Model Answer
0 min readIntroduction
India has historically faced significant challenges in maternal and child health outcomes, particularly in rural and remote areas where access to timely and accurate health information is limited. To address this, the Ministry of Health and Family Welfare, Government of India, launched the 'Kilkari' initiative. Meaning 'a baby's gurgle', Kilkari is a mobile-based health service designed to bridge critical information gaps. Conceived as part of the broader efforts under the National Rural Health Mission (now subsumed under the National Health Mission), Kilkari leverages mobile technology to deliver essential healthcare messages directly to new and expectant mothers, thereby empowering them with knowledge for healthier pregnancies and childhoods. This initiative is a testament to the government's commitment to improving public health infrastructure and citizen-centric health services through digital means.
Significance of the 'Kilkari' Initiative with reference to National Rural Health Mission
The 'Kilkari' initiative holds immense significance, particularly in the context of the National Rural Health Mission (NRHM), which aimed to provide accessible, affordable, and quality healthcare to the rural population. Kilkari complements and strengthens the objectives of NRHM (and subsequently the National Health Mission - NHM) in several crucial ways:- Bridging Information Gaps: In rural and remote areas, access to health facilities and qualified health workers can be challenging. Kilkari delivers timely, accurate, and stage-specific health information directly to beneficiaries' mobile phones, overcoming geographical barriers and literacy challenges.
- Empowering Women: It empowers pregnant women and new mothers with knowledge about pregnancy care, safe childbirth practices, infant care, nutrition, hygiene, and the recognition of danger signs. This knowledge enables them to make informed decisions about their health and their child's well-being.
- Promoting Uptake of Services: The messages encourage women to avail essential health services such as Antenatal Care (ANC), Postnatal Care (PNC), institutional deliveries, and complete immunization for their children, thereby improving service utilization rates.
- Reinforcing Frontline Worker Efforts: Kilkari acts as a powerful reinforcement tool for the efforts of Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). The audio messages reiterate critical advice provided by these frontline workers, enhancing message retention and behavioural change.
- Cost-Effective and Scalable: Being a centrally hosted mobile health service, it requires no additional investment in technology or infrastructure from states/UTs, making it a cost-effective and highly scalable solution for public health outreach across diverse regions of India.
- Addressing High-Risk Factors: With iterations like Kilkari 2.0, there is an increased emphasis on addressing high-risk conditions such as diabetes, hypertension, and severe anemia during pregnancy, providing targeted content and support.
- Digital India Integration: Launched as part of the Digital India initiative, Kilkari leverages the widespread mobile penetration in the country to deliver health services, aligning with the broader goal of digital empowerment and service delivery.
Target Audience of 'Kilkari'
The 'Kilkari' initiative is primarily aimed at:- Pregnant Women: Messages commence from the second trimester of pregnancy, providing guidance on antenatal care, nutrition, preparation for delivery, and identifying danger signs.
- New Mothers: The service continues until the child is one year old, offering crucial information on postpartum care, breastfeeding, newborn care, immunization schedules, and early childhood development.
- Infants via Caregivers: While the direct recipient is usually the mother, the messages are designed to benefit the infant by educating the primary caregiver (mother or family member) on best practices for child health.
Implementation of 'Kilkari'
The implementation of the 'Kilkari' initiative is designed for wide reach and ease of access, particularly in rural settings:1. Technology and Delivery Mechanism:
- Interactive Voice Response (IVR) System: Kilkari predominantly uses a centralized IVR-based mobile health service. This means beneficiaries receive pre-recorded audio messages directly on their mobile phones.
- Free Service: The service is entirely free of cost for both the states/UTs and the beneficiaries, ensuring equitable access.
- Weekly, Stage-Specific Messages: The system delivers 72 time-appropriate audio messages weekly, tailored to the specific stage of pregnancy or the age of the child. The content is designed to evolve with the beneficiary's needs.
- Local Languages: Messages are delivered in local dialects and languages to ensure better understanding and cultural relevance. As of latest information, Kilkari is available in twelve languages including Hindi, Bihari, Odia, Assamese, Bengali, Telugu, Marathi, Gujarati, Kannada, Konkani, Meitei, and English.
- Fictitious Doctor Character: The audio messages are often delivered in the voice of a fictitious doctor character, such as "Dr. Anita," to create a sense of trust and authority.
2. Data Integration and Management:
- RCH Portal Integration: The programme is seamlessly integrated with the Ministry of Health and Family Welfare's centralized Reproductive Child Health (RCH) portal. This portal serves as the single source of information for fetching pregnant mothers' data (Last Menstrual Period - LMP or Date of Birth - DoB) to schedule Kilkari calls.
- Call Retrial Mechanism: To maximize reach, the system employs a 'retry' algorithm, attempting to call subscribers multiple times (up to 9 times) to ensure that a call is answered.
3. Content Development and Evolution:
- Expert Collaboration: The health-messaging framework for Kilkari was developed in partnership with national and international public health experts, ensuring accuracy and compliance with public health priorities.
- User Testing: Content is repeatedly user-tested with beneficiaries to ensure accessibility, engagement, and impact, often involving multiple rounds of testing to get the language and relevance right for rural women.
- Kilkari 2.0: The augmented version, Kilkari 2.0, expands delivery channels to include WhatsApp for multimedia content and facilitates two-way communication. It also places greater emphasis on high-risk factors and challenges related to gender and equity, adopting a 'fit-for-purpose' approach based on women's access to technology and risk profiles.
4. Reach and Expansion:
- Initially piloted in Bihar, the service has progressively scaled up. As of early 2024, the Kilkari project is being implemented in over 20 States and Union Territories across India, with plans for further expansion to all States and UTs by 2026.
Conclusion
The 'Kilkari' initiative represents a significant stride in India's public health efforts, particularly in advancing maternal and child health outcomes by leveraging mobile technology. By providing timely, accurate, and culturally relevant health information directly to new and expectant mothers, it addresses critical knowledge gaps, promotes healthier practices, and encourages the utilization of essential healthcare services. Its integration with the National Health Mission's existing infrastructure, its cost-free delivery, and its targeted approach make it a powerful tool for improving health indicators, especially in underserved rural areas. As Kilkari continues to evolve with initiatives like Kilkari 2.0, its potential to further strengthen India's healthcare delivery system and empower millions of women remains immense, contributing significantly to a healthier future for the nation's mothers and children.
Answer Length
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