Acombination of rapid proliferation of mobile technologies coupled with improved connectivity has opened up innovative possibilities for ICTs in last-mile service delivery like never before. While the impact is being seen in many areas of service delivery, radical changes are taking place particularly in community-based healthcare and agriculture extension services. The following are some areas where there is significant scope for radical shifts as a result of the innovative use of ICTs.
Decentralisation of expert services
Experts are hard to find, particularly in the health and agriculture sectors. We cannot increase their numbers in the short term either. Another problem is that a large percentage of these experts tend to be based in cities, thereby making service delivery in rural and disadvantaged areas even more challenging. So we have to find a way to take the services of experts to these areas using whatever relevant resources we have at the community level and connect these areas with experts using various ICT tools.
In health, there are initiatives underway that connect certified rural medical practitioners (RMP), such as “pharmacists” (who sell medicines in rural areas, more commonly albeit, derogatorily known as quack doctors) or community-based health workers to doctors through technological tools. The RMP uses applications on tablets or smartphones to capture patient information systematically following medical algorithms and when submitted, the medical record gets transferred over to a doctor with a desktop who looks at the data, opens a communication channel to speak to the patient directly, instructs the RMP for further investigation if required, and writes down a prescription, which gets instantaneously transferred over to the mobile device of the RMP. This e-prescription can also be printed if the RMP has access to a printer.
In agriculture, initiatives are being taken to connect agriculture extension workers such as government Sub-Assistant Agriculture Officers (SAAOs), agriculture input sellers, info-mediaries at rural tele-centers and so on, to capture problems that farmers are facing in the fields and send these to an agriculture expert for review and recommendations. The recommendations can be transferred to the farmer via phone calls, text messages or voice messages.
The above mentioned are cases where certain functions of an expert are being “decentralised” to non-experts with some degree of relevant knowledge, under the direct supervision of experts. These new modes of service delivery will obviously not be able to address all underlying issues – but there are certainly some cases that can be effectively, particularly cost-effectively, handled by such remote consultation, thereby reducing chances of exploitation and mistreatment of disadvantaged people.
Optimised workflow of field forces
In both health and agriculture, there are literally thousands of field workers who are the last-mile solution providers to the beneficiary. In health, community workers undertake a variety of activities which need optimisation, such as determining which households to visit and when, reporting on activities at regular intervals, disseminating messages, etc. Each community health worker is generally responsible for covering nearly 2,000 households, which makes workflow optimisation extremely important to ensure prioritised interventions based on need.
For instance, a project called mTika has been piloting the use of mobile phones in the optimisation of vaccination delivery services. This project enables digital recording of birth information of every newborn in the pilot area, and tracks whether the child comes to vaccination camps on time. Reminder messages are sent prior to a health camp, and if they do not show up targeted household-based investigation or advocacy can be undertaken.
In the area of agriculture, agriculture extension workers need to disseminate messages to hundreds of farmers regarding the time and location of training sessions that they regularly hold. In another ICT-based project, the farmers in the pilot location are pre-registered into an information system. As soon as a training session location and time are planned, an automated mass text message goes out to the farmers in that particular locality, thereby saving significant costs and time spent on letting them know about the event via physical visits.
Capacity building of field forces
In both health and agriculture, training of field forces is an extremely expensive affair. Now, various mobile-device based applications are being developed that enable community health workers and agriculture extension workers to update their knowledge as and when needed.
Health-related training materials are being digitised and put into the tablets and smartphones of community health workers for self-paced learning. Gaming applications are also being developed for learning through entertainment. Short videos that can be disseminated through mobile phones and seen at leisure or shown to beneficiaries are also being developed. This mode of communication enables a low-cost mechanism for training and capacity building.
Another critical outcome of information being collected at the field through mobile devices is that the data gets automatically digitised at the point of collection, which can be sent throughout the entire management chain. This means different layers of management can use that data to make decisions and send appropriate instructions down the chain.
Health administrators can use dashboards for targeting interventions such as medicine supplies or health camps based on real-time data sent from the field. Agriculture administrators can use it to plan for possible shortages or surpluses in certain crops, forecast pest and disease problems in a particular locality and take measures accordingly.
Opportunities arising out of the proliferation and advancement of mobile technologies are endless. We will soon be entering a world where all phones will be smartphones, access to the internet will be ubiquitous and cheap, field workers will be equipped with technologies and diagnostics tools, and beneficiaries will be able to access information on demand – all this is bound to fundamentally change the nature of service delivery at the doorstep for the better in ways that we cannot even imagine today. What we are doing now is just a drop in the bucket in preparation for what is to come.
The writer is CEO and Founder of mPower, a technology-based social enterprise.