GIS based Decision Support System
Commissionerate of Health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The Commissionerate of Health (COH) is given the critical task of supervising, monitoring and enhancing medical services across the state of Gujarat. It keeps track of existing medical hospitals, sub centers, primary health care centers and based on requirements, enhances them or sanctions new such centers to ensure that all un-served habitations can be covered and provided health care facilities within their neighbourhood. The sanctioning of health care centers is done on the basis of well defined guidelines/rules (Indian Public Health Standards, IPHS) which lay down the quantity and type of health care facility as against the population of a region. Based on these guidelines, COH issues orders to enhance the infrastructure at existing sites or to provide for completely new health care facilities in sites which remain un-addressed. Decision making in a critical department such as health has always been a challenge because of a lack of clarity on the actual status of infrastructure at the ground level. In the absence of this clarity, the Commissionerate of Health found it difficult to make informed decision and sanctions about where should new health centers be constructed. Most of the decisions were based on informal feedbacks received from staff working in the field or when there was a huge public demand for healthcare facilities in their vicinity. Recommendations were made by political figures and local leaders. So decisions and services of COH were not standardized and had no concrete basis. Additionally, in places where health care centers existed, it was essential to monitor the quality and quantity of infrastructure available in terms of human resources or medical equipments. The core problem was with planning for better distribution and maintenance of healthcare services by getting a comprehensive overview of current distribution of various health care parameters. Some of the key challenges in the existing system 1.Earlier the process of establishing the health facilities were manual and with recommendations of local leaders 2.There was no rational planning of new health facilities setup and no connection with ground level realities 3.Limited Health service delivery centres, uneven distributed, no rational allocation of health centres 4.Uneven ratio of Population and health care workers and resources 5.No Single tool to evaluate the health programs with respect to their geographic coverage 6.The evaluation of health facilities performance and programmes were not well established

B. Strategic Approach

 2. What was the solution?
The GIS based decision support system was proposed by the Commissioner of Health. The idea was to establish a direct link between the COH head office and the ground level administration so that the COH is able to keep track of the medical facilities available and can hence take more informed decisions. The prime objective was to set up a tool which can support planning and assist in prompt and sound decision making while evaluating the performance of healthcare services being provided state wide. This is an internal tool which is used on a day to day basis to assess grass root level state of health infrastructure and improve them to achieve better quality of public life. The GIS based maps can be helpful in identifying the outbreak of a certain disease or even the source of the outbreak with the data integrated to the GIS system A GIS based planning and monitoring solution enhances the ability of health care managers: 1. To understand, and use the insight obtained from a location perspective for planning 2.Implement a program that achieves the goal of better health care with better resource productivity The GIS application – an interactive spatial analysis tool- enables the Health Officer to perform 1.Re - districting. 2.Provide solutions for various healthcare programs like ANC(Antenatal Mother Care) Immunization of Child, Family Planning 3.Monitoring of various health programs like Antenatal Mother Care 4.Monitoring of Human Resource and Performance (.i.e. of Class I II & III also of Health Programs & Hospital Performance) 5.Re distribution of resources according to need and type of population (ie.SC/ST) 6.Re-locating health jurisdictions for effective utilization of health infrastructure With a clear view of the type and quality of health care facilities all across the state, decision making has been transformed from a recommendation based system to a rule based system which has led to standardization across the state. The head office is no able to clearly see a GIS based map which shows how healthcare facilities are spread out throughout the state. Based on the current pattern, they are also able to apply rules and perform a criteria based analysis to clearly point out the regions which are in need of enhancement or new sanctions. While decision making was a huge challenge earlier, with the GIS decision support system, the COH officials are able to identify requirements within a few minutes and propose sanctions accordingly. As a result, decision making is more standardized and based on concrete facts rather than political recommendations. Faster rollout of infrastructure is possible now as there is very little hesitation in making decisions. The concrete outputs as a result of the DSS have been listed in sections below and they clearly show the improvement in healthcare administration as compared to the situation before.

 3. How did the initiative solve the problem and improve people’s lives?
The solution analyses existing areas with inadequate health facilities and Human resource to deliver better and uniform healthcare services. A population centric gap analysis is done and new facilities and HR requirements are sanctioned to ensure that there is parity in healthcare services through the states and each area gets its sanctioned service. At the same time, the capacity of existing HR and infrastructure is being strengthened by recruiting medical and paramedical staff, extensive training for skill improvement and enhanced program performance. This is achieved by developing framework of gap analysis and identifying weakness in all components with support structure (As monitoring tool) at SC, PHC, and Taluka and district level. DSS has potential to find the gaps in infrastructure, HR, programs and performance which are being used in full in planning and monitoring of all said components on the basis of population and state government/GOI norms and policies. Due to DSS, policy makers are more informed about ground level realities and geographical distribution of infrastructure which helps them make more sound and prompt decisions thereby enabling better delivery. Computer and internet facilities are available in all the health department offices and at all the districts and Talukas.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Since a GIS based decision support system was envisioned, the department turned to BISAG - the state’s nodal agency for GIS based services. BISAG assisted the COH in development of the GIS based Decision Support System. This portal operates on SQL server by using ARC GIS software. It has the following features: 1.Technology based facility mapping 2.Technology based gap analysis and GIS support to induce parity in health care 3.GIS Based GAP analysis provides opportunity to allocate health facilities which are more convenient to provide access to the vulnerable groups 4.It provides opportunity for rational deployment of health staff and need base distribution of resources 5.It provides the opportunity to evaluate health programs up to Sub-Center level as per the indicators 6.It provides an opportunity to evaluate the performance of health facilities and programs by using GIS based DSS tools. 7.Current Health Facilities with their actual Lat. & Long. Are mapped & clubbed with population census 2011. 8.This provides an insight of current status of available health facilities with their respective population and provides an opportunity to plan for new health facilities to underserved areas according to IPHS 2012, RHS 2012 standards Details of base line study done: 1.Mapping of actual 7210 SC, 1168 PHC, 300 CHC, 30SDH, 24Dh and other health facilities locations, SC, PHC, Taluka, and District Boundary in GIS environment. 2.Gap analysis by using population of Census 2001 & 2011 & Current available health facilities (No. of CHC, PHC, SC etc.) districts wise. 3.Gaps in current health facilities as per IPHS 2012 & RHS 2012 norms are as below: 1. CHC – Existing - 300;Required-358; Gap-58 2. PHC – Existing – 1168;Required-1433;Gap-265 3. SC - Existing -7274;Required- 9156;Gap-1035 Problems identified: 1.Low orientation of IT in existing staff 2.Exhaustive process for training of staff as it was tedious job 3.Establishing inter-sectoral coordination between various departments like Urban and Rural Development, gram panchayats and district authorities. 4.Gaps of CHC, PHC & SC .i.e. deficit in CHC, PHC & SC as per norms of IPHS 2012 & RHS 2012 5.HR and other infra-structure gaps as per standard norms Roll out/implementation model: Gap Analysis & M.O.U with BISAG for Portal Development. Training to Staff & Creation of database. 1.Actual location of each Health facility, SC, PHC, CHC, SDH, DH(Latitude and Longitude) taken using Google Earth application 2.Health facility location place mark in Google earth software by each DQMO. & Taluka M&E at Taluka and District level 3.Health facility location place mark done as per BISAG and census code. 4.Lat. / Long. Obtained were integrated in the actual GIS application of BISAG 5.Mapping of SC, PHC, CHC, SDH, DH location and Boundary in GIS environment 6.Integration of Geo-Spatial Database with departmental Health data 7.Population and standard norms based criteria for GIS analysis of Infrastructure, HR, Programs and Performance. 8.Identification of habitation not served by present criteria 9.Identification of most suitable habitation location for proposed Health facility based on the Demography and available infrastructure facility 10.Finally developed GIS based Decision Support Information system(Web GIS) TRAINING: District and Taluka MIS Coordinators were trained on whole mapping process periodically at State Project Office with technical support from BISAG. Training imparted mainly on following points: 1.How to locate the school using Google Earth Software 2.Use of KML file with Google Earth application 3.Mapping the health facility village code with Census village code.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
1.State GIS Committee : Principal Secretary (Family Welfare) & Commissioner of Health (Chairman), Additional Director (Health), Additional Director (Medical Services), Additional Director (Family Welfare ), Additional Director (Medical Education), Additional Director (SIHFW), Director IIPH-Gandhinagar, All Program Officers, Deputy Director Rural (Member secretary), State Nodal Officer- GIS, IT Cell 2.District GIS Cell:- DDO (District Development Officer) Chair Person, CDHO(Chief District Health Officer) Member Secretary, ADHO ( Additional District Health Officer), DQAMO (District Quality Assurance Medical Officer) Other Program Officers as Member 3.BISAG (Bhaskaracharya Institute For Space Applications and Geo-Informatics), Gandhinagar
 6. How was the strategy implemented and what resources were mobilized?
Financial Resources: Rs. 78 Lakhs allotted from State Budget for this project. This was used in the portal development. Technical Resources: Since BISAG is the state level nodal agency for all geospatial services and GIS based development, an M.O.U was signed with BISAG for portal development and overall maintenance. COH also has a dedicated IT cell equipped with skilled manpower who provide support for day to day operations and maintenance of the project. Human Resource: All state and district level staff of COH areinvolved in this project. In GIS based decision support portal http://117.218.18.109:9090, policy and decision makers of 26 districts, 8 Corporations 225 Taluka health offices, 6 RDD and State level officers across the state of Gujarat are registered. For enrolment, username and password is provided through the department.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Based on information from Decision Support System new health facilities have been sanctioned by Government of Gujarat in short span of time. If we compare the year before and after the initiative, there is a stark difference in the nature of decisions and sanctions made. Prior to this initiative, all decisions were demand based and not need based. Recommendations for new facilities came from local figures. As a result almost no sanctions have been made in the year before which were based on just requirements of various regions. So the pattern of health facilities was skewed in favour of regions where there was more pressure regardless of the fact that whether the region actually needs more health centers as per IPHS or not. Post the deployment of the decision support system, COH was firstly able to perform a population centric gap analysis and clearly identify as to which areas of the Gujarat are non-compliant with the IPHS and where a significant improvement is required in health care centers. Once this gap analysis was done, necessary sanctions could be proposed to senior management who did not hesitate in making decisions because the actual ground level reality was visible to them through the decision support system. The enhancements done in 2013-14 based on the Decision Support System are listed below which are the most successful outputs: 1. Community Health Centers – With a gap of 58 CHCs, 26 CHCs have already been sanctioned and ready for deployment. 2. Primary Health Center 0 With a gap of 265 PHC, 135 have already been sanctioned. 3. Sub Center – With a gap of 1882 SC, 847 have been sanctioned. 4. 109 posts of Junior Pharmacists have been sanctioned based on requirement. 5. Posts of 180 Lab Technicians has been sanctioned. 6. Posts of 44 X-Ray Technicians has been sanctioned. The standout factor here is that these are need based sanctions and are not based on political recommendations or people pressure. The availability of the DSS brings in high confidence in decision making. Recently in 2014, approximately 377 Sub centers have been sanctioned based on the GIS decision support system.

 8. What were the most successful outputs and why was the initiative effective?
As the logins are provided to all concerned Health Officials (State & District Level), they can monitor the progress and performance of the health facilities and health programmes through data entry status, reports & charts. This provides an input for appropriate decisions. State GIS Cell and District GIS Cell have been established for monitoring and are accountable for data entry and quality of data. For monitoring of progress and evaluation of activities we have established the State GIS Cell & District GIS cell. The hierarchy for the same is as follows: State GIS Committee comprising of the following members monitors overall progress of the project: 1.Principle Secretary (Family Welfare) & Commissioner of Health – Chairman of the Committee 2.Additional Director (Health) 3.Additional Director (Medical Services) 4.Additional Director (Family Welfare) 5.Additional Director (Medical Education) 6.Additional Director (State Institute of Health & Family Welfare) 7.Director BISAG 8.Director IIPH-Gandhinagar 9.Dy. Dir. Rural (Member secretary) 10.All Program Officers 11.State Nodal Officer GIS The administrative structure at District Level GIS is as following for day to day monitoring : 1.District Development Officer as Chair Person 2.CDHO Member Secretary 3.Other Program Officers as Member 4.DQAMO (District Coordinator) 5.District Program Manager GIS 6.District Data Analyst/Data Manager RCH 7.ADHO DGIS Officer

 9. What were the main obstacles encountered and how were they overcome?
The primary problem during implementation was to deal with the Low Orientation of IT in existing staff. While most were skilled enough to use computers or access the internet for basic work, GIS was a relative new concept. This obstacle was even more crucial to overcome because the actual mapping exercise needed to be done in the field by district level officials. So sensitization to GIS decision support system was crucial for them. This was overcome through training which is regularly provided by BISAG on the mapping process. Training was imparted mainly on the following aspects: 1.How to locate the school using Google Earth Software 2.Use of KML file with Google Earth application 3.Mapping the health facility village code with Census village code. Another major obstacle was to establish a inter-sectoral coordination between various departments like Urban and Rural Development, gram panchayats and district authorities. This rapport building was essential to be able to firstly identify un-served localities and further roll out infrastructure through speedy approvals and clearances. Over some time, this inter-sectoral coordination was established with the joint efforts of the stakeholders towards achieving something collectively greater than their individual efforts.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The benefits of the initiative have been segregated into benefits for CoH and benefits for citizens : Benefits To organization: A state of the art GIS facility which enables CoH to make prompt and informed decisions and helps in planning provision of healthcare services from an early stage to ensure parity. The DSS not only allows decision making for health centers but based on the attributes tagged, COH can also make informed decisions about sanctioning staff or medical equipments as required by various centers. Availability of an information intensive tool such as this has led to increased confidence in decision making and better compliance to IPHS which is a nationally accepted healthcare standards. While earlier, decision were haphazard, the decision support system helps to identify areas of focus and assist CoH staff in making concentrated efforts in that direction leading to more fruitful utilisation of public funds. Benefits To citizens: Based on information from DSS new health facilities have been sanctioned for the public. Approximately 26 Community Health Centers, 135 Primary Health Centers and 847 Sub Centers have been rolled out in 2013-2014. In 2014-2015, approximately 377 Sub centers have been sanctioned recently. This promptness in decision making ensures that citizens are better served and have quick access to healthcare facilities. More than 320 staff has been sanctioned to various centers across the state which has helped these centers in providing better services to citizens.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The GIS application has been developed in-house by BISAG and customized as per the needs of the Commissionerate of Health. As such, software development and maintenance costs are very low. More importantly, support for this application is readily available from BISAG. Complete training and capacity building exercises have been conducted for staff to ensure that they are able to churn the benefits of the GIS decision support system. The ready support and utility value of this system makes it sustainable. The solution is quite scalable because it is capable of handling data associated with an ever growing number of health care centers. Sustainability of the solution comes from the fact that cost of maintenance and operations are extremely low while the benefits continue to be high. State & District Level GIS Cell is already in function with the support of permanent staff. The initiative is transferable because firstly it helps to comply with the IPHS which is highly recommendable and advised. More importantly, decision making in health care is a challenge which has its root in the fact that we are a developing nation and infrastructure feasibility is a key issue, especially for the government sector. A decision support system is highly advisable as it brings authenticity to decisions and provides ample information to substantiate the decisions. Because such GIS systems are easily available and can be developed with a little administrative backing, the initiative is transferable indeed.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
It is mandatory to provide children from age group of 6-14 years, mothers and the public in general with comprehensive health care services which can be accessed within 30 minutes from their homes. This project assists various organizations such as Health and Family Welfare Department, Local health authorities i.e. Municipal Corporation, Jilla Panchayat, Nagar Panchayat or Panchayat in identifying requirements to improve access to healthcare services to ensure parity in healthcare services provided across the state. In GIS based decision support system, Planning officials, Researchers, Social Workers and NGOs are able to check existing facilities available under Health Department for specific categories of the human population and their respective areas. Further analysis on requirements can be done on the basis of criteria based analyses. The distinctive features and accomplishments of the projects are: 1.Integration of Geo-Spatial Database with Departmental of Health and family welfare i.e. Hospital Information System, Health Information System etc. which provides information on vital parameters relating to health and quality of services. DSS has been made operational in all the districts of the state through which data from all the Health imparting facilities 2are being constantly collected and disseminated. 2.Criteria based GIS Analysis 3.Category wise( Infrastructure, HR, Program and performance base and indicators) 4.Facility Wise( rural and urban area) These key features have equipped the department with the ability to make sound decisions at any point of time depending on the scenario. Our key learning from this initiative has been that there is huge scope for transformation in governance, provided that the right facilities and tools are made available to decision makers and policy makers such as in this case. Within a year of deployment, CoH was able to successfully deploy a massive number of Sub Centers and Primary health care centers in un-served areas. The number of sanctions done within a year points to the scope for change and improvement. This initiative has opened doors to new possibilities and tools which can help the CoH make better decisions in other aspects of health administration as well such as the disease monitoring system which is a relatively new initiative.

Contact Information

Institution Name:   Commissionerate of Health
Institution Type:   Government Agency  
Contact Person:   Dr V.S Dhruwey
Title:   State Nodal Officer, GIS  
Telephone/ Fax:   00917923237376
Institution's / Project's Website:  
E-mail:   gishealthgujarat@gmail.com  
Address:   Commissionerate of Health, Block 5, Floor 3
Postal Code:   382010
City:   Gandhinagar
State/Province:   Gujarat
Country:  

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