In an exclusive interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN), Naveen Jain, Mission Director, National Health Mission, and CEO, State Health Assurance Agency, Government of Rajasthan, shares how Rajasthan as a state has been enhancing the current projects by focusing on strengthening of software and integrating other advanced features to make the healthcare offerings better and much more developed compared to other states..
You have undertaken various initiatives in information technology (IT) in the last 2 years of your tenure. What are you planning next? What initiatives have been implemented in last 1 year?
When eHEALTH conducted its health summit in July 2015, we showcased ASHA-Soft, which is an online payment and monitoring system, and we were in the process of introducing Online Job Application System (OJAS), which is an online payment module. Now after 1 year, I can say that we have evolved further with our other two biggest innovations that include e-Upkaran and integrated ambulance project. As such, both the projects have attracted attention of many in India and the main force behind the success of these two projects is their software architecture.
The e-Upkaran module will take care of repair and maintenance of equipment along with keeping an eye on their usage. We have mostly seen that devices are not being used efficiently, so such an innovative system will keep an eye and generate alerts to the institutions. As far as an integrated ambulance system is concerned, every state has many types of ambulance systems and none of them are on a single command. In Rajasthan, we thought of creating a single command and converging different ambulance numbers, such as 104 and 108, on one call. Furthermore, we included base ambulances which were not used optimally. Now, the integrated ambulance system has Emergency Ambulance Service (108), Medical Advice Service (104), 104 Janani Express and base ambulances that are operational from all health institutions along with a helpline call centre. In this way, these four elements have been integrated in one and it is backed by a very strong software. There is a mobile application for drivers, along with a navigation procedure built in the system. This enables drivers to reach the site at the right time and whether he is on the right track or not.
What are your plans in the coming years?
We would like to consolidate our previous IT interventions. In the last 2 years, we have done around 10 to 12 interventions. Some of them are very big and huge in their size. In last 1.5 years, ASHA-Soft has evolved very well and many states are now following us. In fact, some of them have implemented it. OJAS has also come up very well and we are further improving it to make a good software. Integrated ambulance project software and e-Upkaran software have already started, but we are analysing their performance. We would like to make them as much user-friendly as much possible. In 2017, we would be consolidating softwares rather than building a new one.
In addition to that, we will be soon coming up with electronic Vaccines Intelligence Network (eVIN). The project has been supported by the United Nations Development Programme (UNDP). In more than 2,000 cold chains of Rajasthan, we have installed the sensors. There is machine called ‘Temperature Logger’ which gives an indication about vaccines whether they are stored at optimal temperatures or not. Maintaining the potential of vaccination and avoiding the stock out is the main purpose behind the implementation of this software. By merely sitting in Jaipur, we can know about the vaccination process and its status. All the cold chain handlers have been united in a common user group and the entire effort will be launched soon. Interestingly, it will help us in saving a lot of money by avoiding the wastage of vaccination.
We have more than 2,000 cold chains and maintaining so many cold chains and keeping vaccination intact is a big challenge. eVIN will help us and we have installed sensors and loggers on these ice-lined refrigerators (ILRs) which are there in cold chains. Additionally, all the cold chain handlers have been given SIM with a mobile app. They will feed the data and at the Jaipur level we can get the summary of what is happening in the immunisation sector. Next year, we would also like consolidate all our previous softwares and innovations.
Our mobile application, Mobile Saghan Nirikshan Abhiyaan (MSNA), which was developed with the help of the United Nations Population Fund (UNFPA) and BSG Group is also running well. More than 15,000 inspections have been done, but now there is a need to analyse the data. Based on this analysis, decisions will be undertaken.
How Rajasthan is different in terms of implementation of IT from other states?
Actually, through our various government projects, we collect a lot of data; however, we are not adequately using the data. Whenever we develop a software, we are very particular about ‘dashboard’ to ensure that the person responsible at the helm of affairs should be in the position to see the points where he should make interventions. Almost every state project, such as ASHASoft, OJAS, Kuposhan Watch, etc., has been given such dashboards, as well as analytical reports. Based on these analytical reports, we are able to find the gaps and fix the responsibilities. We are promoting the champions and trying to give message to the wrongdoers. This is how IT is making impact on the healthcare sector.
You are also the CEO of Rajasthan State Health Assurance Agency. You have been given the tough task of running this scheme? How has been your experience?
Yes, I was given the charge of Bhamashah Swasthya Bima Yojana (BSBY) in February 2016. Initially, there were many issues related to the functioning of software, as well as there were some issues regarding the package rates. The claims were very less and whatever claims we were having were not processed on time. Additionally, there was no system to keep a check on “progress”. I can claim that in the last 6 months, with our constant efforts, we have been able solve many problems. We thank our insurance company called New India Insurance Company, as well as Department of Information Technology under the leadership of Shri Akhil Arora, who has been kind enough to look at the various problems and now the software has evolved very well. Now various protocols and guidelines have been established. This was the first year of the schemes, so naturally such challenges were expected. We have been able to understand the problems and devise solutions.
What are your future plans? What do you think what has worked actually? How could you come out from the problem?
As such, BSBY is doing well and all are saying that it has taken off. We need to ensure that the actual beneficiaries come to know about the scheme. The involvement of accredited social health activists (ASHAs) has proven to be the game changer. We conducted videoconferencing with 40,000 ASHAs, which is not an easy task, at Atal Seva Kendras. Again IT was of great help. As many of the guidelines were neither formulated nor clarified, we formulated and clarified them and put them on our website. I think now our website is very much structured. We also maintain a Twitter handle, Facebook page and Google+ account. Using social media, we can share with people the performance details of the scheme, as well as share the problems, performance and success stories that motivated people to go for the scheme. I think involving ASHAs and social media, making all the guidelines and evaluating the software and finding the gaps and solving the software problem also came handy.
What are your future plans for BSBY?
In very first year, the BSBY scheme has been able to make a dent. Now, many people know about this scheme. We need to work on the quality aspect. As the schemes will grow and new private hospitals will join with us, there may be chances of fraudulent practices. Earlier in many states it has been reported that health insurance schemes are being misused, but we will be very much alert about this.
Insurance agency is sending its team to many hospitals for inspections. Whenever they conduct such audits and sudden inspections, we support them fully. They have deempanelled some of the hospitals and we have kept their decisions intact. We have not changed their decisions as this will create an atmosphere of trust amongst the hospitals and companies. I think we will work on the people’s complaints. Whatever complaints we are getting, we have asked the district collectors to investigate into them. Either it is a complaint from a normal beneficiary or a complaint from a hospital not getting payments from the insurance companies.