Intern, Community Systems Foundation

Seth Davis, Programme Advisor, Community Systems Foundation

The text below is a reblog of Project ASMAN’s June 2019 newsletter which can be downloaded here. 
Maternal health is often considered to reflect a country’s healthcare system. When a pregnant woman faces challenges or complications at the time of delivery, all the elements of a healthcare system from doctors and nurses, to well-equipped and adequately stocked healthcare clinics, must come together to ensure the mother and her baby survive and thrive. 

In the last decade, India has made great strides in improving maternal health. The maternal mortality ratio (MMR) has been reduced to 130 per 100,000 live births in 2014-16 (1), but this needs to come down even further, to 70 by 2030, in line with the global Sustainable Development Goals (2). Likewise, while there has been a rapid decline in under-5 deaths (3), India still loses about 2040 new-borns every single day (4). India needs to reduce its neonatal mortality rate to 12 or less by 2030, in keeping with the Sustainable Development Goals (5).

It is but obvious that this task, of reducing maternal and newborn deaths, needs to be taken on a war footing. Given the wide variation amongst the states, ASMAN has been rolled out as a proof-of-concept, in 81 select healthcare facilities in the two high-need states of Madhya Pradesh and Rajasthan, where maternal and neonatal mortality rates are amongst the highest.
​The ASMAN Programme
Empowering nurses and healthcare providers to use best practices and deliver quality care during delivery and for the first 48 hours after birth, is critical, to ensure the survival of mothers and newborns. The ASMAN programme delivers this through in-facility and on-ground support; provision for continual learning; and remote support centres.

Present across 81 healthcare facilities in Rajasthan and Madhya Pradesh, the ASMAN digital platform is a tablet based intrapartum and immediate postpartum decision support tool for healthcare providers:

• Nurses use the platform to enter real time data on digitised maternity case sheets. These case sheets include digitised Safe Childbirth Checklist along with provision for digital vital recording.
• The e-partograph helps monitor labour progress.
• Alerts and notifications inform staff about high-risk cases so they can receive timely support.              
• A Live dashboard helps health workers and managers monitor all cases in real-time; identify and manage high-risk cases; refer cases to higher centres; and make urgent decisions if necessary.​​

Continual learning is an important pillar of ASMAN. The programme makes use of game-based case scenarios and e-learning modules to keep the nursing staff informed and equipped to handle complicated cases. It also makes use of some of the existing government initiatives to train healthcare providers about safe childbirth practices and management of complicated cases.

Remote support centres have been set up at 3 medical colleges in Rajasthan (Kota, Ajmer and Jhalawar) and 1 medical college in Madhya Pradesh (Indore) for round-the-clock support. Here, specialist doctors are available whenever required to help advise or confirm a nurse’s choice of intervention in the event of a complicated case. This support is already helping to reduce referrals because nurses have the confidence to manage cases at their health facility itself.

Additionally, on-ground support through mentoring and supervisory visits from the programme officers are helping to support nurses and improve the availability of necessary amenities in the labour room.

Early trends are showing improvement in facility case management and appropriate referrals.

To stay updated on Project ASMAN and subscribe to their newsletter, please visit http://www.asmanalliance.in/.

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(1) WHO South-East Asia Regional Office. India has achieved groundbreaking success in reducing maternal mortality. [online] Available at: http://www.searo.who.int/mediacentre/features/2018/india-groundbreaking-sucess-reducing-maternal-mortality-rate/en/ 
(2) World Health Organization. SDG 3: Ensure healthy lives and promote wellbeing for all at all ages. [online] Available at: https://www.who.int/sdg/targets/en/ 
(3) UNICEF. Neonatal Health | UNICEF. [online] Available at: http://unicef.in/whatwedo/2/neonatal-health
(4) Vikaspedia. India Newborn Action Plan — Vikaspedia. [online] Available at: http://vikaspedia.in/health/nrhm/national-health-mission/india-newborn-action-plan
(5) Sustainable Development UN. Goal 3: Sustainable Development Knowledge Platform. [online] Available at: https://sustainabledevelopment.un.org/sdg3 ​
(6) ASMAN IMPACT. ASMAN Alliance. Available at: https://www.asmanalliance.in/