Kilkari

A woman dies in childbirth every twenty minutes in India and for every woman who dies, 20 more suffer lifelong ailments. Two children under age five die every minute while four out of ten children don’t realize their full potential due to chronic under-nutrition/stunting. However, a significant proportion of maternal and child deaths are preventable.

The 3-delays framework for understanding maternal mortality mentions the significance of the lack of access to preventive care information in causing the first delay-decision to seek care. This is caused by the lack of concomitant focus on primary care and preventive/promotive health services.

The lack of focus on primary care and promotive health services leads to lack of access to preventive care information and poor understanding of complications and risk factors amongst pregnant women and mothers, thereby causing a delay in the decision to seek care. Providing critical healthcare information to women and families creates awareness of complications and risk factors and develops agency to demand healthcare. 

ARMMAN is currently implementing the largest mobile-based maternal messaging program in the world - Kilkari - in collaboration with the Ministry of Health and Family Welfare (MoHFW). Kilkari is a free mobile voice call service that sends timed and targeted preventive care information through automated calls during pregnancy and infancy directly to the phones of the enrolled women in 18 states of India.

The high mobile penetration in India positions voice calls as an excellent mechanism for reaching women and families with this critical life-saving healthcare information using the principles of behaviour change communication, enabling women and families to make a timely decision to seek care.

Subscribers receive one pre-recorded call per week, linked to the woman’s stage of pregnancy or the child’s age, from the second trimester of pregnancy until the child is one year old (72 weeks). Calls are currently available in 6 languages (Hindi, Bihari, Oriya, Assamese, Bengali, Telugu).

In the next version of Kilkari (2.0), low risk women and children will have access to nuanced voice calls and/or multimedia content with 2-way communication using WhatsApp, based on their access to technology. Those with high-risk conditions and/or equity-encumbrance will be supported via targeted content, 2-way communication, long-term handholding (call centre/WhatsApp support).

Innovations focussed on high-risk pregnancies and infancies are being piloted in another program (mMitra) and will be scaled through Kilkari. Innovations being tested include AI/predictive analytics for improving program performance (we have a long-term collaboration with Google Research on AI), urban high risk pregnancy tracking, WhatsApp as a channel for sending targeted information in multimedia format and 2-way communication.

Kilkari has reached over 27 million women and their children in 18 states of India till date, and has over 1.9 million subscribers at present. It will be scaled across India in the next four years as we expand to 4-5 new states every year.

A study conducted in Madhya Pradesh by Johns Hopkins University to measure the effectiveness and cost-effectiveness of Kilkari showed optimistic outcomes including an increase in father’s knowledge and improvement in the timeliness of child immunization. Research also indicates that exposure to Kilkari has helped improve levels of some health behaviors across marginalized groups.

As we focus on the increased integration of Kilkari within the health system, we will improve the national database of mothers and children, enabling excluded women to enter the formal system with access to maternity welfare benefits (requiring a bank account and social security number), thereby catalyzing sustainable intergenerational change.