MICRO HEALTH FRANCHISE SYSTEM

Micro Health Franchise System provides high quality care to mother and child of reproductive age.

www.umeedsey.org

Introduction FINCON Services Inc.

Management Consulting Firm Worked Internationally with ADB

Poverty Eradication Initiative CSR: Raise resources worth $70

million

Project: UmeedSey Grand Challenge:

Saving Lives at Birthwww.umeedsey.org

What are we Trying to Achieve with UmeedSey Project Quality MNCH Services in remotest part of the

country in a financially sustainably and commercially viable model.

Reform of Public health system and availability of real time accurate data for policy formulation.

BIO Surveillance System at policy/ decision level. Reduced financial burden on the Public ex-

checker Micro Health Insurance

Publication:

Clinical Decision Support System for Mother and Child HealthThe purpose of the CDSS is to

improve diagnosis process and to provide assistance to healthcare professionals via investigation or examination of patient’s data.

In this paper we are going to present a Clinical DecisionSupport System (CDSS) that eliminate delays faced bycommunity midwives/ lady health visitors in providingstandardized/ cost effective healthcare services tomother and child in remote areas of the country.

Challenges: While designing complete m-health software for midwifes; we

had a number of challenges ahead of us. 1. How to ensure early diagnosis? (Decrease Cost per

pregnancy)2. Triage a normal delivery case than a complicated and

emergency case?3. Monitor CMWs/LHVs activity? (Quality of Service)4. Share patient profile with expert doctor via Electronic

Medical Record; that provides detail and concise summary of a pregnancy case? (Referral Doctor)

5. Link Supply Chain Processes with CMWs/ LHVs activities. (Internal Audit)

How does CDSS Keeps the track of Patient Status?

Flow of Antenatal:

First Trimester (13 Weeks)

Second Trimester (13 Weeks)

Third Trimester (13 Weeks)

16 appointments for nulliparous women (primigravida) 14 for parous women.(multigravida)

T1 Visit 1Contact CMW

T1 Visit 2Confirmation of Pregnancy

T1 Visit 3CMW Collect Information

xt1v2

State 3xt1v3

T1 Visit 4Booked

Appointment(10-12 Week)

xt1v4State 4

Post Natal (06 Weeks)

State 2

T2 Visit 5(14 – 16 Week)

T2 Visit 6(18 – 20 Week)

T2 Visit 7(22 – 24 Week)

T2 Visit a(25 Week) For

nulliparous women

xt2v5

xt2v6

xt2v7

State 6

State 7

State a

T3 Visit 8(28 Week)

T3 Visit b(31 Week)For

nulliparous women

T3 Visit 9(32 – 34 Week)

T3 Visit 10(36 Week)

T3 Visit 11(38 Week)

T3 Visit 12(40 Week)

T3 Visit c(41 Week)

P1 Visit 13(24-48 hrs

After Birth)

P1 Visit 14(6-7 Days)

P1 Visit d(6th Week)

xt3v8

xt3vb

xt3v9

xt3v10

xt3v11

xt3v12

xt3vc

State b

State 9

State 10

State 11

State 12

State c

xpv13

xpv14

xpv15

State 14

State 15

State 1

State 5 State 8

xt2va

State 13

Step 1: Defining the Complete Antenatal Care States40 STATES

How does CDSS Keeps the track of Patient Status? Step 2: Defining the Sequence of States (ACTIONS)

10-12 weeks

14 – 16 Week 18 - 20 weeks 22-24 week

For nulliparous women 25 weeks

Visit a

Measurement of blood pressure

Contact Care professional

Register Patient

Confirmation of Pregnancy

Get history(pervious)

28 weeks

For nulliparous women 31 weeks

Visit b 32-34 weeks 36 weeks 38 weeks 40 weeks41 weeks

Visit c

CBC( hemoglobin)

Blood typing(RH +ive,-ive)

Hepatitis B

Rubella titer

Screen genetic diseases(If any)

Measure height of uterus

First dose of tetanus toxoid

Anomly ultrasound scan

Second dose of Tetanus toxoid

Look for Edema

Measure height of fundus

CBC (hemoglobin review)

Measure height of fundus

Ask for fetal movements

Oral glucose tolerance test(if needed)

Offer anti-D prophylaxis(If needed) second dose of anti-D prophylaxis

Check the position of the baby

offer a membrane sweep

offer induction of labor

Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus Measure height of fundus

Look for Edema Look for EdemaLook for EdemaLook for Edema Look for EdemaLook for Edema Look for Edema

CBC (hemoglobin review)

Measurement of Weight\height

Test urine for protein, sugar and bacteria

Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS) Check fetal hearts(FHS)

Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of Weight Measurement of WeightMeasurement of Weight

Measurement of blood pressure: Measurement of blood pressure Measurement of blood pressureMeasurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure: Measurement of blood pressure:

Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar Test urine for protein and sugar

41 weeks End Visit c

Check fetal hearts(FHS)

Look for Edema

Measure height of fundus

Measurement of Weight

Measurement of blood pressure:

Test urine for protein and sugar

P1 Visit 13 P1 Visit 14

(24-48 hrs After Birth)

P1 Visit d

(6-7 Days) (6th Week)

Post Nata End

Ultrasound scan(Dating)

ComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaintsComplaints Complaints

Update history(If any)

Ultrasound scan

PrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescriptionPrescription

Status Status Status StatusStatus Status Status StatusStatusStatus StatusStatusStatus

Prescription

Medication

Random blood Sugar

Physical Examination

Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movements Ask for fetal movementsAsk for fetal movements

Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia Check for Anemia

Check for Fetal presentation

P1 Visit 15

28 days

How does CDSS Keeps the track of Patient Status? Step 3: Define Data and Its Relationship to State

Start

Weight gain ABNORMALWeight > 0.5kg/wkkABNORMAL Weight < 0.5kg/wk

NORMAL

0.5kg/wk

check for anemia,

Malnutrition

U/S for IUGR

End

U/S for twin Poly hydro-amino R/O PET

Start

Height

NORMAL

Height > 4ft 8 inch

ABNORMALHeight < 4ft 8 inch

Institutional Delivery

End

How does CDSS Keeps the track of Patient Status? Step 4: Creating a Complete Patient Profile

Start AgePast Medical /

Surgical History

Family history / genetic history

Obstetric history

Physical examination

Antenatal visit record

Lab testsUltrasound

scanEnd

Age <18

Others

Chromosomal problems

Any birth defect

Any one in the family had:

Anemia

Foliate deficiency

anemia

Iron deficiency

anemia

Height > 4ft 8inch

Low HB & high MCV

Low HB & low MCV <= 80

BP

BP < 140/90

BP <= 150/110

BP > 140/90

Weight > 0.5kg

AB

Protein

Leukocyte

HbsAg

Negative

Negative

Abnormal

Abnormal

Positive

0-5hpf

Negative

Current medication

Hepatitis

Obstetric surgery

Diabetes

Renal diseases

Hypertensi-on

Anemia

Cardiac problems

Blood transfusion

Abdomino-pelvic surgery

Hypertension

Cousin marriage

Cardiac

Multiple Preg

Drug abuse

Diabetes

Heamoglobinpathies

Smoking

Porphyria

Inherited Diseases

Allergies Gravida Outcomes

18 > age < 35

Age > 35

Height < 4ft 8inch

Height

Lymph nodes

Jaundice

Oro-dental hygiene

Edema

Nipple

Weight

Goiter

Breast

Varicose veins

Conjunctiva

Weight = 0.5kg

Weight < 0.5kg

Weeks of gestation

Edema

Fundal height

Doctor signature

Weight gain

Next visit

FM

Date

Presentation and engagement

Normal

Positive

Negative

Normal

Positive

RFT

Pap smere

HCV

LFT

Blood group

Blood sugar

HB%(g/dl)

Urine test

Glucose

Anomaly

Dating

FHS

parity

Pregnancy number

Last delivery > 2 yrs

Last delivery < 2 yrs

Abortion

Tubal Pregnancy

Twin Pregnancy

Pre-term pregnancy

Full term pregnancy

Alive

Still birth

Modes of Delivery

NVD

Forcep or Vaccum

LSCS

Patent

Multi-gravida

Primiri-gravida

Hb >10 Hb < 10

Negative

O

B

APositive

RH factor

Negative

How does CDSS Keeps the track of Patient Status? Step 5: Matching Profile against defined patterns.

Start

Anemia Gestational diabetes

Preeclampsia (toxemia)

Eclampsia (severe form of pre-eclampsia)

Hyperemesis gravidarum (HG)

Placenta previa

Feel tired or weak

Placental abruption Preterm labor Multiple

Pregnancies Fetal problems

Feel faint

Shortness of breath

Low number of red blood

cells(Hb<10)

Look pale

Extreme thirst

Screening test shows high blood sugar

levels

Previous child weight

Family Diabetes

Swelling of hands and face

Too much protein in

urine

Stomach pain

Blurred vision

Dizziness

Headache

Seizures

Swelling

Edema

Too much protein in

urine

Nausea

Vomiting

Weight loss

Reduced appetite

Dehydration

Feeling faint or fainting

Painless vaginal

bleeding during second

or third trimester

Vaginal bleeding

Fluid or tissue passing from

the vaginaPelvic pressure

Contractions

uterus is larger than expected for the dates in

pregnancy

increased morning sickness

increased appetite

excessive weight gain, especially in

early pregnancy

fetal movements

felt in different parts of

abdomen at same time

Baby moving less than normal

Baby is smaller than normal

for gestational age

Some problems have no symptoms, but are found with prenatal

test

End

Hunger

Fatigue

Cramping

Abdominal pain

Miscarriage

Uterine tenderness

High blood pressure

High blood pressure

CDSS – Early Diagnosis (Saving Lives) While all of this is happening in

the background; a CMW will see three simple set of instructions.

If the screen is green, the midwife can proceed normally.

Conversely, a red screen will alert the midwife to an emergency situation – transport the patient immediately to EmOC facility.

Finally, a Orange screen – get expert advice from referral doctor.

Electronic Medical Record

Monitoring and Evaluation

Supply Chain Management System

• Once Program Officer and Operational Manager approves this CMW request. Store Keeper dispatches the consignment to franchisee.

• CMW Request tool kit through her mobile app

• Program Officer Receives this request and wait for Operational Manager approval

Innovation in Mother and Child Health Care System

Mobile Application

MNCH Triage (UmeedSey)

CMW Trainings (KhanPur)

CMW Trainings (Chakwal)

Websitehttp://umeedsey.org/

QUESTIONS? THE END