Focus

Healing Rajasthan

In this era when scientific and technological innovations are at

their peaks and we are making sincere efforts to eradicate deadly diseases like

AIDS and tuberculosis, the state of Rajasthan, just three years back, was still

vulnerable with a vector- borne disease, malaria.Just three years back,

Rajasthan was quite vulnerable with a vector-borne disease, Malaria. Also,

maternal and infant mortality rate was on the rise and out of control. The

authorities found it difficult to deliver adequate health services on time due

to lack of information related to case detection and availability and

distribution of medicines and vaccines. It was also difficult for officials to

react to the information.

But now, after three years, cases of Malaria, and maternal and

infant deaths have reduced substantially. The response time to detect cases or

outbreaks has come down. There is significant improvement in management of

equipments and services. So, what happened in the last three years that changed

the scenario of the health system of Rajasthan?

"HEALING has impact on the masses

because we have managed to reach rural areas with better surveillance and

monitoring"

Online Healing

It was all thanks to HEALING (Health Information System for

Government), an integrated health information system for Medical, Health and

Family Welfare department. HEALING has been developed, maintained, and supported

by the National Informatics Centre (NIC), Rajasthan.

In the beginning of the year 2004, the Rajasthan state health

authorities decided to have a comprehensive online information system that would

help manage the health services better. And the department chose NIC as the

developing and implementing agency for such a system. One option was to develop

and install a standalone application, but this was discarded keeping in view the

geographical spread of the state where two-thirds of the area is either hilly or

desert land.

Another reason to discard this option was that it would need

redundant transfer and compilation of data at different levels, ie, at the

district, state, and national level. Installing such a system would mean

repetition of work at different levels resulting in wastage of time, effort, and

manpower. Considering the above factors and to minimize implementation and

operational issues it was decided to develop a Web-based portal with front-end

as ASP.Net/ASP and MS SQL Server as backend, and then to deploy the system on

high-end servers connected to thick Internet backbone.

Challenges

But there were some challenges in the way to make this portal

successful. Some that needed immediate attention were lack of IT infrastructure

facilities in terms of hardware, software, and Internet connectivity, and

motivation of the staff to use this Web portal. The staff was apprehensive in

using the system due to lack of computer awareness and the perception that it

would increase workload.

The state government solved the problem of IT infrastructure by

releasing funds, and NIC ensured proper installation and implementation of the

system. NIC also motivated and trained field level staff by conducting regular

awareness and operational training sessions. Local offices of the NIC in

districts have provided excellent handholding support to the district health

officials.

Some features of the system include role-based password

protected access to the user. To ease the information transmission from remote

locations, the system was made available on a 24x365 basis. The scalable design

of the system ensured minimum changes for implementation at any level, whenever

required. The user does not need to compile or aggregate the data at different

levels because all the analysis is available in the form of text and graph

reports, and that too at the click of a button.

Noticeable Changes

It was in January 2005, when district officials actually started

working on the system. The data was brought from below district level, ie,

Primary Health Centers (PHC), and fed into the system on a weekly and monthly

basis. The impact of developments that took place in the last three years can

now be seen. These can be broadly classified into three categories-improved

service delivery, functional efficiency, and transparency.

Service delivery has been improved by better stock control of

vaccines and medicines resulting in improvement of immunization coverage,

availability of essential drugs throughout the state, effective redressal of

public grievances, and patients' record management in tracking patients for

follow up action.

According to Dr Digamber Singh, minister, Medical, Health and

Family Welfare, Government of Rajasthan, "In a way, this software has

impact on the masses because we have managed to reach the rural areas with

better surveillance and monitoring. In other words, we have reached the

unreached."

Functional efficiency has improved by faster availability of

information. Previously, it took several weeks for the data to reach from the

lower level to state level but now the information is quickly made available

online with ready to use analytical reports, and action can be taken immediately

on various issues like effective control of a disease occurring or an outbreak,

and in the up-keep of equipments. Online availability of information at all

levels is helping the Indian government to monitor programs using HEALING.

"It is for the first time that we have

the PHC level information available online"

According to RK Meena, principal health secretary, Government of

Rajasthan, who played a very instrumental role in implementing this software in

the state: "Having this software in the department is like a dream come

true. We can do wonders in terms of better service delivery to our people. It is

for the first time that we have the PHC level information available

online".

Transparency has increased as the same information is available

at all levels, audit logs eliminate instances of false reporting about data

transmission from field locations. This in turn has helped in improving the

quality of information.

According to Indu Gupta, SIO, NIC, Rajasthan, "HEALING has

a promising future and efforts are on to expand the scope of the project from

PHCs to the sub-center." She added that the software has also been shared

with the states of Gujarat and Karnataka.

The grass root level data will move from sub-centers to PHCs and

then be fed into the system. Thus, health information up to the sub-center would

be available online at all levels, from PHCs to state and national levels. The

system enables the department in effective and efficient delivery of health

services by providing an online monitoring mechanism.

Sandeep Sharma