| 4. In which ways is the initiative creative and innovative?
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Vision: - To maintain a balance of Sex Ratio at Birth (SRB) & ultimately overall sex ratio..
A Detailed study of skewed sex ratio, methods of misuse of technology, provisions of The PC & PNDT Act, 1994 (The Act for short), use of the information from sonography conducted of pregnant woman, Data of overall Sex Ratio, Child Sex Ratio (0-6 years) & Sex Ratio at Birth was done. Discussions were held between State Health Officials & NIC Gujarat regarding directions of Hon’ble High Court of Gujarat for on-line submission & details of form ‘F’. It was decided that a tool be developed which can be useful for better implementation of the Act and can help the administration comply with the directions of the High Court. Problems like motivating the Medical fraternity to fill Form F data online were identified.
Initially the project was launched in Gandhinagar District of Gujarat in Jan-13 followed by roll out across all the district of the State in phased manner.
A web portal was created and User Ids & Passwords were given to every clinic for submission of data of sonography of pregnant women as prescribed in the Act through an online ICT enabled Application
Analysis of the Non compliant clinics was earlier done manually and was not 100% accurate. In the current system, analytics has been incorporated to ensure that the automated notices are being generated and sent to the non compliant clinics.
Complaint lodging and monitoring has been included in the application to ensure better monitoring and grievance redressal along with status update facility for all the users.
Active Sensitization & Problem solving exercises from District Appropriate Authority, District Information Officers (NIC) & State Officials are performed through workshops group meetings.
Data is saved in a central server which can be analysed in various cross sectional mode. The Authorities can view the data for any desired period for specific clinic/ clinics and get the data exported in desired format. The data like total forms uploaded, clinics not reported, cases from outside Gujarat, Women with no. of female daughter wise, robust query module, etc. can be studied & printed. Even the form “F” of the woman concerned can be viewed & printed for necessary action.
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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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The initiative was led by the Commissioner of Health in the light of directions of the High Court of Gujarat. The project was implemented in January 2013.
The stakeholders of the project are listed below :
1. Joint Secretary, Rural Health and Chairperson PNDT
2. Additional Director (Family Welfare), Commissionerate of Health
3. Assistant Director (Rural Health), Commissionerate of Health
4. Assistant Director (Family Welfare), Commissionerate of Health
5. Principle Systems Analyst, National Informatics Center, Gujarat
6. Systems Analyst, National Informatics Center, Gujarat
7. Medical Officer, PNDT Cell
National Informatics Center provided all the technical support and assistance in development of the portal. The department provided the overall guidance and functional support in implementing the system.
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| 6. How was the strategy implemented and what resources were mobilized?
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NIC state Centre Gujarat Officials prepared the Web Portal, analytical application, contact information & also put up a real time counter of total Form-F uploaded in the State "www.betivadhaao.gujarat.gov.in". It was done by the department at ZERO cost. The Appropriate Authorities & NIC Official at District level were oriented during the Workshops andMeetings regarding the methods of monitoring the data, trouble shooting, identifying the culprits form the data analysis and interpretation. Authorities were instructed to attend the complaint lodged in the complaint section and take necessary actions within the time framed also the authorities were instructed to compare physical and online form F & verify the details of sonography uploaded.
The web portal was developed by in house support from National Informatics Center and hence financial resources required were almost negligible.
At State level NIC State Level officials were involved in implementation. At the Commissionerate of Health, Assistant Director (FW) & Medical Officer, PC & PNDT Cell, Gandhinagar are responsible for administration of the web portal.
At district level DIOs and Chief District Health officers are involved in rollout, monitoring and supporting the services.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The project on the whole helped to reduce manual work for CoH employees. Prompt availability of data ensured effective monitoring of sonography being performed across the state. The concrete outputs of the initiative have been listed below:
1)Creation of vast database of sonography with following add-ons.
a.Data of Children with chromosomal disorder, metabolic disorder, congenital anomaly, Mental retardation, Haemoglobinopathy, sex linked disorders, single gene disorder.
b.Mothers with pregnancy during advanced age (i.e >= 35 years)
c.Mother/ Father/ Siblings having genetic disease.
d.Pregnant women with history of genetic or medical disease in the family.
e.Data of invasive procedures like amniocentesis, chorionic villi aspiration, foetal biopsy, cordocentesis etc.
f.Data of laboratory tests and results of procedures like, chromosomal studies, biochemical studies, molecular studies and pre-implantation genetic diagnosis.
2)Analytical applications enabled the appropriate authorities to identify the culprits on co-relations of intelligence based information.
3)Real time availability of Sonography data with quick MIS generation.
4)Easy management and analysis of Form F data for district health officials
5)Tracking of pregnant women seeking the services of determination of sex of her foetus.
6)Long time defaulters in Online reporting can be enlisted and investigated for breach for breaching the PC & PNDT (Pre-natal Diagnostic Technique)Act.
7)Online Complaint sections facilitated any one to complain against the persons breaking the provision of the PC & PNDT Act.
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| 8. What were the most successful outputs and why was the initiative effective?
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1)Regular cross verification of number of physical and online forms uploaded.
2)Comparing the details of Form F in physical and online forms uploaded.
3)Co-relations of intelligence based information gathered by the health personnel with the clinic suspected on the basis of online Form F information.
4)Cross checking of details of pregnant women, detection of discrepancies, field investigation regarding the breach of the Act or the MTP Act is done on a regular basis. If a breach is detected actions are taken immediately as per provisions of the ACT.
5)Every single complaint uploaded is acted upon. After a fact finding phase, necessary action is taken if essential. The actions taken are further updated on the portal which helps in monitoring progress.
6)Appropriate Authorities have been instructed to monitor the sex ratio at birth obtained from Civil Registration System & focus on the doubtful areas/ clinics.
7)Sex ratio in the deliveries conducted at the clinics every month is monitored to identify the wrongdoers.
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| 9. What were the main obstacles encountered and how were they overcome?
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One of the biggest hurdles in implementation was to ensure that all doctors and radiologists using sonography to examine pregnant women comply with the online system and make efforts to upload all the sonography details online.
This was to some extent overcome due to the fact that the implementation of the project was based on High Court directions which could not be defied without seriously endangering their medical practitioner’s license. It is however essential to applaud the spirit in which this initiative was accepted not just by public hospital doctors but by private ones too which was perhaps the biggest success.
One of the pain points was to get doctors to fill both Form F and upload the data online. This was overcome through Workshops/ meetings with the concerned Professional Association to convince them that the efforts were directed towards a noble cause and that wholesome participation will benefit the state.
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