In order to explore how tele-care innovations are working to address service gaps and help communities adapt to COVID-19 realities, the COVID Action Collaborative is publishing a series of articles that highlight various tele-care initiatives launched by CAC partners. This piece is the second article in this series. It highlights two organisations that are working to serve communities across India through tele-care interventions: the Bangalore Birth Network (BBN) and the Academy of Family Physicians of India (AFPI).
Since the inception of the COVID-19 outbreak, the tele-care solutions that have emerged have been designed to target different demographics and provide support in different domains. The Bangalore Birth Network is an organisation dedicated to promoting and practicing evidence-based, respectful maternity care. It is focused on helping pregnant and postpartum women and infants, particularly from under-resourced populations. The Academy of Family Physicians of India is a medical society with state chapters across India that is dedicated to promoting professional leadership, conducting healthcare advocacy, engaging in policy development and shaping the health system. AFPI is working to bring back awareness of the importance of the family doctor, which is especially pertinent during the times of COVID-19. The COVID Action Collaborative interviewed Dr Madhavi Latha from BBN and Dr Jyotika Gupta from AFPI on their respective pan-India helplines: the COVID-19 Mother and Child Helpline and the AFPI Helpline for Coronavirus (wefightcorona.in).
Adapting to a New Reality
Both Dr Jyotika and Dr Madhavi noted that when COVID-19 first broke out and the lockdown went into effect on March 24th, the reaction among communities across the country was one of fear, apprehension and confusion on how to proceed. Due to the lockdown, there was an abrupt cease in services provided to pregnant women and young mothers, apart from high-risk pregnancy cases. Women are nervous about pregnancy under normal circumstances, but add COVID-19 to the equation and that anxiety increases threefold. These women wanted to see their gynaecologist, but hospitals had stopped receiving non-high-risk cases. BBN decided to reach out to people through a helpline to help fill this gap. Similarly, communities across India did not know who to reach out for basic medical support and guidance during this time, leading to widespread panic. In response, AFPI decided to develop a helpline for people to speak to a registered family doctor who could address their concerns and provide informed guidance.
Immediately, AFPI took this idea forward. The organisation called for volunteers from its network to provide counselling support through the helpline and engaged a pro-bono technical support partner to develop the technology. The response from volunteers was significant, with many physicians eager to play a role, and the helpline received 50 volunteers within the first 48 hours alone. The volunteers trained each other to utilise the software using a cascading training model. The AFPI helpline was then launched on March 27th and was operational from 7am to 12am. When the innovation was first launched, it was a chatbox before the video call option was developed. Queries would be answered through the chat-box and then follow up would be conducted over call on an as-needed basis. From June 8th onwards, the AFPI helpline shifted from a chat box to a tele-video consultation format. It now caters to COVID and non-COVID cases. A core support group within AFPI manages the helpline, which is supported by a group of volunteers who conduct the execution. Among the volunteers, there are teams dedicated to scientific content creation, operations and marketing. The marketing team designed creatives for outreach and promotion of the helpline, and medical students were engaged to help with this process. AFPI reached out through social media as much as possible to spread the word about this resource, and it reached out to doctors in their network to circulate promotional materials in their own groups. The helpline received 35 users on the day after its launch alone.
Bangalore Birth Network had already been running a helpline for a project called Baby Gold, focusing on the practices that should be followed within one hour of birth. Due to the urgency of the COVID-19 crisis, they decided to convert the Baby Gold Helpline into the COVID-19 Mother and Child Helpline. BBN reached out to counsellors and interested parties to help with the counselling component. Counsellors were recruited with a range of language abilities to ensure maximum coverage. BBN developed a training module based on guidelines from key leadership and thematic bodies, such as FOGSI and WHO. Within a week, the counsellors were ready and they were able to launch the helpline on April 3rd. The helpline is operated from 9am to 8pm. In order to use the service, beneficiaries should give a missed call to the helpline number in order to receive a survey to fill out with language preferences and pregnancy status. Based on the results of the survey, the beneficiary will be called back by the appropriate counsellor. BBN reached out to the community largely through social media. Volunteers designed posters in multiple languages, and requested the counsellors to spread the word. The organisation used SMS dissemination to reach out to lower-income populations. Members of the Birth Network were asked to share the SMS with people who likely were not on Facebook or WhatsApp.
Both Dr Jyotika and Dr Madhavi were able to share just how critical these innovations have proven to be. When AFPI started its chatbox, it would receive regular queries about how to sterilise delivery packages. One resident welfare association asked about whether it is possible to use bleaching powder to sterilise an apartment complex. AFPI had a microbiologist calculate the exact ratio for dilution that should be used in order to be effective, and shared information with the RWA on the process to follow. One gentleman who contacted the helpline shared that he wanted a prescription for Vitamin D for himself and his two children because he had read that it would protect him from COVID-19. Dr Jyotika worked to explain that Vitamin D consumption does not in fact provide full protection from COVID-19 and connected him with a local doctor for further queries. Experience with this helpline reinforced the notion that “no question is silly, and no doubt is small.”
Similarly, the COVID-19 Mother and Child Helpline has been getting called from all parts of India. One such call came in from a tribal area of Rajasthan. A volunteer had reached out to share that there had been a case of a 34-week pregnant woman being denied care in a PHC because she came in with shortness of breath and the PHC workers did not have PPE and were too nervous to touch her. The patient ended up passing away the following day due to pre-eclampsia, which may have been prevented if the health workers had checked her blood pressure. BBN volunteered to train the PHC staff to prepare them to conduct services safely during COVID-19 and connected them with a PPE supplier. Another example of support provided by the helpline took place in Pakistan. A woman in the first trimester of pregnancy had excessive vomiting and was previously denied care in the hospital. The helpline guided her to go to the emergency room, which she did and was able to rehydrate. A follow-up call revealed that her condition significantly improved.
Collaborations and the Way Forward
AFPI and BBN were able to leverage networks and partnerships to effectively implement their tele-care interventions. In states with Birth Networks, the COVID-19 Mother and Child Helpline has been able to connect people to doctors in their local networks. BBN also collaborated with taxi services to help ferry new mothers to the hospital and with mental health and domestic violence helplines post launch. AFPI worked with a technical support freelancer to establish the technology platform and with the Medical Students Association of India to reach out for volunteers. Certain psychiatrists and psychologists reached to collaborate through referrals. AFPI also tied up with the Mfine tele-consultation portal. Moving forward, there is room for future collaborations and tie-ups for both helplines in order to ensure access to specialised expertise and to improve the reach of the platforms.
The COVID-19 Mother and Child Helpline and the AFPI Helpline for Coronavirus are both driven by an urgency to help communities and provide support during this challenging time. They are both available free of cost to ensure that they are accessible to all members of society, regardless of circumstance. Dr Jyotika noted that AFPI wants to be able to tell their patients that “I am your family doctor and I am here for you.” Dr Madhavi reiterated this sentiment, sharing that at BBN “we all genuinely want to be there for people.” While COVID-19 has caused significant disruptions to the health system, these innovations highlight how the outbreak has also presented an opportunity to expand and enhance the ways in which care and support can be provided to patients and communities.
By Catherine Cove