Innovative Practices of e-governance in Health Sector

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1 Innovative Practices of e-governance in Health Sector MedLEaPR (Medico Legal Examination and Post Mortem Reports) System FSL & other Laboratory Tests Reports integrated with MedLEaPR System MCTS (Mother & Childs Tracking System) Online blood availability Portal e-hospital Integrated Hospital Management System Health Management Information System Mukhya Mantri Muft Illaj Yojna Online Drug Inventory & Supply Chain Management

2 On-line Drug Inventory and Supply Chain Management System of NRHM Haryana Simplify Drug Procurement, Distribution and Inventory management in transparent, effective and efficient manner NIC-HrSC /NRHM Haryana 2

3 Situation Before Initiative Drugs, Surgical and Sutures were procured in decentralized mode There was manual monitoring of flow of Drugs, Surgical and Sutures from purchase to consumption at District and State Level Small staggered orders from 21 districts lead to non supply by the suppliers There was no tool to monitor and evaluate the demand, consumption, inspection, budget and other documentary evidences NIC-HrSC /NRHM Haryana 3

4 Situation Before Initiative No track of flow between procurement and consumption - leading to shortage /excess No control on critical issues like alert of expiry medicine, supply of medicine by vendor No quality control, drugs reached reordering level Require continuous monitoring to ensure that each transaction is accounted for and makes inventory records, a more cumbersome process for officials - time wasting & prone to errors NIC-HrSC /NRHM Haryana 4

5 Situation Before Initiative Not more than one person was able to access data at the same time unless they keep multiple copies of reports, which again was wastage of paper Due to excessive Paper work, often searching the relevant information was tedious exercise Errors in addition, transposition of figures, Incorrect recording of a transaction, Incomplete recording of a transaction NIC-HrSC /NRHM Haryana 5

6 Objectives of On-line System To implement the new Drug Policy of Haryana Govt Executing procurement of good quality drugs, Surgical and Sutures at reasonable price for the state & to meet the requirement Streamlining the distribution of drugs to Health institutions To ensure availability of drugs at all times Strengthening the system of Quality Controls, over drugs procurement and distribution NIC-HrSC /NRHM Haryana 6

7 Motivators for Project Initiative New drug purchase policy for all Districts of Haryana Absence of monitoring tool for timely corrective action Strategic planning and corrective administrative action cannot be taken in absence of real time data Compilation of paper based data is time consuming and thus delay in implementation of the decision Monitoring & evaluation for demand, consumption, inspection, budget and other documentary evidences NIC-HrSC /NRHM Haryana 7

8 Strategies adopted for bringing about the transformation Studied State s new Drug purchase policy, System study done by visiting at General Hospital, Community Health Centre, Primary Health Centre etc Application Software Requirements Specifications & System Design, Software Development, Testing 3 rd party security audit & Hosting at HSDC Preparation for Training of Trainers at State HQ who in turn provide training at District level NIC-HrSC /NRHM Haryana 8

9 Strategies adopted for bringing about the transformation Pilot Implementation, Collection of Change Requests Modification, stabilization and Roll-out of application Periodic review of implementation at monthly Civil Surgeon meetings Communication and dissemination strategy - approach used through Video Conferencing, s and feedback/ complaint registration modules NIC-HrSC /NRHM Haryana 9

10 NRHM HQ Procurement of Drugs Distribution AMBALA KARNAL KAITHAL HISAR BIHWANI ROHTAK GURGAON AMBALA KARNAL KAITHAL HISAR BHIWANI ROHTAK GURGAON PANCHKULA PANIPAT JIND FATEHABAD NARNAUL JHAJJAR FARIDABAD YAMUNA NAGAR KURUKSHETRA SIRSA SONIPAT PALWAL MEWAT REWARI 10

11 Medical college PHC / UPHC CHC / UHC Warehouse SDH GH MMU - Mobile Medical Unit FRU First Referral Unit URCH- Urban Reproductive Child Health Central Store Dispensary TB Hospital Manual National Programme 11

12 Process flow of Supply Management - Procurement Cycle Purchase Order of the Drugs By NRHM/State/Medical College Budget Vendor / Supplier accepts the Order through the Online System Vendor / Supplier will generate supply order Vendor / Supplier will generate the shipment back to NRHM/State Warehouse will receive the drugs and update the same using this application NIC-HrSC /NRHM Haryana 12

13 Process flow of Supply Management Quality Control Random Sample is picked as per norms laid by State Sample details are updated in web portal Courier details are sent to State Quality Control wing State QC wing receives the Courier from all warehouses and Random sample from each batch is taken (randomized is done by Computer), details are updated Codification is done, updated in portal and sent to third party empanelled testing Lab NIC-HrSC /NRHM Haryana 13

14 Process flow of Supply Management Quality Assurance Testing Lab receive the samples and test result is uploaded using the portal If the test report Fails, Portal auto freeze the distribution of drugs In case of failure, the batch replacement will be started from vendor In case of success, the drug is available in portal to warehouse for distribution NIC-HrSC /NRHM Haryana 14

15 Process flow of Supply Management - Distribution Health facilities will prepare indent, 7 days before taking the delivery of medicines, Indenting is done as per roster and entitlement and it will indent the drugs which are available in the Warehouse. Warehouse will issue the drugs against indent and shall update in the portal Health facilities will receive the medicines and update the portal NIC-HrSC /NRHM Haryana 15

16 Process flow of Supply Management Receipt & Consumption Health facility receive the indented drugs which are available in warehouse, based on the type of indent, generated, like Normal regular Indent Special Indent, Free Indent etc. Health facility will show the drug consumption on weekly basis through the portal NIC-HrSC /NRHM Haryana 16

17 NRHM Procurement Cycle Purchase Order Supplier Vendor Accept Vendor Supply Order Supplier Generate Shipment NRHM Warehouse QC Process 17

18 Distribution of Drugs From Warehouse Health Institute Issue Receive Indent GH SDH Entitlement CHC PHC Central Store RCH Reproductive Child Health Dispensary UCH Urban Child Health 18

19 NIC-HrSC /NRHM Haryana 19

20 Snap Shots of Android Application NIC-HrSC /NRHM Haryana 20

21 Dashboard- Rate Contract Analysis NIC-HrSC /NRHM Haryana 21

22 Dashboard- PO Quantity Receipt Ratio at Warehouse NIC-HrSC /NRHM Haryana 22

23 Report -Age of Medicine NIC-HrSC /NRHM Haryana 23

24 Top 5 consumption Drug District Wise NIC-HrSC /NRHM Haryana 24

25 State Level Monitoring Account Screen NIC-HrSC /NRHM Haryana 25

26 State Level Monitoring Account Screen NIC-HrSC /NRHM Haryana 26

27 State Level Monitoring Account Screen NIC-HrSC /NRHM Haryana 27

28 Highlights/positive features of the initiative - Transparency and stakeholder participation Dashboards for Higher Authorities included in the system for monitoring purposes Drug Management from Procurement to Distribution has improved due to online monitoring of each activity through the system Alerts are generated with different colours for drugs likely to be expired, same is also sent through NIC-HrSC /NRHM Haryana 28

29 Highlights/positive features of the initiative - Transparency and stakeholder participation Non Availability Certificate generation before any local purchase of medicines and consumables with an objective of better utilization of local fund available with Institute and Civil Surgeon resulting wastage of Drugs are avoided Intra-Institute, Intra warehouse and intra-district drug transfer with objective of optimum utilization of Drugs The system suggests not placing Purchase Orders to those vendors whose products are always of non standard quality NIC-HrSC /NRHM Haryana 29

30 Summary Statistics of Existing Portal Number of live Users: 1. Health Institutions / Users : 1006 / Vendors : 123 / Test Labs : 7/7 4. Medical Colleges : 5/5 5. Warehouse/User : 7/ State Level User: 2(State/NRHM)/ State Level User-(Programme Monitor)- 6 Programmes 8. USAID Monitoring : 1/2 9. District Level /User : 21 / National Programme Monitoring: (21*6) 126

31 Performance of Web Portal Budget handled by Portal State : 73 Crores NRHM: 45 Crores Medical College: 15 Crores Process (at Warehouse - till Sept. 2014) Average Indents/Month: 2059/ 4.9 Crore (Number/Values) Average Issue /Month: 2013/ 4.0 Crore (Number/Values) GAP: 46 indents/month in State(translate it as NAC) Process (at District till Sept 2014) Local Purchase(LP) Total Non-Availability Certificate(NAC) ( Number): 10,143 Total LP( in Rs): 5,40,61,053/-

32 Performance Indicators monitored 1. Age of Inventory at various level 2. Fill Rate 3. Inventory turnover 4. Supply Tracking 5. Monitoring medicine expiry and re-distribution 6. Budget and payment monitoring 7. Demand Analysis Key Performance Indicators for Essential Medicines Supply Chain - Central Level 32

33 Increased efficiency of processes and effectiveness of outcomes Automatic intimation feature reduced the time of correspondence thus increased the efficiency Before this system, there was no time limit to know whether Vendor has declined or accepted the order, now for vendors 72 hours has been fixed to accept or reject the order and NRHM can take decisions to cancel and reorder to another vendor Timely intimation has increased availability of order in Health Institute System continuously monitors expiry of medicine, various alerts and dashboard reports are helping NRHM to transfer the medicines, where these are required, so process efficiency improved by system NIC-HrSC /NRHM Haryana 33

34 Improvement in Overall efficiency of Drug Supply Management provides the consolidated source of information showcasing drug supply progress; allows actors to learn from each other s experiences, building on expertise and knowledge; generates (written) reports that contribute to transparency and accountability, and allows for lessons to be shared more easily; Reveals mistakes in decision making and offers paths for learning and improvements NIC-HrSC /NRHM Haryana 34

35 Improvement in Overall efficiency of Drug Supply Management Provides a basis for questioning and testing assumptions; Provides a means for NRHM seeking to learn from their experiences and to incorporate them into policy and practice Provides a way to assess the crucial link between implementers and beneficiaries on the ground and decision-makers Adds to the retention and development of institutional memory Provides a more robust basis for raising funds and influencing policy NIC-HrSC /NRHM Haryana 35

36 Sustainability of the initiative Standard practice recommended by Government of India for security is imposed while designing and developing the system The Open Web Application security Project (OWASP) standards has been followed to make the portal more and more secure Website hosted on State Data Center of Haryana, which is secure in all aspect physical and well virtual furtive agents Master trainers have been trained at District level for handholding. NIC-Haryana expertise is available on long term basis to NRHM NIC-HrSC /NRHM Haryana 36

37 Outcomes: impact/benefits Manual System Due to manual process, monitoring was tedious On-line System monitoring is done in effective and efficient manner at higher level also. Information about, to be expire drugs, is not available easily so it is difficult to take corrective action Alerts are generated for, to be expire drugs, in advance so that corrective action can be taken and same can be consumed at other needy place. Drug Stock position in all health institutes not available instantly so it is difficult to forecasting for drugs requirement In online system, drug stock position is available for all institutes so forecasting of drugs can be made NIC-HrSC /NRHM Haryana 37

38 Outcomes: impact/benefits Manual System On-line System Tracking of Purchase order placed for drug was not there Tracking of Purchase Order places for drug is online visible at all level No analysis was available identifying abnormal consumption / distribution of drugs System facilitate analysis and reports on distribution / consumption of drugs. Helps in identification of abnormality / diversion/ Pilferage of drugs No MIS reports available for planning & decision making purposes Various MIS reports and dashboards are available, which helps in proper planning & timely decision making NIC-HrSC /NRHM Haryana 38

39 Positive features of the initiative - Innovation & Replicable Process Software adhere to procurement procedures adopted in the state of Haryana, Any other state adopting the same procurement procedure can replicate this software with minor customization NIC-HrSC /NRHM Haryana 39

40 Positive features of the initiative - Innovation & Replicable Process Essential Drug List of State and Drugs which are available in Haryana are to be included and made ready Initial Stock Entry at the Institute level made ready so that Consumption module can be used and stock position can be obtained Initial stocks available in all the institutes will be entered and consumption of this stocks will be made online. Few Software Developers will work in the software for one year under the guidance of NIC State officer Know how on the Indent Module, Purchase Order preparation module, Sample Lifting module and Receipt of the same at Institute level will be transferred to State team NIC-HrSC /NRHM Haryana 40

41 Positive features of the initiative - Innovation & Replicable Process Security audit is being carried out as without this the application cannot be hosted in NIC Data Centre State NRHM will start with few institutes in SHQ, identify the issues, resolve them and extend it to all other warehouses/institutes NIC officials in the district will be trained to provide support and training to district warehouse and institute officials NIC-HrSC /NRHM Haryana 41

42 Positive features of the initiative - Innovation & Replicable Process All the institutes and district warehouse will be provided an NIC account, so that all the communications are done through the portal. As NIC services has got the facility of sending SMS through the mail service itself A mobile based enquiry system also will be made available for the institutes and district warehouses to know the first hand stock position at their respective places NIC-HrSC /NRHM Haryana 42

43 Highlights/positive features of the initiative - Innovation & Replicable Process Vendors / Quality Agencies are provided a separate link so that they can register themselves using this portal. An authorized person from State Health will verify these Vendors and Quality agencies to get access to this portal NIC-HrSC /NRHM Haryana 43

44 Highlights/positive features of the initiative - Innovation & Replicable Process Host the application in Staging environment in your State Data Centre Prepare Meta Data and make the masters ready State Health / NRHM will check the master data and shall confirm to NIC to proceed further for customization Rates for each and every drug has to be fed by State Health Access permission for Institutes to be set for respective drugs NIC-HrSC /NRHM Haryana 44

45 FUTURE EXPANSION / PLANNING For procurement of Medical Equipments Integration with e-payment gateway Auto generation of Purchase order on the basis of consumption pattern For Procurement of Items (other than Drugs) through the same Procurement Cycle Integration of Doctor performance and Drug Inventory with possibility of SMS integration for Citizen SMS and Web Interface for citizens on key events and performance analytics NIC-HrSC /NRHM Haryana 45

46 Recognition NIC-HrSC /NRHM Haryana 46

47 Recognition NIC-HrSC /NRHM Haryana 47

48 Recognition Nominated under Innovative use of Technology in E-Governance for India Health & Wellness Award NIC-HrSC /NRHM Haryana 48

49 Contact: Ghan Shyam Bansal Dy. DG NIC & SIO Haryana; em: 49

50 Abbreviation 1. GH General Hospital 2. SDH Sub Divisional Hospital 3. CHC Community Health Centre 4. UHC Urban Health Centre 5. PHC Primary Health Centre 6. UPHC Urban Primary Health Centre 7. URCH Urban Reproductive Child Health 8. QC Quality Control 9. PO Purchase Order 10. FRU First Referral Unit 11. MMU Mobile Medical Unit 12. TB Tuberculosis 13. HSDC Haryana Sate Data Centre 14. MD Managing Director 15. NRHM National Rural Health Mission 16. Addl. CS Health Additional Chief Secretary, Health 17. DDG Deputy Director General 18. PSA Principal System Analyst 19. SSA Senior System Analyst 20. SPC State Project Coordinator 21. SPL State Project Leader NIC-HrSC /NRHM Haryana 50