Sushma Taywade

Placed at:   Mandla, Madhya Pradesh 24 Dr. Sushma Taywade

Education: Bachelors in Ayurvedic Medicine & Surgery from Pt.K.L.Sharma Govt. Ayurvedic Medical College & Institute Bhopal, M.P., Master’s in Hospital Administration from Institute of Management Studies, DAVV Indore M.P. Post Graduate Diploma in management of Reproductive and Child health programmes

Prior work experience:

Worked as a Healthcare Quality Consultant for implementation of Indian Public Health Standard and ISO certification in all levels of public health centers under NRHM Govt. of Maharashtra.
One key work during fellowship
Issue:

Mandla is a predominantly tribal district with low education and health indicators. It also figures in the 17 high risk districts on parameters of maternity and child health of the state. Undulating terrains, large geographical area, thinly populated habitations and villages renders a big challenge for qualitative delivery of services. The district also witnesses high incidence of malnourishment. Malnutrition in Madhya Pradesh is much higher than the national averages for India. Malnourishment in children and women is a major determinant of mortality and morbidity. It is important to remember that the body’s resistance to disease can be effectively developed through adequate nutrition.
The department of Women & Child Development is one of the very few department with mandate of universal coverage which not only requires service delivery to a large number of beneficiaries but the staff through which services are being delivered is huge in numbers. Therefore, at times it becomes difficult to ensure qualitative delivery of services at the cutting edge level.
Any strategy which may prove to be effective in arresting the increasing trend of malnourishment should invariably include correct identification of malnourished children. I believe this is the first and one of the most critical steps towards formulating a strategy for addressing malnourishment. Traditional system for identification of malnutrition status of a child seems to be process intensive, elementary and prone to human error. The usual practice of any Aanganwadi worker is to first measure the weight of a child then plot a graph on the WHO graph sheet. This manual process was a bottleneck in correct identification of nutrition based classification of category of a child. It was also observed that some Anganwadi workers did not know how to plot WHO Graph of a child which was affecting the actual identification of severely malnourished children. And once such child is left out in such a manner, he/ she actually further deprived of the protocol and corrective actions set for malnourished children.

It was also observed that field staffs (Anganwadi Worker) were not taking regular measurements of every child at required time intervals and hence identification of actual category of malnutrition was inaccurate. The regular and intensive monitoring and follow-ups of malnourished children were also not strong enough in the manual process because monitoring of ICDS supervisor’s regular field visits was also a big challenge for the department.

What was done:

District Mandla, Madhya Pradesh has introduced ‘Vatsalya Mandla’, a GPS enabled Tablet/Mobile Android based Application operating in both online/offline modes for data capturing and reporting.
It is the only district in Madhya Pradesh where Women and Child Development Department’s Sector Supervisors (72 Nos) are using tablets application for reporting and monitoring. The Vatsalya software automatically identifies malnourished children as per WHO graph and send alerts to various key officials about severely malnourished children to be sent to NRCs. Online records of almost one lac children already being maintained and monitored using the Vatsalya application.
 GPS enabled tablets provided to all district, block and sector level staff – Smooth, real time and correct flow of data is a pre condition to ensure effective functioning of ICDS services. There are 2100 Aanganwadi centres, 72 Sector Supervisors and 9 Community Development Project Officers at the block level. It is an uphill task to collect, collate and analyse information from 2100 locations in a limited time period. Moreover, if this entire set of activities has to be done on a monthly basis quality of data becomes a serious issue. A rough estimate to calculate the transition time of flow of information from Aanganwadi to district level requires 10-12 days.

Under Vatsalya Mandla project all the department functionaries till sub- block/ sector level have been provided with GPS- enabled tablet which uses an online application to create digital record of every child registered at Aanganwadi Center. Sector supervisor does the monthly data entry for weight of children registered in all Aanganwadi Centers under her sector. This data is easily synchronised at the server which enables generation of several types of reports for further follow ups.
 Online application & simplest possible of data entry – The Vatsalya Mandla software works on a very simple principle of monthly data entry. As soon as a child’s weight data is entered on the application, it automatically identifies malnourished children according to the WHO standards. Even growth charts of every child registered in a Aanganwadi centre is auto plotted which also enables to generate Aanganwadi/ sector/ block wise list of children under normal, malnourished and severely malnourished children. This was very simple but a great leap in ensuring effective delivery of services atleast to the most deserving children because numbers of malnourished children were actually having a name now at every tier of the departmental set up. To ensure effective monitoring, this list of malnourished children is accessible to various key officials in the district including NRCs.
 Strengthening of monitoring. Geo- mapping of each Aanganwadi in the district has been done. Inspections being done by a sector supervisor or CDPO generates an inspection log which shows the location of visit vis a vis the location of Aangadiwadi centre. This innovative feature of using GPS enabled tablet has resulted in actual inspections of Aanganwadi being done by the sector supervisors and CDPOs as the number of visits in a month and their actual locations can be traced through the Vatsalya Mandla software. Regular and frequent visit by the supervisory staff has resulted in the strengthening of monitoring thereby, in improving the delivery of services.

 Data analysis made possible- Data captured from Aanganwadi provides a mine of information which enables generation of several types of reports for further follow ups especially for malnourished children e.g.

• Aanganwadi/ sector/ block wise list of malnourished children
• List of children whose weight measurements not recorded during a month
• List of children whose weight is consistently decreasing over a period of time
• Inspection log of sector supervisors and CDPOs
• Children who needs to be admitted to NRCs

Capturing data even from shadow areas – About 50% of the district’s geographical area is under forest cover and Mandla district has one of the highest numbers of forest villages in the State. Spread over some 9000 sq. kms there are many villages where there is no any connectivity of mobile or internet (shadow areas). Keeping this fact in mind, the software application was prepared in a manner to capture data even from such locations which falls under shadow areas. So the software application can function even in offline mode.

Other important features:
It also ensures regular monitoring of data entries and follow-up of severely malnourished children through regular alerts to various key officials and generates various required reports. Other important features of Vatsalya are as follows:-
1) Communication started with Parents through SMS Alerts
2) Tablet based data capturing
3) Geo-mapping of Aanganwadis
4) GPS tracked Field Visits/Aanganwadi Inspections of supervisors
5) Alerts for children above 5 yrs –these children must be enrolled in school .

Impact:

Intensive efforts and time lags required for data collection, collation and finalisation to generate various required reports has been reduced remarkably. The focus of the entire team has now shifted from mere collection of data to its optimum use through Vatsalya application. It has also reduced costs of stationary materials invested for collecting huge numbers of data offline across all Anganwadis of the district.
Vatsalya application has greatly helped in auto-identification of various categories of malnourished children as per WHO standard. It has also improved intensive monitoring of malnourished children and regular follow-ups of severely malnourished children for NRC admits. Previously identification of malnutrition was carried out manually by using WHO graph, which was inaccurate in many cases because of lack of skills to use that graph, negligence by Anganwadi worker/field staffs and lack of effective monitoring mechanism and follow-ups etc.
Data capturing with the help of Tablet (inbuilt with Vatsalya android application) by Sector Supervisors has removed various manual data collection and reporting processes. It has improved accuracy of data collection and reporting drastically. Now senior district level officials can easily monitor status of malnutrition and field visits of sector Supervisors thereby ensuring actual field inspections. The follow-ups of NRC admission have increased significantly by top level officials. The application has helped greatly to severely malnourished category children & their families as they were having higher risk of exclusion in that category because of negligence/ indifference of aanganwadi workers.
Some of the Output of Vatsalya Mandla Application-
• No of children registered (0-5yr): Almost 1 lac
• No. of children weight has taken: More than 90 % per month.
• No of field visits per month done by Supervisors: Max.1631 ( Avg-22 visits/Sector Supervisor/month)
• Malnourished children Identification Gap: Severe Malnourished -945, Moderate – 4509
• Percentage of NRC occupancy utilized – Above 90%
• Alerts for children above 5 yrs –these children must be enrolled in school, around 14,000 children are already enrolled in the school.
AWARDS & ACCOLADES-
• CSI-Nihilent e- Governance “Awards for Excellence 2013-14” for Innovative Use of Mobile Technology.
• Winner of MAP-IT (Madhya Pradesh Agency for Promotion for Information & Technology) “m-Governance Award 2013-14”.
• Runner up of m-Billionth South Asia Award 2015 under m-Health category.
• Nominated for Pradhan Mantri Excellence Award 2015.