SakhiCare

An offline-first maternal healthcare assessment and triage platform for frontline health workers in rural settings.

SakhiCare empowers Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs) with instant clinical danger sign triage, offline case logging, and background server synchronization. It brings low-latency decision support to remote clinical encounters.

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Table of Contents

• Overview
• Features
• Product Experience
• Architecture
• Technology Stack
• Design Philosophy
• Local Development
• Future Roadmap
• Team
• License

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Overview

SakhiCare is designed specifically for high-volume, low-connectivity healthcare environments. In rural clinical settings, frontline health workers often perform critical maternal screenings without reliable internet access. SakhiCare offers immediate rule-based danger sign calculation (Red / Amber / Green triage), local case persistence, and scheduled background sync when connectivity resumes.

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Features

• Instant Clinical Danger Sign Triage — Real-time assessment based on maternal vital signs (Blood Pressure, Haemoglobin) and qualitative danger symptoms (Bleeding, Fever, Severe Headache, Reduced Fetal Movement).
• Clear Visual Risk Stratification:
  • RED: Immediate emergency referral triggered by vaginal bleeding or high blood pressure ($\ge 140/90\text{ mmHg}$).
  • AMBER: High-priority observation triggered by fever or severe headache.
  • GREEN: Normal maternal checkup.
• Offline-First Dashboard — Displays connectivity status, pending sync count, quick assessment triggers, and recent case history.
• FastAPI Sync Server — Authenticated ingestion, durable Supabase persistence, FHIR export, notification audit, and deferred synchronization.
• Care Desk Portal — React + Vite portal for authenticated medical officers, supervisors, dispatchers, and administrators.
• Secure location/audio handling — Point-of-care coordinates are captured only with device permission; recordings are uploaded to private Supabase Storage only after authenticated sync.
• Interoperability Ready — Included FHIR R4 JSON bundle specs for seamless EHR integration.

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Product Experience

┌──────────────────┐      ┌──────────────────┐      ┌──────────────────┐
│ 1. Open Dashboard│ ───> │ 2. New Assessment│ ───> │ 3. Instant Triage│
└──────────────────┘      └──────────────────┘      └──────────────────┘
         ▲                                                   │
         │                                                   ▼
┌──────────────────┐                                ┌──────────────────┐
│ 5. Backend Sync  │ <───────────────────────────── │ 4. Review Cases  │
└──────────────────┘                                └──────────────────┘

1. Dashboard — Monitor network status badge ("Offline") and pending record count.
2. New Assessment — Input maternal vitals (BP, Hb) and select observed danger signs.
3. Instant Triage — Receive immediate Red/Amber/Green color-coded referral advisories.
4. Review Cases — Browse local case histories under "My Cases".
5. Backend Sync — Tap "Sync Now" to push pending records to the FastAPI server.

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Architecture

graph TD
    classDef mobile fill:#E0F2F1,stroke:#00796B,stroke-width:1px,color:#004D40;
    classDef storage fill:#E8F5E9,stroke:#388E3C,stroke-width:1px,color:#1B5E20;
    classDef server fill:#FFF3E0,stroke:#F57C00,stroke-width:1px,color:#E65100;

    A[ANM / ASHA User]:::mobile -->|Inputs Vitals & Symptoms| B[Jetpack Compose UI]:::mobile
    B -->|Rule Engine Triage| C[Risk Assessment Card Red/Amber/Green]:::mobile
    B -->|Local Write| D[Room DB + SQLCipher Encrypted]:::storage
    D -->|Queued Items| E[WorkManager Sync Worker]:::storage
    E -->|REST API POST /sync| F[FastAPI Backend Server]:::server
    F -->|Authenticated durable writes| G[Supabase Postgres + private Storage]:::storage
    F -->|Bundle Export| H[FHIR R4 JSON Converter]:::server

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Technology Stack

Component	Technology	Version	Purpose
Language	Kotlin	2.0.0	Primary language for Android application
UI Framework	Jetpack Compose	1.7.0	Declarative UI framework for modern Android UI
Local Database	Room + SQLCipher	2.6.1	Local encrypted SQLite database layer
Background Sync	WorkManager	2.9.0	Deferred background synchronization manager
Backend Framework	FastAPI	0.111.0	High-performance Python REST API server
Backend Runtime	Python	3.11+	Execution engine for backend services
Database Engine	Supabase Postgres	managed	Production relational database engine
Data Standard	FHIR R4	4.0.1	Standardized healthcare data payload format

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Design Philosophy

SakhiCare uses a clinical color system designed for high usability under sunlight and high-stress rural clinical workflows.

• Teal Primary (#00796B / #004D40) — Professional medical backdrop inspiring calm and confidence.
• Red Emergency (#D32F2F) — High urgency indicator for immediate maternal referral.
• Amber Warning (#F57C00) — Moderate risk indicator requiring secondary monitoring.
• Green Normal (#388E3C) — Clear confirmation of normal maternal parameters.

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Local Development

Prerequisites

• Android Studio (Koala or newer) with JDK 17+
• Python 3.11+
• pip package installer

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1. Running the FastAPI Backend

# Navigate to backend directory
cd backend

# Create virtual environment (optional)
python3 -m venv venv
source venv/bin/activate  # On Windows: venv\Scripts\activate

# Install requirements
pip install -r requirements.txt

# Start FastAPI dev server
uvicorn main:app --reload --port 8000

Production configuration

Use supabase/README.md and backend/.env.example as the deployment contract. The backend receives the database URL, JWT secret, service-role key, SMS key, and OneSignal REST key only through its secret manager. The portal and APK receive only the Supabase URL and public publishable/anon key.

Build an APK with the deployed API and public Supabase values supplied as Gradle properties:

./gradlew assembleRelease \
  -PSAKHICARE_API_BASE_URL=https://api.example.org/ \
  -PSUPABASE_URL=https://your-project.supabase.co/ \
  -PSUPABASE_ANON_KEY=your-public-publishable-key

Release signing is intentionally not debug-signed. Supply RELEASE_STORE_FILE, RELEASE_STORE_PASSWORD, RELEASE_KEY_ALIAS, and RELEASE_KEY_PASSWORD from a protected CI secret store for a distributable APK/AAB.

Verify backend health at: http://127.0.0.1:8000/health

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2. Running the Android Application

1. Ensure JDK 17 is active (export JAVA_HOME=/opt/homebrew/opt/openjdk@17).
2. Run automated test suites:

   ./gradlew testDebugUnitTest

3. Assemble the debug APK:

   ./gradlew assembleDebug

4. Output APK location: app/build/outputs/apk/debug/app-debug.apk.

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3. Running the Care Desk Portal (React + Vite)

# Navigate to portal directory
cd portal

# Install dependencies (if not already installed)
npm install

# Start development server
npm run dev

# Build production bundle
npm run build

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Implementation Status & Verification

All four phases of SakhiCare are fully implemented, hardened, and verified:

• Phase 1: Offline ASHA Foundation
  • Room encrypted SQLite database with Keystore passphrase provider.
  • Deterministic clinical triage engine adhering to mohfw-hrp-v1.0.
  • Offline-first encounters, WorkManager sync queue, and conflict resolution.
• Phase 2: Voice Note to Form
  • Vernacular voice-note recording with SHA-256 integrity verification.
  • AI extraction into structured fields with strict clinician confirmation before persistence.
  • Configurable audio retention policy purging audio once clinically validated.
• Phase 3: Durable Backend & Care Desk Portal
  • FastAPI service with SQLAlchemy models and Alembic database migrations.
  • JWT Bearer authentication with server-enforced RBAC and facility scoping.
  • React + Vite Care Desk with SSE real-time updates and clinical case acknowledgement.
• Phase 4: Escalation, SMS, Transport, and Release Hardening
  • 108 Emergency Transport coordination state machine with capability-based hospital routing.
  • Multi-channel escalation chain with Block Supervisor fallback (SUPERVISOR_ANITA).
  • Privacy-preserving minimal SMS contract (zero patient identity leakage).
  • Webhook callback for SMS delivery receipts decoupled from clinical state.
  • Deterministic demo data seeder and clean purge (POST /api/v1/demo/seed, POST /api/v1/demo/purge).
  • Zero fake network switches or canned fallbacks in production builds.

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Team

• Arjun S
• Saurav G

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License

This project is licensed under the MIT License - see the LICENSE file for details.