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


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

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

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  • The Slide depicts key operational windows in the Mamta Vahan ICT Application
  • This links well with the HRIS findings –we found that capacity building was needed and essential (more needs to be done for scale up), and that capacity building is needed to USE the data. Also leadership is critical to get the HRIS going – and to model USE of data . Also we set out to build a system that can integrate with and complement the existing HMIS – which does NOT collect much data on health workers at all.
  • Different kinds of HR reports are available which includes information about current deployment scenario, skill and specialty distribution.
  • Need to clarify if data is for entire state, or just Ranchi – or some other mix??
  • Transcript

    • 1. From e-Governance to mGovernance Scripting new dimensions Dr. Manish Ranjan, IAS Mission Director, National Health Mission, Ranchi Jharkhand Thursday, March 6, 2014 1
    • 2. • The need for effective and holistic governance is very well reflected in UN Secretary General’s words – " 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
    • 3. The Information Technology revolution provides us a wonderful opportunity to optimize and improve governance across all sectors: The key implementation measure being e-Governance
    • 4. e-Governance 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.  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 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
    • 5. 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
    • 6. 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 Thursday, March 6, 2014 7
    • 7. Using HMIS for performance monitoring: HMIS Dashboards Indicators: 2013-14 Q1 (Apr –– Jun 2013) Q1 (Apr Jun 2013) Q2 (Jul –– Sep 2013) Q2 (Jul Sep 2013) Sahibganj Godda Sahibganj Godda Pakur Kodarma Garhwa Palamu Chatra Latehar Lohardaga Gumla Simdega Giridih Pakur Deoghar Dumka Kodarma Jamtara Dhanbad Hazaribagh Garhwa Palamu Bokaro Ramgarh Khunti Chatra Hazaribagh Latehar Lohardaga Ranchi Gumla Saraikela Purbi Singhbhum Pashchimi Singhbhum Simdega Sahibganj Godda Giridih Deoghar Dumka Jamtara Dhanbad Bokaro Ramgarh Ranchi Khunti Saraikela Purbi Singhbhum Pashchimi Singhbhum Pakur Kodarma Garhwa Palamu Chatra Latehar Lohardaga Good performing Promising Low Very low Gumla Simdega Giridih Hazaribagh Deoghar Dumka Jamtara Dhanbad Q3 (Oct –– Dec 2013) Q3 (Oct Dec 2013) Bokaro Ramgarh Ranchi Khunti Saraikela Purbi Singhbhum Pashchimi Singhbhum 16 indicator based dashboard based on life cycle approach
    • 8. Dumka - Block wise HMIS based Dashboard Quarter 1, 2 & 3 (2013-14) Good Performing Promising Very low performing Low performing Q3, Q2 & Q1- Average Index values - Component wise Overall Index SN Blocks Q3 Q2 Q1 1. Reproductive age 2. Pregnancy Care group Q3 Q2 Q1 Q3 Q2 Q1 3. Child Birth Q3 Q2 Q1 4. Postnatal mother and new born Care 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
    • 9. 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 Thursday, March 6, 2014 10
    • 10. Automated Work plan generated through MCTS
    • 11. 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 surveillance Minimizing patient default rate Effective program management Linking TB database with UID Achievements 64,425 notified TB patients (up to 20.02.2014) in Nikshay 222 Private health facilities have been registered & 908 TB patients notified by them
    • 12. Generation & utilization of information Central TB Division Database State TB Cell Quarterly and Annual Performance Reports Quarterly Feedback District TB Centre DOTS Plus site C&DST Laboratory TB Register PHIs including DMCs DOT Provider Treatment Card for each patient at PHIs Laboratory Register at DMC Monthly PHI Report (Paper Based) Tuberculosis Unit
    • 13. National Anti Malaria Management Information System (NAMMIS)
    • 14. Components Home MIS Data Entry MIS Output MIS Administration Change Password My Profile Log Out NAMMIS Collaborative Tools
    • 15. The State of Jharkhand has consistently been appreciated at the The State of Jharkhand has consistently been appreciated at the National level for effective and holistic use of this application National level for effective and holistic use of this application
    • 16. 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 ( • 24 X 7 Call Center (1075 / 1800-11-4377)
    • 17. Data Flow All the districts in the State provide weekly reports
    • 18. 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
    • 19. Strategic Management Information System (SIMS) under NACP Direction of data flow Each level, sends data to next level after validation Primary reporting unit levels (with in a district) DAPCU SACS NACO (District Level) (State Level) (National Level) Monitoring and Feedback Monitoring and Feedback Report generation and use of data Monitoring and Feedback Report generation and use of data Report generation and use of data
    • 20. Reporting units in SIMS Reporting Unit Level Reporting 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 SIMS Negative reports can be verified in SIMS After verifying becomes CLHA MIS As 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
    • 21. The Mamta Vahan Initiative: Innovating with local entrepreneurs 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 Thursday, March 6, 2014 22
    • 22. Management Information System (MIS) interplay in the Initiative Home Page of the Application Call Details Entry Format Vehicle andDetail Entry Form Form Facility Owner Details Entry Feedback Detail Entry From Thursday, March 6, 2014 23
    • 23. What has the initiative achieved??? 3, 60,637 pregnant women rendered services from July 2011 till June 2013 56% of the services utilized by marginalized population groups in 2012-13 (SC- 11900, ST – 29013,OBC -37011) Thursday, March 6, 2014 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) Progressive increase in the Institutional Delivery Rates in the State: from 40% in 2011-12 to 46% in 2013-14 24
    • 24. Performance Analysis of Mamta Vahan MIS Use of Computer Application makes self monitoring and analysis possible Average calls attended per day: 457 % calls received versus attended (facility to home): 98% Thursday, March 6, 2014 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 Data analyzed for financial years 2010-11, 2011-12 and 2012-13 25
    • 25. National Cold chain MIS Objective -- To capture real time data for efficient cold chain Objective To capture real time data for efficient cold chain management management
    • 26. NCCMIS Achievements Components of NCCMIS Details of cold chain points HR Status Equipment and spares status and transactions Under repair and condemnation details Availability of cold chain space Baseline details of the cold chain data uploaded on the portal Regular monitoring of the data and updation by the state cold chain team Tracking of under repair equipments and follow up with the districts for fixing the problem New supplies to districts are crossed checked with the inventory captured in NCCMIS
    • 27. Jharkhand Rural Health Mission Society website • Inaugurated in 2011 the website provides a comprehensive overview of all activities and interventions ongoing in the State ( Thursday, March 6, 2014 28
    • 28. 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
    • 29. HRIS Strengthening Approach
    • 30. 1629
    • 31. 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
    • 32. Web based MIS for Malnutrition Treatment Centers (MTCs) A web based MIS has been developed for all 70 MTCs in the State URL is The MIS application has been operational since April 2013 Thursday, March 6, 2014 33
    • 33. Impact of MTC MIS Improved cure rates
    • 34. 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
    • 35. Vehicle Tracking System  Real Time tracking of Mobile Medical Units ( vts/)  60 of the 100 operational MMUs have been equipped with this system  Has resulted in improved accountability and service delivery
    • 36. Biometrics application Ensures accountability Improved efficiency Adherence to timeliness Increased work output
    • 37. Widening the horizon Immediate need to further increase the scope of e-Governance initiatives The answer e-Governance e-Governance m-Governance
    • 38. m-Governance  The extension of eGovernance 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 
    • 39. m-Governance v/s e-Governance  M-Governance compliments e-Governance: expands reach  Available anywhere and anytime  Addresses the mobility of Government itself. Available data from TRAI is testimonial to this: Mobile Users (Wireless) in Internet and Broadband users India as on June 2013 as on June 2013 (millions) (millions) Total subscribers: 903.09 Internet subscribers: 21.89 Urban : 545.48, Rural: 357.61 Broadband subscribers: 15.20 In addition 176.50 million subscribers accessed internet by mobile devices between April to June 2013
    • 40. m-Health Wide use of m-health applications across the globe: 247 million people have downloaded a health app 40000 medical apps are now available for tablets and smartphones 59% of patients in emerging markets use at least one mHealth application or service compared with 35% in the developing world
    • 41. m-Health initiatives in Jharkhand Realizing the need Government of Jharkhand has initiated various m-Health initiatives
    • 42. Mobile banking: The next era of financial inclusion India : Statistics 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 Mobility –~903 Mn+ Telecom connections (Expected to touch1.1 Bn by 2015) –Tele-density stands at 73.1% –Rural tele-density at 41.7% –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 43
    • 43. m-pesa Services Services Payments Payments •• Money Transfer Money Transfer •• To To registered registered M-Pesa M-Pesa account account •• To any bank account To any bank account •• To any mobile in India To any mobile in India •• Cash withdrawal Cash withdrawal •• Person to Merchant Person to Merchant •• Airtime recharge Airtime recharge •• Utility /DTH payments Utility /DTH payments •• Merchant Payments Merchant Payments Deposits Deposits •• Interest bearing Savings Bank Interest bearing Savings Bank Account Account • Being piloted in Namkum block in Ranchi district • Disbursement of funds to 44 beneficiaries initiated Why M-Pesa for JSY Disbursals?  M-Pesa offers last mile delivery of Banking &  M-Pesa offers last mile delivery of Banking & financial services financial services  Leverage on the existing Telecom  Leverage on the existing Telecom infrastructure infrastructure  Rapid scaling up of Agent points  Rapid scaling up of Agent points  Efficiency & transparency in payment  Efficiency & transparency in payment disbursals disbursals  Online monitoring & reporting  Online monitoring & reporting  Ease of use  Ease of use  Works on USSD on any feature phone  Works on USSD on any feature phone  Available in vernacular language  Available in vernacular language
    • 44. CommCare: Mobile Solution for Frontline Workers Use CommCare Mobile for complex data collection, submitted to the web in real-time Manage Clients Use “case management” to track client data Mobile Manage Data Engage with Multimedia Use images, audio, and video to educate and engage frontline workers and their clients. “Active Data Management” utilizes the data you collect to focus on the continuous performance improvement of your workforce. Manage Apps and Users Remotely manage your CommCare application and mobile workforce from our web-based application. Web Monitor & Support Workforce
    • 45. CommCare: Jharkhand Roadmap Being 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
    • 46. Linking Women to Services: Quality of Maternal Care (MoM-QC) • 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
    • 47. The Proposed Model Engaging Women & Community through voice based social media, Mobile Vaani Information on Entitlements, BPCR and QoC disseminated via the social media network Validated data published online Women & communities call a toll-free number to give feedback., leave or seek information The submitted information validated People can call into the toll-free number to listen to published reports Bring reports to the attention of health providers and facilities Validated data also published for access on same toll-free number Improvement in QoC
    • 48. Step 1: Receive weekly Request SMS Step 2: Health worker counts and notes Step 3: Send response SMS on time: Receive incentive Registered health facility Step 6: Taking appropriate action Process overview Step 5: Reports via internet, smart phone e-mail The system accept SMS messages from any mobile network
    • 49. 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
    • 50. e-Governance initiatives: providing a comprehensive approach Potential to revolutionize service delivery mechanisms Enhance transparency & accountability Exploits modern ICTs Electronic HIS Potential to improve access to services Uses pay-for performance Addresses extrinsic & intrinsic motivation Works on the face of quality in the health system
    • 51. 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