Capacity Building of ASHA using AI in Help Module

Document Revision History

Table of Contents

1.1 Definitions, Acronyms, and Abbreviations

Document Purpose

About Piramal Swasthya

Background

1.2 Background of ASHA Concept

1.3 Roles & Responsibilities of ASHA

About FLW Application

Scope of work

Dependencies

Assumptions

NonFunctional requirements

Problem Statement

Success Criteria

Use Cases Annexture-I
Definitions, Acronyms, and Abbreviations

Document Purpose

The purpose of this document is to define the Use cases for Integrating YugasaBot in Frontline Health Workers (FLW) App

About Piramal Swasthya
Piramal Swasthya Management and Research Institute (PSMRI), an initiative under the aegis of Piramal Foundation. Is one of the largest not-for-profit organizations in India. Piramal Swasthya is contributing with its experience and expertise of building innovative solutions that impact at scale.Piramal Swasthya is focused on bridging the public healthcare gaps by supplementing and complementing the Government of India's vision to meet Universal Health Coverage. In the primary public healthcare space with a focus on Maternal, Child and Adolescent Health and Non-communicable Diseases. Piramal Swasthya has more than a decade-long experience in operating several healthcare innovations at scale, which are addressing the primary healthcare needs of the most underserved and marginalized populations across India. Piramal Swasthya is operational in 21 States in India through 35 innovative public healthcare delivery programs and has served more than 112 million beneficiaries so far.One such innovation is AMRIT (Accessible Medical Records via Integrated Technologies) which is a digital health platform developed by Piramal Swasthya that stores electronic health records of beneficiaries for the use of public primary healthcare service delivery and decision-making. The platform enables the connection between beneficiaries, health facilities, and frontline workers in an integrated ecosystem through technology.

Health and Wellness Centre Application is a comprehensive application with 12 Service packages.A comprehensive Web based EHR Application with 12 CPHC service modules catering to primary health service delivery in lower health facilities. ? Since it is just an over-view of the Platform, i think this can stay as is, since it would become very Lengthy if expanded MMU Application: Offline and Online Application to support operations in outreach programs.

HIHL Application: Helpline CRMexpand CRM or add to abbreviationsAgree Added (Customer Relationship Management) to support services like 104, 1097, MCTS and ECD with inbound and outbound facilities.

Telemedicine Solution: Providing Video and Audio consultation services with Specialists

Smart Phone Applications: SAKHI/ Utprerona Android Mobile App ASHAs.

Point of Care Device: AMRIT is integrated with PoCT devices like Fetosense and Healthcube etc.

ABDM compliant: since each applicaiton has different ABDM compliance, this is becoming a blanket statement i feel. I think , this can remain as is , since this is related to the other applicationsand AMRIT is integrated with ABDM for ABHA with all three (M1, M2, M3) milestones.

Background of ASHA Concept
The Government of India launched National Rural Health Mission (NRHM) in 2005 to address the health needs of rural population, especially the vulnerable sections of society. The Sub Centre (SC) is the most peripheral level of contact with the community under the public health infrastructure. This caters to a population norm of 5000, but is effectively serving much larger population at the SC level.Thus, provision for new band of community based functionaries, named Accredited Social Health Activist (ASHA) was made to fill this void. ASHA is the first port of call for any health-related demands of the rural population, especially women and children, who find it difficult to access health services.ASHA is volunteer health activists in the communities, who is creating awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing public health services. She is a promoter of good health practices.ASHA will be entitled for Performance Based Incentives fixed by the NRHM State HQ for prefixed activities only. The performance based incentives required to be given on monthly basis to ASHA.The role, responsibilities and profile for ASHA is given below.
Roles & Responsibilities of ASHA
The roles and responsibilities of an ASHA include the functions of a healthcare facilitator, a service provider and a health activist. Broadly, her functions involve providing preventive, promotive and basic curative care in a role complementary to other health functionaries; educating and mobilizing communities particularly those belonging to marginalized communities, for adopting behavior related to better health and create awareness on social determinants, enhancing better utilization of health services; participation in health campaigns and enabling people to claim health entitlements. She is also providing a minimum package of curative care as appropriate and feasible for that level and making timely referrals for further treatment.

ASHA is expected to fulfill her role through below 5 major activities in the community

1. Home Visits
2. Ensuring her community to attend the Village Health, Sanitation and Nutrition Day (VHSND)
3. Mobilizing the community to health facility
4. Holding village level meeting
5. Maintain Health records

Frontline Health Worker (FLW) Application is designed and developed for ASHAs as a Job aid tool to serve her community. ASHAs usually uses multiple registers for beneficiary registration, enumeration, and data collection. This leads to challenges of manual errors, loss of data and data accuracy. In this context Piramal Swasthya Management Research Institute have developed a Mobile application for ASHAs to digitalize and reduce manual work.

SAKHI/Utprerona is an Android mobile application specially designed for healthcare programs and consultation services render by ASHAs' to serve pregnant women, mothers and newborns in India. This ultimately eliminates pen and paperwork by ASHAs and carry out entering beneficiaries' data in a digitalized process with increased ease and accuracy of data. We named it SAKHI for Bihar State and Utprerona for Assam State
Problem Statement
Frontline Health Workers, especially ASHAs, face challenges with insufficient information, more dependent on seeking help from ANM and CHO. To avoid such situations and make ASHA Self-dependent to make a decision ,ASHA should have Help Module like AI Model that helps ASHA to take a right decision to serve her beneficiary when there is a need.
Scope of work

In-Scope:

• Integrating YugasaBot in FLW app for the In-scope Use Case, without disrupting existing features for ASHA Support on Capacity Building
• This module should have Multi-lingual Support like Hindi, Assamese
• Any relevant changes related to APIs and Database to be handled
• Respective UI to be taken care
• Functional Testing related to Integration Part
• Ensure Regression stability.

Out-of-Scope:

• Any other enhancements or Add-on features non-related to AI Solutions
• Licenses to the any Third-Party tools, Software Library etc. are Not Applicable

Dependencies

• Application Source code from PSMRI GitHub
• App runs on Services and Database hosted on AMRIT Server
• App functions using the User credentials created from Admin panel, can be provided separately

Assumptions

• ASHA workers are equipped with smart devices (phones or tablets) capable of running the necessary applications.
• The ASHA workers have basic digital literacy to navigate through the app.
• Internet connectivity is accessible in the regions where ASHA workers operate.

Non-Functional requirements
Taking care of Beneficiary Data Privacy and Security to safeguard the sensitive information like:

SPI, PII, SPII Application should meet and satisfy requirements of performance, capacity, compatibility, security, usability, reliability, and scalability.

Use Case
8.1 ASHA Support on Capacity Building*Accessing Module wise Support Questions via Help Button

1. Hamburger Menu: From the existing hamburger menu on the landing page should have the "Help button"
2. Help Button: After Clicking help button, Navigate to a screen with following support Sections,

• 
  
  • EC Services (Family Planning Services)
  • ANC Services
  • PNC Services
  • Infant & Child Services
  • Immunization Services
  • NCD Services
  • TB Services

1. Questionnaire Display: Show relevant questions after selecting the above Section. (Refer Annexture)
   • Example Questions:
     • For PNC Services: "Danger signs?"
     • For Infant and Child services: "Danger signs in Newborn?", When to see doctor?
   • ASHA can click on these questions and get responses for further guidance.
2. Regional Language Support: Questionnaires are viewable in the regional language.

*Acceptance Criteria*

• Support Modules should not be empty, without any Sections
• Ensure any sections should not be without questions
• When any question is selected there should be relevant Responses
• Responses should be very simple and understandable to ASHA
• Resources should be specific to the Geographical regions. (eg. NHM resources)
• Responses should be based on the Regional languages
• There should not be any App Crashes
• Should work on low bandwidth internet too(like 5-10 MBPS)

Mockups:

Existing App Screenshots:  

Acceptance Criteria 

• Predictive analytics should be beneficiary and case specific  
• Accurate and understandable display of patient information, including vitals and medical history 
• Responses should be in regional languages. 
• There should not be any App Crashes 

Success Criteria: 
1.Usage Metrics: 

• Number of ASHA workers using the chatbot in a day/week/month. 
• Usage of AI Bot by ASHA in day. 
• Number of Queries used against each ASHA in a day. 
• Usage of feature (against 2 Use Cases) against each ASHA in a day. 

2.Pre and Post indicators to check on the improvements 

• Improvement in knowledge or skills about ASHAs activities as measured by pre- and post-interaction assessments. 

3.User Satisfaction:  

• Open discussion, taking feedback from ASHA regarding the usability and helpfulness of the tool. 

Annexture-I
Following is the Section wise Questions Mentioned in Use Case 1 1.

ANC Service
Advice for Pregnant Women on Managing Anemia

• What are some iron-rich foods that should be included in diet?
• How to increase iron absorption?
• What should I know about taking IFA tablets?
• Side effects from IFA tablets?
• Can IFA tablets be consumed with tea, coffee, or milk?
• How long to take IFA tablets?

1. PNC Service

• Danger Signs in PNC Care?
• What are common post-partum complications to watch for?

1. Infant and Child Service

• Danger Signs in Infant?
• What should I do if the baby is asphyxiated at birth?
• How should I handle a cold or hypothermic baby?
• What steps should I take if the baby has a fever?

(Referral Links for Training Material for ASHAs for training AI Bot: ASHA Training Modules :: National Health Mission (nhm.gov.in) )