Navigating care for safe childbirth

When the farming community in Madya Pradesh, India produces acres of lush green crops ready for harvest, Nek Narayan Patel takes extra care to check on his pregnant clients who work the fields. As a patient care navigator who lives in the community, Patel knows that some expectant mothers may put their family’s welfare over their own health.

He recalls the story of one client who was pregnant with her seventh child and severely anemic. “But she did not want to lose her daily wage working in the pea field to visit the hospital,” he said, sharing how he called for an ambulance to convince the mother to visit the health facility for a blood transfusion.  “There is a lot of poverty in this area and during harvest season, all the villagers prioritize their fields over everything else.”

Patel, 41, has been a care-navigator since February 2022, a role designed to help monitor pregnant women at risk and get them the health care they need for a safe, healthy birth. He is one of 32 young, tech savvy men on motorbikes recruited through an innovative maternal health project, called Integrated Women in Health Network (iWIN), to assist auxiliary nurse midwives (ANMs) in ensuring women receive the right care, at the right time to prevent complications at birth.

This project is funded by Takeda Pharmaceuticals’ Global CSR Program, and led by Jhpiego, a global health non-profit and Johns Hopkins University affiliate, in partnership with the government of Madhya Pradesh. iWIN offers client-centered, continuous, and coordinated care by leveraging frontier technological solutions as well as programmatic innovations across public and private sector facilities. The overall goal is to reach  43% of the state’s population and impact care for  an estimated 900,000 annual pregnancies.

Care navigators are a strategic addition to the network of health services: they have a basic knowledge of government healthcare services, data entry, and the use of smartphones. Their familiarity with  community members, a desire to do good for their people, and their ability to be mobile make them a key asset to the community health system. In addition to navigating high-risk pregnant women, they also help ensure the availability of equipment and resources, the functioning of the ANM online application, called ANMOL, data quality, and adherence to best practices.

The care navigators also support ANMs in using the Bluetooth enabled point of care diagnostic kit, ‘ANMOL SAKHI, for antenatal checkups during Village Health and Nutrition Days (VHNDs).

Since the kit launched last summer, ANM Lakshmi Sharma has experienced its benefits firsthand. “We are now able to accurately measure fetal heart rate using the fetal heart monitor, check how a pregnant woman is gaining weight through the weighing machine, check blood pressure through the blood pressure instrument and also accurately get the hemoglobin using the hemoglobinometer right here in the village,” she said.

“These readings get added to the ANMOL application through Bluetooth which makes it even more convenient. And the care navigators are just a call away if we face any issue with the instruments or the ANMOL app. Plus, if we find ourselves running out of some drugs or consumables, the care navigator helps us procure those immediately. This helps us focus on our work and provide quality services to expectant mothers. Because of this, we are being able to detect more high-risk pregnancies and that too, in early trimesters.”

So far, Patel and the other iWIN care navigators have successfully guided over 20,000 high-risk pregnant women in Madhya Pradesh, ensuring the management of 91% of pregnancy-induced hypertension cases, 65% of gestational diabetes cases, and 79% of anemia cases. Through the care navigators’ supportive supervision of ANMs during the health days, the availability and functionality of equipment have increased from 69% to 86%, availability and sufficiency of resources have risen from 71% to 87%, and key practices have improved from 70% to 80%.

The success of the care navigation model has prompted other projects in women’s cancer to adopt this approach to ensure the continuum of care from screening to confirmatory diagnosis to treatment and follow up as per the diagnosis. In Madhya Pradesh, this role has influenced the scope of work of existing block-level community mentors who now also provide supportive supervision to ANMs and help navigate high-risk pregnant women.

Nek Narayan Patel knows his work is of utmost significance: “Very often in this community, pregnant women neglect their health because of lack of awareness. Anemia is a big issue. And of course, poverty.” Pointing to the women lined up at the Baroda Hada village day care center for the monthly health/wellness days, he says, “If these women were asked to go all the way to the community health center in Patan for their antenatal checkups, more than half of them would not go. I help ensure that VHNDs are as effective as possible as this is the closest and most convenient for women to visit. I help identify and manage high-risk pregnancies on time. I alert ANMs on birth preparedness and complication readiness. Like right now, one of the pregnant women who has come for ANC has low weight. So, she is at high risk. Her mid-upper arm circumference will confirm that she might be malnourished.” As he dashes off to speak to this woman and the ANM, he says, “We will ensure she learns about nutrition. We will alert the accredited social health activist (ASHA) to keep a special check on her and ensure she is eating nutritious food. We will be specially vigilant about her weight gain.”

Ambadas Suresh Adhav is a physician, and program manager in technology and operations, working in Jhpiego India’s maternal health programming. Indrani Kashyap is Associate Director, Regional Communications, based in Jhpiego’s India office.

Raji Cherian, Senior Program Officer for Maternal, Newborn & Child Health based in Jhpiego’s Madhya Pradesh office contributed to this story.