Gupta Anil, Agrawal Ritu, Gupt Anadi, Guleri Rajesh, Bajpayee Devina, Joshi Naresh, Sarin Enisha, Gupta Sachin, Kumar Harish
IPE Global, New Delhi, India.
Department of Health and Family Welfare, National Health Mission, Himachal Pradesh, India.
J Family Med Prim Care. 2021 Oct;10(10):3712-3719. doi: 10.4103/jfmpc.jfmpc_466_21. Epub 2021 Nov 5.
High-risk pregnancy (HRP) puts current pregnancy at an increased risk of complications. In the absence of pre-existing HRP implementation model of the country, in collaboration with the Government of Himachal Pradesh, a new digital HRP model called the 'SEWA-A System E-approach for Women at risk' was developed. The current article demonstrates a model for the early identification and line listing of high-risk pregnant women (PW) with appropriate referrals and increased engagement with the healthcare workers using a digital tool in the form of the Android App.
SEWA was implemented as a pilot intervention in two community development blocks of the Chamba district. The key implementation steps included finalizing protocols for the identification of HRPs, defining processes and roles, mapping health facilities, setting up the communication loop, and developing of digital solutions. The digital app, used by the auxiliary nurse midwife (ANM) and program officers, tracked PW for a year from October 19 to October 20 and recorded the ANC visits, referrals, and birth outcomes. A qualitative assessment was conducted among the health workers to find out their level of acceptance.
A total of 1,340 high-risk PW were identified. The intervention year saw a rise in the identification of HRP to 27.9% from 3.5% in the previous year. A total of 2,559 conditions were tagged to the identified 1,340 women categorized into current pregnancy (81%), previous pregnancy (16%), and any existing chronic illness (3%). A majority of the women who required urgent referrals were provided referrals. The application recorded 53% of the delivered HRP with a digital birth preparedness plan, prepared and shared with the PW and Accredited Social Health Activists (ASHA), by text message for compliance.
The SEWA application is a feasible and sustainable solution to complement the competency of the care providers for early identification of the high-risk conditions and reduce the burden of preventable unprecedented deaths around the time of birth.
高危妊娠（HRP）会使当前妊娠出现并发症的风险增加。在该国缺乏预先存在的高危妊娠实施模式的情况下，与喜马偕尔邦政府合作，开发了一种名为“SEWA——针对高危女性的系统电子方法”的新型数字高危妊娠模式。本文展示了一种通过安卓应用程序形式的数字工具，对高危孕妇（PW）进行早期识别和列管，并进行适当转诊以及增强与医护人员互动的模式。
SEWA在昌巴区的两个社区发展街区作为试点干预措施实施。关键实施步骤包括确定高危妊娠识别方案、定义流程和角色、绘制卫生设施地图、建立沟通循环以及开发数字解决方案。辅助护士助产士（ANM）和项目官员使用的数字应用程序，从2019年10月到2020年10月对孕妇进行了为期一年的跟踪，并记录了产前检查就诊情况、转诊情况和分娩结局。对医护人员进行了定性评估，以了解他们的接受程度。
共识别出1340名高危孕妇。干预当年，高危妊娠的识别率从前一年的3.5%上升至27.9%。在识别出的1340名女性中，共标记了2559种情况，这些女性分为当前妊娠（81%）、既往妊娠（16%）和任何现有慢性病（3%）。大多数需要紧急转诊的女性都得到了转诊。该应用程序记录了53%已分娩的高危孕妇的数字分娩准备计划，该计划通过短信为合规目的准备并与孕妇和经认证的社会健康活动家（ASHA）共享。
SEWA应用程序是一种可行且可持续的解决方案，可补充护理提供者早期识别高危情况的能力，并减轻出生前后可预防的意外死亡负担。
