| 4. In which ways is the initiative creative and innovative?
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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.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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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
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| 6. How was the strategy implemented and what resources were mobilized?
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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.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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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.
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| 8. What were the most successful outputs and why was the initiative effective?
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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
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| 9. What were the main obstacles encountered and how were they overcome?
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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.
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