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Monitoring Medication Adherence For People With Mental Health Issues

Updated: Jun 22, 2021

Implemented By

Mental Health Acton Trust (MHAT) And Everwell Health Solutions

In Association With

Microsoft Research And Microsoft For Startups

About The Project


Mental health issues are becoming increasingly prevalent in India, and patients in rural India often find it difficult to access quality care. It is estimated that in India, the economic loss due to mental health conditions between 2012-2030 will be 1.03 trillions USD.

Mental Health Action Trust (MHAT) caters to patients with mental health belonging to economically economically disadvantaged sections of Kerala, India. Consistent adherence to medication is crucial for treatment. However, with limited financial and human resources, it is tough to measure adherence through conventional means. Hence, a low cost, low maintenance technological intervention, like 99DOTS was introduced, in association with Microsoft Research and Microsoft for Startups, to monitor adherence rates and impart better virtual, remote care to the patients

Project Description

A pilot was conducted in early 2020, with 25 patients from one clinic being monitored using 99DOTS technology. The treatment support and patient adherence was managed by the MHAT volunteers on the Everwell Hub, a digital platform for staff to support patients' adherence. Patients made a free call to an assigned toll-free number each time they took their medication, this would prompt the system to record and appropriately reflect the information on the patient dashboard.

This in turn empowered providers to monitor adherence in real time. The providers could also add notes on the platform to manage patient medication history. The patients also received a series of daily reminders (via SMS and automated calls). Missed doses triggered SMS notifications to care providers, who followed up with personal, phone-based counseling. The Everwell Hub was available on the web and app.


The adherence rate was as high as 95%. Healthcare volunteers were less burdened to personally follow-up with every patient, and could provide differentiated care. Adherent patients could proceed with less supervision, while limited program resources were focused on cases that needed the most attention. Remote follow-up with patients also proved a timely solution in light of the Covid-19 pandemic, that restricted travel for patients and volunteers. Moreover, automated reminders to patients provided additional motivation and support to patients to remain consistent with their medication.

The Way Forward

The Successful Pilot Has Led To The Adherence Technology Being Extended To Support More Mental Health Patients

99DOTS is an adherence reporting mechanism, and the subsequent care was valued by the patients and the providers. The patients cited that they were less likely to forget the medications because of 99DOTS and the SMS reminders. Given the high level of acceptance of this program, it has been extended to an additional 1000 patients across 32 treatment centers in Kerala, India in August 2020, in collaboration with MHAT, Microsoft Research and Microsoft for Startups.

"The 99dots intervention has improved the way we approach care for patients with mental health issues. We work in extremely resource constrained environments - health workers and associated staff often feel burdened with the high volume of patients to follow up with on a daily basis. With the introduction of the 99dots innovation in mental health, our volunteers now follow up with patients who need immediate care and attention, and on a real-time basis. -Dr. Manoj kumar, Clinical director, MHAT

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