According to the latest WHO and UNICEF estimates of national immunisation coverage, India was home to the third largest number of zero-dose children worldwide in 2022, with more than 1.1 million. Rajasthan, India's largest state, has an estimated 70,000 zero-dose children.
One solution with the potential to help the state reach the unreached is the digitalisation of health system information. India's public health system, boasting the world's largest decentralised community health workforce, is transitioning from paper-based to digital tracking systems to improve healthcare delivery and outcomes.
"I have been using Kushi Baby’s ASHA app for over a year. I am very grateful for the data integration feature of the app that saves a lot of time collecting duplicate data for different healthcare programmes and also gives me a due list of newborn children whose primary vaccinations are due for a targeted follow-up, saving me time and energy in the long run."
– Suman Sharma, ASHA worker
Female community health workers, including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) spend up to 20 hours a month on a mix of paper and digital reporting across fragmented primary health programmes. Digital solutions are further fragmented, with separate applications for different health programmes, resulting in a lack of uniform adoption across the country, and even within individual states.
Khushi Baby, which translates in English to 'Happy Baby' is a non-profit organisation founded in 2014 in Rajasthan. They are building digital health platforms for community health systems. Since its inception, Khushi Baby has spent 200,000 hours learning and co-creating with community health workers in the field to design an integrated health, worker-centric, digital health platform called the Community Health Integrated Platform (CHIP).
CHIP was first used as a community-based surveillance tool for COVID-19 in 2020 and has since evolved to be used for several different purposes, including performing a digital health census, conducting follow-up of primary health care across different programmes such as family planning, maternal and child health.
"When the Khushi Baby application was launched, I initially hesitated to use the app because of the learning curve and difficulty in using and understanding a digital app," says Suman Sharma, an ASHA worker from Mavli district of Udaipur, Rajasthan." [Now] I have been using Kushi Baby's ASHA app for over a year. I am very grateful for the data integration feature of the app that saves a lot of time collecting duplicate data for different healthcare programmes and also gives me a due list of newborn children whose primary vaccinations are due for a targeted follow-up, saving me time and energy in the long run."
CHIP consists of offline-ready mobile applications for the key health workers in the Indian public health system, namely ASHAs, ANMs and medical officers. Health workers can monitor community needs and healthcare performance in real-time using artificial intelligence and GIS-based (geographic information system) dashboards, and track over 800 health indicators at a cost of just US$ 0.07, or six Indian rupees, per beneficiary
"The ANM app has all the data I need at my fingertips," says Dharna Prajapat, an Auxiliary Nurse Midwife in Udaipur, Rajasthan."I have been working with Khushi Baby since 2017. Initially, we used to only track child immunisation and NCDs on the Khushi Baby app and relied on paper-based registers for other health programmes at the primary healthcare centre. I had to then copy data from the books to a digital portal, which would steer away from my focus on attending to new patients.
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"Before, I used to enter the data of the same beneficiary three times. Now the offline feature of the app allows me to gather data on the go and collect information on all the programmes. I don't have to carry my heavy paper registers everywhere. I can check my do-list anytime and anywhere with the offline feature, enabling me to care for more beneficiaries."
Khushi Baby now works as the technical support partner to the Government of Rajasthan under a non-financial agreement. This role includes the design, development, implementation and evaluation of digital health systems for community health management. The Government of India has sanctioned US$ 13 million for the scale-up of CHIP in Rajasthan. To date, 70,000 ASHAs have used CHIP to track 40 million beneficiaries.
Supporting Innovation: The INFUSE Pacesetters Programme
To support this work, Gavi has announced that it will provide US$ 1 million in support to Khushi Baby from its INFUSE Pacesetters programme. The programme selects the most promising innovations each year from local entrepreneurs to receive Gavi and partner support. These solutions address critical gaps and challenges in immunisation programmes and healthcare delivery more broadly. Khushi Baby received its first INFUSE grant in 2017.
"Gavi has been with us in our early days evaluating our digital health platform in a randomised controlled trial," says Khushi Baby's CEO and Co-Founder Ruchit Nagar."Now they are here to support our scale-up as a digital public good, not just for vaccination monitoring but for horizontal health systems strengthening. Above all, this grant will empower us and our partners to identify and immunise 10,000 zero-dose children in India."
"Before, I used to enter the data of the same beneficiary three times. Now the offline feature of the app allows me to gather data on the go and collect information on all the programmes. I don’t have to carry my heavy paper registers everywhere. I can check my do-list anytime and anywhere with the offline feature, enabling me to care for more beneficiaries."
– Dharna Prajapat, Auxiliary Nurse Midwife
With Gavi's support, Khushi Baby will support the identification, confirmation and data-driven catch-up of immunisation sessions for 10,000 zero-dose children, help ASHAs transition from paperless work to automated reports and automate community engagements via the CHIP platform.
Using this health systems approach, CHIP is leveraging follow-up on routine immunisation to monitor indicators across other primary healthcare services beyond immunisation and allow ASHAs to track multiple primary healthcare reports. This allows health workers to report on more than 52 activities for performance-based incentives, increasing their remuneration.
For example, ASHA's screening for the social determinants of health on the CHIP platform have contributed towards the creation of the first village-level map of multidimensional poverty in India, which has implications for health, education and public distribution departments. Simultaneously, Khushi Baby is actively building the capacity of health officials to use the CHIP platform independently, driving localised data-driven decision making.