India: Primary Care Functions

The Saharsa district in Bihar, India is marked by high levels of poverty and barriers to accessing quality health services. In efforts to increase access to vital maternal, newborn, and child health including nutrition (MNCHN) services, this area is serviced by 35 health sub-centres and a vast network of Frontline Health Workers (FLWs) and supervisors. However, the effective delivery of these services has been historically challenged by a lack of coordination among the health workforce and limited capacity and resources (including a lack of paper-based tools and job aids) to plan and deliver comprehensive care. In 2012, the Continuum of Care Services (CCS) was launched as part of a collaborative effort to improve the capacity of FLWs to deliver essential and quality MNCHN services across the continuum of care. The CCS is a comprehensive mobile health tool with a suite of modules built upon the government’s Integrated Family Health Initiative’s framework for MNCHN service provision.1 The CCS incorporates various checklists, diagnostic assessments, records, and counseling support aids to better equip the health workforce with the tools and knowledge to deliver appropriate care. These aids are differently designed to meet the needs of women and children based on their respective stages of pregnancy, delivery, post-delivery and newborn care. The type of care patients receive at each stage of care is unique to their history and plans for the future, promoting the delivery of person-centered services.

To promote better coordination and continuity among caretakers, the content within the tool is specific to the cadre of the health worker, corresponding to their roles and responsibilities within the frontline health management structure. In addition, the tool supports better supervision and coordination mechanisms through task scheduling, performance monitoring, and technical support (to prevent the disruption of information flow), and a built-in feature for health workers in the same catchment area to share relevant cases.1 The use of the tool by FLWs has made strides to increase the number of women accessing critical care at the right time, with a demonstrated increase in contact by a FLW for the appropriate management of conditions after the first 24 hours of delivery from 6.7% to 59.5% in the first year of its adoption. Additionally, it has improved the quality and experience of care, including the comprehensiveness of home visits. In light of the successes of the CCS, CARE India is proposing to scale the system in Bihar and pursue further integration with the Mother and Child Tracking System, India’s national database to track pregnancies and newborns. More information on the CCS can be accessed here.


  1. Dimagi D. Continuum of Care   Services: A Holistic Approach to Using   MOTECH Suite for Community Workers. Dimagi; 2014.