Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India.
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India.
Front Public Health. 2022 Jul 22;10:856561. doi: 10.3389/fpubh.2022.856561. eCollection 2022.
Technology Enabled Community Health Operations (TeCHO+) is a mobile and web-based application (app) for frontline health workers. It includes features such as real-time data entry, automated generation of the work plan, and a decision support system generating alerts for high-risk cases. Since 2019, the programme is implemented across all 33 districts of Gujarat, catering to a population of over 60 million. This study aims to compare changes in the coverage, quality of data reporting maternal and child health services, and time spent in the documentation before and after the introduction of the TeCHO+ app.
To address the study aim, a mixed-method design with a realist evaluation approach was adopted. The survey was conducted with randomly selected beneficiaries from 32 sub-centers across two districts of Gujarat State in India. We surveyed 215 postpartum women and mothers of 102 children at baseline (pre) and 246 postpartum women and mothers of 119 children post 1 year of the TeCHO+ programme intervention in 2020. For qualitative data, total 29 Auxiliary Nurse Midwives, 12 Data Entry Operators and 10 Primary Health Center Medical Officers were purposively selected from 32 PHCs and interviewed to understand the pathways leading to the programme outcome.
Following introduction of TeCHO+, the coverage of full antenatal care (ANC; 75.6% vs. 67.9%, -value < 0.0001), consumption of at least 180 iron-folic acid tablets (93% vs. 77%, -value < 0.001), early initiation of breastfeeding (42.7% vs. 24.2%, -value < 0.001), five home-visits by ANM during the first month after delivery (36.2% vs. 27.9%, -value = 0.056), HBV0 vaccination (67.2% vs. 35.3%, -value < 0.0001) and Pentavalent 2 (100% vs. 95.1%, -value = 0.015) improved. The overall concordance rate for routine maternal health indicators (a measure of data quality) improved from 69.1 to 80.5%, while that for routine child health indicators improved from 86.6 to 92.1%. The programme resulted in 1.7 h saving a day of ANM's productive time and 1.5 h (a day) of data entry operator's time.
The TeCHO+ programme has improved access to care. It impacted both coverage of maternal and child health services and data reporting quality of various maternal and child high-risk conditions. Considering the programme's success, other disease services might be added to the scope of TeCHO+ software.
技术赋能社区卫生运营（TeCHO+）是一款面向一线卫生工作者的移动和网络应用程序（app）。它具有实时数据录入、自动生成工作计划以及为高危病例生成警报的决策支持系统等功能。自 2019 年以来，该项目已在古吉拉特邦的 33 个区实施，服务人群超过 6000 万。本研究旨在比较在引入 TeCHO+应用程序前后，孕产妇和儿童卫生服务覆盖范围、数据报告质量以及文档记录时间的变化。
为了实现研究目标，采用了混合方法设计，并采用现实主义评估方法。该调查是在印度古吉拉特邦两个区的 32 个基层医疗中心随机选择的受益人中进行的。我们在基线（预）调查了 215 名产后妇女和 102 名儿童的母亲，在 2020 年 TeCHO+项目干预 1 年后调查了 246 名产后妇女和 119 名儿童的母亲。对于定性数据，我们从 32 个初级保健中心中专门选择了 29 名辅助护士助产士、12 名数据录入员和 10 名初级保健中心医疗官员进行访谈，以了解导致该项目结果的途径。
在引入 TeCHO+之后，全面产前护理（ANC；75.6% 对 67.9%，-值<0.0001）、至少服用 180 片铁叶酸片（93% 对 77%，-值<0.001）、早期开始母乳喂养（42.7% 对 24.2%，-值<0.001）、产后第一个月由 ANM 进行的五次家访（36.2% 对 27.9%，-值=0.056）、乙肝疫苗 0（67.2% 对 35.3%，-值<0.0001）和五联疫苗 2（100% 对 95.1%，-值=0.015）的覆盖率有所提高。常规孕产妇健康指标（数据质量的衡量标准）的总体一致性从 69.1%提高到 80.5%，而常规儿童健康指标的一致性从 86.6%提高到 92.1%。该项目使辅助护士助产士每天的生产时间节省了 1.7 小时，数据录入员的时间节省了 1.5 小时（每天）。
TeCHO+项目提高了获得医疗保健的机会。它既影响了孕产妇和儿童卫生服务的覆盖范围，也影响了各种孕产妇和儿童高危情况的数据报告质量。考虑到该项目的成功，可能会将其他疾病服务添加到 TeCHO+软件的范围中。
