eJharkhand 2014 - e-Governance Implementations – Opportunities and Challenges - Dr Manish Ranjan, Mission Director, NHM, Jharkhand

From e-Governance to m-Governance

Scripting new dimensions

Saturday, April 8, 2023 1

Dr. Manish Ranjan, IASMission Director,National Health Mission, Ranchi Jharkhand

• The need for effective and holistic governance is very well reflected in UN Secretary General’s words

– "...as we all know, infrastructure is not just a matter of roads, schools and power grids. It is equally a question of strengthening democratic governance and the rule of law. Without accountability, not only of the government to its people but of the people to each other, there is no hope for a viable democratic State. "

– Ban Ki Moon

The Information Technology revolution provides us a wonderful opportunity to optimize and improve

governance across all sectors:The key implementation measure being e-Governance

e-Governance

These technologies can serve a variety of different ends: better delivery of government services

to citizens improved interactions with business and

industry citizen empowerment through access to

information efficient government management

Performance of the governance via electronic medium in order to

facilitate an efficient, speedy and transparent process of disseminating information and provide efficient and

effective service delivery to the citizens.

e-Governance aims at making the interaction between government and citizens (G2C), government and business enterprises (G2B), and inter-agency relationships (G2G) more friendly, convenient, transparent, and inexpensive

e-Governance initiatives in health sector in Jharkhand

– Health Management Information System (HMIS)

– Mother and Child Tracking System

– Direct Bank Transfer – Case Based Web Based ICT

application for TB (Niskhay)– National Anti Malaria

Management Information System (NAMMIS)

– Integrated Disease Surveillance Program web portal

– Mamta Vahan MIS– National Cold Chain

Management Information System

– JRHMS website– Human Resources for Health– MTC MIS– WIFS MIS– Vehicle tracking system– Chikitsya Salah: 104– E-Blood Bank– Biometrics Application– Video conferencing through

skype– Online reporting for PCPNDT

act

Health Management Information System• Facility wise data uploaded from Health facilities (District to Health Sub

Center level)• Jharkhand one of the few States having facility wise data entry • 4545 out of 4582 health units entering data every month• 270 indicators being monitored on a monthly basis

Saturday, April 8, 2023 7

Bokaro

Palamu Chatra Hazaribagh

KodarmaGiridih

Deoghar

GoddaSahibganj

Pakur

GarhwaDhanbad

Khunti

RanchiLohardaga

Gumla

Pashchimi SinghbhumPurbi SinghbhumSimdega

Saraikela

Latehar

Jamtara

Ramgarh

Dumka

Bokaro

Palamu Chatra Hazaribagh

KodarmaGiridih

Deoghar

GoddaSahibganj

Pakur

GarhwaDhanbad

Khunti

RanchiLohardaga

Gumla

Pashchimi SinghbhumPurbi SinghbhumSimdega

Saraikela

Latehar

Jamtara

Ramgarh

Dumka

Bokaro

Palamu Chatra Hazaribagh

KodarmaGiridih

Deoghar

Godda

Sahibganj

Pakur

GarhwaDhanbad

Khunti

RanchiLohardaga

Gumla

Pashchimi SinghbhumPurbi SinghbhumSimdega

Saraikela

Latehar

Jamtara

Ramgarh

Dumka

Q2 (Jul – Sep 2013)Q2 (Jul – Sep 2013)Q1 (Apr – Jun 2013)Q1 (Apr – Jun 2013)

Q3 (Oct – Dec 2013)Q3 (Oct – Dec 2013)

Good performing

Promising

Low

Very low

Using HMIS for performance monitoring: HMIS Dashboards Indicators: 2013-14

16 indicator based dashboard based on life

cycle approach

Dumka - Block wise HMIS based DashboardQuarter 1, 2 & 3 (2013-14)

Good Performing Promising Low performing Very low performing

Q3, Q2 & Q1- Average Index values - Component wise

SN BlocksOverall Index 1. Reproductive age

group 2. Pregnancy Care 3. Child Birth 4. Postnatal mother and new born Care

Q3 Q2 Q1 Q3 Q2 Q1 Q3 Q2 Q1 Q3 Q2 Q1 Q3 Q2 Q1

1 DHQ 0.5086 0.4617 0.4912 1.0000 0.6220 0.5587 0.4595 0.4581 0.5976 0.3831 0.4117 0.3992 0.3382 0.3992 0.3995

2 Gopikandar 0.4759 0.5911 0.5111 0.4572 0.6139 0.3333 0.3526 0.4332 0.3294 0.1013 0.3343 0.4113 0.8354 0.8896 0.8593

3 Dumka Sadar 0.4390 0.4602 0.4794 0.1031 0.0502 0.0294 0.4452 0.5505 0.4961 0.6667 0.6667 0.6812 0.4977 0.4919 0.6115

4 Masalia 0.4213 0.4402 0.4174 0.2752 0.2785 0.3333 0.4977 0.3375 0.2825 0.0614 0.0764 0.1173 0.6486 0.8581 0.7827

5 Kathikund 0.3951 0.5492 0.5660 0.1515 0.4756 0.3333 0.3099 0.4560 0.4486 0.0914 0.3520 0.5086 0.8088 0.8048 0.8575

6 Jarmundi 0.3617 0.4327 0.4337 0.1200 0.3333 0.3333 0.2463 0.2617 0.2420 0.1004 0.1884 0.1742 0.7790 0.8099 0.8415

7 Raneshwar 0.3408 0.4374 0.3940 0.1397 0.4071 0.4392 0.2835 0.3495 0.2876 0.2778 0.2489 0.2950 0.5567 0.6566 0.5327

8 Shikaripada 0.3283 0.5138 0.4697 0.0136 0.2888 0.2667 0.4035 0.6197 0.5256 0.1759 0.2992 0.2432 0.5335 0.6717 0.6716

9 Ramgadh 0.3167 0.4069 0.4618 0.0306 0.4294 0.3333 0.2867 0.3093 0.3391 0.1125 0.0911 0.1870 0.6408 0.6804 0.8265

10 Saraiyahat 0.3132 0.4108 0.4031 0.0000 0.1602 0.1228 0.3246 0.4748 0.4595 0.0867 0.1682 0.1161 0.6258 0.6427 0.6873

11 Jama 0.2684 0.3688 0.3877 0.0020 0.3115 0.2798 0.2724 0.3094 0.3396 0.0472 0.1057 0.0990 0.5571 0.6205 0.6737

Mother and Child Tracking System• Flagship program for enlisting and tracking of beneficiaries for effective

service utilization• Generation of automated work plans for facilitating delivery of services• Beneficiaries enlisted in 2013-14:

– Mother 347,643– Children 262,649

• Beneficiaries enlisted since inception in January 2011:– Mother 1,414,553– Children 1,474,098

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Automated Work plan generated through MCTS

Nikshay: Case Based Web Based ICT application for TB• A case based-web based recording & reporting system in RNTCP• Designed and developed by NIC (HQ)• Enables healthcare service delivery, ensuring voluntary participation

of various stakeholders and integrating public and private sectors

Objectives:Promoting real time TB surveillanceMinimizing patient default rateEffective program managementLinking TB database with UID

Achievements64,425 notified TB patients (up to 20.02.2014) in Nikshay222 Private health facilities have been registered & 908 TB patients notified by them

http://nikshay.gov.in/user/login.aspx

Generation & utilization of information

PHIs including DMCs

Monthly PHI Report (Paper Based)

Tuberculosis Unit

TB Register

District TB Centre

State TB CellCentral TB Division Database

Quarterly FeedbackQuarterly and Annual Performance Reports

Laboratory Register at DMC

Treatment Card for each patient at PHIs

C&DST Laboratory DOTS Plus site

DOT Provider

National Anti Malaria Management Information System (NAMMIS)

ComponentsHome

MIS Data Entry

MIS Output

MIS Administration

Change Password

My Profile

Log Out

NAMMIS Collaborative Tools

The State of Jharkhand has consistently been appreciated at the National level for effective and holistic use of this application

The State of Jharkhand has consistently been appreciated at the National level for effective and holistic use of this application

Integrated Disease Surveillance Programme (IDSP)

• Objective: Strengthening of Disease Surveillance System for epidemic prone diseases to detect and respond to outbreaks

• Use of Information Technology for collection, compilation, analysis & dissemination of data

• Network– Data Centers – Training Centers – Video Conferencing System• Software / IDSP Portal (www.idsp.nic.in)• 24 X 7 Call Center (1075 / 1800-11-4377)

Data Flow

All the districts in the State provide weekly reports

Impact of IDSP portal• Progressive increase in case reporting (Acute Diarrhea Diseases, Food

Poisoning, Chicken Pox, Measles ,Malaria, Dengue, AES, Chikungunya, JE, Jaundice etc. over the years

Strategic Management Information System (SIMS) under NACP

Primary reporting unit levels(with in a district)

DAPCU(District Level)

SACS(State Level)

NACO(National Level)

Direction of data flowEach level, sends data to next

level after validation

Monitoring and Feedback

Report generation and use of data

Report generation and use of data

Report generation and use of data

Monitoring and Feedback

Monitoring and Feedback

Reporting units in SIMSReporting Unit

LevelReporting Unit Type

State State AIDS Control Society (SACS)

District District AIDS Prevention Control Unit (DAPCU)

Units within districts

ICTC, Blood Bank, ART, CCC, STI clinic, Link worker, Laboratory

Report verification in SIMSNegative reports can be verified in SIMSAfter verifying becomes

CLHA MISAs part of the pediatric

program the Pediatric Anti Retroviral Treatment (ART)

record online software filled up for each child

coming to the ART center

CLHA: Children Living With HIV / AIDS, CCC: Community Care Centers, STI: Sexually Transmitted Infections

The Mamta Vahan Initiative: Innovating with local entrepreneurs

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The Innovation: Free referral transport for pregnant women and new borns

Launched on 4th July 2011 in Ranchi, entire state covered by October 2011

Advocacy and commitment observed at the highest level with the then State Cabinet

Ministers and Member of Parliaments launching the service across various districts

Management Information System (MIS) interplay in the Initiative

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Home Page of the Application

Call Details Entry FormatFacility Detail Entry Form

Feedback Detail Entry From

Vehicle and Owner Details Entry Form

What has the initiative achieved???

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3, 60,637 pregnant women rendered

services from July 2011 till June 2013

Progressive increase in the Institutional Delivery

Rates in the State: from 40% in 2011-12 to 46% in

2013-14

In 2012-13 referrals by Mamta Vahan accounted for

43% of institutional deliveries in Government facilities in the State (Total institutional deliveries: 325712,

Referrals: 139601)

56% of the services utilized by marginalized

population groups in 2012-13 (SC- 11900, ST –

29013,OBC -37011)

Performance Analysis of Mamta Vahan MISUse of Computer Application makes self

monitoring and analysis possible

Saturday, April 8, 2023 25Data analyzed for financial years 2010-11, 2011-12 and 2012-13

Average calls attended per

day: 457

Average cases transported per

day: 391

% calls received versus attended

(home to facility): 96%

Average time taken to reach the facility: 50

minutes

Average cost per run: Rs 460

% calls received versus attended

(facility to home): 98%

National Cold chain MISObjective - To capture real time data for efficient cold chain management Objective - To capture real time data for efficient cold chain management

Components of NCCMIS

Details of cold chain pointsHR StatusEquipment and spares status and transactionsUnder repair and condemnation detailsAvailability of cold chain space

NCCMIS AchievementsBaseline details of the cold chain data uploaded on the portalRegular monitoring of the data and updation by the state cold chain teamTracking of under repair equipments and follow up with the districts for fixing the problemNew supplies to districts are crossed checked with the inventory captured in NCCMIS

Jharkhand Rural Health Mission Society website• Inaugurated in 2011 the website provides a comprehensive

overview of all activities and interventions ongoing in the State (http://210.212.20.93:8082/jrhms/)

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Human Resource Information System (HRIS) in Jharkhand• Ministry of Health and Family Welfare, Govt of Jharkhand

initiated efforts to establish a web-based HR Management Information System in July 2010

• IntraHealth International through USAID Vistaar Project supported the effort

• Used an open source application, iHRIS Manage• Major Activities

– System requirement study– Customisation of software– Development of data collection form– Orientation of staff for data collection and entry– Standardisation of job titles – Actual data collection, entry, verification and validation for Ranchi

district (all cadres) and Medical Officers for entire State– Generation of HRIS reports

HRIS Strengthening Approach

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HRIS: Key Results Online Health Workforce directory for State- 4,437 Online Doctors directory for all districts -1,628 Online Health Workforce directory for Ranchi - 1,947 Basic HRIS reports designed and available for use Customized reports are being used for decision making process Doctors deployed in

Dept. of Home (Jail), Social Welfare, Labour, Employment & Training included in iHRIS

State Level MToT completed in August 2013 iHRIS Manage Administrator Technical Training completed in Nov

2013 at New Delhi for 5 Person from DoHFW District level training for block levels users Completed for 23

districts in Dec 13

A web based MIS has been developed for all 70 MTCs in the State URL is http://mtc.dreamworksinfotech.com/ The MIS application has been operational since April 2013

Web based MIS for Malnutrition Treatment Centers (MTCs)

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Impact of MTC MIS

Improved cure rates

Weekly Iron and Folic Acid Supplementation (WIFS) MIS • Need for WIFS MIS

– Un-availability of proper MIS for Adolescent Health Programme in Jharkhand.

– To establish of MIS with available resources and manpower

– To streamline the reporting channel block level to state level.

– Reduce Working hour and Manpower for WIFS MIS

Impact of pilot intervention in Khunti district:

Reporting ensured from all blocks

Consistent coverage

Vehicle Tracking System

Real Time tracking of Mobile Medical Units (http://rosmertaengg.com/vts/)

60 of the 100 operational MMUs have been equipped with this system

Has resulted in improved accountability and service delivery

Biometrics application

Ensures accountability

Improved efficiency

Adherence to timeliness

Increased work output

Widening the horizon

e-Governance e-Governance

Immediate need to further increase the scope of e-Governance initiatives

The answer

m-Governance

m-Governance The extension of e-

Governance to mobile platforms

Strategic use of government services and applications which are only possible using cellular/mobile

telephones Laptop computers personal digital

assistants (PDAs) wireless internet infrastructure

m-Governance v/s e-Governance M-Governance compliments e-Governance: expands reach Available anywhere and anytime Addresses the mobility of Government itself.

Mobile Users (Wireless) in India as on June 2013

(millions)

Internet and Broadband users as on June 2013 (millions)

Total subscribers: 903.09 Internet subscribers: 21.89

Urban : 545.48, Rural: 357.61 Broadband subscribers: 15.20

Available data from TRAI is testimonial to this:

In addition 176.50 million subscribers accessed internet by mobile devices between April to June 2013

m-Health

Wide use of m-health applications across the globe:247 million people have downloaded a health app40000 medical apps are now available for tablets and smartphones59% of patients in emerging markets use at least one m-Health application or service compared with 35% in the developing world

m-Health initiatives in JharkhandRealizing the need Government of Jharkhand has initiated various m-Health initiatives

Mobile banking:The next era of financial inclusion

Banking–Barely 300m bank accounts in a country of 1.2bn people, Unique bank account holders even lesser

–Only 35% of the adult population has a bank account–Serviced by 106 K bank branches, 150K ATM network one of the lowest ATM per inhabitant ratio –69% population is rural, with ~639K villages–Only 5% villages have bank branches, 73% of farmer households have no access to formal sources of credit

Robust Mobile Money ecosystem is key to Financial Inclusion

India : StatisticsMobility

–~903 Mn+ Telecom connections (Expected to touch1.1 Bn by 2015)–Tele-density stands at 73.1%–Rural tele-density at 41.7%

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ServicesPayments

• Money Transfer • To registered M-Pesa

account• To any bank account• To any mobile in India

• Cash withdrawal• Person to Merchant

• Airtime recharge• Utility /DTH payments• Merchant Payments

Deposits • Interest bearing Savings Bank

Account

ServicesPayments

• Money Transfer • To registered M-Pesa

account• To any bank account• To any mobile in India

• Cash withdrawal• Person to Merchant

• Airtime recharge• Utility /DTH payments• Merchant Payments

Deposits • Interest bearing Savings Bank

Account

m-pesa

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Why M-Pesa for JSY Disbursals? M-Pesa offers last mile delivery of

Banking & financial services Leverage on the existing Telecom

infrastructure Rapid scaling up of Agent points Efficiency & transparency in payment

disbursals Online monitoring & reporting Ease of use

Works on USSD on any feature phone

Available in vernacular language

M-Pesa offers last mile delivery of Banking & financial services

Leverage on the existing Telecom infrastructure

Rapid scaling up of Agent points Efficiency & transparency in payment

disbursals Online monitoring & reporting Ease of use

Works on USSD on any feature phone

Available in vernacular language

• Being piloted in Namkum block in Ranchi district

• Disbursement of funds to beneficiaries initiated

CommCare: Mobile Solution for Frontline Workers

Manage Apps and UsersRemotely manage your CommCare application and mobile workforce from our web-based application.

Monitor & Support Workforce“Active Data Management” utilizes the data you collect to focus on the continuous performance improvement of your workforce.

Web

Manage DataUse CommCare Mobile for complex data collection, submitted to the web in real-time

Manage ClientsUse “case management” to track client data

Engage with MultimediaUse images, audio, and video to educate and engage frontline workers and their clients.

Mob

ile

CommCare: Jharkhand RoadmapBeing piloted in Chandil block in Seraikella-Kharsawan

•Objective: To create a field-tested Standardized Open-Source Mobile App for Sahiyas that:

• helps in tracking pregnant women & children, home visit scheduling

• is easy to use for low-literate users• includes multimedia content such as images, audio, & video

for BCC• contains key data points as required by MCTS• works in online & offline mode (for areas with no

connectivity)• tracks immunizations• is replicable and scalable• sophisticated supportive supervision mechanisms

• Engaging women for improving demand for services

• Create a m-channel linking women to quality services by– Using the technology to inform women and

communities about entitlements, and schemes like JSY, JSSK

– Promote Birth Planning and service uptake– Feed back patient experiences to private and

public providers and facilities for continuous quality improvement

Linking Women to Services: Quality of Maternal Care (MoM-QC)

The Proposed Model

Women & communities call a toll-free number to give feedback., leave or seek information

The submitted information validated

Validated data published online

Validated data also published for access on same toll-free number

People can call into the toll-free number to listen to published reports

Engaging Women & Community through voice based social media, Mobile Vaani

Information on Entitlements, BPCR and QoC disseminated via the social media network

Improvement in QoC

Bring reports to the attention of health providers and facilities

Registered

health facility

Process overview

Step 1: Receive weeklyRequest SMS

Step 2: Health workercounts and notes

Step 3: Send response SMS on time: Receive incentive

Step 5:Reports via internet, smart phone e-mail

Step 6: Taking appropriateaction

The system accept SMS messages from any mobile network

SMS for Life in Jharkhand• Problems existent in logistics

management– Stock outs in peripheral health structures– Health logistics– Lack of accurate surveillance data

→ SMS for Life to quantify the problem → SMS for Life to improve surveillance &

HMIS → Need for evidence based planning and

action as India is working towards increasing universal coverage and health spending

e-Governance initiatives: providing a comprehensive approach

Works on the face of quality in the health system

Exploits modern ICTs Electronic HIS

Uses pay-for performance

Enhance transparency & accountability

Potential to improve access to services

Addresses extrinsic & intrinsic motivation

Potential to revolutionize service delivery mechanisms

Way forward

It’s only the tip which has been explored

e-Governance is rising

The potential is unparalleled and the need of the hour is to harness the resources effectively and optimally