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In India, a woman dies in childbirth every twenty minutes. Two children under 5 years old die every minute while 4 of 10 children do not realize their full potential due to chronic under-nutrition/stunting. Poor health awareness among women and a faltering primary health system leads to poor management of high-risk conditions, resulting in preventable mortality and morbidity. Current health policy, backed by evidence, focuses on institutionalizing delivery, with a 54% increase in hospital-based deliveries from 1992-93 to 2015-16. However, only 51.2% of women had 4 antenatal visits. Even with uptake of care, overworked health workers overlook counselling. Urban India has a virtually non-existent government primary care system and tertiary hospitals/private clinics are approached for first-contact care. In rural India, limited training (23 days) of community health workers (ASHAs) creates gaps in skills and motivation. ASHAs also prioritize incentive-linked activities that exclude counselling. Providing critical health information to women during pregnancy and infancy creates awareness of complications and risks and develops agency to seek and demand timely healthcare. Regular training of community health workers (ASHAs) creates an efficient primary health care system with early detection and better management of high-risk pregnancies and infancies.
ARMMAN has developed Kilkari is a free voice-call service providing critical preventive care information to women during pregnancy and infancy, with multiple tries and a missed call system to rehear the call. As at 2021, Kilkari has reached over 20 million women and children, with 2.5 million subscribers at present. Concurrently, we have Mobile Academy, a mobile-based refresher training course for ASHAs accessed via a simple voice call, with 165,000 ASHAs trained. Both programs are available in 5 languages across 13 states, with a pan-India scale-up planned by 2025. Implemented by ARMMAN in partnership with the Health Ministry, they are the largest programs of their kind in the world. For more information on our services, refer to our slide deck.